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).

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

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.

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.

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...

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.

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.

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.

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.

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.

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...

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.

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

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.

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.

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.

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…

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.

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…

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 ...

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

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…

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.

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…

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.

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

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.

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...

[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.

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.

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...

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.

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.

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.

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...

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...

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.

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.

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

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

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.

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.

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)

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

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

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.

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.

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....

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)

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.

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...

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,…

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

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.

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)

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

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.

ePrescribing: Reducing Costs through In-Class Therapeutic Interchange.

Science.gov (United States)

Stenner, Shane P; Chakravarthy, Rohini; Johnson, Kevin B; Miller, William L; Olson, Julie; Wickizer, Marleen; Johnson, Nate N; Ohmer, Rick; Uskavitch, David R; Bernard, Gordon R; Neal, Erin B; Lehmann, Christoph U

2016-12-14

Spending on pharmaceuticals in the US reached $373.9 billion in 2014. Therapeutic interchange offers potential medication cost savings by replacing a prescribed drug for an equally efficacious therapeutic alternative. Hard-stop therapeutic interchange recommendation alerts were developed for four medication classes (HMG-CoA reductase inhibitors, serotonin receptor agonists, intranasal steroid sprays, and proton-pump inhibitors) in an electronic prescription-writing tool for outpatient prescriptions. Using prescription data from January 2012 to June 2015, the Compliance Ratio (CR) was calculated by dividing the number of prescriptions with recommended therapeutic interchange medications by the number of prescriptions with non-recommended medications to measure effectiveness. To explore potential cost savings, prescription data and medication costs were analyzed for the 45,000 Vanderbilt Employee Health Plan members. For all medication classes, significant improvements were demonstrated - the CR improved (proton-pump inhibitors 2.8 to 5.32, nasal steroids 2.44 to 8.16, statins 2.06 to 5.51, and serotonin receptor agonists 0.8 to 1.52). Quarterly savings through the four therapeutic interchange interventions combined exceeded $200,000 with an estimated annual savings for the health plan of $800,000, or more than $17 per member. A therapeutic interchange clinical decision support tool at the point of prescribing resulted in increased compliance with recommendations for outpatient prescriptions while producing substantial cost savings to the Vanderbilt Employee Health Plan - $17.77 per member per year. Therapeutic interchange rules require rational targeting, appropriate governance, and vigilant content updates.

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.

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.

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.

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.

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.

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.

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.

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".

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.

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...

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.

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.

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)

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

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.

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.

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.

[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.

"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.

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.

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)

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.

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.

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

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.

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

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...

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

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.

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

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.

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.

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.

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

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...

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.

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

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.

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.

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...

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

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.

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.

[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.

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

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.

PET/CT Based Dose Planning in Radiotherapy

DEFF Research Database (Denmark)

Berthelsen, Anne Kiil; Jakobsen, Annika Loft; Sapru, Wendy

2011-01-01

radiotherapy planning with PET/CT prior to the treatment. The PET/CT, including the radiotherapy planning process as well as the radiotherapy process, is outlined in detail. The demanding collaboration between mould technicians, nuclear medicine physicians and technologists, radiologists and radiology......This mini-review describes how to perform PET/CT based radiotherapy dose planning and the advantages and possibilities obtained with the technique for radiation therapy. Our own experience since 2002 is briefly summarized from more than 2,500 patients with various malignant diseases undergoing...... technologists, radiation oncologists, physicists, and dosimetrists is emphasized. We strongly believe that PET/CT based radiotherapy planning will improve the therapeutic output in terms of target definition and non-target avoidance and will play an important role in future therapeutic interventions in many...

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)

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.

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 ...

Employing the therapeutic operating characteristic (TOC) graph for individualised dose prescription.

Science.gov (United States)

Hoffmann, Aswin L; Huizenga, Henk; Kaanders, Johannes H A M

2013-03-07

In current practice, patients scheduled for radiotherapy are treated according to 'rigid' protocols with predefined dose prescriptions that do not consider risk-taking preferences of individuals. The therapeutic operating characteristic (TOC) graph is applied as a decision-aid to assess the trade-off between treatment benefit and morbidity to facilitate dose prescription customisation. Historical dose-response data from prostate cancer patient cohorts treated with 3D-conformal radiotherapy is used to construct TOC graphs. Next, intensity-modulated (IMRT) plans are generated by optimisation based on dosimetric criteria and dose-response relationships. TOC graphs are constructed for dose-scaling of the optimised IMRT plan and individualised dose prescription. The area under the TOC curve (AUC) is estimated to measure the therapeutic power of these plans. On a continuous scale, the TOC graph directly visualises treatment benefit and morbidity risk of physicians' or patients' choices for dose (de-)escalation. The trade-off between these probabilities facilitates the selection of an individualised dose prescription. TOC graphs show broader therapeutic window and higher AUCs with increasing target dose heterogeneity. The TOC graph gives patients and physicians access to a decision-aid and read-out of the trade-off between treatment benefit and morbidity risks for individualised dose prescription customisation over a continuous range of dose levels.

Employing the therapeutic operating characteristic (TOC) graph for individualised dose prescription

International Nuclear Information System (INIS)

Hoffmann, Aswin L; Huizenga, Henk; Kaanders, Johannes HAM

2013-01-01

In current practice, patients scheduled for radiotherapy are treated according to ‘rigid’ protocols with predefined dose prescriptions that do not consider risk-taking preferences of individuals. The therapeutic operating characteristic (TOC) graph is applied as a decision-aid to assess the trade-off between treatment benefit and morbidity to facilitate dose prescription customisation. Historical dose-response data from prostate cancer patient cohorts treated with 3D-conformal radiotherapy is used to construct TOC graphs. Next, intensity-modulated (IMRT) plans are generated by optimisation based on dosimetric criteria and dose-response relationships. TOC graphs are constructed for dose-scaling of the optimised IMRT plan and individualised dose prescription. The area under the TOC curve (AUC) is estimated to measure the therapeutic power of these plans. On a continuous scale, the TOC graph directly visualises treatment benefit and morbidity risk of physicians’ or patients’ choices for dose (de-)escalation. The trade-off between these probabilities facilitates the selection of an individualised dose prescription. TOC graphs show broader therapeutic window and higher AUCs with increasing target dose heterogeneity. The TOC graph gives patients and physicians access to a decision-aid and read-out of the trade-off between treatment benefit and morbidity risks for individualised dose prescription customisation over a continuous range of dose levels

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...

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

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.

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)

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.

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

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.

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…

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.

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.

Adjustment of legally binding local plans

DEFF Research Database (Denmark)

Hvingel, Line Træholt; Aunsborg, Christian; Christensen, Finn Kjær

2012-01-01

Traditionally, and by law, new urban areas in Denmark are regulated and planned through legally binding local plans. Recently a tendency has occurred: The municipalities make the legally binding local plans quite open for future adjustment, and they are using a substantial amount of ‘empowerment ...... the considerations of legal rights, the extend of the legal use of empowerment provisions and the combination of the use of legal binding local plans and other legal instruments such as easements and sales agreements.......Traditionally, and by law, new urban areas in Denmark are regulated and planned through legally binding local plans. Recently a tendency has occurred: The municipalities make the legally binding local plans quite open for future adjustment, and they are using a substantial amount of ‘empowerment...... provisions’ which empower the municipalities to later ruling. This way of making plans postpones the actual regulation of an area (i.e. the planning permission) making it an individual ruling for instance at the application of building permits. Case studies show examples of this way of regulating an area...

The diagnostic and therapeutic impact of MRI: an observational multi-centre study

International Nuclear Information System (INIS)

Hollingworth, William; Todd, Christopher J.; Bell, Matthew I.; Arafat, Qais; Girling, Simon; Karia, Kanti R.; Dixon, Adrian K.

2000-01-01

AIM: To provide information about the diagnostic and therapeutic impact of magnetic resonance imaging (MRI) and to compare the findings across diagnostic groups. MATERIALS AND METHODS: A prospective, observational study of 2017 consecutive referrals for MRI of the head, spine or knee at four imaging centres. Clinicians completed questionnaires before MRI stating initial diagnoses, diagnostic confidence and treatment plans. After imaging, a second questionnaire evaluated clinicians' revised diagnosis and treatment plans in the light of imaging findings. Patients were grouped into nine diagnostic categories for analysis. Comparison between pre- and post-imaging was used to assess the diagnostic and therapeutic impact of MRI. RESULTS: In seven of nine diagnostic groups MRI findings were associated with a diagnostic impact. Diagnoses were revised or discarded following normal MR findings and diagnostic confidence was increased by confirmative MR findings. There was no statistically significant diagnostic impact for suspected pituitary or cerebello-pontine angle lesions. In five of nine diagnostic groups (knee meniscus, knee ligament, multiple sclerosis, lumbar and cervical spine) MRI findings had a clear impact on treatment plans. CONCLUSION: This study demonstrates that in most diagnostic categories, MRI influences diagnosis and treatment. However, experimental studies are needed to prove that these diagnostic and therapeutic impacts lead to improved health. Hollingworth (2000)

The diagnostic and therapeutic impact of MRI: an observational multi-centre study

Energy Technology Data Exchange (ETDEWEB)

Hollingworth, William; Todd, Christopher J.; Bell, Matthew I.; Arafat, Qais; Girling, Simon; Karia, Kanti R.; Dixon, Adrian K

2000-11-01

AIM: To provide information about the diagnostic and therapeutic impact of magnetic resonance imaging (MRI) and to compare the findings across diagnostic groups. MATERIALS AND METHODS: A prospective, observational study of 2017 consecutive referrals for MRI of the head, spine or knee at four imaging centres. Clinicians completed questionnaires before MRI stating initial diagnoses, diagnostic confidence and treatment plans. After imaging, a second questionnaire evaluated clinicians' revised diagnosis and treatment plans in the light of imaging findings. Patients were grouped into nine diagnostic categories for analysis. Comparison between pre- and post-imaging was used to assess the diagnostic and therapeutic impact of MRI. RESULTS: In seven of nine diagnostic groups MRI findings were associated with a diagnostic impact. Diagnoses were revised or discarded following normal MR findings and diagnostic confidence was increased by confirmative MR findings. There was no statistically significant diagnostic impact for suspected pituitary or cerebello-pontine angle lesions. In five of nine diagnostic groups (knee meniscus, knee ligament, multiple sclerosis, lumbar and cervical spine) MRI findings had a clear impact on treatment plans. CONCLUSION: This study demonstrates that in most diagnostic categories, MRI influences diagnosis and treatment. However, experimental studies are needed to prove that these diagnostic and therapeutic impacts lead to improved health. Hollingworth (2000)

BiovaxID, a personalized therapeutic vaccine against B-cell lymphomas

Czech Academy of Sciences Publication Activity Database

Reiniš, Milan

2008-01-01

Roč. 10, č. 5 (2008), s. 526-534 ISSN 1464-8431 Institutional research plan: CEZ:AV0Z50520514 Keywords : B-cell lymphomas * tumor antigen * therapeutic vaccine Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 2.913, year: 2008

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 ...

[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.

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.

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

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

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...

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.

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

Assessing the relationship between the WNSSP and therapeutic participation in adolescents in low response states following severe traumatic brain injury.

Science.gov (United States)

Patrick, Peter D; Wamstad, Julia Buch; Mabry, Jennifer L; Smith-Janik, Shannan; Gurka, Matthew J; Buck, Marcia L; Blackman, James A

2009-06-01

This study examines the relationship between scores on the Western Neuro Sensory Stimulation Profile (WNSSP) and therapeutic participation as it relates to rehabilitation readiness (RR) in adolescents with low response following severe traumatic brain injury (TBI). This is a serial observational design using multiple measures of clinical status and participation. Ten children, mean age 16.7 years, who remained in a low response state (30 days or more) were assessed with the WNSSP and videotaped during physical and occupational therapy sessions. Associations were evaluated between WNSSP scores and participation scores related to arousal, awareness and communication. The WNSSP was only associated with the communication score (p < 0.0001). The arousal and awareness scores had no significant impact on the WNSSP score. These results suggest that scores on the WNSSP may be related to the return of communication skills in adolescents in low response states as one part of assessing their therapeutic participation and ultimate rehabilitation readiness. This ability may assist in making decisions regarding care planning.

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

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.

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

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....

[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

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.

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...

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.

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.

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.

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 ...

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.

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

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…

Communication techniques for improved acceptance and adherence with therapeutic footwear.

Science.gov (United States)

van Netten, Jaap J; Francis, Anthony; Morphet, Ashley; Fortington, Lauren V; Postema, Klaas; Williams, Anita

2017-04-01

Clients' acceptance and adherence with orthoses can be influenced by a clinician's communication skills. In this clinical note, we describe two communication techniques, in the context of therapeutic footwear. Person-centred communication involves engaging with and listening to the attitudes of the client towards their condition, as well as discussing acceptance and expectations, in a structured consultation. Building a relationship is crucial and requires clients to feel heard and understood. An important influence on the acceptance and adherence is that a client makes a conscious decision to receive their device. This active receipt can be facilitated through shared decision making, wherein clinicians give clear, relevant and meaningful examples, based on clinical evidence, and ensure this is understood. Two communication techniques for clinicians providing therapeutic footwear are described. These can be adapted for use with provision of other assistive technologies to improve client acceptance and adherence. Clinical relevance Small changes in how clinicians communicate to their clients in daily practice can have a big influence on the subsequent acceptance and adherence with therapeutic footwear and indeed other prescribed assistive technologies.

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.

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

Radiation therapy treatment planning: CT, MR imaging and three-dimensional planning

International Nuclear Information System (INIS)

Lichter, A.S.

1987-01-01

The accuracy and sophistication of radiation therapy treatment planning have increased rapidly in the last decade. Currently, CT-based treatment planning is standard throughout the country. Care must be taken when CT is used for treatment planning because of clear differences between diagnostic scans and scans intended for therapeutic management. The use of CT in radiation therapy planning is discussed and illustrated. MR imaging adds another dimension to treatment planning. The ability to use MR imaging directly in treatment planning involves an additional complex set of capabilities from a treatment planning system. The ability to unwarp the geometrically distorted MR image is a first step. Three-dimensional dose calculations are important to display the dose on sagittal and acoronal sections. The ability to integrate the MR and CT images into a unified radiographic image is critical. CT and MR images are two-dimensional representations of a three-dimensional problem. Through sophisticated computer graphics techniques, radiation therapists are now able to integrate a three-dimensional image of the patient into the treatment planning process. This allows the use of noncoplanar treatment plans and a detailed analysis of tumor and normal tissue anatomy; it is the first step toward a fully conformational treatment planning system. These concepts are illustrated and future research goals outlined

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...

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

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.

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.

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.

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.

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....

Is there still a place for the concept of 'therapeutic regression' in psychoanalysis?

Science.gov (United States)

Spurling, Laurence S

2008-06-01

The author uses his own failure to find a place for the idea of therapeutic regression in his clinical thinking or practice as the basis for an investigation into its meaning and usefulness. He makes a distinction between three ways the term 'regression' is used in psychoanalytic discourse: as a way of evoking a primitive level of experience; as a reminder in some clinical situations of the value of non-intervention on the part of the analyst; and as a description of a phase of an analytic treatment with some patients where the analyst needs to put aside normal analytic technique in order to foster a regression in the patient. It is this third meaning, which the author terms "therapeutic regression" that this paper examines, principally by means of an extended discussion of two clinical examples of a patient making a so-called therapeutic regression, one given by Winnicott and the other by Masud Khan. The author argues that in these examples the introduction of the concept of therapeutic regression obscures rather than clarifies the clinical process. He concludes that, as a substantial clinical concept, the idea of therapeutic regression has outlived its usefulness. However he also notes that many psychoanalytic writers continue to find a use for the more generic concept of regression, and that the very engagement with the more particular idea of therapeutic regression has value in provoking questions as to what is truly therapeutic in psychoanalytic treatment.

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...

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.

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 ...

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.

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...

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.

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.

Transport fleet sizing by using make and buy decision-making

OpenAIRE

Stojanović Đurđica; Nikoličić Svetlana; Miličić Milica

2011-01-01

Cost reduction is among the main quoted reasons for logistics outsourcing, while transport capacities and operations are among the most outsourced logistics areas. However, according to transaction costs theory, there is often room for transport insourcing. Furthermore, nowadays many authors stress that mixed solutions can give better results than “make” or “buy” alternatives. “Make or buy” decision-making normative models, methods, and procedures in transport planning are not much expl...

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.

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

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.

Epistemological beliefs and therapeutic health concepts of physiotherapy students and professionals.

Science.gov (United States)

Bientzle, Martina; Cress, Ulrike; Kimmerle, Joachim

2014-10-01

Health knowledge develops fast and includes a lot of ambiguous or tentative information. In their daily routine, both health care students and professionals continuously have to make judgments about the viability of health knowledge. People's epistemological beliefs (EBs) and their therapeutic health concepts are factors that influence how they deal with health knowledge. However, very little is known about the occurrence of these factors at different stages of people's career. The present study examines the EBs and therapeutic health concepts of physiotherapy students in their vocational training and the EBs and therapeutic health concepts of professionals. In a cross-sectional study physiotherapy students and professional physiotherapists filled in a questionnaire that measured their personal EBs about physiotherapy and medicine, as well as their biomedical and biopsychosocial therapeutic health concepts. We compared the participants' EBs regarding both knowledge domains, and their therapeutic health concepts using paired samples t-tests. We also examined the differences between first-year students, advanced students, and professionals regarding their EBs and their therapeutic health concepts using ANOVAs. Eighty-three students and 84 professionals participated in this study, 114/167 (68%) participants were female. EBs as well as therapeutic health concepts differed depending upon the participants' training status. Professionals had more sophisticated EBs than students regarding both knowledge in physiotherapy (F(2, 164) = 6.74, P = 0.002, η(2)(p) = 0.08) and knowledge in medicine (F(2, 164) = 5.93, P = 0.003, η(2)(p) = 0.07). In addition, high values in a biopsychosocial therapeutic health concept already occurred in an early phase of training (F(2, 164) = 5.39, P = 0.005, η(2)(p) = 0.06), whereas increased values in a biomedical concept did not occur until people's professional life (F(2, 164) = 10.99, P students as

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…

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...

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.

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

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.

Customer-focused planning: Beyond integrated resource planning

International Nuclear Information System (INIS)

Hastings, P.C.

1992-01-01

Integrated resource planning (IRP) evolved from the growing recognition by utilities and regulators that efforts to influence the use of electricity by customers could be more cost-effective than simply expanding the generation system. Improvements in IRP methodology are taking many different forms. One major effort is to move planning closer to the customer. Customer-focused planning (CFP) starts with customer values and uses these to drive decision-making within the utility. CFP is process- rather than product- oriented and typically operates at the bulk power system level. Options available to meet customer needs include electricity, alternative fuels, capital substitution, and end-use management or control. The customer selects the option(s) based on a value set that typically includes safety, reliability, convenience, and cost. There are also four possible levels of decision-making: the end-use; customer/power meter; transmission/distribution interface; and the utility bulk power system. Challenges of implementing CFP include identifying customer wants, needs, and values; integration of utility planning efforts; and the dynamics of the CFP process, in which costs can change with each modification of the transmission and distribution system. Two examples of recent moves toward CFP at Central Maine Power are reviewed. 2 refs., 1 fig

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

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.

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.

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

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

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.

Curcumin as potential therapeutic natural product: a nanobiotechnological perspective.

Science.gov (United States)

Shome, Soumitra; Talukdar, Anupam Das; Choudhury, Manabendra Dutta; Bhattacharya, Mrinal Kanti; Upadhyaya, Hrishikesh

2016-12-01

Nanotechnology-based drug delivery systems can resolve the poor bioavailability issue allied with curcumin. The therapeutic potential of curcumin can be enhanced by making nanocomposite preparation of curcumin with metal oxide nanoparticles, poly lactic-co-glycolic acid (PLGA) nanoparticles and solid lipid nanoparticles that increases its bioavailability in the tissue. Curcumin has manifold therapeutic effects which include antidiabetic, antihypertensive, anticancer, anti-inflammatory and antimicrobial properties. Curcumin can inhibit diabetes, heavy metal and stress-induced hypertension with its antioxidant, chelating and inhibitory effects on the pathways that lead to hypertension. Curcumin is an anticancer agent that can prevent abnormal cell proliferation. Nanocurcumin is an improved form of curcumin with enhanced therapeutic properties due to improved delivery to the diseased tissue, better internalization and reduced systemic elimination. Curcumin has multiple pharmacologic effects, but its poor bioavailability reduces its therapeutic effects. By conjugating curcumin to metal oxide nanoparticles or encapsulation in lipid nanoparticles, dendrimers, nanogels and polymeric nanoparticles, the water solubility and bioavailability of curcumin can be improved and thus increase its pharmacological effectiveness. © 2016 Royal Pharmaceutical Society.

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.

Integrating strategic environmental assessment with industry planning: a case study of the Pasquai-Porcupine forest management plan, Saskatchewan, Canada.

Science.gov (United States)

Noble, Bram F

2004-03-01

Strategic environmental assessment (SEA) is gaining widespread recognition as a tool for integrating environmental considerations in policy, plan, and program development and decision-making. Notwithstanding the potential of SEA to improve higher-order decision processes, there has been very little attention given to integrating SEA with industry planning practices. As a result, the benefits of SEA have yet to be fully realized among industrial proponents. That said, SEA practice is ongoing, albeit informally and often under a different label, and is proving to be a valuable tool for industry planning and decision-making. Based on a case study of the Pasquai-Porcupine forest management plan in Saskatchewan, Canada, this paper illustrates how an integrated approach to SEA can contribute to industry environmental decision-making and can enhance the quality and deliverability of industry plans.

Spatiotemporal radiotherapy planning using a global optimization approach

Science.gov (United States)

Adibi, Ali; Salari, Ehsan

2018-02-01

This paper aims at quantifying the extent of potential therapeutic gain, measured using biologically effective dose (BED), that can be achieved by altering the radiation dose distribution over treatment sessions in fractionated radiotherapy. To that end, a spatiotemporally integrated planning approach is developed, where the spatial and temporal dose modulations are optimized simultaneously. The concept of equivalent uniform BED (EUBED) is used to quantify and compare the clinical quality of spatiotemporally heterogeneous dose distributions in target and critical structures. This gives rise to a large-scale non-convex treatment-plan optimization problem, which is solved using global optimization techniques. The proposed spatiotemporal planning approach is tested on two stylized cancer cases resembling two different tumor sites and sensitivity analysis is performed for radio-biological and EUBED parameters. Numerical results validate that spatiotemporal plans are capable of delivering a larger BED to the target volume without increasing the BED in critical structures compared to conventional time-invariant plans. In particular, this additional gain is attributed to the irradiation of different regions of the target volume at different treatment sessions. Additionally, the trade-off between the potential therapeutic gain and the number of distinct dose distributions is quantified, which suggests a diminishing marginal gain as the number of dose distributions increases.

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...

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.

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...

INFORMATION SYSTEM STRATEGIC PLANNING WITH ENTERPRISE ARCHITECTURE PLANNING

Directory of Open Access Journals (Sweden)

Lola Yorita Astri

2013-05-01

Full Text Available An integrated information system is needed in an enterprise to support businessprocesses run by an enterprise. Therefore, to develop information system can use enterprisearchitecture approach which can define strategic planning of enterprise information system. SMPNegeri 1 Jambi can be viewed as an enterprise because there are entities that should be managedthrough an integrated information system. Since there has been no unification of different elementsin a unity yet, enterprise architecture model using Enterprise Architecture Planning (EAP isneeded which will obtain strategic planning of enterprise information system in SMP Negeri 1Jambi. The goal of strategic planning of information system with Enterprise Architecture Planning(EAP is to define primary activities run by SMP Negeri 1 Jambi and support activities supportingprimary activities. They can be used as a basis for making data architecture which is the entities ofapplication architecture. At last, technology architecture is designed to describe technology neededto provide environment for data application. The plan of implementation is the activity plan madeto implemented architectures by enterprise.

Williamsport Area Community College Long Range Planning: The Long Range Plan, Update 1987.

Science.gov (United States)

Williamsport Area Community Coll., PA.

This update to Williamsport Area Community College's (WACC's) 1984-89 long-range plan offers a status report on each of the plan's 78 objectives, reassigns responsibility for specific objectives to make the plan responsive to the current organizational structure of the college, and offers 11 new objectives for the 1986-87 academic year. After…

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.

The attitude-behavior discrepancy in medical decision making.

Science.gov (United States)

He, Fei; Li, Dongdong; Cao, Rong; Zeng, Juli; Guan, Hao

2014-12-01

In medical practice, the dissatisfaction of patients about medical decisions made by doctors is often regarded as the fuse of doctor-patient conflict. However, a few studies have looked at why there are such dissatisfactions. This experimental study aimed to explore the discrepancy between attitude and behavior within medical situations and its interaction with framing description. A total of 450 clinical undergraduates were randomly assigned to six groups and investigated using the classic medical decision making problem, which was described either in a positive or a negative frame (2) × decision making behavior\\attitude to risky plan\\attitude to conservative plan (3). A discrepancy between attitude and behavior did exist in medical situations. Regarding medical dilemmas, if the mortality rate was described, subjects had a significant tendency to choose a conservative plan (t = 3.55, P 0.05). However, regardless of the plan chosen by the doctor, the subjects had a significant opposing attitude (P Framing description had a significant impact on both decision making behavior and attitude (t behavior = -3.24, P framing of a description has an impact on medical decision-making.

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.

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.

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...

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.

Intuition, subjectivity, and Le bricoleur: cancer patients' accounts of negotiating a plurality of therapeutic options.

Science.gov (United States)

Broom, Alex

2009-08-01

Cancer patients are now combining complementary and alternative medicine (CAM) with biomedical cancer treatments, reflecting an increasingly pluralistic health care environment. However, there has been little research done on the ways in which cancer patients juggle multiplicity in claims to expertise, models of disease, and therapeutic practice. Drawing on the accounts of cancer patients who use CAM, in this article I develop a conceptualization of therapeutic decision making, utilizing the notion of bricolage as a key point of departure. The patient accounts illustrate the "piecing together" (or bricolage) of therapeutic trajectories, drawing on intuitive, embodied knowledge, as well as formalized "objective" scientific expertise. Le bricoleur, as characterized here, actively mediates, rather than accepts or rejects CAM or biomedicine, and utilizes a combination of scientific expertise, embodied physicality, and social knowledge to make decisions and assess therapeutic effectiveness. Although these "border crossings" are potentially subversive of established biomedical expertise, the analysis also illustrates the structural constraints (and penalties) associated with bricolage, and furthermore, the interplay of a repositioning of responsibility with neoliberal forms of self-governance.

Canada's green plan: Summary. Le plan vert du Canada: Resume

Energy Technology Data Exchange (ETDEWEB)

1990-01-01

A summary is presented of Canada's Green Plan, a comprehensive action plan to ensure a healthy environment for the future. The plan defines targets and schedules which will drive federal environmental initiatives, and incorporates concepts of sustainable development. Elements of the plan include initiatives to combat and prevent water pollution; control ocean dumping; control smog-causing emissions; provide tighter air pollution standards; provide for sound waste management according to the principles of reduce, reuse, recycle, and recover; assess and control chemical wastes; sustain Canadian forests and maintain their diversity while shifting forest management from sustained yield to sustainable development; maintain and enhance environmental sustainability in the agro-food sector and the fishery sector; preserve and protect national parks and wildlife; and preserve and enhance the integrity, health, biodiversity and productivity of Arctic ecosystems. With respect to global-scale problems, measures will be taken to stabilize greenhouse gas emissions, limit acid rain-related emissions, and phase out the use of ozone-depleting substances. The plan also intends to improve Canada's capability to respond to environmental emergencies, improve environmental decision-making by strengthening and building of partnerships, promote environmental science research and development, and make effective and balanced use of enviromental laws, with market-based approaches for environmental protection.

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

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.

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.

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…

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.

A planning concept incorporating the knowledge of both planning and operations personnel

Energy Technology Data Exchange (ETDEWEB)

Valenca, M M; Nepomuceno, L; Teixeira, J C.F.; Santos, Junior, A [Universidade Estadual de Campinas, SP (Brazil)

1994-12-31

In this paper, the electrical operation planning problem and the available technological possibilities for the improvement of planner`s work process are analyzed. The importance of the expert`s experience in efficient operation plans production is pointed out. The useful knowledge in planning and operating environments and their automation by Artificial Intelligence techniques are evaluated. Finally, conception of a decision-making support system allowing the interaction of storage expertise with analysis programs proposed, in order to improve the planning process. (author) 15 refs., 4 figs.

Development and evaluation of a training program for therapeutic radiographers as a basis for online adaptive radiation therapy for bladder carcinoma

International Nuclear Information System (INIS)

Foroudi, Farshad; Wong, Jacky; Kron, Tomas; Roxby, Paul; Haworth, Annette; Bailey, Alistair; Rolfo, Aldo; Paneghel, Andrea; Styles, Colin; Laferlita, Marcus; Tai, Keen Hun; Williams, Scott; Duchesne, Gillian

2010-01-01

Aims: Online adaptive radiotherapy requires a new level of soft tissue anatomy recognition and decision making by therapeutic radiographers at the linear accelerator. We have developed a therapeutic radiographer training workshop encompassing soft tissue matching for an online adaptive protocol for muscle invasive bladder cancer. Our aim is to present the training program, and its evaluation which compares pre and post training staff soft tissue matching and bladder contouring using Cone Beam Computer Tomography (CBCT). Materials and Methods: Prior to commencement of an online adaptive bladder protocol, a staff training program for 33 therapeutic radiographers, with a separate ethics approved evaluation component was developed. A multidisciplinary training program over two days was carried out with a total of 11 h of training, covering imaging technology, pelvic anatomy and protocol specific decision making in both practical and theoretical sessions. The evaluation included both pre training and post training testing of staff. Results: Pre training and post training, the standard deviations in the contoured bladder between participants in left-right direction were 0.64 vs 0.59 cm, superior-inferior 0.89 vs 0.77 cm and anterior-posterior direction was 0.88 vs 0.52 cm respectively. Similarly the standard deviation in the volume contoured decreased from 40.7 cc pre training to 24.5 cc post training. Time taken in contouring was reduced by the training program (19.8 vs 17.2 min) as was the discrepancy in choice of adaptive radiotherapy plans. The greatest reduction in variations in contouring was seen in staff whose pre training had the largest deviations from the reference radiation oncologist contours. Conclusion: A formalized staff training program is feasible, well received by staff and reduces variation in organ matching and contouring. The improvement was particularly noticed in staff who pre training had larger deviations from the reference standard.

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...

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.

[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.

Supply chain planning with sustainability considerations: an integrative framework

DEFF Research Database (Denmark)

Wang, Yang; Akkerman, Renzo; Birkved, Morten

2011-01-01

This paper proposes a modelling framework for combining supply chain planning and sustainability assessment, illustrating how sustainability assessments of logistic activities can be improved by supply chain planning input, and supply chain planning can in turn make use of the results from sustai...... produced on industrial scale, studying several important planning decisions like temperature treatments and choice of packaging materials.......This paper proposes a modelling framework for combining supply chain planning and sustainability assessment, illustrating how sustainability assessments of logistic activities can be improved by supply chain planning input, and supply chain planning can in turn make use of the results from...

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.

Evidence-based medicine, the research-practice gap, and biases in medical and surgical decision making in dermatology.

Science.gov (United States)

Eaglstein, William H

2010-10-01

The objectives of this article are to promote a better understanding of a group of biases that influence therapeutic decision making by physicians/dermatologists and to raise the awareness that these biases contribute to a research-practice gap that has an impact on physicians and treatment solutions. The literature included a wide range of peer-reviewed articles dealing with biases in decision making, evidence-based medicine, randomized controlled clinical trials, and the research-practice gap. Bias against new therapies, bias in favor of indirect harm or omission, and bias against change when multiple new choices are offered may unconsciously affect therapeutic decision making. Although there is no comprehensive understanding or theory as to how choices are made by physicians, recognition of certain cognition patterns and their associated biases will help narrow the research-practice gap and optimize decision making regarding therapeutic choices.

Planning Support Systems (PSS-Based Spatial Plan Alternatives and Environmental Assessment

Directory of Open Access Journals (Sweden)

Hee-Sun Choi

2016-03-01

Full Text Available Spatial planning is at the core of national land and urban development. Many countries and cities seek sustainable development through various means such as coordinated environmental planning, environmental assessment, and internalization of environmental analysis and planning. A Planning Support System (PSS is a GIS (Geographic Information System-based, spatial decision-making support system that incorporates a variety of theories and pertinent models. This study adopted the “What if?” model to design an alternative spatial plan that includes generation of predictive scenarios and is relatively easy to use. In the cities studied, we identified a total of six scenarios based on the main drivers of development—namely, population and spatial policies. Subsequently, we assessed the alternatives for their environmental impact, preparing sensitivity maps for each major environmental issue in the target area (natural ecosystem, air and microclimate, natural disasters. One projected advantage of the “What if?” model is that its digital visualization of proposed plans may improve public awareness and involvement. Furthermore, the tool is expected to be highly useful in ensuring the objectivity of quantitative analyses. However, it is necessary to develop a PSS that is both standardized and tailored to the particular needs of each area. Finally, the development of an e-governance system will be beneficial in ensuring public access to the decision making process.

EMMPRIN in gynecologic cancers: pathologic and therapeutic aspects.

Science.gov (United States)

Liu, Dan-tong

2015-07-01

The highly glycosylated transmembrane protein extracellular matrix metalloproteinase inducer (EMMPRIN) is associated with several pathological conditions, including various types of cancers. In different gynecological malignancies, such as ovarian, cervical, and endometrial cancers, EMMPRIN plays significant roles in cell adhesion modulation, tumor growth, invasion, angiogenesis, and metastasis by inducing the production of various molecules, including matrix metalloproteinases and vascular endothelial growth factor. Because of its high level of expression, EMMPRIN can possibly be used as a diagnostic marker of gynecological cancers. Recent studies have showed that targeting EMMPRIN, especially by RNA interference (RNAi) technology, has promising therapeutic potential in basic research on gynecological cancer treatments, which make a platform for the future clinical success. This review study focused on the association of EMMPRIN in gynecological cancers in the perspectives of pathogenesis, diagnosis, and therapeutics.

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.

Introduction to Strategic Planning in Student Affairs: A Model for Process and Elements of a Plan

Science.gov (United States)

Ellis, Shannon E.

2010-01-01

Planning from a strategic perspective has been a mainstay of organizational management for decades. Founded in the private sector, strategic planning is now embraced by the nonprofit world as a catalyst for sound resource allocation, transformative decision making, and motivating staff. Student affairs professionals who think, plan, and act…

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

Operational Plan Ontology Model for Interconnection and Interoperability

Science.gov (United States)

Long, F.; Sun, Y. K.; Shi, H. Q.

2017-03-01

Aiming at the assistant decision-making system’s bottleneck of processing the operational plan data and information, this paper starts from the analysis of the problem of traditional expression and the technical advantage of ontology, and then it defines the elements of the operational plan ontology model and determines the basis of construction. Later, it builds up a semi-knowledge-level operational plan ontology model. Finally, it probes into the operational plan expression based on the operational plan ontology model and the usage of the application software. Thus, this paper has the theoretical significance and application value in the improvement of interconnection and interoperability of the operational plan among assistant decision-making systems.

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.

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)

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 ...

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.

Family planning and family vision in mothers after diagnosis of a child with autism spectrum disorder.

Science.gov (United States)

Navot, Noa; Jorgenson, Alicia Grattan; Vander Stoep, Ann; Toth, Karen; Webb, Sara Jane

2016-07-01

The diagnosis of a child with autism has short- and long-term impacts on family functioning. With early diagnosis, the diagnostic process is likely to co-occur with family planning decisions, yet little is known about how parents navigate this process. This study explores family planning decision making process among mothers of young children with autism spectrum disorder in the United States, by understanding the transformation in family vision before and after the diagnosis. A total of 22 mothers of first born children, diagnosed with autism between 2 and 4 years of age, were interviewed about family vision prior to and after their child's diagnosis. Grounded Theory method was used for data analysis. Findings indicated that coherence of early family vision, maternal cognitive flexibility, and maternal responses to diagnosis were highly influential in future family planning decisions. The decision to have additional children reflected a high level of adaptability built upon a solid internalized family model and a flexible approach to life. Decision to stop childrearing reflected a relatively less coherent family model and more rigid cognitive style followed by ongoing hardship managing life after the diagnosis. This report may be useful for health-care providers in enhancing therapeutic alliance and guiding family planning counseling. © The Author(s) 2015.

Language Planning and Planned Languages: How Can Planned Languages Inform Language Planning?

Directory of Open Access Journals (Sweden)

Humphrey Tonkin

2015-04-01

Full Text Available The field of language planning (LP has largely ignored planned languages. Of classic descriptions of LP processes, only Tauli (preceded by Wüster suggests that planned languages (what Wüster calls Plansprache might bear on LP theory and practice. If LP aims "to modify the linguistic behaviour of some community for some reason," as Kaplan and Baldauf put it, creating a language de novo is little different. Language policy and planning are increasingly seen as more local and less official, and occasionally more international and cosmopolitan. Zamenhof's work on Esperanto provides extensive material, little studied, documenting the formation of the language and linking it particularly to issues of supranational LP. Defining LP decision-making, Kaplan & Baldauf begin with context and target population. Zamenhof's Esperanto came shortly before Ben-Yehuda's revived Hebrew. His target community was (mostly the world's educated elite; Ben-Yehuda's was worldwide Jewry. Both planners were driven not by linguistic interest but by sociopolitical ideology rooted in reaction to anti-Semitism and imbued with the idea of progress. Their territories had no boundaries, but were not imaginary. Function mattered as much as form (Haugen's terms, status as much as corpus. For Zamenhof, status planning involved emphasis on Esperanto's ownership by its community - a collective planning process embracing all speakers (cf. Hebrew. Corpus planning included a standardized European semantics, lexical selectivity based not simply on standardization but on representation, and the development of written, and literary, style. Esperanto was successful as linguistic system and community language, less as generally accepted lingua franca. Its terminology development and language cultivation offers a model for language revival, but Zamenhof's somewhat limited analysis of language economy left him unprepared to deal with language as power.

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.

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....

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

Science.gov (United States)

Court, Laurence E.; Kisling, Kelly; McCarroll, Rachel; Zhang, Lifei; Yang, Jinzhong; Simonds, Hannah; du Toit, Monique; Trauernicht, Chris; Burger, Hester; Parkes, Jeannette; Mejia, Mike; Bojador, Maureen; Balter, Peter; Branco, Daniela; Steinmann, Angela; Baltz, Garrett; Gay, Skylar; Anderson, Brian; Cardenas, Carlos; Jhingran, Anuja; Shaitelman, Simona; Bogler, Oliver; Schmeller, Kathleen; Followill, David; Howell, Rebecca; Nelson, Christopher; Peterson, Christine; Beadle, Beth

2018-01-01

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated arc therapy (VMAT) plans for patients with head/neck cancer and 4-field box plans for patients with cervical cancer. It is a combination of specially developed in-house software that uses an application programming interface to communicate with a commercial radiotherapy treatment planning system. It also interfaces with a commercial secondary dose verification software. The necessary inputs to the system are a Treatment Plan Order, approved by the radiation oncologist, and a simulation computed tomography (CT) image, approved by the radiographer. The RPA then generates a complete radiotherapy treatment plan. For the cervical cancer treatment plans, no additional user intervention is necessary until the plan is complete. For head/neck treatment plans, after the normal tissue and some of the target structures are automatically delineated on the CT image, the radiation oncologist must review the contours, making edits if necessary. They also delineate the gross tumor volume. The RPA then completes the treatment planning process, creating a VMAT plan. Finally, the completed plan must be reviewed by qualified clinical staff. PMID:29708544

Consensus Treatment Plans for New-Onset Systemic Juvenile Idiopathic Arthritis

Science.gov (United States)

DeWitt, Esi Morgan; Kimura, Yukiko; Beukelman, Timothy; Nigrovic, Peter A.; Onel, Karen; Prahalad, Sampath; Schneider, Rayfel; Stoll, Matthew L.; Angeles-Han, Sheila; Milojevic, Diana; Schikler, Kenneth N.; Vehe, Richard K.; Weiss, Jennifer E.; Weiss, Pamela; Ilowite, Norman T.; Wallace, Carol A.

2012-01-01

Objective There is wide variation in therapeutic approaches to systemic juvenile idiopathic arthritis (sJIA) among North American rheumatologists. Understanding the comparative effectiveness of the diverse therapeutic options available for treatment of sJIA can result in better health outcomes. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans and standardized assessment schedules for use in clinical practice to facilitate such studies. Methods Case-based surveys were administered to CARRA members to identify prevailing treatments for new-onset sJIA. A 2-day consensus conference in April 2010 employed modified nominal group technique to formulate preliminary treatment plans and determine important data elements for collection. Follow-up surveys were employed to refine the plans and assess clinical acceptability. Results The initial case-based survey identified significant variability among current treatment approaches for new onset sJIA, underscoring the utility of standardized plans to evaluate comparative effectiveness. We developed four consensus treatment plans for the first 9 months of therapy, as well as case definitions and clinical and laboratory monitoring schedules. The four treatment regimens included glucocorticoids only, or therapy with methotrexate, anakinra or tocilizumab, with or without glucocorticoids. This approach was approved by >78% of CARRA membership. Conclusion Four standardized treatment plans were developed for new-onset sJIA. Coupled with data collection at defined intervals, use of these treatment plans will create the opportunity to evaluate comparative effectiveness in an observational setting to optimize initial management of sJIA. PMID:22290637

Environmental planning and management of urban natural landscapes

Directory of Open Access Journals (Sweden)

A.R. Sadeghi

2016-07-01

Full Text Available Advantages of urbanization such as access to clean water, health, and overall easier life in cities, as well as the disadvantages or its negative effects on environment cannot be ignored. Today, there are numerous environmental problems due to the reduction in ecologically valuable places within urban areas. Bringing nature to the cities appears to be essential to enhance urban environment and to reduce environmental problems in urban communities. In fact, issues resulting from the idea of "sustainability" as a policy-making goal require an integrated environmental policy-making approach. The innovations of new environmental policy-making require policy-making mechanisms that can deal with interdependent characteristics of environmental problems. To this end, new structures have emerged known as Environmental Planning and Management and Strategic Environmental planning and management. This analytical – descriptive article aims to re-examine the origins and concepts related to environmental planning using a field and desk study. With the introduction of urban natural landscape, Environmental planning considers such spaces within the city. In this regard, Khoshk River, Shiraz, Iran, as an urban natural landscape, was analyzed. Environmental planning-based polices were proposed to improve quality of the place under discussion.

Prospective utility of therapeutic ultrasound in dentistry-Review with recent comprehensive update

Directory of Open Access Journals (Sweden)

Shalu Rai

2012-01-01

Full Text Available Background: The utility of ultrasound (US for therapeutic purposes is still in its infancy. Therapeutic US (TUS has been used widely in medical field for urological application, surgical intervention, bone healing, and osteointegration in cancer and healing of full thickness excised skin lesions, and within dentistry as a prediagnostic, diagnostic and therapeutic purpose. The purpose of the paper is to review and determine the efficacy of US as one of the treatment modalities for its role in maxillofacial region to reduce pain and promote soft tissue healing. Materials and Methods: A Medline search included of the international literature published between 1976 and 2011 and was restricted to English language articles, published work of past researchers including in vitro and in vivo studies, recent additions of textbooks on surgical and therapeutic applications of US and, current articles in conference papers and reports accessed from the internet using Google search engine on therapeutic ultrasound. Results: Very few article regarding effect of therapeutic of US for its use of insonation for treatment of patient with pain and soft tissue injury are available. This review article mainly emphasizes the therapeutic utility of US in dentistry for its effectiveness to decrease joint stiffness, reduce pain and muscle spasms and improve muscle mobility. In vivo studies have shown very little clinical effects. Conclusions: Further research is warranted in this clinically important area to make the development of noninvasive, multifunctional ultrasound devices for repair, regeneration and other therapeutic utility a success.

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

Planning that works: Empowerment through stakeholder focused interactive planning (SFIP)

International Nuclear Information System (INIS)

Beck, J.E.; Ison, S.A.

1994-01-01

This paper describes a powerful planning tool that can enable government, private industries, and public interest organizations to actualize their visions through sound decision making. The stakeholder focused interactive planning model is designed to integrate and ultimately gain stakeholder investment in the success of attainment of their vision. The only concessions required of the planning organization using this process is the acceptance of the premise that sustained vision success requires the support of both internal and external stakeholders and that each step in the process must be used as a validation of the previous step and essential to the completion of the next step. What is stakeholder/public involvement? It is the process in which the stakeholders (both internal and external) values, interests and expectations are included in decision-making processes. The primary goal of public involvement efforts is to include all those who have a stake in the decision, whether or not they have already been identified. Stakeholders are individuals, contractors, clients, suppliers, public organizations, state and local governments, Indian tribes, federal agencies, and other parties affected by decisions

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)

An Interactive Simulation Tool for Production Planning in Bacon Factories

DEFF Research Database (Denmark)

Nielsen, Jens Frederik Dalsgaard; Nielsen, Kirsten Mølgaard

1994-01-01

The paper describes an interactive simulation tool for production planning in bacon factories. The main aim of the tool is to make it possible to combine the production plans of all parts of the factory......The paper describes an interactive simulation tool for production planning in bacon factories. The main aim of the tool is to make it possible to combine the production plans of all parts of the factory...

Reducing the sensitivity of IMPT treatment plans to setup errors and range uncertainties via probabilistic treatment planning

International Nuclear Information System (INIS)

Unkelbach, Jan; Bortfeld, Thomas; Martin, Benjamin C.; Soukup, Martin

2009-01-01

Treatment plans optimized for intensity modulated proton therapy (IMPT) may be very sensitive to setup errors and range uncertainties. If these errors are not accounted for during treatment planning, the dose distribution realized in the patient may by strongly degraded compared to the planned dose distribution. The authors implemented the probabilistic approach to incorporate uncertainties directly into the optimization of an intensity modulated treatment plan. Following this approach, the dose distribution depends on a set of random variables which parameterize the uncertainty, as does the objective function used to optimize the treatment plan. The authors optimize the expected value of the objective function. They investigate IMPT treatment planning regarding range uncertainties and setup errors. They demonstrate that incorporating these uncertainties into the optimization yields qualitatively different treatment plans compared to conventional plans which do not account for uncertainty. The sensitivity of an IMPT plan depends on the dose contributions of individual beam directions. Roughly speaking, steep dose gradients in beam direction make treatment plans sensitive to range errors. Steep lateral dose gradients make plans sensitive to setup errors. More robust treatment plans are obtained by redistributing dose among different beam directions. This can be achieved by the probabilistic approach. In contrast, the safety margin approach as widely applied in photon therapy fails in IMPT and is neither suitable for handling range variations nor setup errors.

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...

Imaging findings and therapeutic alternatives for peripheral vascular malformations

International Nuclear Information System (INIS)

Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Santos, Daniela dos; Abud, Thiago Giansante; Abud, Daniel Giansante

2010-01-01

Peripheral vascular malformations represent a spectrum of lesions that appear through the lifetime and can be found in the whole body. Such lesions are uncommon and are frequently confounded with infantile hemangioma, a common benign neoplastic lesion. In the presence of such lesions, the correlation between the clinical and radiological findings is extremely important to achieve a correct diagnosis, which will guide the best therapeutic approach. The most recent classifications for peripheral vascular malformations are based on the blood flow (low or high) and on the main vascular components (arterial, capillary, lymphatic or venous). Peripheral vascular malformations represent a diagnostic and therapeutic challenge, and complementary methods such as computed tomography, Doppler ultrasonography and magnetic resonance imaging, in association with clinical findings can provide information regarding blood flow characteristics and lesions extent. Arteriography and venography confirm the diagnosis, evaluate the lesions extent and guide the therapeutic decision making. Generally, low flow vascular malformations are percutaneously treated with sclerosing agents injection, while in high flow lesions the approach is endovascular, with permanent liquid or solid embolization agents. (author)

Nuclear data for the production of therapeutic radionuclides. Summary report of third research coordination meeting

International Nuclear Information System (INIS)

Sublet, J.-Ch.; Capote Noy, R.

2006-08-01

A summary is given of the Third Research Coordination Meeting on Nuclear Data for the Production of Therapeutic Radionuclides. The new library of evaluated cross-section will cover reactor and accelerator production of therapeutic radionuclides to appropriate specific activities and purity, along with the relevant decay data. A few new reactions were added at this meeting. Technical discussions and the resulting work plan to conclude the data evaluation activities are summarized for every reaction path. Timescales and agreed actions to deliver the database and Technical Report are also given. (author)

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

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.

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.

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.

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

Corridor X in Serbia: Approach to spatial planning

Directory of Open Access Journals (Sweden)

Milijić Saša

2003-01-01

Full Text Available For the infrastructural corridor's area, of the national importance, is predicted making spatial plans of area of special use, as the most complex instruments for the developing and arranging management of these areas. These plans should have an integrative and problem-oriented approach towards development planning and arrangement of such an area, and it is obliged to include: a complex evaluation of state and function of infrastructural system in the corridor; an analysis of infrastructural corridor influence on the development of the planning area and its surrounding; an alternative conception of long-term protection, improvement, organization and use of the planning area; a choice of the priorities and assumption of the realization phases; instructions for the implementation of the plan etc. The approach in making of this category of plans, as well as, experiences in planning, arrangement and use of multimodal corridors, have been considered on the example of Spatial plan of the infrastructural corridor E-75 section Belgrade-Nis area.

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...

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.

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.

Towards a European Energy Technology Policy - The European Strategic Energy Technology Plan (Set-Plan)

International Nuclear Information System (INIS)

Mercier, A.; Petric, H.; Peteves, E.

2008-01-01

The transition to a low carbon economy will take decades and affect the entire economy. There is a timely opportunity for investment in energy infrastructure. However, decisions to invest in technologies that are fully aligned with policy and society priorities do not necessarily come naturally, although it will profoundly affect the level of sustainability of the European energy system for decades to come. Technology development needs to be accelerated and prioritized at the highest level of the European policy agenda. This is the essence of the European Strategic Energy Technology Plan (SET-Plan). The SET-Plan makes concrete proposals for action to establish an energy technology policy for Europe, with a new mind-set for planning and working together and to foster science for transforming energy technologies to achieve EU energy and climate change goals for 2020, and to contribute to the worldwide transition to a low carbon economy by 2050. This paper gives an overview of the SET-Plan initiative and highlights its latest developments. It emphasises the importance of information in support of decision-making for investing in the development of low carbon technologies and shows the first results of the technology mapping undertaken by the newly established Information System of the SET-Plan (SETIS).(author)

Public accountability in planning for new housing areas

NARCIS (Netherlands)

Kang, V.; Korthals Altes, W.K.

2015-01-01

Planning new housing areas involves balancing many interests and local authorities must make decisions in a way that is accountable. Formal accountability is organised differently in plan-led and development-led planning systems. In plan-led systems, accountability relates to the question of whether

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.

The business plan of Izakaya restaurant in Helsinki

OpenAIRE

Du, Peng

2017-01-01

The objective of thesis was to study the main areas of creating a business plan and to make research toward the current market environment of Asian fusion restaurant in the Helsinki area in order to make a realistic business plan of a Japanese Izakaya restaurant. The theoretical study is based on several business books, some suggestion from different types of restaurant owners in Helsinki, the business plan outline was finally made. For the empirical study, a survey of market analysis,...

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.

Surface-functionalized nanoparticles for biosensing and imaging-guided therapeutics

Science.gov (United States)

Jiang, Shan; Win, Khin Yin; Liu, Shuhua; Teng, Choon Peng; Zheng, Yuangang; Han, Ming-Yong

2013-03-01

In this article, the very recent progress of various functional inorganic nanomaterials is reviewed including their unique properties, surface functionalization strategies, and applications in biosensing and imaging-guided therapeutics. The proper surface functionalization renders them with stability, biocompatibility and functionality in physiological environments, and further enables their targeted use in bioapplications after bioconjugation via selective and specific recognition. The surface-functionalized nanoprobes using the most actively studied nanoparticles (i.e., gold nanoparticles, quantum dots, upconversion nanoparticles, and magnetic nanoparticles) make them an excellent platform for a wide range of bioapplications. With more efforts in recent years, they have been widely developed as labeling probes to detect various biological species such as proteins, nucleic acids and ions, and extensively employed as imaging probes to guide therapeutics such as drug/gene delivery and photothermal/photodynamic therapy.

Development of Potential Small Molecule Therapeutics for Treatment of Ebola Virus.

Science.gov (United States)

Schafer, Adam Michael; Cheng, Han; Lee, Charles; Du, Ruikun; Han, Julianna; Perez, Jasmine; Peet, Norton; Manicassamy, Balaji; Rong, Lijun

2017-10-10

Ebola virus has caused 26 outbreaks in 10 different countries since its identification in 1976, making it one of the deadliest emerging viral pathogens. The most recent outbreak in West Africa from 2014-16 was the deadliest yet and culminated in 11,310 deaths out of 28,616 confirmed cases. Currently there are no FDA-approved therapeutics or vaccines to treat Ebola virus infections. The slow development of effective vaccines combined with the severity of past outbreaks emphasizes the need to accelerate research into understanding the virus lifecycle and the development of therapeutics for post exposure treatment. Here we present a summary of the major findings on the Ebola virus replication cycle and the therapeutic approaches explored to treat this devastating disease. The major focus of this review is on small molecule inhibitors. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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…

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 ...

Planning ahead: Improving escalation plans before the weekend.

Science.gov (United States)

Zarkali, Angeliki; Black, Duncan; Smee, Elizabeth; Deshraj, Anshul; Smallwood, Nicholas

2014-01-01

Handover is the system by which responsibility for patient care is transferred between healthcare professionals. A significant aspect of handover is the existence of an escalation plan for each patient in case of deterioration over the weekend. According to the Royal College of Physicians, all patients should have a clear escalation plan documented in the notes before a weekend, since parent medical teams (Consultant team in charge of care) are best placed to make these decisions. If left to on-call teams, at a time of deterioration over a weekend, they might not have all available information, the patient might be unable to be involved in the decisions, and the family might not be consulted. With this is mind, we decided to analyse the existing handover process in a medium sized district general hospital, with the aim of improving the process and the documentation of escalation plans. The results from our retrospective analysis of the system in place revealed a significant lack of documentation of escalation plans in the medical notes. Three sample wards were selected to analyse the current handover system and test proposed measures before hospital-wide implementation. After trialling of a physical handover meeting in addition to the existing intranet system and a proforma for the Friday ward round, the documentation of escalation plans in the patients' notes improved from 9.1% to 41.1%. Based on these results, as well as formal feedback from junior doctors and informal feedback from other staff, the physical handover meeting and Friday ward round proforma will be implemented throughout the Trust. Our interventions led to an improvement in the documentation of escalation plans in our hospital, thus saving precious time in the event of a patient's deterioration. This also ensures that families and patients are involved in the decision making process and kept informed, and reduces the burden for the weekend on-call teams.

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

A Therapeutic Communication Study of Families with Children Suffering from Cancer

Directory of Open Access Journals (Sweden)

Devie Rahmawati

2017-12-01

Full Text Available Therapeutic communication is a relatively new area of research in Indonesia. It is widely known that the success of therapeutic communication is largely influenced by the medical providers’ communication effectiveness when dealing with their clients. This paper reports on research that aimed to explore the connection between therapeutic communication and satisfaction and dissatisfaction as experienced by families of child cancer patients. It used a quantitative approach with a cross-sectional design. The sample was the families of child cancer patients who were acccompanying the patients during hospital stay treatment at an Indonesian public hospital in Jakarta over the period December of   2014 – March 2015. There were 23 respondents for the research. The statistical test used was chi-square with an 0.05 level of significance. The result indicated that 56.5% of the respondents were satisfied with the therapeutic communication provided by nursing staff and that those who praticed therapeutic communication well, were 22 times more likely to provide a satisfactory level to the families  of   child  cancer  patients  compared  with  those who  did not  apply good therapeutic communication  (the value of p=0.003 and Odds ratio= 22. Thus, the research indicated that the medical providers’ communication effectiveness was associated with the patients’ satisfaction. We suggest that medical providers be given workshops on how to improve their communication skills to make their clients more satisfied with the medical services.

76 FR 7098 - Dealer Floor Plan Pilot Program

Science.gov (United States)

2011-02-09

... Plan Pilot Program AGENCY: U.S. Small Business Administration (SBA). ACTION: Program implementation with request for comments. SUMMARY: SBA is introducing a new Dealer Floor Plan Pilot Program to make... Plan Pilot Program was created in the Small Business Jobs Act of 2010. Under the new Dealer Floor Plan...

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

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

[Are therapeutics decisions homogeneous in multidisciplinary onco-urology staff meeting? Comparison of therapeutic options taken in four departments from Paris].

Science.gov (United States)

Audenet, F; Lejay, V; Mejean, A; De La Taille, A; Abbou, C-C; Lebret, T; Botto, H; Bitker, M-O; Roupret, M

2012-06-01

One of the priorities of the "Plan against the Cancer" in France is to ensure the discussion of all cancer cases in a multidisciplinary meeting staff (RCP). The multidisciplinary collaboration is proposed to guarantee a discussion between specialists in every cases, particularly in complex cases. The aim of this study was to compare the therapeutic decision taken in four RCP in Paris Île-de-France academic centres for three identical cases. Three cases of urological oncology (prostate cancer [PCa], renal cell carcinoma [RCC] and bladder tumour) were selected by a single urologist, not involved in further discussion. These cases were blindly presented in four academic urology department from Paris: Pitié-Salpêtrière Hospital, Mondor Hospital, the Georges-Pompidou European Hospital and Foch Hospital. The four centres met the criteria of quality of RCP in terms of multidisciplinarity, frequency and standardization. The therapeutic suggestions were similar in the RCC cases, there were differences in the surgical approaches and preoperative work-up in the PCa case and, lastly, the proposals were different for the bladder cancer case. The decisions relies on clinical data and preoperative work-up but also on the experience and habits of the centre of excellence. For complex cases that does not fit with current guidelines, the panel discussion can lead to different therapeutic options from a centre to another and is largely influenced by the local organisation of the RCP. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Therapeutic Inertia in the New Landscape of Multiple Sclerosis Care

Directory of Open Access Journals (Sweden)

Gustavo Saposnik

2018-03-01

Full Text Available The landscape of multiple sclerosis (MS treatment is constantly changing. Significant heterogeneity exists in the efficacy and risks associated with these therapies. Therefore, clinicians have the challenge to tailor treatment based on several factors (disease activity level, risk of progression, individual patient preferences and characteristics, personal expertise, etc., to identify the optimal balance between safety and efficacy. However, most clinicians have limited education in decision-making and formal training in risk management. Together, these factors may lead to therapeutic inertia (TI; defined as the absence of treatment initiation or intensification when therapeutic goals are unmet. TI may lead to suboptimal treatments choices, worse clinical outcomes, and more disability. This article provides a succinct overview on factors influencing TI in MS care.

Stem Cell Therapy: A Promising Therapeutic Method for Intracerebral Hemorrhage.

Science.gov (United States)

Gao, Liansheng; Xu, Weilin; Li, Tao; Chen, Jingyin; Shao, Anwen; Yan, Feng; Chen, Gao

2018-01-01

Spontaneous intracerebral hemorrhage (ICH) is one type of the most devastating cerebrovascular diseases worldwide, which causes high morbidity and mortality. However, efficient treatment is still lacking. Stem cell therapy has shown good neuroprotective and neurorestorative effect in ICH and is a promising treatment. In this study, our aim was to review the therapeutic effects, strategies, related mechanisms and safety issues of various types of stem cell for ICH treatment. Numerous studies had demonstrated the therapeutic effects of diverse stem cell types in ICH. The potential mechanisms include tissue repair and replacement, neurotrophy, promotion of neurogenesis and angiogenesis, anti-apoptosis, immunoregulation and anti-inflammation and so forth. The microenvironment of the central nervous system (CNS) can also influence the effects of stem cell therapy. The detailed therapeutic strategies for ICH treatment such as cell type, the number of cells, time window, and the routes of medication delivery, varied greatly among different studies and had not been determined. Moreover, the safety issues of stem cell therapy for ICH should not be ignored. Stem cell therapy showed good therapeutic effect in ICH, making it a promising treatment. However, safety should be carefully evaluated, and more clinical trials are required before stem cell therapy can be extensively applied to clinical use.

49 CFR 659.23 - System security plan: contents.

Science.gov (United States)

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false System security plan: contents. 659.23 Section 659... State Oversight Agency § 659.23 System security plan: contents. The system security plan must, at a... system security plan; and (e) Document the rail transit agency's process for making its system security...

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

[Therapeutic education in oncology: involving patient in the management of cancer].

Science.gov (United States)

Pérol, David; Toutenu, Pauline; Lefranc, Anne; Régnier, Véronique; Chvetzoff, Gisèle; Saltel, Pierre; Chauvin, Franck

2007-03-01

The notion of therapeutic education was only recently introduced in cancer. Although the term is commonly used, no standard definition exists for the concept and principles of therapeutic education and its efficacy remains to be assessed. Therapeutic education is complementary to the healthcare approach and aims to get the patients more involved in their disease and the treatment decision-making process. This discipline, placed at the interface of human and social sciences, was first developed for the management of chronic diseases (diabetes, asthma). It derives from the principle that involving patients in their own care and management can help them better adjust to life with a chronic disease. The lengthening survival time of cancer patients, which contributes to making cancer a chronic disease, as well as changes in the patient-caregiver relationship contribute to the development of therapeutic education in cancer. Pilot studies, conducted principally in the United States, evaluating the side effects of chemotherapy and the management of pain, have demonstrated that such educational programs could improve patient quality of life and decrease the side effects of treatments. The success of these programs depends on several parameters: taking into account patient's opinion in the elaboration and preparation of the programs; involving skilled multidisciplinary teams engaged in iterative educational actions; having recourse to methodological tools to evaluate the impact of implemented programs. Consistent with the World Health Organization guidelines, research should be conducted in France in order to elaborate and implement cancer-specific education programs and evaluate their potential benefit. Patient education programs on pain, fatigue, nutrition and treatment compliance are currently being developed at Saint-Etienne Regional Resource Centre for cancer information, prevention and education, within the framework of the Canceropole Lyon Auvergne Rhône-Alpes.

Acute radiation syndrome caused by accidental radiation exposure - therapeutic principles

Directory of Open Access Journals (Sweden)

Dörr Harald

2011-11-01

Full Text Available Abstract Fortunately radiation accidents are infrequent occurrences, but since they have the potential of large scale events like the nuclear accidents of Chernobyl and Fukushima, preparatory planning of the medical management of radiation accident victims is very important. Radiation accidents can result in different types of radiation exposure for which the diagnostic and therapeutic measures, as well as the outcomes, differ. The clinical course of acute radiation syndrome depends on the absorbed radiation dose and its distribution. Multi-organ-involvement and multi-organ-failure need be taken into account. The most vulnerable organ system to radiation exposure is the hematopoietic system. In addition to hematopoietic syndrome, radiation induced damage to the skin plays an important role in diagnostics and the treatment of radiation accident victims. The most important therapeutic principles with special reference to hematopoietic syndrome and cutaneous radiation syndrome are reviewed.

Inverse planning of energy-modulated electron beams in radiotherapy

International Nuclear Information System (INIS)

Gentry, John R.; Steeves, Richard; Paliwal, Bhudatt A.

2006-01-01

The use of megavoltage electron beams often poses a clinical challenge in that the planning target volume (PTV) is anterior to other radiosensitive structures and has variable depth. To ensure that skin as well as the deepest extent of the PTV receives the prescribed dose entails prescribing to a point beyond the depth of peak dose for a single electron energy. This causes dose inhomogeneities and heightened potential for tissue fibrosis, scarring, and possible soft tissue necrosis. Use of bolus on the skin improves the entrant dose at the cost of decreasing the therapeutic depth that can be treated. Selection of a higher energy to improve dose homogeneity results in increased dose to structures beyond the PTV, as well as enlargement of the volume receiving heightened dose. Measured electron data from a linear accelerator was used as input to create an inverse planning tool employing energy and intensity modulation using bolus (e-IMRT TM ). Using tools readily available in a radiotherapy department, the applications of energy and intensity modulation on the central axis makes it possible to remove hot spots of 115% or more over the depths clinically encountered. The e-IMRT TM algorithm enables the development of patient-specific dose distributions with user-defined positions of peak dose, range, and reduced dose to points beyond the prescription point

Paths toward reclamation: therapeutic jurisprudence and the regulation of medical practitioners.

Science.gov (United States)

Freckelton, Ian; Flynn, Joanna

2004-08-01

Much about what used to be termed "disciplinary" investigations and hearings is being revisited in the modern era. Therapeutic jurisprudence enables informed and sensitive awareness to potentially therapeutic and counter-therapeutic effects of both investigations and hearings conducted by medical regulatory authorities. This article analyses key aspects of authorities' processes from the perspective of notifiers/complainants and practitioners. Using developments at the Victorian Medical Practitioners Board as a base, it addresses issues of both investigative procedures and decision-making at formal and informal hearings, as well as the ramifications of re-hearings for the integrity of peer review informed regulation. It argues that where reclamation of practitioners is possible (namely where impropriety is not of the most serious order), there is much that is constructive about a focus upon enhancement of performance and competence levels, rather than the traditional preoccupation with whether registered status needs to be affected as a result of practitioner conduct.

Assessing Professional Decision-Making Abilities.

Science.gov (United States)

McNergney, Robert; Hinson, Stephanie

1985-01-01

Describes Teacher Development Decision Exercises, a computer-based method of diagnosing abilities of elementary and secondary school supervisors (principals, staff developers, curriculum coordinators) to make professional preactive or planning decisions. This approval simulates assessment of supervisors' abilities to use professional knowledge to…

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 ...

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 ...

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 ...

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 ...

24 CFR 290.15 - Disposition plan.

Science.gov (United States)

2010-04-01

... DEVELOPMENT HUD-OWNED PROPERTIES DISPOSITION OF MULTIFAMILY PROJECTS AND SALE OF HUD-HELD MULTIFAMILY..., the sales price that is acceptable to HUD, and the assistance that HUD plans to make available to a... plan, the environmental reviews required by 24 CFR part 50. ...

Significance of forecasting factors for correction of therapeutic tactics in children with lymphogranulomatosis

International Nuclear Information System (INIS)

Kobikov, S.Kh.

1989-01-01

Ways of reducing the frequency of lymphogranulomatosis recurrences in 347 children after radio and chemotherapy are considered. Children are irradiated using the Rocus gamma therapeutic device and accelerators applying 15-25 MeV energy electron beam. Integral focal doses make up 40-45 Gy

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

ADEM - a system for recording and retrieving AECB decision-making

Energy Technology Data Exchange (ETDEWEB)

Beare, J W

1995-04-01

A concept and plan is proposed for a system to record on-going decision-making by the AECB so that the decision-making can be retrieved in the future. The system could also be used to retrieve past decision-making. (author). 4 tabs., 1 fig.

ADEM - a system for recording and retrieving AECB decision-making

International Nuclear Information System (INIS)

Beare, J.W.

1995-04-01

A concept and plan is proposed for a system to record on-going decision-making by the AECB so that the decision-making can be retrieved in the future. The system could also be used to retrieve past decision-making. (author). 4 tabs., 1 fig

Soft Space Planning in Cities unbound

DEFF Research Database (Denmark)

Olesen, Kristian

This paper analyses contemporary experiments of building governance capacity in new soft spaces in Denmark through processes of spatial strategy-making. The paper argues that new soft spaces are emerging in Danish spatial planning, which set out to promote more effective forms of strategic spatial...... planning, and how their obsession with promoting economic development at the expense of wider planning responsibilities support contemporary neoliberal transformations of strategic spatial planning....... planning. The Danish case of soft space planning demonstrates how Danish soft spaces at subnational scales fail to fill in the gaps between formal planning structures and provide the glue that binds formal scales of planning together as promised in the soft space literature. This raises a number...

A proposal of group decision making procedure for supporting social consensus making

International Nuclear Information System (INIS)

Shimizu, Yoshiaki

1996-01-01

Being interested in supporting social consensus making, in this paper, we have proposed a group decision making procedure through conflict resolution in the following situation: each group has a different privilege with decision making; the final goal should be evaluated by a few qualitative sub-goals besides quantitative ones. For this purpose, we have developed a step-wise procedure that has been popularly adapted when encountered with complicated and large-scale problem-solving. As well as at the value system design phase, we applied the analytic hierarchy process, AHP to decide weights standing for the privilege at the decision making phase. Then, after rearranging the hierarchy of the sub-goals depending on the nature, we have provided an iterative procedure to derive a final solution from a discrete optimization problem. To reduce the difficulties of multi-objective decision making thereat, we took a scoring method for total evaluation and applied the genetic algorithm as a solution method. Through numerical experiments applied to a planning problem of the radioactive waste management system, we have shown numerically the proposed approach is very promising for social consensus making. (author)

Ecological support for rural land-use planning.

Science.gov (United States)

David M. Theobald; Thomas Spies; Jeff Kline; Bruce Maxwell; N. T. Hobbs; Virginia H. Dale

2005-01-01

How can ecologists be more effective in supporting ecologically informed rural land-use planning and policy? Improved decision making about rural lands requires careful consideration of how ecological information and analyses can inform specific planning and policy needs. We provide a brief overview of rural land-use planning, including recently developed approaches to...

The impact of participation in strategic planning and action planning on management control effectiveness: An analysis of independent and joint effects

OpenAIRE

Bedford, David S.; Bednark, Piotr; Dossi, Andrea; Ditillo, Angelo; Gosselin, Maurice; Madsen, Dag Øivind

2016-01-01

This research paper examines the independent and joint effects of participation in strategic planning and action planning. There is extensive research about employee participation in both the fields of strategic planning and budgeting. However, there is a lack of research about the interaction between participation in strategic planning and budgeting. Drawing on the research on participation in decision-making processes, the hypothesis is that strategic planning and action plan...

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.

Views on planning and expectations of SEA: the case of transport planning

International Nuclear Information System (INIS)

Hilden, Mikael; Furman, Eeva; Kaljonen, Minna

2004-01-01

This paper examines the effectiveness of strategic environmental assessment (SEA) in transport planning in the light of different views of planning: synoptic optimising planning, communicative planning and planning as a social struggle. The analysis uses empirical materials from 17 case studies collected by survey from Member Countries of the United Nation's Economic Commission for Europe (UN/ECE) and further processed in a practitioners' workshop, and also a detailed case study carried out in Finland. The case studies and the workshop identified a set of necessary conditions and facilitating factors that contribute to the effectiveness of strategic environmental assessments in transport planning. Our findings suggest that transport planning can often best be characterised as a social struggle over problem definitions and future choices. Thus, the effectiveness of SEA will depend on how well the assessment fits into the planning context and on its actual contribution to debates on problem definitions. Specific procedural steps may improve the effectiveness but explicit requirements to recognise SEA in decision making are likely to be a key condition

Looking for a more participative healthcare: sharing medical decision making

OpenAIRE

Bravo, Paulina; Escuela de Enfermería, Pontificia Universidad Católica de Chile, Chile. School of Medicine, Cardiff University. Reino Unido. Enfermera, doctora en Salud Pública.; Contreras, Aixa; Escuela de Enfermería, Pontificia Universidad Católica de Chile, Chile. enfermera matrona, magister en Psicología Social Comunitaria.; Perestelo-Pérez, Lilisbeth; Servicio de Evaluación del Servicio Canario de la Salud, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). España. psicóloga, doctora en Psicología Clínica y de la Salud.; Pérez-Ramos, Jeanette; Fundación Canaria de Investigación y Salud (FUNCIS). España. psicóloga.; Málaga, Germán; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. médico internista, magister en Medicina.

2014-01-01

The healthcare model is shifting from a paternalistic towards a more inclusive and participative approach, such as shared decision making (SDM). SDM considers patients as autonomous and responsible agents. SDM is a therapeutic approach where healthcare providers and patients share the best evidence available to make a decision according to the values and preferences of the patient. Decision aids are tools that can facilitate this information exchange. These tools help patients to increase kno...

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.)

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.

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.)

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

A case-based approach to understanding vacation planning

Science.gov (United States)

Susan I. Stewart; Christine A. Vogt

1999-01-01

Vacations provide an opportunity to make many choices, and even for travelers who want their vacations to be spontaneous, planning is often an important part of vacationing. Although descriptive studies of travel planning have sketched out the elements of the vacation plan, these elements have not been drawn together in a conceptual model of the consumer planning...

The special effects of hypnosis and hypnotherapy: A contribution to an ecological model of therapeutic change.

Science.gov (United States)

Mende, Matthias

2006-04-01

There is ample evidence that hypnosis enhances the effectiveness of psychotherapy and produces some astounding effects of its own. In this paper, the effective components and principles of hypnosis and hypnotherapy are analyzed. The "special" hypnotic and hypnotherapeutic effects are linked to the fact that the ecological requirements of therapeutic change are taken into account implicitly and/or explicitly when working with hypnotic trances in a therapeutic setting. The hypnotic situation is described--theoretically and in case examples--as a therapeutic modality that gratifies and aligns the basic emotional needs to feel autonomous, related, competent, and oriented. It is shown how the hypnotic relationship can help promote a sound ecological balance between these needs--a balance that is deemed to be a necessary prerequisite for salutogenesis. Practical implications for planning hypnotherapeutic interventions are discussed.

Integrated Planning: Why is it so hard?

International Nuclear Information System (INIS)

Hesser, A.

1994-01-01

In this paper, the Manager of Planning integration at DOE-Richland and the Program Manager for Hanford Mission Planning at Pacific Northwest Laboratory and Westinghouse Hanford Company describe some of the reasons why integrated planning is so hard and what can be done to correct the situation. The authors use experiences from the last three years at Hanford to illustrate some of the difficulties in site integrated planning. The authors argue that integrated planning was not a major part of the previous diverse Site missions, but the change of mission has not resulted in a corresponding change of attitude about the need for such planning. Moreover, the DOE-RL staff is not structured or manned for planning, and a site perspective is the exception, rather than the norm. Contributing to this situation is the compartmentalization of funding and decision making and the diffusion of responsibility. The decision-making process at DOE sites is often not clear because of the evolving role of stakeholders, and agencies outside the DOE, especially regulators, are co-decision makers. The regulatory process and the requirements of environmental impact statements contribute to the diffusion of authority

[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.

A Survey of Multi-Objective Sequential Decision-Making

OpenAIRE

Roijers, D.M.; Vamplew, P.; Whiteson, S.; Dazeley, R.

2013-01-01

Sequential decision-making problems with multiple objectives arise naturally in practice and pose unique challenges for research in decision-theoretic planning and learning, which has largely focused on single-objective settings. This article surveys algorithms designed for sequential decision-making problems with multiple objectives. Though there is a growing body of literature on this subject, little of it makes explicit under what circumstances special methods are needed to solve multi-obj...

Difficulties in the therapeutic relationship in cognitive-behavioral therapy. M. Linehan's dialectical behavior therapy in work with borderline personality disorder.

OpenAIRE

Monika Romanowska

2015-01-01

According to popular opinions therapeutic relationship doesn't play a significant role in cognitive-behavioral therapy. Furthermore it is frequently assumed that cognitive therapist doesn't pay attention to processes taking place during the session, focuses solely on a realization of an earlier planned protocol and convinces patient to rational thinking minimizing the role of emotions. Contrary to this beliefs CBT therapists often focus on a therapeutic relationship and use it in a process of...

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.

Pandemic influenza preparedness: an ethical framework to guide decision-making

Directory of Open Access Journals (Sweden)

Gibson Jennifer L

2006-12-01

Full Text Available Abstract Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.

Patients' Values in Clinical Decision-Making.

Science.gov (United States)

Faggion, Clovis Mariano; Pachur, Thorsten; Giannakopoulos, Nikolaos Nikitas

2017-09-01

Shared decision-making involves the participation of patient and dental practitioner. Well-informed decision-making requires that both parties understand important concepts that may influence the decision. This fourth article in a series of 4 aims to discuss the importance of patients' values when a clinical decision is made. We report on how to incorporate important concepts for well-informed, shared decision-making. Here, we present patient values as an important issue, in addition to previously established topics such as the risk of bias of a study, cost-effectiveness of treatment approaches, and a comparison of therapeutic benefit with potential side effects. We provide 2 clinical examples and suggestions for a decision tree, based on the available evidence. The information reported in this article may improve the relationship between patient and dental practitioner, resulting in more well-informed clinical decisions. Copyright © 2017 Elsevier Inc. All rights reserved.

The Secret Life of Exosomes: What Bees Can Teach Us About Next-Generation Therapeutics.

Science.gov (United States)

Marbán, Eduardo

2018-01-16

Mechanistic exploration has pinpointed nanosized extracellular vesicles, known as exosomes, as key mediators of the benefits of cell therapy. Exosomes appear to recapitulate the benefits of cells and more. As durable azoic entities, exosomes have numerous practical and conceptual advantages over cells. Will cells end up just being used to manufacture exosomes, or will they find lasting value as primary therapeutic agents? Here, a venerable natural process-the generation of honey-serves as an instructive parable. Flowers make nectar, which bees collect and process into honey. Cells make conditioned medium, which laboratory workers collect and process into exosomes. Unlike flowers, honey is durable, compact, and nutritious, but these facts do not negate the value of flowers themselves. The parallels suggest new ways of thinking about next-generation therapeutics. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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.

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.

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 ...

Therapeutic patient education in heart failure: do studies provide sufficient information about the educational programme?

Science.gov (United States)

Albano, Maria Grazia; Jourdain, Patrick; De Andrade, Vincent; Domenke, Aukse; Desnos, Michel; d'Ivernois, Jean-François

2014-05-01

Therapeutic patient education programmes on heart failure have been widely proposed for many years for heart failure patients, but their efficiency remains questionable, partly because most articles lack a precise programme description, which makes comparative analysis of the studies difficult. To analyse the degree of precision in describing therapeutic patient education programmes in recent randomized controlled trials. Three major recent recommendations on therapeutic patient education in heart failure inspired us to compile a list of 23 relevant items that an 'ideal' description of a therapeutic patient education programme should contain. To discover the extent to which recent studies into therapeutic patient education in heart failure included these items, we analysed 19 randomized controlled trials among 448 articles published in this field from 2005 to 2012. The major elements required to describe a therapeutic patient education programme were present, but some other very important pieces of information were missing in most of the studies we analysed: the patient's educational needs, health literacy, projects, expectations regarding therapeutic patient education and psychosocial status; the educational methodology used; outcomes evaluation; and follow-up strategies. Research into how therapeutic patient education can help heart failure patients will be improved if more precise descriptions of patients, educational methodology and evaluation protocols are given by authors, ideally in a standardized format. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

A multi-agent paradigm as structuring principle for planning support systems

NARCIS (Netherlands)

Saarloos, D.J.M.; Arentze, T.A.; Borgers, A.W.J.; Timmermans, H.J.P.

2008-01-01

Although urban plans may appear simple once completed, they are the outcomes of a highly complex decision-making process. This complexity makes it difficult to develop Planning Support Systems (PSS) that are comprehensive, flexible, intelligent and, yet, understandable to users. Great improvements

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...

An expert system for a local planning environment

NARCIS (Netherlands)

Meester, G.J.; Meester, G.J.

1993-01-01

In this paper, we discuss the design of an Expert System (ES) that supports decision making in a Local Planning System (LPS) environment. The LPS provides the link between a high level factory planning system (rough cut capacity planning and material coordination) and the actual execution of jobs on

Shangri-La revisited: an exploration of therapeutic efficacy among intentional communities.

Science.gov (United States)

Francis, T L

1992-04-01

Field and literature surveys were employed to explore the therapeutic efficacy of a reportedly common set of social structures found among some Intentional Communities (ICs). Substance misuse served as an example of social problems plausibly related to the examined social structures, which included: (1) meditative practices, (2) progressive education, (3) holistic health practices, (4) nutritional diet, (5) open policy making, (6) equally or equitably shared resources, (7) integrating membership processes, and (8) environmental concern. The field survey identified and examined 11 such ICs, and the literature exploration concerning the structures found that they appear to be therapeutic. Future research should focus on refining the study of structural and antecedent variables and on finding relationships between these variables to communities in the larger society.

Fight malaria at home: Therapeutic and prophylaxis clinical data

Directory of Open Access Journals (Sweden)

Deepak Bhattacharya

2011-06-01

Full Text Available Objective: To identify a new, safe and effective source to combat and prevent drug resistant malaria therapeutically and to make it as a home-made bio-medicine which is called as OMARIA (Orissa malaria research indigenous attempt and use it on long term basis (decade in mono clinical station and in field. Methods: The rind of a lesser known Indian indigenous fruit dalimba/ Punica granatum (P. granatum is taken. Manual process to make a hand-made or home-made bio-medicine is done. Hand-filled into gelatin capsules and administered as an internal medicine. Therapy to 532 clinical cases is given at the Govt Red Cross Clinic, and Prophylaxis at site is administered to 401 cases by adopting 3 villages. Results: Hydrophyllic, ellagitannins viz., punicalagin (C 48H28O 30; mw 1 1 00~1 1 25, punicalin (C 34H22O 22; mw 780~785, ellagic acid (C14H6O8; mw 302 and K+ co-exists as the only drug moieties. OMARIA has no other confounding or confabulating compounds. There is non alkaloid. Conclusions: OMARIA delivers therapeutics and prophylaxis to drug resistant Plasmodium falciparum (P. falciparum cases. There are no side effects and no contradictions. Non-toxic at bolus/loading doses. No case progressed to cerebral malaria. OMARIA is a first time work. Original report on pan global basis.

Louisiana's 2017 Master Plan for a Sustainable Coast

Science.gov (United States)

Haase, B.

2017-12-01

The Coastal Protection and Restoration Authority is charged with coordinating restoration and protection investments through the development and implementation of Louisiana's Comprehensive Master Plan for a Sustainable Coast. The first master plan was submitted to the Louisiana Legislature in 2007 and is mandated to be updated every five years. The plan's objectives are to reduce economic losses from flooding, promote sustainability by harnessing natural processes, provide habitats for commercial and recreational activities, sustain cultural heritage and promote a viable working coast. Two goals drive decision making about the appropriate suite of restoration and protection projects to include in the Plan: restore and maintain Louisiana's wetlands and provide flood protection for coastal Louisiana's citizens. As part of the decision making process, a wide range of additional metrics are used to evaluate the complex, competing needs of communities, industries, navigation and fisheries. The master plan decision making process includes the identification of individual protection and restoration projects that are evaluated with landscape, storm surge, and risk assessment models and then ranked by how well they perform over time across the set of decision drivers and metrics. High performing projects are assembled into alternatives constrained by available funding and river resources. The planning process is grounded not only on extensive scientific analysis but also on interdisciplinary collaboration between scientists, engineers, planners, community advocates, and coastal stakeholders which creates the long-term dialogue needed for complex environmental planning decisions. It is through this collaboration that recommended alternatives are reviewed and modified to develop the final Plan. Keywords:alternative formulation, comprehensive planning, ecosystem restoration, flood risk reduction and stakeholder engagement

Risk evaluation and monitoring in multiple sclerosis therapeutics.

Science.gov (United States)

Clanet, Michel C; Wolinsky, Jerry S; Ashton, Raymond J; Hartung, Hans-Peter; Reingold, Stephen C

2014-09-01

Risk for multiple sclerosis (MS) disease-modifying therapies (DMT) must be assessed on an ongoing basis. Early concerns regarding the first-approved DMTs for MS have been mitigated, but recently licensed therapies have been linked to possibly greater risks. The objective of this review is to discuss risk assessment in MS therapeutics based on an international workshop and comprehensive literature search and recommend strategies for risk assessment/monitoring. Assessment and perception of therapeutic risks vary between patients, doctors and regulators. Acceptability of risk depends on the magnitude of risk and the demonstrated clinical benefits of any agent. Safety signals must be distinguishable from chance occurrences in a clinical trial and in long-term use of medications. Post-marketing research is crucial for assessing longer-term safety in large patient cohorts. Reporting of adverse events is becoming more proactive, allowing more rapid identification of risks. Communication about therapeutic risks and their relationship to clinical benefit must involve patients in shared decision making. It is difficult to produce a general risk-assessment algorithm for all MS therapies. Specific algorithms are required for each DMT in every treated-patient population. New and evolving risks must be evaluated and communicated rapidly to allow patients and physicians to be well informed and able to share treatment decisions. © The Author(s) 2013.

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...

"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

THE SIGNIFICANCE OF MANAGEMENT INFORMATION SYSTEMS FOR ENHANCING STRATEGIC AND TACTICAL PLANNING

Directory of Open Access Journals (Sweden)

Akram Jalal Karim

2011-08-01

Full Text Available Management Information Systems (MIS is the key factor to facilitate and attain efficient decision making in an organization. This research explores the extent to which management information systems implemented to make successful decisions at two selected financial organizations. The research examined whether the selected financial institutions of Bahrain vary as to the use of Management Information Systems leadership of decision making for strategic and tactical planning purposes. The research adapted the quantitative research design to examine two research hypotheses. A total of 190 forms were equally distributed to those who are working at different management levels at the selected organizations. The results of the research showed that MIS was primarily used to enhance strategic planning in both financial institutions. The regression analysis revealed that Tactical planning is found to have no effect on Decision Making, while Strategic planning has a clear effect on the Decision Making Effectiveness in both organizations

Planning Security Services for IT Systems

OpenAIRE

Henderson, Marie; Page, Howard Philip

2014-01-01

Often the hardest job is to get business representatives to look at security as something that makes managing their risks and achieving their objectives easier, with security compliance as just part of that journey. This paper addresses that by making planning for security services a 'business tool'.

Transport fleet sizing by using make and buy decision-making

Directory of Open Access Journals (Sweden)

Stojanović Đurđica

2011-01-01

Full Text Available Cost reduction is among the main quoted reasons for logistics outsourcing, while transport capacities and operations are among the most outsourced logistics areas. However, according to transaction costs theory, there is often room for transport insourcing. Furthermore, nowadays many authors stress that mixed solutions can give better results than “make” or “buy” alternatives. “Make or buy” decision-making normative models, methods, and procedures in transport planning are not much explored. Instead, research is rather focused on carrier selection techniques, whereby it is supposed that outsourcing transport capacities is the most suitable solution. The purpose of this paper is to contribute to the body of literature on classical “makeor-buy” decision-making in transport fleet sizing in a non-logistics enterprise. It goes beyond the basic “make or buy” decisionmaking, and intermediate solutions (i.e., “make and buy” are explored. Practical directions are given according to theoretical principles, and a case study is used to exemplify the main deductions. The research also has practical implications. Many enterprises in transition economies have faced the question of what to do with their in-house transport fleets. The obtained results are of interest to merchants and manufacturing enterprises that already have a private transport fleet and are considering how to rationalize it.

Landscape in Green Infrastructures & Interscalar Planning

OpenAIRE

Galan, Juanjo

2015-01-01

The transversal and interdisciplinary quality of landscape makes it an essential and useful element in regional and local planning. On the other hand, Green Infrastructures provide an exceptional tool to put in relation different planning scales and offer new possibilities and functions for the design and management of open spaces. The Strategic Plan for the Calderona Mountain Range (Valencia province, Spain) shows how these two concepts: Landscape and Green Infrastructure can work hand in...

SCOPE – An Integrated Framework for Multi-Attribute Decision Making

DEFF Research Database (Denmark)

Leleur, Steen

2004-01-01

that are supported by a methodology of both a systemic and a systematic type. Specific use is made of operational research methods such as critical systems heuristics, scenario technique, stakeholder analysis and multi‐attribute decision making (MADM). To deal with issues of complexity and ambiguity, planning......This article presents an integrated framework for multi‐attribute decision making named SCOPE (System for Combined Planning and Evaluation) that was developed to assess infrastructure policy initiatives—in complex decision environments. The framework comprises scanning as well as assessment issues...

The Internet and the therapeutic education of patients: A systematic review of the literature.

Science.gov (United States)

Gremeaux, V; Coudeyre, E

2010-12-01

To evaluate from a review of the literature the interest of using the Internet as a tool for the therapeutic education of patients. A systematic review of Pubmed was carried out using the key words: the Internet, or World Wide Web and patient education, or patient preference, or self-care. The search was restricted to articles in English published between 1990 and 2009. References to the selected articles were also analyzed. Only randomized controlled studies were retained. Thirty-nine articles concerning 20 different diseases met the inclusion criteria and were analyzed. Different types of programs were proposed: informative, interactive, cognitive-behavioral and programs concerning self-management of the disease and the treatment. These different approaches were sometimes compared. The use of quality Internet sites made it possible to induce beneficial changes in lifestyle habits, and to diminish subjective and/or objective symptom severity in chronic invalidating diseases when used as a complement to traditional management. By using the Internet, patients were also able to improve decision-making skills to a degree that was at least as good as that obtained using traditional paper documents. The Internet is an effective complementary tool that can contribute to improving therapeutic education. Nonetheless, healthcare professionals should work with patients to create quality sites that correspond more closely to their expectations. It is also essential for learned societies such as the SOFMER to invest in therapeutic education on the Internet to make quality therapeutic education modules based on factual medical data and complying with good practices available on line. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

A SWOT analysis of Planning Support Systems

NARCIS (Netherlands)

Vonk, G.; Geertman, S.; Schot, P.P.

2007-01-01

Insight into the strengths, weaknesses, opportunities, and threats (SWOT) of planning support systems (PSS) is fragmented between users and system developers. The lack of combined insights blocks development in the right direction and makes potential users hesitant to apply PSS in planning. This

Rule-based decision making model

International Nuclear Information System (INIS)

Sirola, Miki

1998-01-01

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

Rural Transformation and Planning Tactics in the 13th Five-Year Plan Period

Institute of Scientific and Technical Information of China (English)

Luo; Xiaolong; Xu; Xiao; Li; Min

2016-01-01

Rural development has long been the focus of China’s central and local governments. Since the late 2000 s, rural areas have presented new transformation features and development trends. To stimulate rural transformation and development in the 13 th Five-Year Plan period, this paper reviews major ideas on rural development in related disciplines. This study also summarizes main rural transformation features, including the aging population, hollow villages, changes in the allocation of land resource, semi-urbanization, and regional differences in rural development. Finally, it also provides suggestions for planning tactics in the 13 th Five-Year Plan period, such as making differentiated rural development strategies, exploring new methods to stimulate rural stock land planning and use, and enforcing relevant policy and management reforms.

Rural Transformation and Planning Tactics in the 13th Five-Year Plan Period

Institute of Scientific and Technical Information of China (English)

Luo Xiaolong; Xu Xiao; Li Min

2016-01-01

Rural development has long been the focus of China's central and local governments.Since the late 2000s,rural areas have presented new transformation features and development trends.To stimulate rural transformation and development in the 13th Five-Year Plan period,this paPer reviews major ideas on rural development in related disciplines.This study also summarizes main rural transformation features,including the aging population,hollow villages,changes in the allocation of land resource,semi-urbanization,and regional differences in rural development.Finally,it also provides suggestions for planning tactics in the 13th Five-Year Plan period,such as making differentiated rural development strategies,exploring new methods to stimulate rural stock land planning and use,and enforcing relevant policy and management reforms.

Advanced Education and Technology Business Plan, 2007-10

Science.gov (United States)

Alberta Enterprise and Advanced Education, 2007

2007-01-01

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

Better Forecasting for Better Planning: A Systems Approach.

Science.gov (United States)

Austin, W. Burnet

Predictions and forecasts are the most critical features of rational planning as well as the most vulnerable to inaccuracy. Because plans are only as good as their forecasts, current planning procedures could be improved by greater forecasting accuracy. Economic factors explain and predict more than any other set of factors, making economic…

Planning Workshop on Local Level Poverty Monitoring System

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

Md. Abdul Quader - Ranjan Kumar Guha

decision making and incorporate these in preparing the development plans and programmes of the ... and highlight the usefulness of the information in local level planning. The aim ..... proper accounts of the cooperatives for its sustainability.

FDG PET evaluation of therapeutic response and toxicity after radiotherapy for NSCLC

International Nuclear Information System (INIS)

Hicks, R.J.; MacManus, M.P.; Matthews, J.P.; Rischin, D.; Binns, D.; McKenzie, A.F.; Ball, D.L.

2002-01-01

Full text: Positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) is recognised for staging and therapeutic planning of patients with non-small cell carcinoma of the lung (NSCLC). The potential for this technique to be used in the assessment of therapeutic response has also been highlighted but may be limited by false positive results due to inflammatory response, particularly early after radiotherapy (RT). To evaluate the utility of FEX PET for therapeutic monitoring early (<12 weeks) after completion of radical RT we prospectively evaluated metabolic response and radiation toxicity using a standardised scoring system in 73 consecutive patients. All 73 had evaluable PET scans but 6 of the CT scan results were considered non-evaluable for therapeutic response using WHO criteria. PET therapeutic response category differed from that by CT in 40/67 (60%) cases and in 80% of such cases suggested a more marked response than suggested by CT (p 0.0002). Multifactor analysis including PET response, CT response, performance status, weight loss and stage revealed that PET response was the only significant predictor of survival (p 0.0001). Radiation toxicity scores were inversely related to therapeutic response on both PET (p = 0.022) and CT (p =0.029). In particular, more severe (grade 2 or 3) radiotoxicity scores on PET were associated with a greater proportion of partial or complete responses on both PET and CT than were lower (grade 0 and 1) scores (p =0.0044 and 0.041 respectively) consistent with the known relationship between the radiosensitivity of normal host and tumoral tissues. Early after completion of radiotherapy for NSCLC, PET response provides better prognostic stratification than CT response. PET can also identify typical radiation toxicity changes which are associated with response to treatment. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

Planning applications in image analysis

Science.gov (United States)

Boddy, Mark; White, Jim; Goldman, Robert; Short, Nick, Jr.

1994-01-01

We describe two interim results from an ongoing effort to automate the acquisition, analysis, archiving, and distribution of satellite earth science data. Both results are applications of Artificial Intelligence planning research to the automatic generation of processing steps for image analysis tasks. First, we have constructed a linear conditional planner (CPed), used to generate conditional processing plans. Second, we have extended an existing hierarchical planning system to make use of durations, resources, and deadlines, thus supporting the automatic generation of processing steps in time and resource-constrained environments.

Therapeutic drug monitoring in epilepsy clinic: a multi-disciplinary approach

Directory of Open Access Journals (Sweden)

Sunee Lertsinudom

2014-12-01

level. Therapeutic drug monitoring services at the Epilepsy Clinic was useful in supporting clinical information queries. Pharmacists could make use of interpreted drug level information by recommending physicians to monitor drug levels and adjust individual dosage regimen accordingly. It should be noted that physicians accepted pharmacists’ recommendation, denoting multi-disciplinary care team that would lead to greater efficiency.

Evaluation of IMRT plans of prostate carcinoma from four treatment planning systems based on Monte Carlo

International Nuclear Information System (INIS)

Chi Zifeng; Han Chun; Liu Dan; Cao Yankun; Li Runxiao

2011-01-01

Objective: With the Monte Carlo method to recalculate the IMRT dose distributions from four TPS to provide a platform for independent comparison and evaluation of the plan quality.These results will help make a clinical decision as which TPS will be used for prostate IMRT planning. Methods: Eleven prostate cancer cases were planned with the Corvus, Xio, Pinnacle and Eclipse TPS. The plans were recalculated by Monte Carlo using leaf sequences and MUs for individual plans. Dose-volume-histograms and isodose distributions were compared. Other quantities such as D min (the minimum dose received by 99% of CTV/PTV), D max (the maximum dose received by 1% of CTV/PTV), V 110% , V 105% , V 95% (the volume of CTV/PTV receiving 110%, 105%, 95% of the prescription dose), the volume of rectum and bladder receiving >65 Gy and >40 Gy, and the volume of femur receiving >50 Gy were evaluated. Total segments and MUs were also compared. Results: The Monte Carlo results agreed with the dose distributions from the TPS to within 3%/3 mm. The Xio, Pinnacle and Eclipse plans show less target dose heterogeneity and lower V 65 and V 40 for the rectum and bladder compared to the Corvus plans. The PTV D min is about 2 Gy lower for Xio plans than others while the Corvus plans have slightly lower female head V 50 (0.03% and 0.58%) than others. The Corvus plans require significantly most segments (187.8) and MUs (1264.7) to deliver and the Pinnacle plans require fewest segments (82.4) and MUs (703.6). Conclusions: We have tested an independent Monte Carlo dose calculation system for dose reconstruction and plan evaluation. This system provides a platform for the fair comparison and evaluation of treatment plans to facilitate clinical decision making in selecting a TPS and beam delivery system for particular treatment sites. (authors)

Decision making in high-velocity environments: implications for healthcare.

Science.gov (United States)

Stepanovich, P L; Uhrig, J D

1999-01-01

Healthcare can be considered a high-velocity environment and, as such, can benefit from research conducted in other industries regarding strategic decision making. Strategic planning is not only relevant to firms in high-velocity environments, but is also important for high performance and survival. Specifically, decision-making speed seems to be instrumental in differentiating between high and low performers; fast decision makers outperform slow decision makers. This article outlines the differences between fast and slow decision makers, identifies five paralyses that can slow decision making in healthcare, and outlines the role of a planning department in circumventing these paralyses. Executives can use the proposed planning structure to improve both the speed and quality of strategic decisions. The structure uses planning facilitators to avoid the following five paralyses: 1. Analysis. Decision makers can no longer afford the luxury of lengthy, detailed analysis but must develop real-time systems that provide appropriate, timely information. 2. Alternatives. Many alternatives (beyond the traditional two or three) need to be considered and the alternatives must be evaluated simultaneously. 3. Group Think. Decision makers must avoid limited mind-sets and autocratic leadership styles by seeking out independent, knowledgeable counselors. 4. Process. Decision makers need to resolve conflicts through "consensus with qualification," as opposed to waiting for everyone to come on board. 5. Separation. Successful implementation requires a structured process that cuts across disciplines and levels.

Corporate plan 1996/97 to 2000/01

International Nuclear Information System (INIS)

1996-01-01

The main purpose of this corporate plan is to describe the broad programme of work for the planning period and the manner in which it is to be implemented, to identify the strategic and specific objectives and to make the necessary financial forecasts. (author)

Strategy in Generative Planning of Turning Processes

NARCIS (Netherlands)

van Houten, Frederikus J.A.M.; Kals, H.J.J.

1986-01-01

This paper reports on the process and operations planning system ROUND and the strategies which underlie the decision making processes in the planning of turning operations. At first, an outline is given about the environment for which generative systems like ROUND are being developed. The

Podocytes from the diagnostic and therapeutic point of view.

Science.gov (United States)

Müller-Deile, Janina; Schiffer, Mario

2017-08-01

The central role of podocytes in glomerular diseases makes this cell type an interesting diagnostic tool as well as a therapeutic target. In this review, we discuss the current literature on the use of podocytes and podocyte-specific markers as non-invasive diagnostic tools in different glomerulopathies. Furthermore, we highlight the direct effects of drugs currently used to treat primary glomerular diseases and describe their direct cellular effects on podocytes. A new therapeutic potential is seen in drugs targeting the podocytic actin cytoskeleton which is essential for podocyte foot process structure and function. Incubation of cultured human podocyte cell lines with sera from patients with active glomerular diseases is currently also used to identify novel circulating factors with pathophysiological relevance for the glomerular filtration barrier. In addition, treatment of detached urinary podocytes from patients with substances that restore their cytoskeleton might serve as a novel personalized tool to estimate their potential for podocyte recovery ex vivo.

RE-PLAN: An Extensible Software Architecture to Facilitate Disaster Response Planning

Science.gov (United States)

O’Neill, Martin; Mikler, Armin R.; Indrakanti, Saratchandra; Tiwari, Chetan; Jimenez, Tamara

2014-01-01

Computational tools are needed to make data-driven disaster mitigation planning accessible to planners and policymakers without the need for programming or GIS expertise. To address this problem, we have created modules to facilitate quantitative analyses pertinent to a variety of different disaster scenarios. These modules, which comprise the REsponse PLan ANalyzer (RE-PLAN) framework, may be used to create tools for specific disaster scenarios that allow planners to harness large amounts of disparate data and execute computational models through a point-and-click interface. Bio-E, a user-friendly tool built using this framework, was designed to develop and analyze the feasibility of ad hoc clinics for treating populations following a biological emergency event. In this article, the design and implementation of the RE-PLAN framework are described, and the functionality of the modules used in the Bio-E biological emergency mitigation tool are demonstrated. PMID:25419503

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.

Research on the Evaluation System for Rural Public Safety Planning

Institute of Scientific and Technical Information of China (English)

Ming; SUN; Jianxin; YAN

2014-01-01

The indicator evaluation system is introduced to the study of rural public safety planning in this article.By researching the current rural public safety planning and environmental carrying capacity,we select some carrying capacity indicators influencing the rural public safety,such as land,population,ecological environment,water resources,infrastructure,economy and society,to establish the environmental carrying capacity indicator system.We standardize the indicators,use gray correlation analysis method to determine the weight of indicators,and make DEA evaluation of the indicator system,to obtain the evaluation results as the basis for decision making in rural safety planning,and provide scientific and quantified technical support for rural public safety planning.

Achieving Smart Energy Planning Objectives. The Approach of the Transform Project

Directory of Open Access Journals (Sweden)

Ilaria Delponte

2014-05-01

Full Text Available Cities play a dual role in the field of energy and integrated planning. They function as institutional planning and decision making bodies and interfere as actors, e.g. as project developers or launching customers. In the first case their attempts at integrated plans are often unsuccessful in integrating vision, goals and instruments of all stakeholders so that waste, water, energy cycles, urban planning and budgets proceed with no connection to each other.  TRANSFORM Project “Transformation Agenda for Low Carbon Cities” (FP7 tries to improve the integrated energy policy and decision making process of cities, both at a strategic and operational level, by providing the cities with a framework based on overall planning experiences and on-the-field projects and qualitative and quantitative analysis support models. The project intends also to make a step further in the quality of research, by providing a replicable and tested framework for the production of a strategic Transformation Agenda for the city as a whole, combined with district Implementation Plans.

The Open Format and Citizen Participation in Transportation Planning

DEFF Research Database (Denmark)

Flyvbjerg, Bent

1984-01-01

Recent developments in transportation planning and policy indicate that citizen participation and openness may receive less emphasis in the future in favor of more closed methods of decision making and control. Have the merits and drawbacks of citizen participation and openness changed significan......Recent developments in transportation planning and policy indicate that citizen participation and openness may receive less emphasis in the future in favor of more closed methods of decision making and control. Have the merits and drawbacks of citizen participation and openness changed...... with the trend for considering social, environmental, and ethical issues in transportation planning and policy....

Recombinant IκBα-loaded curcumin nanoparticles for improved cancer therapeutics

International Nuclear Information System (INIS)

Banerjee, Subhamoy; Ghosh, Siddhartha Sankar; Sahoo, Amaresh Kumar; Chattopadhyay, Arun

2014-01-01

The field of recombinant protein therapeutics has been evolving rapidly, making significant impact on clinical applications for several diseases, including cancer. However, the functional aspects of proteins rely exclusively on their structural integrity, in which nanoparticle mediated delivery offers unique advantages over free proteins. In the present work, a novel strategy has been developed where the nanoparticles (NPs) used for the delivery of the recombinant protein could contribute to enhancing the therapeutic efficacy of the recombinant protein. The transcription factor, NFκB, involved in cell growth and its inhibitor, IκBα, regulates its proliferation. Another similar naturally available molecule, which inhibits the function of NFκB, is curcumin. Hence, we have developed a ‘green synthesis’ method for preparing water-soluble curcumin nanoparticles to stabilize recombinant IκBα protein. The NPs were characterized by UV–vis and fluorescence spectroscopy, transmission electron microscopy (TEM) and dynamic light scattering before administration into human cervical carcinoma (HeLa) and glioblastoma (U87MG) cells. Experimental results demonstrated that this combined module had enhanced therapeutic efficacy, causing apoptotic cell death, which was confirmed by cytotoxicity assay and flowcytometry analyses. The expression of apoptotic genes studied by semi-quantitative reverse transcription PCR delineated the molecular pathways involved in cell death. Thus, our study revealed that the functional delivery of recombinant IκBα-loaded curcumin NPs has promise as a natural-product-based protein therapeutics against cancer cells. (paper)

Recombinant IκBα-loaded curcumin nanoparticles for improved cancer therapeutics

Science.gov (United States)

Banerjee, Subhamoy; Sahoo, Amaresh Kumar; Chattopadhyay, Arun; Sankar Ghosh, Siddhartha

2014-08-01

The field of recombinant protein therapeutics has been evolving rapidly, making significant impact on clinical applications for several diseases, including cancer. However, the functional aspects of proteins rely exclusively on their structural integrity, in which nanoparticle mediated delivery offers unique advantages over free proteins. In the present work, a novel strategy has been developed where the nanoparticles (NPs) used for the delivery of the recombinant protein could contribute to enhancing the therapeutic efficacy of the recombinant protein. The transcription factor, NFκB, involved in cell growth and its inhibitor, IκBα, regulates its proliferation. Another similar naturally available molecule, which inhibits the function of NFκB, is curcumin. Hence, we have developed a ‘green synthesis’ method for preparing water-soluble curcumin nanoparticles to stabilize recombinant IκBα protein. The NPs were characterized by UV-vis and fluorescence spectroscopy, transmission electron microscopy (TEM) and dynamic light scattering before administration into human cervical carcinoma (HeLa) and glioblastoma (U87MG) cells. Experimental results demonstrated that this combined module had enhanced therapeutic efficacy, causing apoptotic cell death, which was confirmed by cytotoxicity assay and flowcytometry analyses. The expression of apoptotic genes studied by semi-quantitative reverse transcription PCR delineated the molecular pathways involved in cell death. Thus, our study revealed that the functional delivery of recombinant IκBα-loaded curcumin NPs has promise as a natural-product-based protein therapeutics against cancer cells.

Libre courseware for Bayesian decision making

Czech Academy of Sciences Publication Activity Database

Suzdaleva, Evgenia

2005-01-01

Roč. 1, č. 2 (2005), s. 1-3 ISSN 1860-7470 Grant - others:Commission EU(XE) 110330-CP-1-2003-1-ES-MINERVA-M Institutional research plan: CEZ:AV0Z10750506 Keywords : software tools * education * decision making Subject RIV: JC - Computer Hardware ; Software

Program plan recognition for year 2000 tools

NARCIS (Netherlands)

A. van Deursen (Arie); S. Woods; A. Quilici

1997-01-01

textabstractThere are many commercial tools that address various aspects of the Year 2000 problem. None of these tools, however, make any documented use of plan-based techniques for automated concept recovery. This implies a general perception that plan-based techniques is not useful for this

Public information plan. Version 2

International Nuclear Information System (INIS)

1993-01-01

The Public Information Plan is intended to be used in conjunction with the U.S. Department of Energy (DOE) Uranium Mill Tailings Remedial Action (UMTRA) Project Public Participation Plan. The Public Participation Pion describes the DOE procedure for involving the public in the decision-making process related to the UMTRA Project during the stages at which public participation is required and solicited. This Public Information Plan describes the department's procedure for communicating with the public about project policies, plans, and activities. Together, these complementary plans describe the DOE public affairs program for the UMTRA Project. This project was authorized by Congress in the Uranium Mill Tailings Radiation Control Act (UMTRCA) of 1978, (Public Law (PL) 95-6041), as amended. 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, which are located in 10 states, 9 of them west of the Mississippi River. The public has a right to know about proposed government actions and to be heard in the planning of activities that influence their lives. The UMTRA Project is unclassified and the DOE provides accurate information about policy and project activities to interested stakeholders, including the news media, in a timely way. The DOE encourages states and local governments, as well as individuals, to join actively in the decision-making process. This is intended to ensure that the resulting decisions are made with full knowledge of the public's views and that these decisions address the public's concerns to the extent possible within the law. The DOE, through the implementation of the Public Information Plan, keeps the public informed on matters such as health concerns, environmental issues, remedial action construction plans, project costs, and specific site activities

The consequences of introducing IT systems for decision-making processes in healthcare institutions

Directory of Open Access Journals (Sweden)

Marzena Furtak-Niczyporuk

2017-03-01

  Aim: The aim of the study was the diagnosis of management decision-making in the therapeutic entity, for possible implementation tools in the form of an information system, which could accelerate and support the rational process of making those decisions. In addition, work was to evaluate the role of management decisions and the implications of the information system on the process of rational decision-making in the management entity therapeutic.   Material and Methods: The case study method allowed us to show the practical applications and benefits resulting from the application system to support rational decision-making management, in particular in terms of reducing costs and improving the organization of health services offered.   The results and conclusions: Presented system generates a database to support rational decision-making process in the field of management, minimize their costs while improving the organization of health services. Ability to use various functions of the system allows for multi-segment analysis, thanks to the specially chosen and condensed information, both in the form of text and graphics over any time horizon. Benefits of the implications of the system is the speed and efficiency of the whole process of treatment, as well as the reduction of administrative tasks of medical staff, which increases the time for the patient.

Systems Engineering Plan and project record Configuration Management Plan for the Mixed Waste Disposal Initiative

International Nuclear Information System (INIS)

Bryan, W.E.; Oakley, L.B.

1993-04-01

This document summarizes the systems engineering assessment that was performed for the Mixed Waste Disposal Initiative (MWDI) Project to determine what types of documentation are required for the success of the project. The report also identifies the documents that will make up the MWDI Project Record and describes the Configuration Management Plan describes the responsibilities and process for making changes to project documentation

Soft Spaces as Vehicles for Neoliberal Transformations of Strategic Spatial Planning?

DEFF Research Database (Denmark)

Olesen, Kristian

2012-01-01

This paper analyses how policy agendas are being shaped and reshaped in new soft spaces emerging in Danish spatial planning at subnational scales, and how policy-making in these soft spaces seeks to influence formal planning arenas. The paper demonstrates how the new soft planning spaces in Danis...... spatial planning, being used as vehicles for neoliberal transformations of strategic spatial planning. This paper therefore argues for a need to maintain a critical stance towards the emergence of soft spaces in spatial planning.......This paper analyses how policy agendas are being shaped and reshaped in new soft spaces emerging in Danish spatial planning at subnational scales, and how policy-making in these soft spaces seeks to influence formal planning arenas. The paper demonstrates how the new soft planning spaces in Danish...... spatial planning primarily are concerned with promoting policy agendas centred on economic development, whilst doing limited work in filling in the gaps between formal scales of planning, as envisaged in the planning literature. Instead, soft spaces seem to add to the increasing pressures on statutory...

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.

Development of nutrition standards and therapeutic diet specifications for public hospitals in New South Wales.

Science.gov (United States)

Williams, Peter; Hazlewood, Tanya; Pang, Glen

2014-09-01

In New South Wales (NSW), a new suite of nutrition standards for menus and specifications for therapeutic diets to be used in hospitals has been developed. These standards were required to facilitate centralised menu planning and food production, with the move to management of most hospital food services by HealthShare NSW, a state-wide business unit of NSW Health. The standards also aim to improve communication between health professionals, particularly with the increasing use of computerised meal-ordering systems. Nutrition standards have been developed for adult, paediatric and mental health inpatients, and specifications for 147 different adult and paediatric therapeutic diets. There is still significant variation in the nutrition standards for nutrition and therapeutic diets in hospitals across the Australian states, and a move to a more nationally harmonised approach would be welcome. Further research is required to examine the impact of these standards on operating efficiency and patient care outcomes.

Development of new therapeutic methods of lung cancer through team approach study

International Nuclear Information System (INIS)

Park, Jong Ho; Zo, Jae Ill; Baek, Hee Jong; Jung, Jin Haeng; Lee, Jae Cheol; Ryoo, Baek Yeol; Kim, Mi Sook; Choi, Du Hwan; Park, Sun Young; Lee, Hae Young

2000-12-01

The aims of this study were to make the lung cancer clinics in Korea Cancer Center Hospital, and to establish new therapeutic methods of lung cancer for increasing the cure rate and survival rate of patients. Also another purpose of this study was to establish a common treatment method in our hospital. All patients who were operated in Korea Cancer Center Hospital from 1987 due to lung cancer were followed up and evaluated. And we have been studied the effect of postoperative adjuvant therapy in stage I, II, IIIA non-small cell lung cancer patients from 1989 with the phase three study form. Follow-up examinations were scheduled in these patients and interim analysis was made. Also we have been studied the effect of chemo-therapeutic agents in small cell lung cancer patients from 1997 with the phase two study form. We evaluated the results of this study. Some important results of this study were as follows. 1. The new therapeutic method (surgery + MVP chemotherapy) was superior to the standard therapeutic one in stage I Non-small cell lung cancer patients. So, we have to change the standard method of treatment in stage I NSCLC. 2. Also, this new therapeutic method made a good result in stage II NSCLC patients. And this result was reported in The Annals of Thoracic Surgery. 3. However, this new therapeutic method was not superior to the standard treatment method (surgery only) in stage IIIA NSCLC patients. So, we must develop new chemo-therapeutic agents in the future for advanced NSCLC patients. 4. In the results of the randomized phase II studies about small cell lung cancer, there was no difference in survival between Etoposide + Carboplatin + Ifosfamide + Cisplatin group and Etoposide + Carboplatin + Ifosfamide + Cisplatin + Tamoxifen group in both the limited and extended types of small cell lung cancer patients

Therapeutic decisions in ALS patients: cross-cultural differences and clinical implications.

Science.gov (United States)

Andersen, Peter M; Kuzma-Kozakiewicz, Magdalena; Keller, Jürgen; Aho-Oezhan, Helena E A; Ciecwierska, Katarzyna; Szejko, Natalia; Vázquez, Cynthia; Böhm, Sarah; Badura-Lotter, Gisela; Meyer, Thomas; Petri, Susanne; Linse, Katharina; Hermann, Andreas; Semb, Olof; Stenberg, Erica; Nackberg, Simona; Dorst, Johannes; Uttner, Ingo; Häggström, Ann-Cristin; Ludolph, Albert C; Lulé, Dorothée

2018-05-04

Quantitative analysis of decision-making on therapeutic options in different sociocultural context in amyotrophic lateral sclerosis (ALS). ALS patients (n = 244) were consecutively recruited in Germany (n = 83), Poland (n = 83), and Sweden (n = 78) in a prospective cross-cultural study ( www.NEEDSinALS.com ). They were interviewed on preferences for therapeutic techniques including invasive (IV) and non-invasive ventilation (NIV), as well as percutaneous endoscopic gastrostomy (PEG) and on hypothetical termination of these using quantitative questions. Using standardized questionnaires, religiousness, personal values, quality of life, and depressiveness were assessed. NIV was most frequently used in Germany and PEG in Sweden. Swedish patients were most liberal on initiation and termination of PEG, NIV and IV. Polish patients were mostly undecided and were least likely to consider discontinuing supportive management. Current use was partly associated with age, gender and state of physical function; also, financial support explained some variance. Future preferences on therapeutic options from the patient's perspective were also closely associated with cultural factors. The more oriented towards traditional and conservative values, the less likely patients were to decide for invasive therapeutic devices (IV, PEG), the least likely to have ideations to discontinue any device and the more likely to have an undecided attitude. Current use of therapeutic options is determined by medical condition in analogy to clinical guidelines. For future considerations, other factors such as cultural background are crucial, yielding hurdles to be regarded in the implementation of advanced directives in a multicultural environment.

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.

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.

Planning Tool for Strategic Evaluation of Facility Plans - 13570

Energy Technology Data Exchange (ETDEWEB)

Magoulas, Virginia; Cercy, Michael [Savannah River National Laboratory, Savannah River Site, Aiken, SC 29808 (United States); Hall, Irin [Newport News Shipbuilding, 4101 Washington Ave., Newport News, VA 23607 (United States)

2013-07-01

Savannah River National Laboratory (SRNL) has developed a strategic planning tool for the evaluation of the utilization of its unique resources for processing and research and development of nuclear materials. The Planning Tool is a strategic level tool for assessing multiple missions that could be conducted utilizing the SRNL facilities and showcasing the plan. Traditional approaches using standard scheduling tools and laying out a strategy on paper tended to be labor intensive and offered either a limited or cluttered view for visualizing and communicating results. A tool that can assess the process throughput, duration, and utilization of the facility was needed. SRNL teamed with Newport News Shipbuilding (NNS), a division of Huntington Ingalls Industries, to create the next generation Planning Tool. The goal of this collaboration was to create a simulation based tool that allows for quick evaluation of strategies with respect to new or changing missions, and clearly communicates results to the decision makers. This tool has been built upon a mature modeling and simulation software previously developed by NNS. The Planning Tool provides a forum for capturing dependencies, constraints, activity flows, and variable factors. It is also a platform for quickly evaluating multiple mission scenarios, dynamically adding/updating scenarios, generating multiple views for evaluating/communicating results, and understanding where there are areas of risks and opportunities with respect to capacity. The Planning Tool that has been developed is useful in that it presents a clear visual plan for the missions at the Savannah River Site (SRS). It not only assists in communicating the plans to SRS corporate management, but also allows the area stakeholders a visual look at the future plans for SRS. The design of this tool makes it easily deployable to other facility and mission planning endeavors. (authors)

Planning Tool for Strategic Evaluation of Facility Plans - 13570

International Nuclear Information System (INIS)

Magoulas, Virginia; Cercy, Michael; Hall, Irin

2013-01-01

Savannah River National Laboratory (SRNL) has developed a strategic planning tool for the evaluation of the utilization of its unique resources for processing and research and development of nuclear materials. The Planning Tool is a strategic level tool for assessing multiple missions that could be conducted utilizing the SRNL facilities and showcasing the plan. Traditional approaches using standard scheduling tools and laying out a strategy on paper tended to be labor intensive and offered either a limited or cluttered view for visualizing and communicating results. A tool that can assess the process throughput, duration, and utilization of the facility was needed. SRNL teamed with Newport News Shipbuilding (NNS), a division of Huntington Ingalls Industries, to create the next generation Planning Tool. The goal of this collaboration was to create a simulation based tool that allows for quick evaluation of strategies with respect to new or changing missions, and clearly communicates results to the decision makers. This tool has been built upon a mature modeling and simulation software previously developed by NNS. The Planning Tool provides a forum for capturing dependencies, constraints, activity flows, and variable factors. It is also a platform for quickly evaluating multiple mission scenarios, dynamically adding/updating scenarios, generating multiple views for evaluating/communicating results, and understanding where there are areas of risks and opportunities with respect to capacity. The Planning Tool that has been developed is useful in that it presents a clear visual plan for the missions at the Savannah River Site (SRS). It not only assists in communicating the plans to SRS corporate management, but also allows the area stakeholders a visual look at the future plans for SRS. The design of this tool makes it easily deployable to other facility and mission planning endeavors. (authors)

Polymer therapeutics with a coiled coil motif targeted against murine BCL1 leukemia

Czech Academy of Sciences Publication Activity Database

Pola, Robert; Laga, Richard; Ulbrich, Karel; Sieglová, Irena; Král, Vlastimil; Fábry, Milan; Kabešová, Martina; Kovář, Marek; Pechar, Michal

2013-01-01

Roč. 14, č. 3 (2013), s. 881-889 ISSN 1525-7797 R&D Projects: GA ČR GAP301/11/0325; GA AV ČR IAAX00500803 Institutional research plan: CEZ:AV0Z50520514 Institutional support: RVO:61389013 ; RVO:61388971 ; RVO:68378050 Keywords : coiled coil * polymer therapeutics * scFv Subject RIV: CD - Macromolecular Chemistry; EC - Immunology (MBU-M); EB - Genetics ; Molecular Biology (UMG-J) Impact factor: 5.788, year: 2013

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.

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

77 FR 55430 - Arkansas Regulatory Program and Abandoned Mine Land Reclamation Plan

Science.gov (United States)

2012-09-10

... of its regulatory program and abandoned mine land reclamation plan, make grammatical changes, correct... portions of its regulatory program and abandoned mine land reclamation plan, make grammatical changes... Streams. PART 785--REQUIREMENTS FOR PERMITS FOR SPECIAL CATEGORIES OF MINING 785.13, 785.14, 785.15...

[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.

Therapeutics targeting tumor immune escape: towards the development of new generation anticancer vaccines.

Science.gov (United States)

Mocellin, Simone; Nitti, Donato

2008-05-01

Despite the evidence that immune effectors can play a significant role in controlling tumor growth under natural conditions or in response to therapeutic manipulation, it is clear that malignant cells evade immune surveillance in most cases. Considering that anticancer vaccination has reached a plateau of results and currently no vaccination regimen is indicated as a standard anticancer therapy, the dissection of the molecular events underlying tumor immune escape is the necessary condition to make anticancer vaccines a therapeutic weapon effective enough to be implemented in the routine clinical setting. Recent years have witnessed significant advances in our understanding of the molecular mechanisms underlying tumor immune escape. These mechanistic insights are fostering the development of rationally designed therapeutics aimed at reverting the immunosuppressive circuits that undermine an effective antitumor immune response. In this review, the best characterized mechanisms that allow cancer cells to evade immune surveillance are overviewed and the most debated controversies constellating this complex field are highlighted. In addition, the latest therapeutic strategies devised to overcome tumor immune escape are described, with special regard to those entering clinical phase investigation. Copyright (c) 2007 Wiley-Periodicals, Inc.

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.

Green Place-making in practice: from temporary spaces to permanent place

NARCIS (Netherlands)

Cilliers, E.J.; Timmermans, W.; Goorbergh, van den F.; Slijkhuis, J.

2015-01-01

Current spatial planning and sustainability approaches attempt to create competitive, lively and sustainable cities. This paper argues that place-making approaches and green-planning approaches can assist in this regard as these approaches focus on creating qualitative, socially viable and

Material requirements planning: a better way to plan material.

Science.gov (United States)

Tomas, S

1990-08-01

MRP systems can benefit hospitals in their management of material. Systems provide the means to schedule surgical procedures, calculate material requirements, release orders, plan future capacity requirements, and release and track work orders. MRP can be a powerful tool if properly implemented. All it takes is individuals dedicated to maintaining the discipline and data integrity required to make MRP successful.

Planning and developing medical tourism in megalopolis Shiraz

Directory of Open Access Journals (Sweden)

Masoud Safaeepour

2015-01-01

Full Text Available Medical tourism is an international phenomenon where some tourists travel long to reach treatment-therapeutic services because of high expenses, long waits, lacking in insurance, and applying services and insufficient access to health services in the destination. This industry, now, by making 60 billion dollars annually in international level, has been considered as one the most profitable markets and the number of countries to provide facilities and treatment services for foreign tourists tend to increase. Many countries provide applicable and legal plans for development of this industry. This paper aims at planning and improving medical tourism in megalopolis Shiraz. The dominating approach in the present study is developmental-applied and the method is descriptive, analytical and survey study. To analyze the data and to test the research hypothesis, the linear Pearson correlation and ANOVA were used. The results of the present study have indicated that all quality factors of treatment and tourism services, culture, facilities, medical and tourist equipment and ICT, had positive and direct correlation with developing medical tourism and the factor of price had negative and reverse correlation with it. In other words, the higher the price is, the less the medical tourism development is and vice versa. Also, the ANOVA showed that among medical tourists from various countries regarding satisfaction with the price of treatment and tourist services, the quality of treatment and tourist services, culture, facilities, medical and tourist equipment and ICT, there are significant differences and Kuwaiti tourists were the most satisfied tourists and Afghani ones were the least satisfied.

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- ...

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...

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...

Therapeutic peptides for cancer therapy. Part I - peptide inhibitors of signal transduction cascades.

Science.gov (United States)

Bidwell, Gene L; Raucher, Drazen

2009-10-01

Therapeutic peptides have great potential as anticancer agents owing to their ease of rational design and target specificity. However, their utility in vivo is limited by low stability and poor tumor penetration. The authors review the development of peptide inhibitors with potential for cancer therapy. Peptides that inhibit signal transduction cascades are discussed. The authors searched Medline for articles concerning the development of therapeutic peptides and their delivery. Given our current knowledge of protein sequences, structures and interaction interfaces, therapeutic peptides that inhibit interactions of interest are easily designed. These peptides are advantageous because they are highly specific for the interaction of interest, and they are much more easily developed than small molecule inhibitors of the same interactions. The main hurdle to application of peptides for cancer therapy is their poor pharmacokinetic and biodistribution parameters. Therefore, successful development of peptide delivery vectors could potentially make possible the use of this new and very promising class of anticancer agents.

Decision-making under Ambiguity in Neurodegenerative Disease

OpenAIRE

Rogers, Denise

2011-01-01

Decision-making is a complex skill that is essential for daily life. Yet the complexities of this process are often overlooked in favour of more obvious cognitive deficits during neuropsychological assessment, such as memory or attention impairments. Decision-making involves affective and motivational aspects of executive functions (Happaney, Zelazo & Stuss, 2004). Executive functions include a range of abilities that can be divided into three categories: 1) goal setting and planning, 2) acti...

Decision Making: The Toughest Job in the World

Science.gov (United States)

Bullis, Robert V.

1977-01-01

The four phases in rational decision-making are (1) diagnosis, (2) discovering alternative solutions, (3) analyzing and comparing alternatives, and (4) selecting the proper alternative or plan to follow. (Author)

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

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

Decision-making for tracheostomy in amyotrophic lateral sclerosis (ALS): a retrospective study.

Science.gov (United States)

Ceriana, Piero; Surbone, Sara; Segagni, Daniele; Schreiber, Annia; Carlucci, Annalisa

2017-11-01

ALS patients should discuss the issue of tracheostomy before the onset of terminal respiratory failure. While the process of shared decision-making is desirable, there are few data on the practical application of this real-life situation. To determine how a decision-making process is actually carried out, we analysed the episodes of acute respiratory failure preceding tracheostomy. We studied the charts of a group of ALS patients after tracheostomy. An interview focusing on the existence of anticipated directives was carried out. Tracheostomies were classified as planned or unplanned according to the presence of a decision plan. A total of 209 ALS patients were cared for during a three-year period. Of these patients, 34 (16%) were tracheotomised. In 38% of cases, tracheostomy was planned, 41% were unplanned, and 21% remained undiagnosed. A minority of ALS patients make a voluntary decision for tracheostomy before the procedure is conducted. The advising process of care still presents limits that have been thus far poorly addressed. In the future, we will need to develop guidelines for the timing and content of the shared-decision making process.

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 ...

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.

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.

Multispecies genetic objectives in spatial conservation planning.

Science.gov (United States)

Nielsen, Erica S; Beger, Maria; Henriques, Romina; Selkoe, Kimberly A; von der Heyden, Sophie

2017-08-01

Growing threats to biodiversity and global alteration of habitats and species distributions make it increasingly necessary to consider evolutionary patterns in conservation decision making. Yet, there is no clear-cut guidance on how genetic features can be incorporated into conservation-planning processes, despite multiple molecular markers and several genetic metrics for each marker type to choose from. Genetic patterns differ between species, but the potential tradeoffs among genetic objectives for multiple species in conservation planning are currently understudied. We compared spatial conservation prioritizations derived from 2 metrics of genetic diversity (nucleotide and haplotype diversity) and 2 metrics of genetic isolation (private haplotypes and local genetic differentiation) in mitochondrial DNA of 5 marine species. We compared outcomes of conservation plans based only on habitat representation with plans based on genetic data and habitat representation. Fewer priority areas were selected for conservation plans based solely on habitat representation than on plans that included habitat and genetic data. All 4 genetic metrics selected approximately similar conservation-priority areas, which is likely a result of prioritizing genetic patterns across a genetically diverse array of species. Largely, our results suggest that multispecies genetic conservation objectives are vital to creating protected-area networks that appropriately preserve community-level evolutionary patterns. © 2016 Society for Conservation Biology.

Age Effects and Heuristics in Decision Making.

Science.gov (United States)

Besedeš, Tibor; Deck, Cary; Sarangi, Sudipta; Shor, Mikhael

2012-05-01

Using controlled experiments, we examine how individuals make choices when faced with multiple options. Choice tasks are designed to mimic the selection of health insurance, prescription drug, or retirement savings plans. In our experiment, available options can be objectively ranked allowing us to examine optimal decision making. First, the probability of a person selecting the optimal option declines as the number of options increases, with the decline being more pronounced for older subjects. Second, heuristics differ by age with older subjects relying more on suboptimal decision rules. In a heuristics validation experiment, older subjects make worse decisions than younger subjects.

GROWING A COMPANY BY INTERNATIONAL BUSINESS PLANNING

Directory of Open Access Journals (Sweden)

LIVIU NEAMŢU

2014-02-01

Full Text Available This paper seeks to identify an overall plan to coordinate and make effective international development efforts so as to achieve the objectives set in the strategy of firm (corporate business strategy and strategic and operational plans.International Strategy sets out the principles and shows ways due to which the company hopes to have competitive advantages to attract foreign buyers and make full use of the resources available to the firm. As part of the corporate and business strategy of the firm, international strategy must comply with the targets of these strategies by functional and operational adaptation of their international activities.

Patients' experiences with technology during inpatient rehabilitation: opportunities to support independence and therapeutic engagement.

Science.gov (United States)

Fager, Susan Koch; Burnfield, Judith M

2014-03-01

To understand individuals' perceptions of technology use during inpatient rehabilitation. A qualitative phenomenological study using semi-structured interviews of 10 individuals with diverse underlying diagnoses and/or a close family member who participated in inpatient rehabilitation. Core themes focused on assistive technology usage (equipment set-up, reliability and fragility of equipment, expertise required to use assistive technology and use of mainstream technologies) and opportunities for using technology to increase therapeutic engagement (opportunities for practice outside of therapy, goals for therapeutic exercises and technology for therapeutic exercises: motivation and social interaction). Interviews revealed the need for durable, reliable and intuitive technology without requiring a high level of expertise to install and implement. A strong desire for the continued use of mainstream devices (e.g. cell phones, tablet computers) reinforces the need for a wider range of access options for those with limited physical function. Finally, opportunities to engage in therapeutically meaningful activities beyond the traditional treatment hours were identified as valuable for patients to not only improve function but to also promote social interaction. Assistive technology increases functional independence of severely disabled individuals. End-users (patients and families) identified a need for designs that are durable, reliable, intuitive, easy to consistently install and use. Technology use (adaptive or commercially available) provides a mechanism to extend therapeutic practice beyond the traditional therapy day. Adapting skeletal tracking technology used in gaming software could automate exercise tracking, documentation and feedback for patient motivation and clinical treatment planning and interventions.

Development of the Supported Decision Making Inventory System.

Science.gov (United States)

Shogren, Karrie A; Wehmeyer, Michael L; Uyanik, Hatice; Heidrich, Megan

2017-12-01

Supported decision making has received increased attention as an alternative to guardianship and a means to enable people with intellectual and developmental disabilities to exercise their right to legal capacity. Assessments are needed that can used by people with disabilities and their systems of supports to identify and plan for needed supports to enable decision making. This article describes the steps taken to develop such an assessment tool, the Supported Decision Making Inventory System (SDMIS), and initial feedback received from self-advocates with intellectual disability. The three sections of the SDMIS (Supported Decision Making Personal Factors Inventory, Supported Decision Making Environmental Demands Inventory, and Decision Making Autonomy Inventory) are described and implications for future research, policy, and practice are discussed.

SU-E-J-04: A Data-Driven, Response-Based, Multi-Criteria Decision Support System for Personalized Lung Radiation Treatment Planning

International Nuclear Information System (INIS)

Luo, Y; McShan, D; Schipper, M; Matuszak, M; Ten Haken, R; Kong, F

2014-01-01

Purpose: To develop a decision support tool to predict a patient's potential overall survival (OS) and radiation induced toxicity (RIT) based on clinical factors and responses during the course of radiotherapy, and suggest appropriate radiation dose adjustments to improve therapeutic effect. Methods: Important relationships between a patient's basic information and their clinical features before and during the radiation treatment are identified from historical clinical data by using statistical learning and data mining approaches. During each treatment period, a data analysis (DA) module predicts radiotherapy features such as time to local progression (TTLP), time to distant metastases (TTDM), radiation toxicity to different organs, etc., under possible future treatment plans based on patient specifics or responses. An information fusion (IF) module estimates intervals for a patient's OS and the probabilities of RIT from a treatment plan by integrating the outcomes of module DA. A decision making (DM) module calculates “satisfaction” with the predicted radiation outcome based on trade-offs between OS and RIT, and finds the best treatment plan for the next time period via multi-criteria optimization. Results: Using physical and biological data from 130 lung cancer patients as our test bed, we were able to train and implement the 3 modules of our decision support tool. Examples demonstrate how it can help predict a new patient's potential OS and RIT with different radiation dose plans along with how these combinations change with dose, thus presenting a range of satisfaction/utility for use in individualized decision support. Conclusion: Although the decision support tool is currently developed from a small patient sample size, it shows the potential for the improvement of each patient's satisfaction in personalized radiation therapy. The radiation treatment outcome prediction and decision making model needs to be evaluated with more patients and demonstrated for

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.

New therapeutic approaches for treatment of tularaemia: a review

Directory of Open Access Journals (Sweden)

Sandrine eBOISSET

2014-03-01

Full Text Available Antibiotic treatment of tularaemia is based on a few drugs, including the fluoroquinolones, the tetracyclines and the aminoglycosides. Because no effective and safe vaccine is currently available, tularaemia prophylaxis following proven exposure to F. tularensis also relies on administration of antibiotics. A number of reasons make it necessary to search for new therapeutic alternatives: the potential toxicity of first-line drugs, especially in children and pregnant women; a high rate of treatment relapses and failures, especially for severe and/or suppurated forms of the disease; and the possible use of antibiotic-resistant strains in the context of a biological threat. This review presents novel therapeutic approaches that have been explored in recent years to improve tularaemia patients’ management and prognosis. First, the activities of newly available antibiotic compounds were evaluated against F. tularensis, including tigecycline (a glycylcycline, ketolides (telithromycin and cethromycin and fluoroquinolones (moxifloxacin, gatifloxacin, trovafloxacin and grepafloxacin. The liposome delivery of some antibiotics was evaluated. The effect of antimicrobial peptides against F. tularensis was also considered. Other drugs were evaluated for their ability to suppress the intracellular multiplication of F. tularensis. The effects of the modulation of the innate immune response (especially via TLR receptors on the course of F. tularensis infection were characterized. Another approach was the administration of specific antibodies to induce passive resistance to F. tularensis infection. All of these studies highlight the need to develop new therapeutic strategies to improve the management of patients with tularaemia. Many possibilities exist, some unexplored. Moreover, it is likely that new therapeutic alternatives that are effective against this intracellular pathogen could be, at least partially, extrapolated to other human pathogens.

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…

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.

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.

78 FR 30804 - Transmission Planning Reliability Standards

Science.gov (United States)

2013-05-23

... shedding firm load versus planning to shed firm load, while still ensuring that the decision-making process... load loss. NERC states that it developed this information to ensure that an entity adequately... adverse reliability impacts. While consumers and local communities should be able to make decisions about...

Rethinking Participation in Smart Energy System Planning

NARCIS (Netherlands)

Lammers, Imke; Arentsen, Maarten J.

2017-01-01

While the technical layout of smart energy systems is well advanced, the implementation of these systems is slowed down by the current decision-making practice regarding such energy infrastructures. We call for a reorganisation of the decision-making process on local energy planning and address the

Therapeutic Challenges in the Management of Acute Pulmonary Embolism in a Cancer Patient with Chemotherapy-induced Thrombocytopenia

Directory of Open Access Journals (Sweden)

Abuajela Sreh

2017-11-01

Full Text Available This case demonstrates the therapeutic challenges encountered when managing an acute pulmonary embolism in a cancer patient with thrombocytopenia. A 64-year-old man with a history of lung cancer receiving chemotherapy was admitted to Walsall Manor Hospital with haemodynamic instability consistent with a pulmonary embolism, proven on computed tomographic pulmonary angiogram. His platelet count was noted to be 35×109/l (chemotherapy-induced thrombocytopenia. After discussions, he was deemed not suitable for thrombolysis based on risk versus benefits. The patient was initially transfused one adult dose of platelets and treated with half the therapeutic dose of low molecular weight heparin (LMWH. The same management plan was followed until the platelet count exceeded 50×10sup>9/l, after which the patient was established on the full therapeutic dose of LMWH. Clinically, the patient improved and was discharged. Three months after discharge, follow-up revealed sustained clinical improvement while the patient continued to be on the full therapeutic dose of LMWH with a stable platelet count.

Decision Making about Computer Acquisition and Use in American Schools.

Science.gov (United States)

Becker, Henry Jay

1993-01-01

Discusses the centralization and decentralization of decision making about computer use in elementary and secondary schools based on results of a 1989 national survey. Results unexpectedly indicate that more successful programs are the result of districtwide planning than individual teacher or school-level decision making. (LRW)

Real-time inverse planning for Gamma KnifeTM radiosurgery

International Nuclear Information System (INIS)

Wu, Q. Jackie; Chankong, Vira; Jitprapaikulsarn, Suradet; Wessels, Barry W.; Einstein, Douglas B.; Mathayomchan, Boonyanit; Kinsella, Timothy J.

2003-01-01

The challenges of real-time Gamma Knife TM inverse planning are the large number of variables involved and the unknown search space a priori. With limited collimator sizes, shots have to be heavily overlapped to form a smooth prescription isodose line that conforms to the irregular target shape. Such overlaps greatly influence the total number of shots per plan, making pre-determination of the total number of shots impractical. However, this total number of shots usually defines the search space, a pre-requisite for most of the optimization methods. Since each shot only covers part of the target, a collection of shots in different locations and various collimator sizes selected makes up the global dose distribution that conforms to the target. Hence, planning or placing these shots is a combinatorial optimization process that is computationally expensive by nature. We have previously developed a theory of shot placement and optimization based on skeletonization. The real-time inverse planning process, reported in this paper, is an expansion and the clinical implementation of this theory. The complete planning process consists of two steps. The first step is to determine an optimal number of shots including locations and sizes and to assign initial collimator size to each of the shots. The second step is to fine-tune the weights using a linear-programming technique. The objective function is to minimize the total dose to the target boundary (i.e., maximize the dose conformity). Results of an ellipsoid test target and ten clinical cases are presented. The clinical cases are also compared with physician's manual plans. The target coverage is more than 99% for manual plans and 97% for all the inverse plans. The RTOG PITV conformity indices for the manual plans are between 1.16 and 3.46, compared to 1.36 to 2.4 for the inverse plans. All the inverse plans are generated in less than 2 min, making real-time inverse planning a reality

10 CFR 72.186 - Change to physical security and safeguards contingency plans.

Science.gov (United States)

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Change to physical security and safeguards contingency... contingency plans. (a) The licensee shall make no change that would decrease the safeguards effectiveness of... licensee safeguards contingency plan without prior approval of the Commission. A licensee desiring to make...

Executive summary, Hanford Site Pollution Prevention Plan

International Nuclear Information System (INIS)

1992-08-01

A pollution prevention plan is an organized, comprehensive, and continual effort to systematically reduce waste generation. The Hanford Site Pollution Prevention Plan is designed to eliminate or minimize pollutant releases to all environmental media from all aspects of Site operations. These efforts offer increased protection of public health and the environment. This plan reflects the goals and policies for pollution prevention at the Hanford Site and represents an ongoing effort to make pollution prevention part of the Site operating philosophy. The plan encompasses hazardous waste only and excludes radioactive waste and radioactive mixed waste

MARKETING PLAN FOR HOTEL KAKSLAUTTANEN

OpenAIRE

Yu, Yueyuan

2011-01-01

The objective of this thesis was to make a marketing plan for Hotel Kakslauttanen to increase its sales and profit, to improve the satisfaction of customers and to promote popularity and reputation. The quantitative research method was considered to be the most appropriate for this research. In the theoretical part, the study was focused on internal and external marketing environment analysis, marketing strategies management, planning, marketing mix and segmentation. The empirical part in...

Urban sustainability through strategic planning: A case of metropolitan planning in Khulna city, Bangladesh

Directory of Open Access Journals (Sweden)

Md. Ashiq Ur Rahman

2016-06-01

Full Text Available Planning is a crucial element for any development initiative. Planning entails choice making in pursuit of stated goals e.g. improving living conditions for individuals and societies. Planning initiatives are employed within social systems that are governed by institution, and planning intervenes with and may reconfigure these institutions resulting in social change. This paper discusses how urban sustainability can be achieved through strategic action in urban development by analysing the planning process of Khulna city, Bangladesh. This paper reviews different scholarly articles to draw a conceptual framework for identifying the interface of strategic planning, components of strategic action planning and urban sustainability. Based on this conceptual framework this paper identifies the scope of achieving urban sustainability through analysing the current planning practice of Khulna city, Bangladesh. This paper identifies that though the Khulna city plan adopted the approach of strategic planning but it failed to comply with its theoretical notion to achieve the issues related to urban sustainability. Analysis reveals that in terms of social attribute that recognizes the interest of different group of people the exiting planning packages is not sustainable. Similar phenomenon have been observed in terms of recognition of gender and marginalized people in planning, equitable provision of income and employment generation, peoples’ participation in planning and polices for ensuring equitable access to infrastructure services. Therefore the existing planning package of Khulna city failed to achieve the issues of urban sustainability through its adapted strategic planning approach.

Energy management information systems - planning manual and tool

Energy Technology Data Exchange (ETDEWEB)

NONE

2010-07-01

An Energy Management Information System (EMIS) provides relevant information that makes energy, performance visible to various levels of an organization, enabling individuals and departments to plan, make decisions and take effective action to manage energy. This manual has two objectives: 1. To enable companies to conduct EMIS audits and prepare EMIS implementation plans; 2. To provide companies with the tools to prepare a financial business case for EMIS implementation. This manual consists of four parts: 1. EMIS Audit is theoretical and provides the methodology to be used by outside or in-house engineers and consultants to do a thorough EMIS Audit. 2. Implementation Plan is to help industry do the work themselves. 3. Appendices is to help the user develop an EMIS Audit, gather data and score their company, prepare a conceptual and detailed design, as well as a business and financial plan for implementation.

Strategic planning of treatment for hyperthyroid disease

International Nuclear Information System (INIS)

Hoeffer, R.

1994-01-01

Strategic planning of treatment of hyperthyroid disease must correspond to the pathophysiological mechanism of elevation of thyroid hormone serum concentration, i.e. excess stimulation, autonomous thyroid function, destruction induced hyperthyoroxinemia. In cases of excess stimulation one should go to extremes to save the essentially 'normal' thyroid gland and life-long antithyroid drug treatment confronts with total ablation of the thyroid gland in non remitting disease. Size and quantity of regions of autonomously functioning follicles/cells will be the determinant of therapeutic strategy in cases of autonomous thyroid function. Selective surgery confronts with radioiodine treatment aiming at 'restitutio ad integrum'. In destruction induced hyperthyroxinemia antiintlammatory and symptomatic measures may help to bridge the time to the return of normal hormone concentrations. Based on these considerations a detailed therapeutic strategy for hyperthyroid disease can be designed. (author)

Advances in the proteomic discovery of novel therapeutic targets in cancer

Directory of Open Access Journals (Sweden)

Guo S

2013-10-01

Full Text Available Shanchun Guo,1 Jin Zou,2 Guangdi Wang3 1Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, 2Center for Cancer Research and Therapeutic Development, Clark Atlanta University, Atlanta, GA, USA; 3Research Centers in Minority Institutions Cancer Research Program, Xavier University of Louisiana, New Orleans, LA, USA Abstract: Proteomic approaches are continuing to make headways in cancer research by helping to elucidate complex signaling networks that underlie tumorigenesis and disease progression. This review describes recent advances made in the proteomic discovery of drug targets for therapeutic development. A variety of technical and methodological advances are overviewed with a critical assessment of challenges and potentials. A number of potential drug targets, such as baculoviral inhibitor of apoptosis protein repeat-containing protein 6, macrophage inhibitory cytokine 1, phosphoglycerate mutase 1, prohibitin 1, fascin, and pyruvate kinase isozyme 2 were identified in the proteomic analysis of drug-resistant cancer cells, drug action, and differential disease state tissues. Future directions for proteomics-based target identification and validation to be more translation efficient are also discussed. Keywords: proteomics, cancer, therapeutic target, signaling network, tumorigenesis

Eliciting consumer preferences for health plans.

Science.gov (United States)

Booske, B C; Sainfort, F; Hundt, A S

1999-10-01

To examine (1) what people say is important to them in choosing a health plan; (2) the effect, if any, that giving health plan information has on what people say is important to them; and (3) the effect of preference elicitation methods on what people say is important. A random sample of 201 Wisconsin state employees who participated in a health plan choice experiment during the 1995 open enrollment period. We designed a computer system to guide subjects through the review of information about health plan options. The system began by eliciting the stated preferences of the subjects before they viewed the information, at time 0. Subjects were given an opportunity to revise their preference structures first after viewing summary information about four health plans (time 1) and then after viewing more extensive, detailed information about the same options (time 2). At time 2, these individuals were also asked to rate the relative importance of a predefined list of health plan features presented to them. Data were collected on the number of attributes listed at each point in time and the importance weightings assigned to each attribute. In addition, each item on the attribute list was content analyzed. The provision of information changes the preference structures of individuals. Costs (price) and coverage dominated the attributes cited both before and after looking at health plan information. When presented with information on costs, quality, and how plans work, many of these relatively well educated consumers revised their preference structures; yet coverage and costs remained the primary cited attributes. Although efforts to provide health plan information should continue, decisions on the information to provide and on making it available are not enough. Individuals need help in understanding, processing, and using the information to construct their preferences and make better decisions.

Robinson Rancheria Strategic Energy Plan; Middletown Rancheria Strategic Energy Plan, Scotts Valley Rancheria Strategic Energy Plan, Elem Indian Colony Strategic Energy Plan, Upperlake Rancheria Strategic Energy Plan, Big Valley Rancheria Strategic Energy Plan

Energy Technology Data Exchange (ETDEWEB)

McGinnis and Associates LLC

2008-08-01

The Scotts Valley Band of Pomo Indians is located in Lake County in Northern California. Similar to the other five federally recognized Indian Tribes in Lake County participating in this project, Scotts Valley Band of Pomo Indians members are challenged by generally increasing energy costs and undeveloped local energy resources. Currently, Tribal decision makers lack sufficient information to make informed decisions about potential renewable energy resources. To meet this challenge efficiently, the Tribes have committed to the Lake County Tribal Energy Program, a multi Tribal program to be based at the Robinson Rancheria and including The Elem Indian Colony, Big Valley Rancheria, Middletown Rancheria, Habematolel Pomo of Upper Lake and the Scotts Valley Pomo Tribe. The mission of this program is to promote Tribal energy efficiency and create employment opportunities and economic opportunities on Tribal Lands through energy resource and energy efficiency development. This program will establish a comprehensive energy strategic plan for the Tribes based on Tribal specific plans that capture economic and environmental benefits while continuing to respect Tribal cultural practices and traditions. The goal is to understand current and future energy consumption and develop both regional and Tribe specific strategic energy plans, including action plans, to clearly identify the energy options for each Tribe.

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 ...

Report of the Long-Range Planning Committee

International Nuclear Information System (INIS)

1984-01-01

This is the final report of the Long-Range Planning Committee of the Lawrence Livermore National Laboratory. It describes the make-up, purpose, working assumptions, and activities of the Committee and discusses the work done by the Committee on defense matters, energy, a number of additional topics, and future long-range planning activities

Analysis of Development Plans from Communications Perspective

Directory of Open Access Journals (Sweden)

Zohreh Shahghasemi

2016-12-01

Full Text Available The movement towards the goals of "Vision plan 1404" needs the perception of the requirements to prepare plans for achieving the favorite objectives of development. With the advent of the information age, the rules of development policy-making strongly have changed in the world and also unique opportunities areprovided by variables of communications for countries that have been in early stages of development. Based on this, considering the communications in macro-level and in the political, social, economic and cultural development plans is important and necessary. This requires a review and pathology of previous plans and evaluation of their strengths and weaknesses for preparing of more comprehensive future plans. Themain question of this study is: what is the approach of development plans to communications section after Islamic revolution?  Which aspects of communications are considered, and what aspects are ignored?  This study analyzes five development plans after the revolution, by using of qualitative content analysis. Results show that in all five-year plans the focus was on hardware and quantitative dimensions of communication development and media, but qualitative and content aspects, such as the right to universal access to information, freedom to obtain and disseminate information within the constitution, freedom of speech and press, a move towards the information society and knowledge-based, also other dimensions of communications such as human, traditional and social communication has been less considered. In the fourth development plan that is "knowledge" – centered, new fields of communications has been studied comprehensively in comparison to other plans. According to these approaches and new scientific and experimental perspectives, this paper suggests further engagement in communications necessity for development policy-making.

[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.

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

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.

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.

Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?

Science.gov (United States)

Henning-Smith, Carrie; Casey, Michelle; Moscovice, Ira

2017-01-01

Although much has been written about Medicare Part D enrollment, much less is known about beneficiaries' personal experiences with choosing a Part D plan, especially among rural residents. This study sought to address this gap by examining geographic differences in Part D enrollees' perceptions of the plan decision-making process, including their confidence in their choice, their knowledge about the program, and their satisfaction with available information. We used data from the 2012 Medicare Current Beneficiary Survey and included adults ages 65 and older who were enrolled in Part D at the time of the survey (n = 3,706). We used ordered logistic regression to model 4 outcomes based on beneficiaries' perceptions of the Part D decision-making and enrollment process, first accounting only for differences by rurality, then adjusting for sociodemographic, health, and coverage characteristics. Overall, half of all beneficiaries were not very confident in their Part D knowledge. Rural beneficiaries had lower odds of being confident in the plan they chose and in being satisfied with the amount of information available to them during the decision-making process. After adjusting for all covariates, micropolitan residents continued to have lower odds of being confident in the plan that they chose. Policy-makers should pay particular attention to making information about Part D easily accessible for all beneficiaries and to addressing unique barriers that rural residents have in accessing information while making decisions, such as reduced Internet availability. Furthermore, confidence in the decision-making process may be improved by simplifying the Part D program. © 2016 National Rural Health Association.

New Interoperable Tools to Facilitate Decision-Making to Support Community Sustainability

Science.gov (United States)

Communities, regional planning authorities, regulatory agencies, and other decision-making bodies do not currently have adequate access to spatially explicit information crucial to making decisions that allow them to consider a full accounting of the costs, benefits, and trade-of...

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

Advantages of three-dimensional treatment planning in radiation therapy

International Nuclear Information System (INIS)

Attalla, E.M.; ELSAyed, A.A.; ElGantiry, M.; ElTahher, Z.

2003-01-01

This study was designed to demonstrate the feasibility of three-dimensional (3-D) treatment planning in-patients maxilla, breast, bladder, and lung tumors to explore its potential therapeutic advantage over the traditional dimensional (2-D) approach in these diseases. Conventional two-dimensional (2-D) treatment planning was compared to three-dimensional (3-D) treatment planning. In five selected disease sites, plans calculated with both types of treatment planning were compared. The (3-D) treatment planning system used in this work TMS version 5.1 B from helax AB is based on a monte Carlo-based pencil beam model. The other treatment planning system (2-D 0, introduced in this study was the multi data treatment planning system version 2.35. For the volumes of interest; quality of dose distribution concerning homogeneity in the target volume and the isodose distribution in organs at risk, was discussed. Qualitative and quantitative comparisons between the two planning systems were made using dose volume histograms (DVH's) . For comparisons of dose distributions in real-patient cases, differences ranged from 0.8% to 6.4% for 6 MV, while in case of 18 MV photon, it ranged from 1,8% to 6.5% and was within -+3 standard deviations for the dose between the two planning systems.Dose volume histogram (DVH) shows volume reduction of the radiation-related organs at risk 3-D planning

Electronic Health Record for Temporomandibular Joint Disorders – Support in Therapeutic Process

Czech Academy of Sciences Publication Activity Database

Hippmann, R.; Nagy, Miroslav; Dostálová, T.; Zvárová, Jana; Seydlová, M.; Feltlová, E.

2010-01-01

Roč. 6, č. 1 (2010), s. 27-32 ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : electronic health record * automatic speech recognition * dental cross * temporomandibular joint * temporomandibular joint disorders * structured data entry * dentistry * data model * text-to-speech system * Research Diagnostic Criteria for TMD Subject RIV: IN - Informatics, Computer Science http://www.ejbi.org/en/ejbi/article/25-en- electronic - health - record -for-temporomandibular-joint-disorders-support-in-therapeutic-process.html

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...

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.

User-Generated Content and travel planning: An application of the Theory of Planned Behavior

Directory of Open Access Journals (Sweden)

Luiz Augusto Machado Mendes Filho

2012-12-01

Full Text Available User-Generated Content (UGC such as online travel reviews written by travelers and posted to virtual communities are being used more frequently to communicate travel-related information. UGC is therefore helping travelers to make decisions about their travel. Utilizing the Theory of Planned Behavior (TPB, which is one of the most comprehensive models explaining behavioral intention, this study contributes to the further development of theories of online consumer behavior by determining which factors are most important in relation to the use of UGC in the travel industry. The TPB has three independent determinants of behavioral intention: attitude toward the behavior, subjective norm, and perceived behavior control. Therefore the aim of this paper is to examine the roles of attitude, subjective norm and perceived behavior control in respect of travelers’ intention to use UGC when making travel plans.

Plan prediction which policy is preferred by which people?

CERN Document Server

Wyatt, Ray

2017-01-01

This book develops an innovative system, in the form of an "app", that harnesses the power of the internet to predict which sorts of people will prefer which policy in ANY planning situation. It chronicles the accumulated research wisdom behind the system’s reasoning, along with several less successful approaches to policy making that have been found wanting in the past – including the myth, usually peddled by strategic planners, that it is possible to find a "best" plan which optimally satisfies everybody. The book lays out an entirely new kind of Planning Support System (PSS). It will facilitate decision-making that is far more community-sensitive than previously, and it will drastically improve the performance of anyone who needs to plan within socially-sensitive contexts – which is all of us. A standout feature of the system is its commitment to “scientific rigour”, as shown by its predicted plan scores always being graphically presented within error margins so that true statistical significance...

Comparison of various online IGRT strategies: The benefits of online treatment plan re-optimization

International Nuclear Information System (INIS)

Schulze, Derek; Liang, Jian; Yan, Di; Zhang Tiezhi

2009-01-01

Purpose: To compare the dosimetric differences of various online IGRT strategies and to predict potential benefits of online re-optimization techniques in prostate cancer radiation treatments. Materials and methods: Nine prostate patients were recruited in this study. Each patient has one treatment planning CT images and 10-treatment day CT images. Five different online IGRT strategies were evaluated which include 3D conformal with bone alignment, 3D conformal re-planning via aperture changes, intensity modulated radiation treatment (IMRT) with bone alignment, IMRT with target alignment and IMRT daily re-optimization. Treatment planning and virtual treatment delivery were performed. The delivered doses were obtained using in-house deformable dose mapping software. The results were analyzed using equivalent uniform dose (EUD). Results: With the same margin, rectum and bladder doses in IMRT plans were about 10% and 5% less than those in CRT plans, respectively. Rectum and bladder doses were reduced as much as 20% if motion margin is reduced by 1 cm. IMRT is more sensitive to organ motion. Large discrepancies of bladder and rectum doses were observed compared to the actual delivered dose with treatment plan predication. The therapeutic ratio can be improved by 14% and 25% for rectum and bladder, respectively, if IMRT online re-planning is employed compared to the IMRT bone alignment approach. The improvement of target alignment approach is similar with 11% and 21% dose reduction to rectum and bladder, respectively. However, underdosing in seminal vesicles was observed on certain patients. Conclusions: Online treatment plan re-optimization may significantly improve therapeutic ratio in prostate cancer treatments mostly due to the reduction of PTV margin. However, for low risk patient with only prostate involved, online target alignment IMRT treatment would achieve similar results as online re-planning. For all IGRT approaches, the delivered organ-at-risk doses may be