WorldWideScience

Sample records for rational treatment protocols

  1. A protocol and ethical framework for the distribution of rationed chemotherapy.

    Science.gov (United States)

    Hantel, Andrew

    2014-01-01

    Shortages of generic, injectable chemotherapeutics have been increasing in prevalence since 2006. Due to the lack of access to first-line, lifesaving treatments, physicians have been forced to ration chemotherapy between patients. Although the scarcity has been managed with good intentions, it has been done in an ad hoc manner, without the benefit of an ethically grounded and standardized schema. Using an approach based on the "accountability for reasonableness" method by Daniel and Sabin, I establish a framework and protocol for rationing that is specific to chemotherapy. Prior to the state of true shortage, I present guidelines for the use of an adequate supply of chemotherapy with knowledge of upcoming scarcity. Within the rationing framework itself, I first prioritize emergency use of chemotherapeutics and those already receiving treatment at the time of shortage. I advocate for stratifying patients based on the prognostic indicators of their cancer type, using a combination of clinical-trial-based initial response and longer term survival, followed by the patients' line of treatment. All patients who are not able to receive their "best" treatment must receive a sequent, next-best treatment, and their treatment team must have the ability to appeal to a rationing committee in special circumstances. I reject the ideas of stratification based on the intention of the treatment, perceived quality of life, pre-existing condition not impacting performance status, the classical "sickest first" argument, and giving preference to pediatric cases. Lastly, I advocate for any system of rationing to be transparent to those it affects and acknowledge the difficulties it presents to patients and physicians alike. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.

  2. Establishing rational networking using the DL04 quantum secure direct communication protocol

    Science.gov (United States)

    Qin, Huawang; Tang, Wallace K. S.; Tso, Raylin

    2018-06-01

    The first rational quantum secure direct communication scheme is proposed, in which we use the game theory with incomplete information to model the rational behavior of the participant, and give the strategy space and utility function. The rational participant can get his maximal utility when he performs the protocol faithfully, and then the Nash equilibrium of the protocol can be achieved. Compared to the traditional schemes, our scheme will be more practical in the presence of rational participant.

  3. Extraction protocols for orthodontic treatment: A retrospective study

    Directory of Open Access Journals (Sweden)

    Vaishnevi N Thirunavukkarasu

    2016-01-01

    Full Text Available Background and Objectives: Various extraction protocols have been followed for successful orthodontic treatment. The purpose of this study was to evaluate the extraction protocols in patients who had previously undergone orthodontic treatment and also who had reported for continuing orthodontic treatment from other clinics. Materials and Methods: One hundred thirty eight patients who registered for orthodontic treatment at the Faculty of Dentistry were divided into 10 extraction protocols based on the Orthodontic treatment protocol given by Janson et al. and were evaluated for statistical significance. Results: The descriptive statistics of the study revealed a total of 40 (29% patients in protocol 1, 43 (31.2% in protocol 2, 18 (13% in protocol 3, 16 (11.6% in protocol 5, and 12 (8.7% in Type 3 category of protocol 9. The Type 3 category in protocol 9 was statistically significant compared to other studies. Midline shift and collapse of the arch form were noticed in these individuals. Conclusion: Extraction of permanent teeth such as canine and lateral incisors without rational reasons could have devastating consequences on the entire occlusion. The percentage of cases wherein extraction of permanent teeth in the crowded region was adopted as a treatment option instead of orthodontic treatment is still prevalent in dental practice. The shortage of orthodontists in Malaysia, the long waiting period, and lack of subjective need for orthodontic treatment at an earlier age group were the reasons for the patient's to choose extraction of the mal-aligned teeth such as the maxillary canine or maxillary lateral incisors.

  4. Rational Multiparty Computation

    OpenAIRE

    Wallrabenstein, John Ross

    2014-01-01

    The field of rational cryptography considers the design of cryptographic protocols in the presence of rational agents seeking to maximize local utility functions. This departs from the standard secure multiparty computation setting, where players are assumed to be either honest or malicious. ^ We detail the construction of both a two-party and a multiparty game theoretic framework for constructing rational cryptographic protocols. Our framework specifies the utility function assumptions neces...

  5. An evaluation of rational-emotive imagery as a component of rational-emotive therapy in the treatment of test anxiety.

    Science.gov (United States)

    Hymen, S P; Warren, R

    1978-06-01

    This study evaluated the efficacy of rational-emotive imagery as a component of rational-emotive therapy in reduction of college students' test anxiety. 11 volunteers met for 6 1-hr. group treatment sessions over a 3-wk. period. After 2 initial treatment sessions subjects were randomly assigned to groups given either rational-emotive therapy with rational-emotive imagery or rational-emotive therapy without imagery. Contrary to predictions, improvement between groups on self-report and performance measures was nonsignificant. Failure to obtain differences was attributed to similarities in content of treatment sessions and short treatment time. Combined groups reported significant improvement on all dependent measures. Although the study did not yield the predicted benefits of the imagery, results lend further support to the efficacy of rational-emotive therapy procedures in the reduction of test anxiety.

  6. Rational design of nanomaterials for water treatment

    KAUST Repository

    Li, Renyuan

    2015-08-26

    The ever-increasing human demand for safe and clean water is gradually pushing conventional water treatment technologies to their limits and it is now a popular perception that the solutions to the existing and future water challenges will highly hinge upon the further development of nanomaterial sciences. The concept of rational design emphasizes ‘design-for-purpose’ and it necessitates a scientifically clear problem definition to initiate the nanomaterial design. The field of rational design of nanomaterials for water treatment has experienced a significant growth in the past decade and is poised to make its contribution in creating advanced next-generation water treatment technologies in the years to come. Within the water treatment context, this review offers a comprehensive and in-depth overview of the latest progress of the rational design, synthesis and applications of nanomaterials in adsorption, chemical oxidation and reduction reactions, membrane-based separation, oil/water separation, and synergistic multifunctional all-in-one nanomaterials/nanodevices. Special attention is paid on chemical concepts of the nanomaterial designs throughout the review.

  7. Rational desires and the limitation of life-sustaining treatment.

    Science.gov (United States)

    Savulescu, Julian

    1994-07-01

    It is accepted that treatment of previously competent, now incompetent patients can be limited if that is what the patient would desire, if she were now competent. Expressed past preferences or an advance directive are often taken to constitute sufficient evidence of what a patient would now desire. I distinguish between desires and rational desires. I argue that for a desire to be an expression of a person's autonomy, it must be or satisfy that person's rational desires. A person rationally desires a course of action if that person desires it while being in possession of all available relevant facts, without committing relevant error of logic, and "vividly imagining" what its consequences would be like for her. I argue that some competent, expressed desires obstruct autonomy. I show that several psychological mechanisms operate to prevent a person rationally evaluating what future life in a disabled state would be like. Rational evaluation is difficult. However, treatment limitation, if it is to respect autonomy, must be in accord with a patient's rational desires, and not merely her expressed desires. I illustrate the implications of these arguments for the use of advance directives and for the treatment of competent patients.

  8. Rational noncompliance with prescribed medical treatment.

    Science.gov (United States)

    Stewart, Douglas O; DeMarco, Joseph P

    2010-09-01

    Despite the attention that patient noncompliance has received from medical researchers, patient noncompliance remains poorly understood and difficult to alter. With a better theory of patient noncompliance, both greater success in achieving compliance and greater respect for patient decision making are likely. The theory presented, which uses a microeconomic approach, bridges a gap in the extant literature that has so far ignored the contributions of this classic perspective on decision making involving the tradeoff of costs and benefits. The model also generates a surprising conclusion: that patients are typically acting rationally when they refuse to comply with certain treatments. However, compliance is predicted to rise with increased benefits and reduced costs. The prediction that noncompliance is rational is especially true in chronic conditions at the point that treatment begins to move closer to the medically ideal treatment level. Although the details of this theory have not been tested empirically, it is well supported by existing prospective and retrospective studies.

  9. Baseline rationing

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Moreno-Ternero, Juan D.; Østerdal, Lars Peter Raahave

    The standard problem of adjudicating conflicting claims describes a situation in which a given amount of a divisible good has to be allocated among agents who hold claims against it exceeding the available amount. This paper considers more general rationing problems in which, in addition to claims...... to international protocols for the reduction of greenhouse emissions, or water distribution in drought periods. We define a family of allocation methods for such general rationing problems - called baseline rationing rules - and provide an axiomatic characterization for it. Any baseline rationing rule within...... the family is associated with a standard rule and we show that if the latter obeys some properties reflecting principles of impartiality, priority and solidarity, the former obeys them too....

  10. [Rational Rehabilitation in the treatment of post-traumatic stress disorder (PTSD). A pilot study].

    Science.gov (United States)

    Tomasoa, A T; Appelo, M T

    2007-01-01

    In a randomised controlled study, a type of cognitive behavior therapy known as Rational Rehabilitation proved effective in the treatment of patients with chronic mental symptoms. Post-traumatic stress disorder is a serious illness that occurs frequently and can last for many years. Rational Rehabilitation may also be an effective treatment for post-traumatic stress disorder. To investigate, via a pilot study, on the effect of Rational Rehabilitation in patients with post-traumatic stress disorder, whether a randomised controlled study is called for. Nineteen patients with post-traumatic stress disorder, who were awaiting regular treatment, opted to join the study. The effect of Rational Rehabilitation was studied in relation to: symptoms of post-traumatic stress disorder, degree of happiness experienced, autonomy, social support and need for further treatment. results Rational Rehabilitation seems to have a positive effect on all outcome measures, except flashbacks. A controlled study of the effect of Rational Rehabilitation in patients with post-traumatic stress disorder seems justified.

  11. A Rational Threshold Signature Model and Protocol Based on Different Permissions

    Directory of Open Access Journals (Sweden)

    Bojun Wang

    2014-01-01

    Full Text Available This paper develops a novel model and protocol used in some specific scenarios, in which the participants of multiple groups with different permissions can finish the signature together. We apply the secret sharing scheme based on difference equation to the private key distribution phase and secret reconstruction phrase of our threshold signature scheme. In addition, our scheme can achieve the signature success because of the punishment strategy of the repeated rational secret sharing. Besides, the bit commitment and verification method used to detect players’ cheating behavior acts as a contributing factor to prevent the internal fraud. Using bit commitments, verifiable parameters, and time sequences, this paper constructs a dynamic game model, which has the features of threshold signature management with different permissions, cheat proof, and forward security.

  12. Rationality in the Cryptographic Model

    DEFF Research Database (Denmark)

    Hubacek, Pavel

    This thesis presents results in the field of rational cryptography. In the first part we study the use of cryptographic protocols to avoid mediation and binding commitment when implementing game theoretic equilibrium concepts. First, we concentrate on the limits of cryptographic cheap talk...... to implement correlated equilibria of two-player strategic games in a sequentially rational way. We show that there exist two-player games for which no cryptographic protocol can implement the mediator in a sequentially rational way; that is, without introducing empty threats. In the context of computational...... with appealing economic applications. Our implementation puts forward a notion of cryptographically blinded games that exploits the power of encryption to selectively restrict the information available to players about sampled action profiles, such that these desirable equilibria can be stably achieved...

  13. Privacy-Enhancing Auctions Using Rational Cryptography

    DEFF Research Database (Denmark)

    Miltersen, Peter Bro; Nielsen, Jesper Buus; Triandopoulos, Nikolaos

    2009-01-01

    show how to use rational cryptography to approximately implement any given ex interim individually strictly rational equilibrium of such an auction without a trusted mediator through a cryptographic protocol that uses only point-to-point authenticated channels between the players. By “ex interim...

  14. Establishing treatment protocols for clinical mastitis.

    Science.gov (United States)

    Roberson, Jerry R

    2003-03-01

    Each farm has a unique mix of mastitis pathogens and management procedures that have evolved over time. The herd veterinarian should work with the manager/owner to systematically develop treatment protocols that meet the needs and management of the farm. To establish a mastitis treatment protocol, it is necessary to develop a system to routinely identify clinical mastitis cases, develop a herd-specific severity level assessment system, manage the clinical mastitis cases based on severity level and culture result (when available), avoid antibiotic residues, and monitor the success of the system and alter the protocol as necessary.

  15. Rational-Emotive Therapy with Children and Adolescents: Treatment Strategies.

    Science.gov (United States)

    Bernard, Michael E.

    1990-01-01

    Presents rational-emotive therapy (RET) conceptualization of childhood disorders, discussing interaction of child temperament and parenting styles. Discusses RET child treatment goals, which involve modification of negative and inappropriate childhood emotions. Illustrates particular RET cognitive change methods (philosophical disputation;…

  16. Comparative Psychotherapy: Rational-Emotive Therapy Versus Systematic Desensitization in the Treatment of Stuttering

    Science.gov (United States)

    Moleski, Richard; Tosi, Donald J.

    1976-01-01

    The present study examined the efficacy of rational-emotive psychotherapy and systematic desensitization in the treatment of stuttering. Both therapies, making extensive use of in vivo behavioral assignments, were examined under the presence and absence of in vivo tasks. Results show that rational-emotive therapy was more effective in reducing…

  17. The Protocol of Choice for Treatment of Snake Bite

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    Afshin Mohammad Alizadeh

    2016-01-01

    Full Text Available The aim of the current study is to compare three different methods of treatment of snake bite to determine the most efficient one. To unify the protocol of snake bite treatment in our center, we retrospectively reviewed files of the snake-bitten patients who had been referred to us between 2010 and 2014. They were contacted for follow-up using phone calls. Demographic and on-arrival characteristics, protocol used for treatment (WHO/Haddad/GF, and outcome/complications were evaluated. Patients were entered into one of the protocol groups and compared. Of a total of 63 patients, 56 (89% were males. Five, 19, and 28 patients were managed by Haddad, WHO, or GF protocols, respectively. Eleven patients had fallen into both GF and WHO protocols and were excluded. Serum sickness was significantly more common when WHO protocol was used while 100% of the compartment syndromes and 71% of deformities had been reported after GF protocol. The most important complications were considered to be deformity, compartment syndrome, and amputation and were more frequent after the use of WHO and GF protocols (23.1% versus 76.9%; none in Haddad; P = NS. Haddad protocol seems to be the best for treatment of snake-bitten patients in our region. However, this cannot be strictly concluded because of the limited sample size and nonsignificant P values.

  18. An Acupuncture Research Protocol Developed from Historical Writings by Mathematical Reflections: A Rational Individualized Acupoint Selection Method for Immediate Pain Relief

    Directory of Open Access Journals (Sweden)

    Sven Schroeder

    2013-01-01

    Full Text Available While balancing yin and yang is one basic principle of Chinese medicine, balancing methods for combination of meridians and acupoints had been described throughout the history of Chinese medicine. We have identified six historical systems for combinations of acupuncture points in historical writings. All of them represent symmetrical combinations which are defined by the steps in the Chinese Clock. Taking the historical systems as a basis, we calculated the possible combinations that fit into these systems they revealed, leading to a total of 19 systems offering new balancing combinations. Merging the data of these 19 systems, there are 7 combinatorial options for every meridian. On the basis of this data, we calculated 4-meridian combinations with an ideal balance pattern, which is given when all meridians balance each other. We identified 5 of these patterns for every meridian, so we end up with 60 patterns for all the 12 meridians but we find multiple overlapping. Finally, 15 distinct patterns remain. By combining this theoretical concept with the Image and Mirror Concept, we developed an acupuncture research protocol. This protocol potentially solves some problems of acupuncture trials because it represents a rational reproducible procedure independent of examiner experience, but the resulting treatment is individualized.

  19. A protocol proposition of cell therapy for the treatment of chronic obstructive pulmonary disease.

    Science.gov (United States)

    Ribeiro-Paes, J T; Stessuk, T; Marcelino, M; Faria, C; Marinelli, T; Ribeiro-Paes, M J

    2014-01-01

    The main feature of pulmonary emphysema is airflow obstruction resulting from the destruction of the alveolar walls distal to the terminal bronchioles. Existing clinical approaches have improved and extended the quality of life of emphysema patients. However, no treatment currently exists that can change the disease course and cure the patient. The different therapeutic approaches that are available aim to increase survival and/or enhance the quality of life of emphysema patients. In this context, cell therapy is a promising therapeutic approach with great potential for degenerative pulmonary diseases. In this protocol proposition, all patients will be submitted to laboratory tests, such as evaluation of heart and lung function and routine examinations. Stem cells will be harvested by means of 10 punctures on each anterior iliac crest, collecting a total volume of 200mL bone marrow. After preparation, separation, counting and labeling (optional) of the mononuclear cells, the patients will receive an intravenous infusion from the pool of Bone Marrow Mononuclear Cells (BMMC). This article proposes a rational and safe clinical cellular therapy protocol which has the potential for developing new projects and can serve as a methodological reference for formulating clinical application protocols related to the use of cellular therapy in COPD. This study protocol was submitted and approved by the Brazilian National Committee of Ethics in Research (CONEP - Brazil) registration number 14764. It is also registered in ClinicalTrials.gov (NCT01110252). Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  20. Three-stage treatment protocol for recalcitrant distal femoral nonunion.

    Science.gov (United States)

    Ma, Ching-Hou; Chiu, Yen-Chun; Tu, Yuan-Kun; Yen, Cheng-Yo; Wu, Chin-Hsien

    2017-04-01

    In this study, we proposed a three-stage treatment protocol for recalcitrant distal femoral nonunion and aimed to analyze the clinical results. We retrospective reviewed 12 consecutive patients with recalcitrant distal femoral nonunion undergoing our three-stage treatment protocol from January 2010 to December 2014 in our institute. The three-stage treatment protocol comprised debridement of the nonunion site, lengthening to eliminate leg length discrepancy, deformity correction, stabilization with a locked plate, filling of the defect with cement spacer for inducing membrane formation, and bone reconstruction using a cancellous bone autograft (Masquelet technique) or free vascularized fibular bone graft. The bone union time, wound complication, lower limbs alignment, amount of lengthening, knee range of motion, and functional outcomes were evaluated. Osseous union with angular deformity lengthening was 5.88 cm (range 3.5-12 cm). Excellent or good outcomes were obtained in 9 patients. Although the current study involved only a small number of patients and the intervention comprised three stages, we believe that such a protocol may be a valuable alternative for the treatment of recalcitrant distal femoral nonunion.

  1. Hybrid protocols plus natural treatments for inflammatory conditions.

    Science.gov (United States)

    1998-01-01

    Hybrid protocols combine one, two, or three pharmaceutical drugs with several nutritional or immune-based therapies. These protocols are not limited solely to FDA-approved drugs or strictly to alternative therapies. The rationale for using a hybrid protocol is to find an effective antiviral regimen that also restores immune function. The goal is to obtain the benefits of protease inhibitors without viral resistance and side effects which include problems with fat metabolism and cholesterol levels. Natural treatments for inflammatory conditions are also described. Options include licorice root, ginger root, and slippery elm.

  2. When is rational to order a diagnostic test, or prescribe treatment: the threshold model as an explanation of practice variation.

    Science.gov (United States)

    Djulbegovic, Benjamin; van den Ende, Jef; Hamm, Robert M; Mayrhofer, Thomas; Hozo, Iztok; Pauker, Stephen G

    2015-05-01

    The threshold model represents an important advance in the field of medical decision-making. It is a linchpin between evidence (which exists on the continuum of credibility) and decision-making (which is a categorical exercise - we decide to act or not act). The threshold concept is closely related to the question of rational decision-making. When should the physician act, that is order a diagnostic test, or prescribe treatment? The threshold model embodies the decision theoretic rationality that says the most rational decision is to prescribe treatment when the expected treatment benefit outweighs its expected harms. However, the well-documented large variation in the way physicians order diagnostic tests or decide to administer treatments is consistent with a notion that physicians' individual action thresholds vary. We present a narrative review summarizing the existing literature on physicians' use of a threshold strategy for decision-making. We found that the observed variation in decision action thresholds is partially due to the way people integrate benefits and harms. That is, explanation of variation in clinical practice can be reduced to a consideration of thresholds. Limited evidence suggests that non-expected utility threshold (non-EUT) models, such as regret-based and dual-processing models, may explain current medical practice better. However, inclusion of costs and recognition of risk attitudes towards uncertain treatment effects and comorbidities may improve the explanatory and predictive value of the EUT-based threshold models. The decision when to act is closely related to the question of rational choice. We conclude that the medical community has not yet fully defined criteria for rational clinical decision-making. The traditional notion of rationality rooted in EUT may need to be supplemented by reflective rationality, which strives to integrate all aspects of medical practice - medical, humanistic and socio-economic - within a coherent

  3. The costs and cost-effectiveness of an integrated sepsis treatment protocol.

    Science.gov (United States)

    Talmor, Daniel; Greenberg, Dan; Howell, Michael D; Lisbon, Alan; Novack, Victor; Shapiro, Nathan

    2008-04-01

    Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. Beth Israel Deaconess Medical Center. Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.

  4. Accelerated treatment protocols: full arch treatment with interim and definitive prostheses.

    Science.gov (United States)

    Drago, Carl

    2012-01-01

    With the advent of titanium, root form implants and osseointegration, dental treatment has undergone a metamorphosis in recent years. These new techniques enable dentists to provide anchorage for various kinds of prostheses that improve masticatory function, esthetics, and comfort for patients. Implant treatment protocols have been improved relative to implant macro- and micro-geometries, surgical and prosthetic components, and treatment times. Over the past 20 years, immediate occlusal function (also known as loading) has been established as a predictable treatment modality, provided certain specific criteria are met. In many cases, edentulous patients, crippled by the loss of their teeth, can undergo outpatient surgical and prosthetic procedures and return to a masticatory function that is near normal--sometimes after only one day of surgical and prosthetic treatment. This treatment option is also available for patients with advanced, generalized periodontal disease. Computer-assisted design/Computer-assisted manufacturing (CAD/CAM) has transformed how dental prostheses are made, offering improved accuracy, longevity, and biocompatibility; along with reduced labor costs and fewer complications than casting technologies. This article reviews the principles associated with immediate occlusal loading and illustrates one specific accelerated prosthodontic treatment protocol used to treat edentulous and partially edentulous patients with interim and definitive prostheses.

  5. [Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer].

    Science.gov (United States)

    2018-04-01

    Colorectal cancer is one of the most common malignant tumors in China. In 2012 one million thirty six thousand cases of colorectal cancer were diagnosed all over the world, two hundred fifty three thousand cases were diagnosed in China (accounted for 18.6%). China has the largest number of new cases of colorectal cancer in the world. Colorectal cancer has becoming a serious threat of Chinese residents' health. In 2010, the National Ministry of Health organized colorectal cancer expertise of the Chinese Medical Association to write the "Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer" (2010edition), and publish it publicly. In recent years, the National Health and Family Planning Commission has organized experts to revised the protocol 2 times: the first time in 2015, the second time in 2017. The revised part of "Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer" (2017 edition) involves new progress in the field of imaging examination, pathological evaluation, surgery, chemotherpy and radiotherapy. The 2017 edition of the protocol not only referred to the contents of the international guidelines, but also combined with the specific national conditions and clinical practice in China, and also included many evidence-based clinical data in China recently. The 2017 edition of the protocol would further promote the standardization of diagnosis and treatment of colorectal cancer in China, improve the survival and prognosis of patients, and benefit millions of patients with colorectal cancer and their families.

  6. Rationality, religion and refusal of treatment in an ambulance revisited.

    Science.gov (United States)

    McMahon-Parkes, Kate

    2013-09-01

    In their recent article, Erbay et al considered whether a seriously injured patient should be able to refuse treatment if the refusal was based on a (mis)interpretation of religious doctrine. They argued that in such a case 'what is important…is whether the teaching or philosophy used as a reference point has been in fact correctly perceived' (p 653). If it has not been, they asserted that this eroded the patient's capacity to make an autonomous decision and that therefore, in such cases, it is the role of the healthcare professional (HCP) to 'assist patients to think more clearly and rationally' (p 653). There are, however, a number of problems with the reasons why Erbay et al suggest we should help patients to rationalise their decisions and how HCPs should go about this. In this article, the author explores some of their main arguments regarding consent and rationality (particularly in relation to religious beliefs), as well as Erbay et al's normative claim that HCPs have an obligation to promote autonomy by helping patients to come to a 'rational' decision. Ultimately, the author agrees that the (temporary) solution to the dilemma presented in this scenario (which was to insert an intravenous cannula into the patient in order to allow an infusion of fluids in the event that he changed his mind) seemed both pragmatic and ethically permissible. However, it is suggested that the arguments which underpin this conclusion in Erbay et al's article are largely unsound.

  7. Ethics of rationing of nursing care.

    Science.gov (United States)

    Rooddehghan, Zahra; Yekta, Zohreh Parsa; Nasrabadi, Alireza N

    2016-09-21

    Rationing of various needed services, for example, nursing care, is inevitable due to unlimited needs and limited resources. Rationing of nursing care is considered an ethical issue since it requires judgment about potential conflicts between personal and professional values. The present research sought to explore aspects of rationing nursing care in Iran. This study applied qualitative content analysis, a method to explore people's perceptions of everyday life phenomena and interpret the subjective content of text data. Data collection was performed through in-depth, unstructured, face-to-face interviews with open-ended questions. The study population included Iranian nurses of all nursing positions, from clinical nurses to nurse managers. Purposive sampling was employed to select 15 female and 3 male nurses (11 clinical nurses, 3 supervisors, 1 matron, 1 nurse, and 2 members of the Nursing Council) working in hospitals of three cities in Iran. The study protocol was approved by Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all participants. According to the participants, rationing of nursing care consisted of two categories, that is, causes of rationing and consequences of rationing. The first category comprised three subcategories, namely, patient needs and demands, routinism, and VIP patients. The three subcategories forming the second category were missed nursing care, patient dissatisfaction, and nurses' feeling of guilt. Levels at which healthcare practices are rationed and clarity of the rationing are important structural considerations in the development of an equal, appropriate, and ethical healthcare system. Moreover, the procedure of rationing is critical as it not only influences people's lives but also reflects the values that dominate in the society. Therefore, in order to minimize the negative consequences of rationing of nursing care, further studies on the ethical dimensions of this phenomenon

  8. The utilization of Clinical Protocols and Therapeutic Guidelines and the rationalization of judicialization for the right to health

    Directory of Open Access Journals (Sweden)

    Clarice Seixas Duarte

    2017-08-01

    Full Text Available The article analyzes the adoption of the Clinical Protocols and Therapeutic Guidelines (CPTGs as an objective measure to be used by the courts in cases where the purpose is to offer positive benefits in terms of realization of the right to health. Such a benchmark can assist the judge in the task of deciding the legal situation of medication supplies, guaranteeing the prevalence of rationality as outlined in the formulation of related public policies and, consequently, the use of technical-political arguments in the distribution of healthcare goods and resources. However, this is not an absolute parameter, and the content of the CPTGs may be questioned, even judicially. With this, judicial action is used as an instrument of democratization and social control among public choices, which can impact health policy itself.

  9. Proton Beam Therapy for Hepatocellular Carcinoma: A Comparison of Three Treatment Protocols

    Energy Technology Data Exchange (ETDEWEB)

    Mizumoto, Masashi; Okumura, Toshiyuki; Hashimoto, Takayuki [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Fukuda, Kuniaki [Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Oshiro, Yoshiko; Fukumitsu, Nobuyoshi [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Abei, Masato [Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Kawaguchi, Atsushi [Biostatistics Center, Kurume University, Fukuoka (Japan); Hayashi, Yasutaka; Ookawa, Ayako; Hashii, Haruko; Kanemoto, Ayae [Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Moritake, Takashi [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Tohno, Eriko [Department of Diagnostic Radiology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Tsuboi, Koji [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Sakae, Takeji [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Sakurai, Hideyuki, E-mail: hsakurai@pmrc.tsukuba.ac.jp [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan)

    2011-11-15

    Background: Our previous results for treatment of hepatocellular carcinoma (HCC) with proton beam therapy revealed excellent local control with low toxicity. Three protocols were used to avoid late complications such as gastrointestinal ulceration and bile duct stenosis. In this study, we examined the efficacy of these protocols. Methods and Materials: The subjects were 266 patients (273 HCCs) treated by proton beam therapy at University of Tsukuba between January 2001 and December 2007. Three treatment protocols (A, 66 GyE in 10 fractions; B, 72.6 GyE in 22 fractions; and C, 77 GyE in 35 fractions) were used, depending on the tumor location. Results: Of the 266 patients, 104, 95, and 60 patients were treated with protocols A, B, and C, respectively. Seven patients with double lesions underwent two different protocols. The overall survival rates after 1, 3 and 5 years were 87%, 61%, and 48%, respectively (median survival, 4.2 years). Multivariate analysis showed that better liver function, small clinical target volume, and no prior treatment (outside the irradiated field) were associated with good survival. The local control rates after 1, 3, and 5 years were 98%, 87%, and 81%, respectively. Multivariate analysis did not identify any factors associated with good local control. Conclusions: This study showed that proton beam therapy achieved good local control for HCC using each of three treatment protocols. This suggests that selection of treatment schedules based on tumor location may be used to reduce the risk of late toxicity and maintain good treatment efficacy.

  10. Antibiotic prophylaxis in orthopedic surgeries: the results of an implemented protocol

    Directory of Open Access Journals (Sweden)

    Raquel Queiroz

    Full Text Available Though the basic principles of antibiotic prophylaxis have been well established, there is still considerable incorrect usage, including how much is prescribed and especially in the duration of treatment, which is generally superior to what is indicated. The adequate use of these drugs contributes towards decreasing the time of internment of the patient, prevents surgical site infection (SSI, decreasing the development of resistant microorganisms, and towards reduced costs for the hospital pharmacy. A protocol for the use of antibiotic prophylaxis in the Orthopedics and Traumatology Service of the Hospital do Servidor Público Estadual de São Paulo was developed. The objectives of the study were to promote rational antibiotic surgical prophylaxis, through the implantation of a protocol for the use of these drugs in a surgical unit, with the direct contribution of a druggist in collaboration with the Infection Control Committee, to evaluate the adhesion of the health team to the protocol during three distinct periods (daily pre-protocol, early post-protocol and late post-protocol and to define the consumption of antimicrobials used, measured as daily defined dose.

  11. Optimal public rationing and price response.

    Science.gov (United States)

    Grassi, Simona; Ma, Ching-To Albert

    2011-12-01

    We study optimal public health care rationing and private sector price responses. Consumers differ in their wealth and illness severity (defined as treatment cost). Due to a limited budget, some consumers must be rationed. Rationed consumers may purchase from a monopolistic private market. We consider two information regimes. In the first, the public supplier rations consumers according to their wealth information (means testing). In equilibrium, the public supplier must ration both rich and poor consumers. Rationing some poor consumers implements price reduction in the private market. In the second information regime, the public supplier rations consumers according to consumers' wealth and cost information. In equilibrium, consumers are allocated the good if and only if their costs are below a threshold (cost effectiveness). Rationing based on cost results in higher equilibrium consumer surplus than rationing based on wealth. Copyright © 2011 Elsevier B.V. All rights reserved.

  12. Efficacy of 2 finishing protocols in the quality of orthodontic treatment outcome.

    Science.gov (United States)

    Stock, Gregory J; McNamara, James A; Baccetti, Tiziano

    2011-11-01

    The objectives of this prospective clinical study were to evaluate the quality of treatment outcomes achieved with a complex orthodontic finishing protocol involving serpentine wires and a tooth positioner, and to compare it with the outcomes of a standard finishing protocol involving archwire bends used to detail the occlusion near the end of active treatment. The complex finishing protocol sample consisted of 34 consecutively treated patients; 1 week before debonding, their molar bands were removed, and serpentine wires were placed; this was followed by active wear of a tooth positioner for up to 1 month after debonding. The standard finishing protocol group consisted of 34 patients; their dental arches were detailed with archwire bends and vertical elastics. The objective grading system of the American Board of Orthodontics was used to quantify the quality of the finish at each time point. The Wilcoxon signed rank test was used to compare changes in the complex finishing protocol; the Mann-Whitney U test was used to compare changes between groups. The complex finishing protocol group experienced a clinically significant improvement in objective grading system scores after treatment with the positioner. Mild improvement in posterior space closure was noted after molar band removal, but no improvement in the occlusion was observed after placement of the serpentine wires. Patients managed with the complex finishing protocol also had a lower objective grading system score (14.7) at the end of active treatment than did patients undergoing the standard finishing protocol (23.0). Tooth positioners caused a clinically significant improvement in interocclusal contacts, interproximal contacts, and net objective grading system score; mild improvement in posterior band space was noted after molar band removal 1 week before debond. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  13. Adult Rhabdomyosarcoma Survival Improved With Treatment on Multimodality Protocols

    International Nuclear Information System (INIS)

    Gerber, Naamit Kurshan; Wexler, Leonard H.; Singer, Samuel; Alektiar, Kaled M.; Keohan, Mary Louise; Shi, Weiji; Zhang, Zhigang; Wolden, Suzanne

    2013-01-01

    Purpose: Rhabdomyosarcoma (RMS) is a pediatric sarcoma rarely occurring in adults. For unknown reasons, adults with RMS have worse outcomes than do children. Methods and Materials: We analyzed data from all patients who presented to Memorial Sloan-Kettering Cancer Center between 1990 and 2011 with RMS diagnosed at age 16 or older. One hundred forty-eight patients met the study criteria. Ten were excluded for lack of adequate data. Results: The median age was 28 years. The histologic diagnoses were as follows: embryonal 54%, alveolar 33%, pleomorphic 12%, and not otherwise specified 2%. The tumor site was unfavorable in 67% of patients. Thirty-three patients (24%) were at low risk, 61 (44%) at intermediate risk, and 44 (32%) at high risk. Forty-six percent were treated on or according to a prospective RMS protocol. The 5-year rate of overall survival (OS) was 45% for patients with nonmetastatic disease. The failure rates at 5 years for patients with nonmetastatic disease were 34% for local failure and 42% for distant failure. Among patients with nonmetastatic disease (n=94), significant factors associated with OS were histologic diagnosis, site, risk group, age, and protocol treatment. On multivariate analysis, risk group and protocol treatment were significant after adjustment for age. The 5-year OS was 54% for protocol patients versus 36% for nonprotocol patients. Conclusions: Survival in adult patients with nonmetastatic disease was significantly improved for those treated on RMS protocols, most of which are now open to adults

  14. Adult Rhabdomyosarcoma Survival Improved With Treatment on Multimodality Protocols

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, Naamit Kurshan [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wexler, Leonard H. [Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Singer, Samuel [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Alektiar, Kaled M. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Keohan, Mary Louise [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Shi, Weiji; Zhang, Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wolden, Suzanne, E-mail: woldens@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2013-05-01

    Purpose: Rhabdomyosarcoma (RMS) is a pediatric sarcoma rarely occurring in adults. For unknown reasons, adults with RMS have worse outcomes than do children. Methods and Materials: We analyzed data from all patients who presented to Memorial Sloan-Kettering Cancer Center between 1990 and 2011 with RMS diagnosed at age 16 or older. One hundred forty-eight patients met the study criteria. Ten were excluded for lack of adequate data. Results: The median age was 28 years. The histologic diagnoses were as follows: embryonal 54%, alveolar 33%, pleomorphic 12%, and not otherwise specified 2%. The tumor site was unfavorable in 67% of patients. Thirty-three patients (24%) were at low risk, 61 (44%) at intermediate risk, and 44 (32%) at high risk. Forty-six percent were treated on or according to a prospective RMS protocol. The 5-year rate of overall survival (OS) was 45% for patients with nonmetastatic disease. The failure rates at 5 years for patients with nonmetastatic disease were 34% for local failure and 42% for distant failure. Among patients with nonmetastatic disease (n=94), significant factors associated with OS were histologic diagnosis, site, risk group, age, and protocol treatment. On multivariate analysis, risk group and protocol treatment were significant after adjustment for age. The 5-year OS was 54% for protocol patients versus 36% for nonprotocol patients. Conclusions: Survival in adult patients with nonmetastatic disease was significantly improved for those treated on RMS protocols, most of which are now open to adults.

  15. Effectiveness of a transdiagnostic internet-based protocol for the treatment of emotional disorders versus treatment as usual in specialized care: study protocol for a randomized controlled trial.

    Science.gov (United States)

    González-Robles, Alberto; García-Palacios, Azucena; Baños, Rosa; Riera, Antonio; Llorca, Ginés; Traver, Francisco; Haro, Gonzalo; Palop, Vicente; Lera, Guillem; Romeu, José Enrique; Botella, Cristina

    2015-10-31

    Emotional disorders (depression and anxiety disorders) are highly prevalent mental health problems. Although evidence showing the effectiveness of disorder-specific treatments exists, high comorbidity rates among emotional disorders limit the utility of these protocols. This has led some researchers to focus their interest on transdiagnostic interventions, a treatment perspective that might be more widely effective across these disorders. Also, the current way of delivering treatments makes it difficult provide assistance to all of the population in need. The use of the Internet in the delivery of evidence-based treatments may help to disseminate treatments among the population. In this study, we aim to test the effectiveness of EmotionRegulation, a new transdiagnostic Internet-based protocol for unipolar mood disorders, five anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder and anxiety disorder not otherwise specified), and obsessive-compulsive disorder in comparison to treatment as usual as provided in Spanish public specialized mental health care. We will also study its potential impact on basic temperament dimensions (neuroticism/behavioral inhibition and extraversion/behavioral activation). Expectations and opinions of patients about this protocol will also be studied. The study is a randomized controlled trial. 200 participants recruited in specialized care will be allocated to one of two treatment conditions: a) EmotionRegulation or b) treatment as usual. Primary outcome measures will be the BAI and the BDI-II. Secondary outcomes will include a specific measure of the principal disorder, and measures of neuroticism/behavioral inhibition and extraversion/behavioral activation. Patients will be assessed at baseline, post-treatment, and 3- and 12-month follow-ups. Intention to treat and per protocol analyses will be performed. Although the effectiveness of face-to-face transdiagnostic protocols has been

  16. NGO-provided free HIV treatment and services in Burkina Faso: scarcity, therapeutic rationality and unfair process

    Directory of Open Access Journals (Sweden)

    Ridde Valéry

    2012-03-01

    Full Text Available Abstract Until 2010, Burkina Faso was an exception to the international trend of abolishing user fees for antiretroviral treatment (ART. Patients were still expected to pay 1,500F CFA (2 Euros per month for ART. Nevertheless, many non-governmental organizations (NGOs exempted patients from payment. The objective of this study was to investigate how NGOs selected the beneficiaries of payment exemptions for government-provided ART and rationed out complementary medical and psychosocial services. For this qualitative study, we conducted 13 individual interviews and three focus group discussions (n = 13 persons with program staff in nine NGOs (4,000 patients, two NGO coordinating structures and one national program. These encounters were recorded and transcribed, and their content was thematically analyzed. The results were presented to the NGOs for feedback. Results indicate that there are no concrete guidelines for identifying patients warranting payment exemptions. Formerly, ART was scarce in Burkina Faso and the primary criterion for treatment selection was clinical. Our results suggest that this scarcity, mediated by an approach we call sociotherapeutic rationality (i.e. maximization of clinical success, may have led to inequities in the provision of free ART. This approach may be detrimental to assuring equity since the most impoverished lack resources to pay for services that maximize clinical success (e.g. viral load that would increase their chances of being selected for treatment. However, once selected into treatment, attempts were made to ration-out complementary services more equitably. This study demonstrates the risks entailed by medication scarcity, which presents NGOs and health professionals with impossible choices that run counter to the philosophy of equity in access to treatment. Amid growing concerns of an international funding retreat for ART, it is important to learn from the past in order to better manage the potentially

  17. NGO-provided free HIV treatment and services in Burkina Faso: scarcity, therapeutic rationality and unfair process.

    Science.gov (United States)

    Ridde, Valéry; Somé, Paul Andre; Pirkle, Catherine M

    2012-03-06

    Until 2010, Burkina Faso was an exception to the international trend of abolishing user fees for antiretroviral treatment (ART). Patients were still expected to pay 1,500F CFA (2 Euros) per month for ART. Nevertheless, many non-governmental organizations (NGOs) exempted patients from payment. The objective of this study was to investigate how NGOs selected the beneficiaries of payment exemptions for government-provided ART and rationed out complementary medical and psychosocial services. For this qualitative study, we conducted 13 individual interviews and three focus group discussions (n = 13 persons) with program staff in nine NGOs (4,000 patients), two NGO coordinating structures and one national program. These encounters were recorded and transcribed, and their content was thematically analyzed. The results were presented to the NGOs for feedback. Results indicate that there are no concrete guidelines for identifying patients warranting payment exemptions. Formerly, ART was scarce in Burkina Faso and the primary criterion for treatment selection was clinical. Our results suggest that this scarcity, mediated by an approach we call sociotherapeutic rationality (i.e. maximization of clinical success), may have led to inequities in the provision of free ART. This approach may be detrimental to assuring equity since the most impoverished lack resources to pay for services that maximize clinical success (e.g. viral load) that would increase their chances of being selected for treatment. However, once selected into treatment, attempts were made to ration-out complementary services more equitably.This study demonstrates the risks entailed by medication scarcity, which presents NGOs and health professionals with impossible choices that run counter to the philosophy of equity in access to treatment. Amid growing concerns of an international funding retreat for ART, it is important to learn from the past in order to better manage the potentially inequitable consequences

  18. Rationing hepatitis C treatment in the context of austerity policies in France and Cameroon: A transnational perspective on the pharmaceuticalization of healthcare systems.

    Science.gov (United States)

    Chabrol, Fanny; David, Pierre-Marie; Krikorian, Gaëlle

    2017-08-01

    New powerful drugs against hepatitis C can cure the disease, but they are not widely distributed because their exorbitant prices are destabilizing healthcare systems in both African and European countries. This article takes access to hepatitis C treatments since 2013 in France and in Cameroon as a lens to analyze the rationing of pharmaceutical treatments in relation to recent transformations of health systems. Access to these treatments is analyzed thanks to ethnographic observation and interviews lead in Paris and Yaoundé, with patients, associations, health professionals and public health experts. In Cameroon, rationing takes place through various layers of socio-economic restrictions, and no patient organization advocates for hepatitis treatment. In France, access to hepatitis C treatments has become politicized, and collective mobilizations have denounced rationing as a threat to the promise of universal social security. In this study, we examine Africa's long experience with rationing in the context of structural adjustment, and we bring together experiences in France and Cameroon. This article analyses the phenomenon of the pharmaceuticalization of healthcare systems, that is to say the growing use of pharmaceuticals in healthcare systems, by documenting the social and political construction of scarcity. Indeed, whereas pharmaceuticalization is a concept that has often been used in situations of drugs abundance, a parallel analysis of rationing highlights a political economy of pharmaceuticals that shapes public health debates and policies according to an economy of scarcity, especially in times of austerity. Copyright © 2017. Published by Elsevier Ltd.

  19. Evaluation of image-guidance protocols in the treatment of head and neck cancers

    International Nuclear Information System (INIS)

    Zeidan, Omar A.; Langen, Katja M.; Meeks, Sanford L.; Manon, Rafael R.; Wagner, Thomas H.; Willoughby, Twyla R.; Jenkins, D. Wayne; Kupelian, Patrick A.

    2007-01-01

    Purpose: The aim of this study was to assess the residual setup error of different image-guidance (IG) protocols in the alignment of patients with head and neck cancer. The protocols differ in the percentage of treatment fractions that are associated with image guidance. Using data from patients who were treated with daily IG, the residual setup errors for several different protocols are retrospectively calculated. Methods and Materials: Alignment data from 24 patients (802 fractions) treated with daily IG on a helical tomotherapy unit were analyzed. The difference between the daily setup correction and the setup correction that would have been made according to a specific protocol was used to calculate the residual setup errors for each protocol. Results: The different protocols are generally effective in reducing systematic setup errors. Random setup errors are generally not reduced for fractions that are not image guided. As a consequence, if every other treatment is image guided, still about 11% of all treatments (IG and not IG) are subject to three-dimensional setup errors of at least 5 mm. This frequency increases to about 29% if setup errors >3 mm are scored. For various protocols that require 15% to 31% of the treatments to be image guided, from 50% to 60% and from 26% to 31% of all fractions are subject to setup errors >3 mm and >5 mm, respectively. Conclusion: Residual setup errors reduce with increasing frequency of IG during the course of external-beam radiotherapy for head-and-neck cancer patients. The inability to reduce random setup errors for fractions that are not image guided results in notable residual setup errors

  20. Adoption of the children's obesity clinic's treatment (TCOCT) protocol into another Danish pediatric obesity treatment clinic

    DEFF Research Database (Denmark)

    Most, Sebastian W; Højgaard, Birgitte; Teilmann, Grete Katrine

    2015-01-01

    BACKGROUND: Treating severe childhood obesity has proven difficult with inconsistent treatment results. This study reports the results of the implementation of a childhood obesity chronic care treatment protocol. METHODS: Patients aged 5 to 18 years with a body mass index (BMI) above the 99th......, but independent of baseline BMI SDS, age, co-morbidity, SES, pubertal stage, place of referral, hours of treatment per year, and mean visit interval time. CONCLUSIONS: The systematic use of the TCOCT protocol reduced the degree of childhood obesity with acceptable retention rates with a modest time...... percentile for sex and age were eligible for inclusion. At baseline patients' height, weight, and tanner stages were measured, as well as parents' socioeconomic status (SES) and family structure. Parental weight and height were self-reported. An individualised treatment plan including numerous advices...

  1. Lahore general hospital protocol for treatment of neovascular glaucoma caused by retinal disease

    International Nuclear Information System (INIS)

    Khaqan, H.A.; Haider, S.A.

    2013-01-01

    To evaluate efficacy of LGH (Lahore General Hospital) protocol for treatment of neovascular glaucoma caused by retinal diseases. Material and Methods: This case series was performed on 9 consecutive eyes of nine patients with uncontrolled neovascular glaucoma at Department of Ophthalmology, Unit II, Lahore General Hospital/PGMI, Lahore. All nine patients completed six months follow up. Among them 6 patients were having PDR (proliferative diabetic retinopathy) and 3 patients having CRVO (central retinal vein occlusion). LGH protocol for treatment of neovascular glaucoma was: To give intravitreal injection of avastin and then PRP (Pan Retinal Photocoagulation) or Trabeculectomy with MMC (Mitomycin C), if PRP and intravitreal avastin fails to control the intra ocular-pressure (IOP). Results: Three patients had IOP control after intravitreal injection of avastin and PRP, 5 patients had uncontrolled IOP after intravitreal avastin and two sessions of PRP, so they under went trabeculectomy with MMC. One patient had uncontrolled IOP despite of full treatment protocol. All other 8 patients IOP remained stable for six months. Conclusion: Significant decrease in intraocular pressure was achieved after observing LGH protocol for treatment of NVG (Neovascular Glaucoma) caused by retinal diseases. (author)

  2. Using research literature to develop a perceptual retraining treatment protocol.

    Science.gov (United States)

    Neistadt, M E

    1994-01-01

    Treatment protocols derived from research literature can help therapists provide more rigorous treatment and more systematic assessment of client progress. This study applied research findings about the influence of task, subject, and feedback parameters on adult performance with block designs to an occupational therapy treatment protocol for parquetry block assembly--an activity occupational therapists use to remediate constructional deficits. Task parameter research suggests that parquetry tasks can be graded according to the features of the design cards, with cards having all block boundaries drawn in being easier than those with some block boundaries omitted. Subject parameter findings suggest that clients' lesions and initial constructional competence can influence their approaches to parquetry tasks. Feedback parameter research suggests that a combination of perceptual and planning cues is most effective for parquetry tasks. Methods to help clients transfer constructional skills from parquetry to functional tasks are also discussed.

  3. Standby Gasoline Rationing Plan. Contingency gasoline rationing regulations

    Energy Technology Data Exchange (ETDEWEB)

    1979-02-01

    The Economic Regulatory Administration issues final rules with respect to standby gasoline rationing. The plan is designed for and would be used only in the event of a severe gasoline shortage. The plan provides that eligibility for ration allotments will be primarily on the basis of motor vehicle registrations. DOE will mail government ration checks to the parties named in a national vehicle registration file to be maintained by DOE. Ration recipients may cash these checks for ration coupons at various designated coupon issuance points. Retail outlets and other suppliers will be required to redeem the ration coupons received in exchange for gasoline sold. Supplemental gas will be given to high-priority activities. A ration banking system will be established with two separate and distinct of ration accounts: retail outlets and other suppliers will open redemption accounts for the deposit of redeemed ration rights; and individuals or firms may open ration rights accounts, which will operate in much the same manner as monetary checking accounts. A white market will be permitted for the sale of transfer of ration rights. A percentage of the total ration rights to be issued will be reserved for distribution to the states as a State Ration Reserve, to be used by the states primarily for the relief of hardship. A National Ration Reserave will also be established. All sections of the Standby Gasoline Rationing Regulations are analyzed. (MCW)

  4. Rationality of limited rationality : some aggregate implications

    OpenAIRE

    Uri M. Possen; Mikko Puhakka

    1994-01-01

    In this paper we let economic agents choose whether to become fully rational or stay boundedly rational. Boundedly rational agents are less sophisticated in their information processing abilities. It is costly to acquire information needed to become fully rational, and thus not all agents are willing to incur those costs. We then explore the aggregate effects of endogenizing the decision whether the agent should or should not become fully rational in handling information. Since fully and boun...

  5. Third degree waiting time discrimination: optimal allocation of a public sector healthcare treatment under rationing by waiting.

    Science.gov (United States)

    Gravelle, Hugh; Siciliani, Luigi

    2009-08-01

    In many public healthcare systems treatments are rationed by waiting time. We examine the optimal allocation of a fixed supply of a given treatment between different groups of patients. Even in the absence of any distributional aims, welfare is increased by third degree waiting time discrimination: setting different waiting times for different groups waiting for the same treatment. Because waiting time imposes dead weight losses on patients, lower waiting times should be offered to groups with higher marginal waiting time costs and with less elastic demand for the treatment.

  6. Treatment Protocol for High Velocity/High Energy Gunshot Injuries to the Face

    Science.gov (United States)

    Peled, Micha; Leiser, Yoav; Emodi, Omri; Krausz, Amir

    2011-01-01

    Major causes of facial combat injuries include blasts, high-velocity/high-energy missiles, and low-velocity missiles. High-velocity bullets fired from assault rifles encompass special ballistic properties, creating a transient cavitation space with a small entrance wound and a much larger exit wound. There is no dispute regarding the fact that primary emergency treatment of ballistic injuries to the face commences in accordance with the current advanced trauma life support (ATLS) recommendations; the main areas in which disputes do exist concern the question of the timing, sequence, and modes of surgical treatment. The aim of the present study is to present the treatment outcome of high-velocity/high-energy gunshot injuries to the face, using a protocol based on the experience of a single level I trauma center. A group of 23 injured combat soldiers who sustained bullet and shrapnel injuries to the maxillofacial region during a 3-week regional military conflict were evaluated in this study. Nine patients met the inclusion criteria (high-velocity/high-energy injuries) and were included in the study. According to our protocol, upon arrival patients underwent endotracheal intubation and were hemodynamically stabilized in the shock-trauma unit and underwent total-body computed tomography with 3-D reconstruction of the head and neck and computed tomography angiography. All patients underwent maxillofacial surgery upon the day of arrival according to the protocol we present. In view of our treatment outcomes, results, and low complication rates, we conclude that strict adherence to a well-founded and structured treatment protocol based on clinical experience is mandatory in providing efficient, appropriate, and successful treatment to a relatively large group of patients who sustain various degrees of maxillofacial injuries during a short period of time. PMID:23449809

  7. Comparison between two treatment protocols with recombinant Human Erythropoietin (rHuEpo in the treatment of late anemia in neonates with Rh-Isoimmunization

    Directory of Open Access Journals (Sweden)

    A.A. Zuppa

    2012-08-01

    Full Text Available Objectve. The Rh-hemolytic disease can lead to a late anemia by hemolytic and hyporigenerative mechanism. We compared the effectiveness of rHuEPO in two care protocols that differ for doses of rHuEPO administrated and for timing of administration. Methods. A cohort of 14 neonates was investigated. The neonates were treated with two different protocols. Protocol A: a dose of 200 U/kg/day of rHuEpo administered subcutaneously starting from the end of the second week of life; Protocol B: a dose of 400 U/kg/day of rHuEpo administered subcutaneously starting from the end of the first week of life. Results. The hematocrit values in the protocol A group decreased during treatment (32,5% vs 25,2%, whereas the hematocrit value in protocol B group remained almost stable (38,7% vs 42,8%. The mean numbers of platelets remained stable in both groups while neutrophils increased in protocol A group and decreased in protocol B (p<0,05. Reticulocyte count increased during treatment in both groups, although only in protocol B group it was statistically significative (p<0,05. Conclusions. Our results suggest a similar efficacy between the two treatment protocols. Increasing doses of rHuEPO do not seem enhancing their effectiveness and the incidence of side effects.

  8. New protocol of clomiphene citrate treatment in women with hypothalamic amenorrhea.

    Science.gov (United States)

    Borges, Lavinia Estrela; Morgante, Giuseppe; Musacchio, Maria Concetta; Petraglia, Felice; De Leo, Vincenzo

    2007-06-01

    To determine if a new protocol of administration of clomiphene citrate (CC) is effective in menstrual cycle recovery in women with hypothalamic secondary amenorrhea. This was an open-label study. Patients comprised a group of eight women with secondary amenorrhea. Interventions. An oral preparation containing CC (50 mg/day) was administered for 5 days followed by a double dose (100 mg/day) for another 5 days, initiated on day 3 after estrogen/progestogen-induced withdrawal bleeding. If ovulation and vaginal bleeding occurred, treatment continued in the two next months with 100 mg/day from day 3 to day 7 day of the cycle. Cycle control was evaluated at each visit, when patients recorded bleeding patterns and tablet intake. Data on the intensity and duration of bleeding were collected. Six patients responded to the first cycle of CC administration, resuming normal menstrual cycles. The other two patients failed to menstruate after the first 10 days of treatment with CC and repeated the same protocol. After the second administration, these two women also had normal menstrual bleeding. The present data show that this new protocol of CC treatment may be useful to restore normal menstrual cycles in young women with hypothalamic amenorrhea.

  9. Procalcitonin-guided antibiotic treatment in critically ill patients.

    Science.gov (United States)

    Hohn, Andreas; Heising, Bernhard; Schütte, Jan-Karl; Schroeder, Olaf; Schröder, Stefan

    2017-02-01

    In critically ill patients, length of antibiotic treatment can be effectively guided by procalcitonin (PCT) protocols. International sepsis guidelines and guidelines on antibiotic stewardship strategies recommend PCT as helpful laboratory marker for a rational use of antibiotics. A number of studies and meta-analyses have confirmed the effectiveness of PCT-protocols for shortening antibiotic treatment without compromising clinical outcome in critically ill patients. But in clinical practice, there is still uncertainty how to interpret PCT levels and how to adjust antibiotic treatment in various infectious situations, especially in the perioperative period. This narrative review gives an overview on the application of PCT-protocols in critically ill patients with severe bacterial infections on the basis of 5 case reports and the available literature. Beside strengths and limitations of this biomarker, also varying kinetics and different maximum values with regard to the infectious focus and pathogens are discussed. PCT-guided antibiotic treatment appears to be safe and effective. Most of the studies revealed a shorter antibiotic treatment without negative clinical outcomes. Cost effectiveness is still a matter of debate and effects on bacterial resistance due to shorter treatments, possible lower rates of drug-related adverse events, or decreased rates of Clostridium difficile infections are not yet evaluated. Guidance of antibiotic treatment can effectively be supported by PCT-protocols. However, it is important to consider the limitations of this biomarker and to use PCT protocols along with antibiotic stewardship programmes and regular clinical rounds together with infectious diseases specialists.

  10. Progress in rational methods of cryoprotection in macromolecular crystallography

    International Nuclear Information System (INIS)

    Alcorn, Thomas; Juers, Douglas H.

    2010-01-01

    Measurements of the average thermal contractions (294→72 K) of 26 different cryosolutions are presented and discussed in conjunction with other recent advances in the rational design of protocols for cryogenic cooling in macromolecular crystallography. Cryogenic cooling of macromolecular crystals is commonly used for X-ray data collection both to reduce crystal damage from radiation and to gather functional information by cryogenically trapping intermediates. However, the cooling process can damage the crystals. Limiting cooling-induced crystal damage often requires cryoprotection strategies, which can involve substantial screening of solution conditions and cooling protocols. Here, recent developments directed towards rational methods for cryoprotection are described. Crystal damage is described in the context of the temperature response of the crystal as a thermodynamic system. As such, the internal and external parts of the crystal typically have different cryoprotection requirements. A key physical parameter, the thermal contraction, of 26 different cryoprotective solutions was measured between 294 and 72 K. The range of contractions was 2–13%, with the more polar cryosolutions contracting less. The potential uses of these results in the development of cryocooling conditions, as well as recent developments in determining minimum cryosolution soaking times, are discussed

  11. Single-Rooted Extraction Sockets: Classification and Treatment Protocol.

    Science.gov (United States)

    El Chaar, Edgar; Oshman, Sarah; Fallah Abed, Pooria

    2016-09-01

    Clinicians have many treatment techniques from which to choose when extracting a failing tooth and replacing it with an implant-supported restoration and when successful management of an extraction socket during the course of tooth replacement is necessary to achieve predictable and esthetic outcomes. This article presents a straightforward, yet thorough, classification for extraction sockets of single-rooted teeth and provides guidance to clinicians in the selection of appropriate and predictable treatment. The presented classification of extraction sockets for single-rooted teeth focuses on the topography of the extraction socket, while the protocol for treatment of each socket type factors in the shape of the remaining bone, the biotype, and the location of the socket whether it be in the mandible or maxilla. This system is based on the biologic foundations of wound healing and can help guide clinicians to successful treatment outcomes.

  12. Improving treatment times for patients with in-hospital stroke using a standardized protocol.

    Science.gov (United States)

    Koge, Junpei; Matsumoto, Shoji; Nakahara, Ichiro; Ishii, Akira; Hatano, Taketo; Sadamasa, Nobutake; Kai, Yasutoshi; Ando, Mitsushige; Saka, Makoto; Chihara, Hideo; Takita, Wataru; Tokunaga, Keisuke; Kamata, Takahiko; Nishi, Hidehisa; Hashimoto, Tetsuya; Tsujimoto, Atsushi; Kira, Jun-Ichi; Nagata, Izumi

    2017-10-15

    Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol. Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008-March 2014) and after implementation (April 2014-December 2016). Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5min, pvs. 26.5min, pvs. 16min, p=0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53min, p=0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0-2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods. Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40

    Science.gov (United States)

    Boone, Margaret; Brown, Nancy J.; Moon, Mary A.; Schuman, Deborah J.; Thomas, Josephine; Wright, Denise L.

    2004-01-01

    This Treatment Improvement Protocol (TIP) addresses the clinical use of buprenorphine in the treatment of opioid addiction. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts…

  14. Efficacy of a sedo-analgesia protocol in pre-hospital trauma treatment

    Directory of Open Access Journals (Sweden)

    Savino Occhionorelli

    2013-06-01

    Full Text Available Pre-hospital trauma treatment is an important situation in which pain should be appropriately assessed and treated, but there is a great lack of studies about it. Literature has widely pointed out that the underanalgesia problem is spread to all groups of patients. The objective of the study is to verify the efficacy of a sedation-analgesia protocol based on the use of NSAIDs, Fentanyl and Midazolam, for prehospital treatment of trauma patients. The protocol was tested in three Emergency Medical Services for a four month period, in which 30 patients were included in the study. Results evidenced a good management of both pain and anxiety in the majority of patients treated, with the achievement of analgesia target in 80% of the patients and sedation target in 100% of the patients.

  15. Rationalization of water consumption in paper industry

    Directory of Open Access Journals (Sweden)

    Žarković Darja

    2004-01-01

    Full Text Available The subject of this paper was to consider the possibilities of economical paper production with rationalization of water consumption. In accordance with the principles of viable development. The pulp & paper industry has had to face global market needs and strict regulation concerning the environment. The basic motive was to provide consistent and high product quality, which is competitive on the market. The pulp & paper industry is one of the largest consumers and pollutants of natural resources. In that light, the rationalization of raw material, water, energy and chemicals consumption with minimization of environmental impact is essential. The European directive on environmental protection obliges producers of pulp & paper to decrease the volume of wastewater and to increase the efficiency treatment. Pulp and paper industry in Serbia and Montenegro will also be faced with the demands for environmental protection. Numerous examples of water consumption rationalization and improvement of water quality in the pulp & paper industry could be found in different literature sources. It is necessary to increase water system closure and implement up-to-date treatment methods. The possibilities for water consumption rationalization, in a real system the paperboard mill UMKA, were examined.

  16. Rationalization: A Bibliography.

    Science.gov (United States)

    Pedrini, D. T.; Pedrini, Bonnie C.

    Rationalization was studied by Sigmund Freud and was specifically labeled by Ernest Jones. Rationalization ought to be differentiated from rational, rationality, logical analysis, etc. On the one hand, rationalization is considered a defense mechanism, on the other hand, rationality is not. Haan has done much work with self-report inventories and…

  17. [Rationalization, rationing, prioritization: terminology and ethical approaches to the allocation of limited resources in hematology/oncology].

    Science.gov (United States)

    Winkler, Eva

    2011-01-01

    The field of oncology with its numerous high-priced innovations contributes considerably to the fact that medical progress is expensive. Additionally, due to the demographic changes and the increasing life expectancy, a growing number of cancer patients want to profit from this progress. Since resources are limited also in the health system, the fair distribution of the available resources urgently needs to be addressed. Dealing with scarcity is a typical problem in the domain of justice theory; therefore, this article first discusses different strategies to manage limited resources: rationalization, rationing, and prioritization. It then presents substantive as well as procedural criteria that assist in the just distribution of effective health benefits. There are various strategies to reduce the utilization of limited resources: Rationalization means that efficiency reserves are being exhausted; by means of rationing, effective health benefits are withheld due to cost considerations. Rationing can occur implicitly and thus covertly, e.g. through budgeting or the implementation of waiting periods, or explicitly, through transparent rules or policies about healthcare coverage. Ranking medical treatments according to their importance (prioritization) is often a prerequisite for rationing decisions. In terms of requirements of justice, both procedural and substantive criteria (e.g. equality, urgency, benefit) are relevant for the acceptance and quality of a decision to limit access to effective health benefits. Copyright © 2011 S. Karger AG, Basel.

  18. Calculation of uncertainties in the protocol of dosimetry for Co 60 beams in Radiotherapy

    International Nuclear Information System (INIS)

    Velazquez M, S.; Carrera M, F.; Sanchez S, J.

    1998-01-01

    The objective in this work is to show how the uncertainty is possible to know in the determination of the absorbed dose in Co 60 photon beams and to establish in a rational form, tolerance levels for this. It is took as base the spanish protocol of dosimetry in Radiotherapy. We have been centered in a Co 60 beam. We utilized the statistical theory of little samples. We allowed to suggest a new approach about the treatment of the tolerance levels and the uncertainty of the measurement. After two years of experience in the practical hospitable application we have gotten to put around 1 % uncertainty in the absolute dosimetry of the Co 60 beam. The presented protocol allows to execute the accuracy requirements in the determination of absorbed doses. (Author)

  19. Rational Decision Making as Performative Praxis: Explaining Rationality's Éternel Retour

    OpenAIRE

    Cabantous, L.; Gond, J-P.

    2011-01-01

    Organizational theorists built their knowledge of decision making through a progressive critique of rational choice theory. Their positioning towards rationality, however, is at odds with the observation of rationality persistence in organizational life. This paper addresses this paradox. It proposes a new perspective on rationality that allows the theorizing of the production of rational decisions by organizations. To account for rationality's éternel retour, we approach rational decision ma...

  20. PROTOCOL OF TREATMENT IN LOW BACK PAIN

    Directory of Open Access Journals (Sweden)

    Alisson Guimbala dos Santos Araujo

    2013-09-01

    Full Text Available Low back pain can be considered as one of the main factors that lead to decreased functional capacity of the human being. Being a frequent dysfunction in people, causing a decrease in quality of life, productivity and functional disability and is associated with important social and economic impact. Therefore the objective of the research was to assess the treatment protocols in low back pain. The study is characterized by being a literature of scientific articles, based on data published in PubMed, SciELO, BIREME and Cochrane from 2000 to 2012. We found eight scientific articles that addressed physical therapy methods in the treatment of low back pain, including a literature review. Related Articles show variation from one to 55 patients in groups, with a total of 185 patients studied. It was concluded then that it hasn’t met a specific treatment that is placed as the most effective for this pathology, although all include electrotherapy, manual therapy, exercise and RPG they show significant results in pain relief, quality of life thereby increasing functionality.

  1. Effect of lime treatment of olive meal on in vitro utilization of total mixed ration containing olive meal as partial maize replacer

    Directory of Open Access Journals (Sweden)

    Ajmal Ashraf

    Full Text Available Aim: Present study pertains to lime treatment of olive meal to improve its digestibility. The objective of the present study was to assess the in vitro dry matter degradability of total mixed ration containing lime treated olive meal at varied levels of maize replacement to know the optimum level of lime and treated olive meal as maize replacement in small ruminant diets. Materials and methods: Study was carried out in two phases. In phase I, A complete diet was formulated and treated with lime at variable concentrations (0-8% at 25% of maize replacement and subjected to in vitro studies as per Tilley and Terry. On the basis of the results of this phase, a concentration of lime for olive treatment was selected and tested at variable levels of maize replacement (0-50% by treated olive cake in phase II. Data was analyzed as per the procedures suggested by Snedecor and Cochran. Results: The in vitro dry matter digestibility (IVDMD of composite diet increased from 43.95% at 0% lime treatment to 48.68% on treating with 8% lime with significant (P<0.05 increase at 6% treatment level. Lime treatment beyond 6% had no further significant effect on improving the digestibility. Graded levels of maize replacement by olive meal treated with 6% lime (lime percentage selected from phase I showed that the in vitro digestibility of mixed ration was not compromised up to 40% replacement level of maize by treated olive meal. Improved digestibility with lime treatment may be due to weakening of internal Hydrogen bonding, thereby disrupting the fiber structure in olive meal. Further lime may be saponifying the high level of fat present in olive meal, which may otherwise negatively impact the digestibility values. Conclusion: It can be concluded that the treatment with up to 6% of lime can effectively increase the digestibility of olive meal. Treated olive meal can replace up to 40% of maize from daily ration without affecting the digestibility of composite ration

  2. Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols

    Directory of Open Access Journals (Sweden)

    Stacey Dawn

    2012-11-01

    Full Text Available Abstract Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©. Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. Methods A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a establishing an advisory knowledge user team in each of three targeted settings; (b assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c adapting protocols for local use, ensuring fidelity of the content; (d selecting intervention strategies to overcome known barriers and implementing the protocols; (e conducting think-aloud usability testing; (f evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing

  3. GnRH and prostaglandin-based synchronization protocols as alternatives to progestogen-based treatments in sheep.

    Science.gov (United States)

    Rekik, M; Haile, A; Abebe, A; Muluneh, D; Goshme, S; Ben Salem, I; Hilali, M El-Dine; Lassoued, N; Chanyalew, Y; Rischkowsky, B

    2016-12-01

    The study investigated, for cycling sheep, synchronizing protocols simultaneously to the standard "P" protocol using progestogens priming with intravaginal devices and gonadotropin. In November 2014, 90 adult Menz ewes were assigned to either the "P" protocol, "PGF" treatment where oestrus and ovulation were synchronized using two injections of prostaglandin 11 days apart or a "GnRH" treatment where the ewes had their oestrus and ovulation synchronized with GnRH (day 0)-prostaglandin (day 6)-GnRH (day 9) sequence. The ewes were naturally mated at the induced oestrus and the following 36 days. Plasma progesterone revealed that 92% of the ewes were ovulating before synchronization and all, except one, ovulated in response to the applied treatments. All "P" ewes exhibited oestrus during the 96-hr period after the end of the treatments in comparison with only 79.3% and 73.3% for "PGF" and "GnRH" ewes, respectively (p sheep after the rainy season when most animals are spontaneously cycling. © 2016 Blackwell Verlag GmbH.

  4. The art of rationing - the need for a new approach to rationing health ...

    African Journals Online (AJOL)

    A key element in dealing with HIV/AIDS in South Africa depends on the resolution of the antiretroviral therapy (ART) paradox: while a universal First-World-style ART programme is unaffordable, a rationed treatment programme that includes ART is not only affordable but also vital for basic human rights reasons, to enhance ...

  5. Simple replantation protocol to avoid ankylosis in teeth intended for orthodontic treatment

    Directory of Open Access Journals (Sweden)

    Yuli Nugraeni

    2009-03-01

    Full Text Available Background: Dento-alveolar trauma resulted from accidents involving the oral regions mostly affect the upper central incisors. Overjet that is beyond 5 mm and incompetent lip also contribute to increase the risk. Several literatures had already discussed different methods of replantation of avulsed teeth. However, it was not meant for further orthodontic treatment. Purpose: The objective of this review is to propose a simple replantation protocol of avulsed teeth which also prevent from ankylosis. Reviews: Protruded teeth usually need orthodontic treatment; therefore, an appropriate management should be done to avoid the development of ankylosis. Ankylosis of the periodontal ligament (PDL becomes a problem in orthodontic tooth movement in repositioned or replanted teeth. In addition, ankylosed teeth also more susceptible to root resorption. Actually, it was caused by the endodontic treatment. In particular, severely protruded or unoccluded teeth are hypofunctional, therefore have narrow PDL, thus it may facilitate to ankylosis development. Ideal management protocol such as the use of root canal sealer i.e. mineral trioxide aggregate (MTA; the using of Emdogain, and resilient wiring or semi-rigid fixation with brackets has become a solution in avulsed teeth arranged for orthodontic treatment. Nevertheless, the presence of oral surgeon, endodontist and orthodontist in the same time, and also ideal preparations after an accident was difficult to achieve. Conclusion: Considering that reducing the ongoing PDL inflammation with intracanal medicaments and maintaining the functional force during mastication is possible; it is concluded that this simple replantation protocol is likely.

  6. Conservative Treatment Protocol for Keratocystic Odontogenic Tumour: a Follow-up Study of 3 Cases

    Directory of Open Access Journals (Sweden)

    Gülsün Yildirim

    2010-07-01

    Full Text Available Background: The keratocystic odontogenic tumour is classified as a developmental cyst derived from the enamel organ or from the dental lamina. The treatment of keratocystic odontogenic tumour of the jaw remains controversial. The aim of this study was to report the outcome of our conservative treatment protocol for keratocystic odontogenic tumour.Methods: Three patients with different complaints referred to Oral and Maxillofacial Surgery Clinic, Faculty of Dentistry, Selçuk University. Initial biopsy was carried out in all patients and keratocystic odontogenic tumours was diagnosed subsequent to histopathological examination. The patients with keratocystic odontogenic tumours were treated by enucleation followed by open packing. This conservative treatment protocol was selected because of existing young aged patients. The average follow-up duration of the cases was 2 years.Results: Out of 3 cases, 2 lesions were present in mandible and 1 lesion in maxilla. There was no evidence of recurrence during follow-up. All the cases were monitored continuously with panoramic radiographs, computed tomography and clinical evaluations.Conclusions: This conservative treatment protocol for keratocystic odontogenic tumours, based on enucleation followed by open packing would be a possible choice with a view of offering low recurrence rate and low morbidity rate particularly in young patients.

  7. Rationality in Society

    NARCIS (Netherlands)

    Flache, Andreas; Dijkstra, Jacob; Wright, James D.

    2015-01-01

    Contemporary theories of rational behavior in human society augment the orthodox model of rationality both by adding various forms of bounded rationality and relaxing the assumptions of self-interest and materialistic preferences. This entry discusses how these extensions of the theory of rational

  8. A Rational Approach to Rational Suicide.

    Science.gov (United States)

    Richman, Joseph

    1992-01-01

    Describes suicide as reaction to internal and external sources of stress and the impact of life events. Notes that, in the elderly, these situations are prevalent in many who are not suicidal. Contends that much more is written about rational suicide than its alternative (rational nonsuicide). Reviews reasons for this and suggests rational…

  9. The rational patient and beyond: implications for treatment adherence in people with psychiatric disabilities.

    Science.gov (United States)

    Corrigan, Patrick W; Rüsch, Nicolas; Ben-Zeev, Dror; Sher, Tamara

    2014-02-01

    Many people with psychiatric disabilities do not benefit from evidence-based practices because they often do not seek out or fully adhere to them. One way psychologists have made sense of this rehabilitation and health decision process and subsequent behaviors (of which adherence might be viewed as one) is by proposing a "rational patient"; namely, that decisions are made deliberatively by weighing perceived costs and benefits of intervention options. Social psychological research, however, suggests limitations to a rational patient theory that impact models of health decision making. The research literature was reviewed for studies of rational patient models and alternative theories with empirical support. Special focus was on models specifically related to decisions about rehabilitation strategies for psychiatric disability. Notions of the rational patient evolved out of several psychological models including the health belief model, protection motivation theory, and theory of planned behavior. A variety of practice strategies evolved to promote rational decision making. However, research also suggests limitations to rational deliberations of health. (1) Rather than carefully and consciously considered, many health decisions are implicit, potentially occurring outside awareness. (2) Decisions are not always planful; often it is the immediate exigencies of a context rather than an earlier balance of costs and benefits that has the greatest effects. (3) Cool cognitions often do not dictate the process; emotional factors have an important role in health decisions. Each of these limitations suggests additional practice strategies that facilitate a person's health decisions. Old models of rational decision making need to be supplanted by multiprocess models that explain supradeliberative factors in health decisions and behaviors. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  10. The Rational Patient and Beyond: Implications for Treatment Adherence in People with Psychiatric Disabilities

    Science.gov (United States)

    Corrigan, Patrick W.; Rüsch, Nicolas; Ben-Zeev, Dror; Sher, Tamara

    2014-01-01

    Purpose/Objective Many people with psychiatric disabilities do not benefit from evidence-based practices because they often do not seek out or fully adhere to them. One way psychologists have made sense of this rehabilitation and health decision process and subsequent behaviors (of which adherence might be viewed as one) is by proposing a “rational patient;” namely, that decisions are made deliberatively by weighing perceived costs and benefits of intervention options. Social psychological research, however, suggests limitations to a rational patient theory that impact models of health decision making. Design The research literature was reviewed for studies of rational patient models and alternative theories with empirical support. Special focus was on models specifically related to decisions about rehabilitation strategies for psychiatric disability. Results Notions of the rational patient evolved out of several psychological models including the health belief model, protection motivation theory, and theory of planned behavior. A variety of practice strategies evolved to promote rational decision making. However, research also suggests limitations to rational deliberations of health. (1) Rather than carefully and consciously considered, many health decisions are implicit, potentially occurring outside awareness. (2) Decisions are not always planful; often it is the immediate exigencies of a context rather than an earlier balance of costs and benefits that has the greatest effects. (3) Cool cognitions often do not dictate the process; emotional factors have an important role in health decisions. Each of these limitations suggests additional practice strategies that facilitate a person’s health decisions. Conclusions/Implications Old models of rational decision making need to be supplanted by multi-process models that explain supra-deliberative factors in health decisions and behaviors. PMID:24446671

  11. A hospital-based child and adolescent overweight and obesity treatment protocol transferred into a community healthcare setting

    DEFF Research Database (Denmark)

    Mollerup, Pernille Maria; Gamborg, Michael Orland; Trier, Cæcilie

    2017-01-01

    BACKGROUND: Due to the pandemic of child and adolescent overweight and obesity, improvements in overweight and obesity treatment availability and accessibility are needed. METHODS: In this prospective study, we investigated if reductions in body mass index (BMI) standard deviation scores (SDS......) and waist circumference (WC) would occur during 1.5 years of community-based overweight and obesity treatment based upon an effective hospital-based overweight and obesity treatment protocol, The Children's Obesity Clinics' Treatment protocol. Height, weight, and WC were measured at all consultations...... was invested per child per year. CONCLUSION: BMI SDS and WC were reduced after 1.5 years of treatment. Hence, this community-based overweight and obesity treatment program may help accommodate the need for improvements in treatment availability and accessibility....

  12. Sensitivity Analysis of Per-Protocol Time-to-Event Treatment Efficacy in Randomized Clinical Trials

    Science.gov (United States)

    Gilbert, Peter B.; Shepherd, Bryan E.; Hudgens, Michael G.

    2013-01-01

    Summary Assessing per-protocol treatment effcacy on a time-to-event endpoint is a common objective of randomized clinical trials. The typical analysis uses the same method employed for the intention-to-treat analysis (e.g., standard survival analysis) applied to the subgroup meeting protocol adherence criteria. However, due to potential post-randomization selection bias, this analysis may mislead about treatment efficacy. Moreover, while there is extensive literature on methods for assessing causal treatment effects in compliers, these methods do not apply to a common class of trials where a) the primary objective compares survival curves, b) it is inconceivable to assign participants to be adherent and event-free before adherence is measured, and c) the exclusion restriction assumption fails to hold. HIV vaccine efficacy trials including the recent RV144 trial exemplify this class, because many primary endpoints (e.g., HIV infections) occur before adherence is measured, and nonadherent subjects who receive some of the planned immunizations may be partially protected. Therefore, we develop methods for assessing per-protocol treatment efficacy for this problem class, considering three causal estimands of interest. Because these estimands are not identifiable from the observable data, we develop nonparametric bounds and semiparametric sensitivity analysis methods that yield estimated ignorance and uncertainty intervals. The methods are applied to RV144. PMID:24187408

  13. Menopause: developing a rational treatment plan.

    Science.gov (United States)

    Vitiello, Danielle; Naftolin, Frederick; Naftoilin, Frederick; Taylor, Hugh S

    2007-12-01

    In recent years, growing importance has been afforded to assisting women in coping with the menopausal transition. Menopause is a normal stage of development and a woman's attitude toward this transition embodies biological, psychological and social influences. An enlarging body of conflicting data concerning menopausal hormone therapy (MHT) demands reassessment of established paradigms of disease prevention and menopausal health. Currently, a woman's decision to participate in or abstain from menopausal HT is personal. It involves not only consideration of risk stratification of potential harm and benefit, but also involves her expectations and attitudes toward perceived physical and emotional changes associated with this change. Through the use of extensive patient history, quality-of-life questionnaires and powerful biological profiling, we may be able to develop a rational approach to menopausal HT that safely guides our patients through this transition.

  14. On rationally supported surfaces

    DEFF Research Database (Denmark)

    Gravesen, Jens; Juttler, B.; Sir, Z.

    2008-01-01

    We analyze the class of surfaces which are equipped with rational support functions. Any rational support function can be decomposed into a symmetric (even) and an antisymmetric (odd) part. We analyze certain geometric properties of surfaces with odd and even rational support functions....... In particular it is shown that odd rational support functions correspond to those rational surfaces which can be equipped with a linear field of normal vectors, which were discussed by Sampoli et al. (Sampoli, M.L., Peternell, M., Juttler, B., 2006. Rational surfaces with linear normals and their convolutions...... with rational surfaces. Comput. Aided Geom. Design 23, 179-192). As shown recently, this class of surfaces includes non-developable quadratic triangular Bezier surface patches (Lavicka, M., Bastl, B., 2007. Rational hypersurfaces with rational convolutions. Comput. Aided Geom. Design 24, 410426; Peternell, M...

  15. General principles for the treatment of non-infectious uveitis.

    Science.gov (United States)

    Díaz-Llopis, Manuel; Gallego-Pinazo, Roberto; García-Delpech, Salvador; Salom-Alonso, David

    2009-09-01

    Ocular inflammatory disorders constitute a sight-threatening group of diseases that might be managed according to their severity. Their treatment guidelines experience constant changes with new agents that improve the results obtained with former drugs. Nowadays we can make use of a five step protocol in which topical, periocular and systemic corticosteroids remain as the main therapy for non infectious uveitis. In addition, immunosuppresive drugs can be added in order to enhance the anti-inflammatory effects and to develop the role of corticosteroid-saving agents. These can be organized in four other steps: Cyclosporine and Methotrexate in a second one; Azathioprine, Mycophenolate Mofetil and Tacrolimus in a third step; biological anti-TNF drugs in fourth position; and a theoretical last one with Cyclophosphamide and Chlorambucil. In the present review we go through the main characteristics and complications of all these treatments and make a rational of this five-step treatment protocol for non infectious posterior uveitis.

  16. Successful Short Desensitization Treatment Protocol with Narrowband UVB Phototherapy (TL-01) in Polymorphic Light Eruption.

    Science.gov (United States)

    Combalia, A; Fernández-Sartorio, C; Fustà, X; Morgado-Carrasco, D; Podlipnik, S; Aguilera, P

    2017-10-01

    Polymorphic light eruption (PLE) is a common idiopathic photodermatosis that typically presents with pruritic papular or papulovesicular lesions on sun-exposed skin between spring and autumn. In many subjects PLE is mild, and can usually be prevented by the use of broad-spectrum topical sunscreens and a gradual increase in sunlight exposure. However, in some individuals, sunlight exposure results in florid PLE and they often benefit from prophylactic desensitization treatment using phototherapy in early spring, an artificial method that induces a "hardening" phenomenon. To describe and evaluate the efficacy of a short desensitization protocol, based on a one-month-treatment, administered twice a week with narrow band UVB in subjects with severe polymorphic light eruption (PLE). A retrospective, open planned and non-randomized study to assess the efficacy of UVB phototherapy in prevention of polymorphic light eruption. Fifteen subjects diagnosed with severe PLE were treated with the standard protocol in our Photobiology Unit between 2014 and 2015. The effect of hardening was sustained during follow up in 87.5% of desensitization treatments. A statistically significant association (pPLE and the response to treatment was found. The effect of hardening was maintained in the vast majority of subjects, obtaining a good benefit with no PLE episodes during all the summer. We demonstrate that our standard protocol is effective, and produces a successful outcome for the majority of PLE subjects. Our protocol is shorter than those currently applied, being favourable both for the patient and the physician. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Competence, practical rationality and what a patient values.

    Science.gov (United States)

    Craigie, Jillian

    2011-07-01

    According to the principle of patient autonomy, patients have the right to be self-determining in decisions about their own medical care, which includes the right to refuse treatment. However, a treatment refusal may legitimately be overridden in cases where the decision is judged to be incompetent. It has recently been proposed that in assessments of competence, attention should be paid to the evaluative judgments that guide patients' treatment decisions. In this paper I examine this claim in light of theories of practical rationality, focusing on the difficult case of an anorexic person who is judged to be competent and refuses treatment, thereby putting themselves at risk of serious harm. I argue that the standard criteria for competence assess whether a treatment decision satisfies the goals of practical decision-making, and that this same criterion can be applied to a patient's decision-guiding commitments. As a consequence I propose that a particular understanding of practical rationality offers a theoretical framework for justifying involuntary treatment in the anorexia case. © 2009 Blackwell Publishing Ltd.

  18. Patient-Specific Internal Dosimetry Protocol for 131 treatment of differentiated thyroid cancer

    International Nuclear Information System (INIS)

    Deluca, G.M.; Rojo, Ana M.; Llina Fuentes, C.S.; Cabrejas, Mariana L.; Cabrejas, R.; Fadel, A.M.

    2008-01-01

    Full text: The most effective treatment against Differentiated Thyroid Cancer (DTC), in its most frequently types: papillar and follicular, is the administration of radioiodine. As a result of a multidisciplinary work, a dosimetrical protocol for radiological protection purpose has been developed that suggests the standards and formalisms for the determination of absorbed doses due to the administration of 131 I activity to DTC patients. This dosimetrical protocol takes into account individual data of each patient (age, gender, the presence or absence of metastases, physiology, physiopathology, biochemical parameters) and involves clinical aspects, the equipment that should be used and the dose assessment procedure of each treatment. Based on the Medical Internal radiation Dose (MIRD) scheme and considering the major critical organs for this therapy, the dosimetrical protocol states the 'how-to' of the following procedures, in adults and paediatric cases: 1) estimation of the red marrow dose (with/without bone metastases) to avoid mielotoxicity (200 cGy); 2) Estimation of the retention / dose rate / dose in lungs after 48 hours from the administration of radioiodine to avoid lung fibrosis; 3) Estimation of the testes dose in young male patients to avoid oligospermia; 4) Estimation of the maximum activity which can be safely administered without damaging the most critical organ for each patient; and 5) Acquisition of images and retention data from patients. This dosimetrical protocol also specifies the requirements and basic steps that should be followed, the essential information, the complementary studies and the basic equipment required to perform an appropriate internal dosimetry evaluation. To be fully implemented, the dosimetrical protocol needs the constitution of a multidisciplinary team including physicians, medical physicists and technicians. Clear instructions should be provided to the patient as his full collaboration is essential. Even though empirical

  19. Treatment influencing down-staging in EORTC Melanoma Group sentinel node histological protocol compared with complete step-sectioning: a national multicentre study.

    Science.gov (United States)

    Riber-Hansen, Rikke; Hastrup, Nina; Clemmensen, Ole; Behrendt, Nille; Klausen, Siri; Ramsing, Mette; Spaun, Eva; Hamilton-Dutoit, Stephen Jacques; Steiniche, Torben

    2012-02-01

    Metastasis size in melanoma sentinel lymph nodes (SLNs) is an emerging prognostic factor. Two European melanoma treatment trials include SLN metastasis diameters as inclusion criteria. Whilst diameter estimates are sensitive to the number of sections examined, the level of this bias is largely unknown. We performed a prospective multicentre study to compare the European Organisation for Research and Treatment of Cancer (EORTC) recommended protocol with a protocol of complete step-sectioning. One hundred and thirty-three consecutive SLNs from seven SLN centres were analysed by five central sections 50μm apart (EORTC Protocol) followed by complete 250μm step-sectioning. Overall, 29 patients (21.8%) were SLN-positive. The EORTC Protocol missed eight of these metastases (28%), one metastasis measuring less than 0.1mm in diameter, seven measuring between 0.1 and 1mm. Complete step-sectioning at 250μm intervals (Extensive Protocol) missed one metastasis (3%) that measured less than 0.1mm. Thirteen treatment courses (34%) performed if inclusion was based on the Combined Protocol would not be performed if assessed by the EORTC Protocol. Thus, 10 patients would be without completion lymph node dissection (EORTC MINITUB study), whilst three patients would not be eligible for anti-CTLA4 trial (EORTC protocol 18071). The corresponding number with the Extensive Protocol would be three; one patient for the MINITUB registration study and two patients for the anti-CTLA4 study. Examining SLNs by close central sectioning alone (EORTC Protocol) misses a substantial number of metastases and underestimates the maximum metastasis diameter, leading to important changes in patient eligibility for various treatment protocols. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Pragmatics & rationality.

    OpenAIRE

    Allott, N. E.

    2007-01-01

    This thesis is about the reconciliation of realistic views of rationality with inferential-intentional theories of communication. Grice (1957 1975) argued that working out what a speaker meant by an utterance is a matter of inferring the speaker's intentions on the presumption that she is acting rationally. This is abductive inference: inference to the best explanation for the utterance. Thus an utterance both rationalises and causes the interpretation the hearer constructs. Human rationality...

  1. Comparison of carboplatin and doxorubicin-based chemotherapy protocols in 470 dogs after amputation for treatment of appendicular osteosarcoma.

    Science.gov (United States)

    Selmic, L E; Burton, J H; Thamm, D H; Withrow, S J; Lana, S E

    2014-01-01

    Many chemotherapy protocols have been reported for treatment of canine appendicular osteosarcoma (OSA), but outcome comparisons in a single population are lacking. To evaluate the effects of protocol and dose intensity (DI) on treatment outcomes for carboplatin and doxorubicin-based chemotherapy protocols. Four hundred and seventy dogs with appendicular OSA. A retrospective cohort study was performed comprising consecutive dogs treated (1997-2012) with amputation followed by 1 of 5 chemotherapy protocols: carboplatin 300 mg/m(2) IV q21d for 4 or 6 cycles (CARBO6), doxorubicin 30 mg/m(2) IV q14d or q21d for 5 cycles, and alternating carboplatin 300 mg/m(2) IV and doxorubicin 30 mg/m(2) IV q21d for 3 cycles. Adverse events (AE) and DI were evaluated. Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare disease-free interval (DFI) and survival time (ST) among protocols. The overall median DFI and ST were 291 days and 284 days, respectively. A lower proportion of dogs prescribed CARBO6 experienced AEs compared to other protocols (48.4% versus 60.8-75.8%; P = .001). DI was not associated with development of metastases or death. After adjustment for baseline characteristics and prognostic factors, none of the protocols provided a significant reduction in risk of development of metastases or death. Although choice of protocol did not result in significant differences in DFI or ST, the CARBO6 protocol resulted in a lower proportion of dogs experiencing AEs, which could be advantageous in maintaining high quality of life during treatment. DI was not a prognostic indicator in this study. Copyright © 2014 by the American College of Veterinary Internal Medicine.

  2. Optimization of the Treatment Protocol in Children with Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    T.O. Kriuchko

    2016-03-01

    Full Text Available The article deals with the substantiation and assessment of the effectiveness of the inclusion of ursodeoxycholic acid preparation Ukrliv suspension in the treatment protocol of children with gastroesophageal reflux disease. Taking into account the results of the studies, the use of ursodeoxycholic acid drug can be recommended as a pathogenetic therapy in the combination treatment of children with gastroesophageal reflux disease. The findings suggest both the efficiency and the high level of safety and tolerability of ursodeoxycholic acid, in particular Ukrliv suspension, during long-term use to prevent recurrences.

  3. Hemangiopericytoma - The need for a protocol-based treatment plan

    Directory of Open Access Journals (Sweden)

    Murugesan Krishnan

    2011-01-01

    Full Text Available Hemangiopericytoma is a vascular tumor which comprises only 1% of all vascular tumors. The frequency of occurrence in the head and neck accounts for about 16-33% of all hemangiopericytomas. In this paper we discuss the surgical management, the difficulties in decision-making and treatment-planning in a case of a maxillary tumor in a five-year-old boy with a two-year follow-up. A five-year-old boy presented with a large unilateral maxillary tumor with nasal obstruction. Computed tomography revealed a heterogeneous mass completely occupying the right maxillary sinus and displacing the lateral wall of the nose and nasal septum. The lesion was diagnosed as hemangiopericytoma after histopathological confirmation. The option of surgical resection (total maxillectomy was carried out after evaluating the available literature. Various treatment modalities like surgery, chemotherapy and radiotherapy were taken into consideration as the tumor has an aggressive nature. Due to the inadequate literature on definitive treatment options for these types of tumors, there was difficulty in arriving at a protocol-based treatment plan.

  4. Slipped capital femoral epiphysis: A modern treatment protocol

    Directory of Open Access Journals (Sweden)

    Slavković Nemanja

    2009-01-01

    Full Text Available The treatment of a patient with slipped capital femoral epiphysis begins with an early diagnosis and accurate classification. On the basis of symptom duration, clinical findings and radiographs, slipped capital femoral epiphysis is classified as pre-slip, acute, acute-on-chronic and chronic. The long-term outcome of slipped capital femoral epiphysis is directly related to severity and the presence or absence of avascular necrosis and/or chondrolysis. Therefore, the first priority in the treatment of slipped capital femoral epiphysis is to avoid complications while securing the epiphysis from further slippage. Medical treatment of patients with acute and acute-on-chronic slipped capital femoral epiphysis, as well as those presented in pre-slip stage, is the safest, although time-consuming. Manipulations, especially forced and repeated, are not recommended due to higher avascular necrosis risk. The use of intraoperative fluoroscopy to assist in the placement of internal fixation devices has markedly increased the success of surgical treatment. Controversy remains as to whether the proximal femoral epiphysis in severe, chronic slipped capital femoral epiphysis should be realigned by extracapsular osteotomies or just fixed in situ. The management protocol for slipped capital femoral epiphysis depends on the experience of the surgeon, motivation of the patient and technical facilities.

  5. Rationing with baselines

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Moreno-Ternero, Juan D.; Østerdal, Lars Peter Raahave

    2013-01-01

    We introduce a new operator for general rationing problems in which, besides conflicting claims, individual baselines play an important role in the rationing process. The operator builds onto ideas of composition, which are not only frequent in rationing, but also in related problems...... such as bargaining, choice, and queuing. We characterize the operator and show how it preserves some standard axioms in the literature on rationing. We also relate it to recent contributions in such literature....

  6. The Effect of Soy Sauce Waste in Ration on Performance of Mojosari Duck

    Directory of Open Access Journals (Sweden)

    G. A. A. Larasati

    2017-06-01

    Full Text Available The purpose of study was to determined the effect of soy sauce waste in ration in the ration on the performance of Mojosari duck. The materials used were 240 of Mojosari which are 20 weeks olds with average body weight 1,385.0 ± 130.85 grams (CV = 9.44%. Feed ingredients used were, rice bran, soybean meal, yellow corn, fish meal, pollard and premix. The design that used was Completely Randomized Design (CRD with 4 treatments and 6 replications.The treatment applied soy sauce waste at level 5, 7,5 and 10%. The parameters observed were consumption, egg production, feed conversion. The data were analyzed by analysis of variance with F test. The results showed that soy sauce waste did not effected on performance (consumption of ration, egg production, ration conversion of Mojosari duck. The conclusion of this research is soy sauce waste be used as feed stuff of Mojosari duck ration until level 10%.

  7. HISTOPATHOLOGICAL AND CYTOLOGICAL ANALYSIS OF TRANSMISSIBLE VENEREAL TUMOR IN DOGS AFTER TWO TREATMENT PROTOCOLS

    Directory of Open Access Journals (Sweden)

    Fabiana Aguena Sales Lapa

    2012-06-01

    Full Text Available The transmissible venereal tumor (TVT is a contagious neoplasm of round cells that frequently affect dogs. The treatment consists of chemotherapy being more effective the vincristine alone, however the resistance emergence to this agent due multidrug resistance of the P-glycoprotein (P-gp, a transporter protein encoded by the MDR1 gene, has been taking the association with other drugs. Recent studies demonstrated the antitumoral effect of the avermectins when associated to the vincristine in the treatment of some neoplasms. Therefore, the objective of the present study was to compare the effectiveness of standard treatment of TVT with vincristine only when compared to combined treatment with vincristine and ivermectin, evaluated through number of applications of the two protocols, histopathological and cytological analysis from 50 dogs diagnosed with TVT during the period of 2007 to 2010. The combined protocol significant reduced the number of applications and cytological and histopathological findings collaborate with the hypothesis that the combination of vincristine and ivermectin promotes faster healing than the use of vincristine alone. Combination treatment with vincristine and ivermectin could be in the future an excellent therapeutic alternative for the treatment of TVT for probably reducing the resistance to vincristine, simultaneously reducing the cost of TVT treatment and promoting a faster recovery of the dog.

  8. Applying radiobiological principles to combined modality treatment of head and neck cancer--the time factor

    International Nuclear Information System (INIS)

    Peters, Lester J.; Withers, H. Rodney

    1997-01-01

    Purpose: Combined modality treatment is indicated for most advanced stage head and neck cancers. It is postulated that the efficacy of combined modality regimens could be enhanced by applying principles derived from radiotherapy fractionation studies to optimize the time factor in treatment scheduling. Methods and Materials: The premise that tumor clonogens surviving a therapeutic intervention undergo accelerated repopulation in a time-dependent fashion as their numbers are depleted is used as a model to interpret the results of various chemoradiotherapy and postsurgical radiotherapy protocols and to suggest ways in which future combined modality regimens can be more rationally designed. Results: Meta-analyses of chemoradiotherapy trials show the general superiority of concomitant vs. neoadjuvant sequential protocols. There is also emerging evidence that both the duration of postoperative radiotherapy and the delay in its instigation affect treatment outcome. These results are compatible with the hypothesis that the overall duration of the 'package deal' of combined modality treatment is an important determinant of outcome. However, a large decrease in duration of the 'package deal' does not necessarily translate into a therapeutic gain because the total dose has to be lowered to prevent intolerable acute reactions. In these circumstances tumor control will improve only if the reduced treatment time circumvents more tumor cell regeneration than the cytoreduction that could be achieved by the extra dose tolerable in a longer time period. More modest reductions in treatment time can be accomplished without dose reduction and so avoid this risk. The design of new protocols should take account of the fact that regeneration of tumor clonogens can be predicted to be nonuniform with time. Thus, the greatest therapeutic gain should be achieved by targeting periods of maximal regenerative capacity for shortening or, alternatively, for intensification of treatment. These

  9. Protocol updated for the treatment of patients in radiotherapy with implanted cardiac devices

    International Nuclear Information System (INIS)

    Martin Martin, G.; Bermudez Luna, R.; Rodriguez Rodriguez, C.; Lopez Fernandez, A.; Rodriguez Perez, A.; Sotoca Ruiz, A.

    2013-01-01

    Radiotherapy treatment can be safely performed in patients with pacemakers or implanted defibrillators, however, it is very important to ensure that the patient receives the minimum dose possible in your heart device. Is considered essential good coordination with the cardiology service before, during and after radiotherapy treatment for the patient safety. Finally we present a protocol updated to treat these patients in radiotherapy. (Author)

  10. Ramsey waits: allocating public health service resources when there is rationing by waiting.

    Science.gov (United States)

    Gravelle, Hugh; Siciliani, Luigi

    2008-09-01

    The optimal allocation of a public health care budget across treatments must take account of the way in which care is rationed within treatments since this will affect their marginal value. We investigate the optimal allocation rules for public health care systems where user charges are fixed and care is rationed by waiting. The optimal waiting time is higher for treatments with demands more elastic to waiting time, higher costs, lower charges, smaller marginal welfare loss from waiting by treated patients, and smaller marginal welfare losses from under-consumption of care. The results hold for a wide range of welfarist and non-welfarist objective functions and for systems in which there is also a private health care sector. They imply that allocation rules based purely on cost effectiveness ratios are suboptimal because they assume that there is no rationing within treatments.

  11. Inaugurating Rationalization: Three Field Studies Find Increased Rationalization When Anticipated Realities Become Current.

    Science.gov (United States)

    Laurin, Kristin

    2018-04-01

    People will often rationalize the status quo, reconstruing it in an exaggeratedly positive light. They will even rationalize the status quo they anticipate, emphasizing the upsides and minimizing the downsides of sociopolitical realities they expect to take effect. Drawing on recent findings on the psychological triggers of rationalization, I present results from three field studies, one of which was preregistered, testing the hypothesis that an anticipated reality becoming current triggers an observable boost in people's rationalizations. San Franciscans rationalized a ban on plastic water bottles, Ontarians rationalized a targeted smoking ban, and Americans rationalized the presidency of Donald Trump, more in the days immediately after these realities became current compared with the days immediately before. Additional findings show evidence for a mechanism underlying these behaviors and rule out alternative accounts. These findings carry implications for scholarship on rationalization, for understanding protest behavior, and for policymakers.

  12. Economic comparison of common treatment protocols and J5 vaccination for clinical mastitis in dairy herds using optimized culling decisions.

    Science.gov (United States)

    Kessels, J A; Cha, E; Johnson, S K; Welcome, F L; Kristensen, A R; Gröhn, Y T

    2016-05-01

    This study used an existing dynamic optimization model to compare costs of common treatment protocols and J5 vaccination for clinical mastitis in US dairy herds. Clinical mastitis is an infection of the mammary gland causing major economic losses in dairy herds due to reduced milk production, reduced conception, and increased risk of mortality and culling for infected cows. Treatment protocols were developed to reflect common practices in dairy herds. These included targeted therapy following pathogen identification, and therapy without pathogen identification using a broad-spectrum antimicrobial or treating with the cheapest treatment option. The cost-benefit of J5 vaccination was also estimated. Effects of treatment were accounted for as changes in treatment costs, milk loss due to mastitis, milk discarded due to treatment, and mortality. Following ineffective treatments, secondary decisions included extending the current treatment, alternative treatment, discontinuing treatment, and pathogen identification followed by recommended treatment. Average net returns for treatment protocols and vaccination were generated using an existing dynamic programming model. This model incorporates cow and pathogen characteristics to optimize management decisions to treat, inseminate, or cull cows. Of the treatment protocols where 100% of cows received recommended treatment, pathogen-specific identification followed by recommended therapy yielded the highest average net returns per cow per year. Out of all treatment scenarios, the highest net returns were achieved with selecting the cheapest treatment option and discontinuing treatment, or alternate treatment with a similar spectrum therapy; however, this may not account for the full consequences of giving nonrecommended therapies to cows with clinical mastitis. Vaccination increased average net returns in all scenarios. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  13. Realization theory for rational systems: Minimal rational realizations

    NARCIS (Netherlands)

    J. Nemcová (Jana); J.H. van Schuppen (Jan)

    2010-01-01

    htmlabstractThe study of realizations of response maps is a topic of control and system theory. Realization theory is used in system identification and control synthesis. A minimal rational realization of a given response map p is a rational realization of p such that the dimension of its state

  14. Dosimetry study on the conventional and three dimensional conformal radiation treatment planning protocols for rectal cancer

    International Nuclear Information System (INIS)

    Cai Yong; He Yuxiang; Han Shukui; Wu Hao; Gong Jian; Xu Bo

    2007-01-01

    Objective: To compare the dose distribution of clinical target volume (CTV), in normal tissues and organs for patients with rectal cancer on the conventional radiotherapy (2D) and three dimension- al conformal radiation treatment (3DCRT). Methods: The CT image data of 36 rectal cancer patients treated with 3DCRT were studied. The CTV, small bowel, colon, bladder, pelvic bone marrow, and femoral head and neck were contoured on consecutive axial slices of CT images. Two 3DCRT and three conventional treatment planning protocols were simulated using three dimensional treatment planning system (CMS Focus 2.31), were defined as 3D-3, 3D-4, 2D-2, 2D-3, 2D-4. The difference of five treatment planning protocols on the CTV and normal structure by analysis of dose-volume histograms (DVHs) were compared. Results: The D 95 and V 95 of these five protocols all exceeded 97%. The conformity index(CI) of 3D was obviously larger than that of 2D protocol. The dose inhomogeneity(DI) in 4 DCRT was less than that of 3 DCRT. The 3D as compared with the 2D, significantly reduced the mean dose of 45 Gy to the small bowel and colon. The 3D-3 as compared with the 2D-3, the 3D-4 as compared with the 2D-4, the mean dose of small bowel and colon was reduced by 28.5% and 25.7%, respectively. The 3D-3 as compared with the 2D-2, the 3D-3 as compared with the 2D-3 and the 3D4 as compared with the 2D-4, the percentage volume of small bowel and colon which received 45 Gy was reduced by 80.8% , 51.1% and 54.7% , respectively. Either the mean dose, or the percentage volume receiving 35 Gy and 45 Gy to the pelvic bone and bladder, the 3D planning protocols had advanage over the 2D planning protocols. The V 45 of bladder in 2D-2 planning proto- col was the highest in all planning protocols, exceeding 98%, but the highest V 45 of bladder was only 50% in the other planning protocols. Conclusions: Even though the difference in pelvic CTV of rectal cancer patients between the conventional radiotherapy and 3

  15. Many faces of rationality: Implications of the great rationality debate for clinical decision‐making

    Science.gov (United States)

    Elqayam, Shira

    2017-01-01

    Abstract Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings from The Great Rationality Debate from the fields of philosophy, economics, and psychology, we identify core ingredients of rationality commonly encountered across various theoretical models. Rationality is typically classified under umbrella of normative (addressing the question how people “should” or “ought to” make their decisions) and descriptive theories of decision‐making (which portray how people actually make their decisions). Normative theories of rational thought of relevance to medicine include epistemic theories that direct practice of evidence‐based medicine and expected utility theory, which provides the basis for widely used clinical decision analyses. Descriptive theories of rationality of direct relevance to medical decision‐making include bounded rationality, argumentative theory of reasoning, adaptive rationality, dual processing model of rationality, regret‐based rationality, pragmatic/substantive rationality, and meta‐rationality. For the first time, we provide a review of wide range of theories and models of rationality. We showed that what is “rational” behaviour under one rationality theory may be irrational under the other theory. We also showed that context is of paramount importance to rationality and that no one model of rationality can possibly fit all contexts. We suggest that in context‐poor situations, such as policy decision‐making, normative theories based on expected utility informed by best research evidence may provide the optimal approach to medical decision

  16. A "Mindful Rational Living" Approach for Addressing HIV in the School Setting

    Science.gov (United States)

    Chenneville, Tiffany; St. John Walsh, Audra

    2016-01-01

    This paper describes a "mindful rational living" approach, which incorporates mindfulness techniques with rational emotive behavioral therapy strategies for addressing HIV in the school setting. The utility of this approach for attending to the physical, mental, and psychosocial aspects of school-based HIV prevention and treatment will…

  17. The cost-effectiveness of an intensive treatment protocol for severe dyslexia in children.

    Science.gov (United States)

    Hakkaart-van Roijen, Leona; Goettsch, Wim G; Ekkebus, Michel; Gerretsen, Patty; Stolk, Elly A

    2011-08-01

    Studies of interventions for dyslexia have focused entirely on outcomes related to literacy. In this study, we considered a broader picture assessing improved quality of life compared with costs. A model served as a tool to compare costs and effects of treatment according to a new protocol and care as usual. Quality of life was measured and valued by proxies using a general quality-of-life instrument (EQ-5D). We considered medical cost and non-medical cost (e.g. remedial teaching). The model computed cost per successful treatment and cost per quality adjusted life year (QALY) in time. About 75% of the total costs was related to diagnostic tests to distinguish between children with severe dyslexia and children who have reading difficulties for other reasons. The costs per successful treatment of severe dyslexia were €36 366. Successful treatment showed a quality-of-life gain of about 11%. At primary school, the average cost per QALY for severe dyslexia amounted to €58 647. In the long term, the cost per QALY decreased to €26 386 at secondary school and €17 663 thereafter. The results of this study provide evidence that treatment of severe dyslexia is cost-effective when the investigated protocol is followed. Copyright © 2011 John Wiley & Sons, Ltd.

  18. Many faces of rationality: Implications of the great rationality debate for clinical decision-making.

    Science.gov (United States)

    Djulbegovic, Benjamin; Elqayam, Shira

    2017-10-01

    Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings from The Great Rationality Debate from the fields of philosophy, economics, and psychology, we identify core ingredients of rationality commonly encountered across various theoretical models. Rationality is typically classified under umbrella of normative (addressing the question how people "should" or "ought to" make their decisions) and descriptive theories of decision-making (which portray how people actually make their decisions). Normative theories of rational thought of relevance to medicine include epistemic theories that direct practice of evidence-based medicine and expected utility theory, which provides the basis for widely used clinical decision analyses. Descriptive theories of rationality of direct relevance to medical decision-making include bounded rationality, argumentative theory of reasoning, adaptive rationality, dual processing model of rationality, regret-based rationality, pragmatic/substantive rationality, and meta-rationality. For the first time, we provide a review of wide range of theories and models of rationality. We showed that what is "rational" behaviour under one rationality theory may be irrational under the other theory. We also showed that context is of paramount importance to rationality and that no one model of rationality can possibly fit all contexts. We suggest that in context-poor situations, such as policy decision-making, normative theories based on expected utility informed by best research evidence may provide the optimal approach to medical decision-making, whereas in the context

  19. Rational management of epilepsy.

    Science.gov (United States)

    Viswanathan, Venkataraman

    2014-09-01

    Management of epilepsies in children has improved considerably over the last decade, all over the world due to the advances seen in the understanding of the patho-physiology of epileptogenesis, availability of both structural and functional imaging studies along with better quality EEG/video-EEG recordings and the availability of a plethora of newer anti-epileptic drugs which are tailormade to act on specific pathways. In spite of this, there is still a long way to go before one is able to be absolutely rational about which drug to use for which type of epilepsy. There have been a lot of advances in the area of epilepsy surgery and is certainly gaining ground for specific cases. Better understanding of the genetic basis of epilepsies will hopefully lead to a more rational treatment plan in the future. Also, a lot of work needs to be done to dispel various misunderstandings and myths about epilepsy which still exists in our country.

  20. Effectiveness of oxaliplatin desensitization protocols.

    Science.gov (United States)

    Cortijo-Cascajares, Susana; Nacle-López, Inmaculada; García-Escobar, Ignacio; Aguilella-Vizcaíno, María José; Herreros-de-Tejada, Alberto; Cortés-Funes Castro, Hernán; Calleja-Hernández, Miguel-Ángel

    2013-03-01

    Hypersensitivity reaction (HSR) to antineoplastic drugs can force doctors to stop treatment and seek other alternatives. These alternatives may be less effective, not as well tolerated and/or more expensive. Another option is to use desensitization protocols that induce a temporary state of tolerance by gradually administering small quantities of the antineoplastic drug until the therapeutic dosage is reached. The aim of this study is to assess the effectiveness of oxaliplatin desensitization protocols. A retrospective observational study was carried out between January 2006 and May 2011. The inclusion criteria were patients undergoing chemotherapy treatment with oxaliplatin who had developed an HSR to the drug and who were candidates for continuing the treatment using a desensitization protocol. The patients' clinical records were reviewed and variables were gathered relating to the patient, the treatment, the HSR, and the desensitization protocol administered. The data were analysed using version 18.0 of the statistics program SPSS. A total of 53 desensitization protocols were administered to 21 patients. In 89 % of these cases, no new reactions occurred while the drug was being administered. New reactions of mild severity only occurred in 11 % of cases, and none of these reactions were severe enough for treatment to be stopped. All patients were able to complete the desensitization protocol. This study confirms that oxaliplatin desensitization protocols are safe and effective and allow patients to continue with the treatment that initially caused an HSR.

  1. Comparing Voice-Therapy and Vocal-Hygiene Treatments in Dysphonia Using a Limited Multidimensional Evaluation Protocol

    Science.gov (United States)

    Rodriguez-Parra, Maria J.; Adrian, Jose A.; Casado, Juan C.

    2011-01-01

    Purpose: This study evaluates the effectiveness of two different programs of voice-treatment on a heterogeneous group of dysphonic speakers and the stability of therapeutic progress for longterm follow-up post-treatment period, using a limited multidimensional protocol of evaluation. Method: Forty-two participants with voice disorders were…

  2. Standby Gasoline Rationing Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-06-01

    The final rules adopted by the President for a Standby Gasoline Rationing Plan are presented. The plan provides that eligibility for ration allotments will be determined primarily on the basis of motor vehicle registrations, taking into account historical differences in the use of gasoline among states. The regulations also provide authority for supplemental allotments to firms so that their allotment will equal a specified percentage of gasoline use during a base period. Priority classifications, i.e., agriculture, defense, etc., are established to assure adequate gasoline supplies for designated essential services. Ration rights must be provided by end-users to their suppliers for each gallon sold. DOE will regulate the distribution of gasoline at the wholesale level according to the transfer by suppliers of redeemed ration rights and the gasoline allocation regulations. Ration rights are transferable. A ration banking system is created to facilitate transfers of ration rights. Each state will be provided with a reserve of ration rights to provide for hardship needs and to alleviate inequities. (DC)

  3. Is there an overprescription of proton pump inhibitors in oncohematologic patients undergoing ambulatory oncospecific treatment?

    Directory of Open Access Journals (Sweden)

    Meritxell Pujal Herranz

    2016-09-01

    Full Text Available Objective: The aim of this study is to evaluate the prevalence of proton pump inhibitors (PPIs prescription, and the level of adequacy of the indication of these drugs in oncohematologic patients under ambulatory oncoespecific treatment. Method: An observational descriptive study in oncohematologic patients under ambulatory oncoespecific treatment. A protocol for the rational use of PPI targeted to oncohematologic patients based on the PPI protocol of our hospital was designed. Patients under active treatment with PPIs were quantified and the appropriateness of their indications evaluated. Results: 111 patients (71 oncologic and 40 hematologic were included. 56% of all oncologic patients and 63% of all hematologic patients were under active treatment with PPIs. After reviewing the indications for PPI in all patients, 72% of oncologic and 12% of hematologic patients did not present evidence justifying treatment with these drugs. Conclusion: It is important the pharmacist to detect unappropriated prescriptions of PPIs, especially among oncologic patients, and to promote a deprescription of these drugs

  4. DIRECT PULP CAPPING IN TREATMENT OF REVERSIBLE PULPITIS IN PRIMARY TEETH- CLINICAL PROTOCOL

    Directory of Open Access Journals (Sweden)

    Nina Milcheva

    2016-10-01

    Full Text Available The pulp of primary teeth is identical morphologically and physiologically to that of permanent teeth and it is capable to answer to pathological stimuli by producing tertiary dentin. When the inflammation of the pulp is in its reversible stage vital methods of treatment are indicated in order to stimulate the healing processes in it and protect its vitality. In Bulgaria the most popular method of treatment of inflammation diseases of the pulp in primary dentition is the mortal amputation. The biological way of treatment is not very common even in cases where there are indications for it. Purpose: The aim of this paper is to present the approbated by us protocol for application of direct pulp capping for treatment of reversible pulpitis in primary teeth. Material and methods: On the base of world experience and our contemporary meta- analysis of the researches published in the last 15 years concerning the problems of diagnostics. We determined clinical and radiographic diagnostic criteria for reversible pulpitis in primary teeth and indications for application of direct pulp capping as a method of treatment. We give clinical steps for application of the method and summarized the clinical and radiographic criteria for success after treatment. Results/conclusion: We gather all the information for applying direct pulp cappingfor treatment of reversible pulpitis in primary dentition. We offer the method of direct pulp capping as a clinical protocol “step by step” and illustrated by scheme which can be useful for students and dentists in their everyday practice.

  5. Addressing Viral Hepatitis in People with Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 53

    Science.gov (United States)

    Substance Abuse and Mental Health Services Administration, 2011

    2011-01-01

    Treatment Improvement Protocols (TIPs) are developed by the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (HHS). Each TIP involves the development of topic-specific best-practice guidelines for the prevention and…

  6. Multi-institutional evaluation of end-to-end protocol for IMRT/VMAT treatment chains utilizing conventional linacs.

    Science.gov (United States)

    Loughery, Brian; Knill, Cory; Silverstein, Evan; Zakjevskii, Viatcheslav; Masi, Kathryn; Covington, Elizabeth; Snyder, Karen; Song, Kwang; Snyder, Michael

    2018-03-20

    We conducted a multi-institutional assessment of a recently developed end-to-end monthly quality assurance (QA) protocol for external beam radiation therapy treatment chains. This protocol validates the entire treatment chain against a baseline to detect the presence of complex errors not easily found in standard component-based QA methods. Participating physicists from 3 institutions ran the end-to-end protocol on treatment chains that include Imaging and Radiation Oncology Core (IROC)-credentialed linacs. Results were analyzed in the form of American Association of Physicists in Medicine (AAPM) Task Group (TG)-119 so that they may be referenced by future test participants. Optically stimulated luminescent dosimeter (OSLD), EBT3 radiochromic film, and A1SL ion chamber readings were accumulated across 10 test runs. Confidence limits were calculated to determine where 95% of measurements should fall. From calculated confidence limits, 95% of measurements should be within 5% error for OSLDs, 4% error for ionization chambers, and 4% error for (96% relative gamma pass rate) radiochromic film at 3% agreement/3 mm distance to agreement. Data were separated by institution, model of linac, and treatment protocol (intensity-modulated radiation therapy [IMRT] vs volumetric modulated arc therapy [VMAT]). A total of 97% of OSLDs, 98% of ion chambers, and 93% of films were within the confidence limits; measurements were found outside these limits by a maximum of 4%, consistent despite institutional differences in OSLD reading equipment and radiochromic film calibration techniques. Results from this test may be used by clinics for data comparison. Areas of improvement were identified in the end-to-end protocol that can be implemented in an updated version. The consistency of our data demonstrates the reproducibility and ease-of-use of such tests and suggests a potential role for their use in broad end-to-end QA initiatives. Copyright © 2018 American Association of Medical

  7. Adolescent rationality.

    Science.gov (United States)

    Moshman, David

    2013-01-01

    Adolescents are commonly seen as irrational, a position supported to varying degrees by many developmentalists, who often appeal to recent research on adolescent brains. Careful review of relevant evidence, however, shows that (1) adults are less rational than is generally assumed, (2) adolescents (and adults) are categorically different from children with respect to the attainment of advanced levels of rationality and psychological functioning, and (3) adolescents and adults do not differ categorically from each other with respect to any rational competencies, irrational tendencies, brain structures, or neurological functioning. Development often continues in adolescence and beyond but categorical claims about adolescents as distinct from adults cannot be justified. A review of U.S. Supreme Court decisions concerning intellectual freedom, reproductive freedom, and criminal responsibility shows ongoing ambivalence and confusion about the rationality of adolescents. Developmental theory and research suggest that adolescents should be conceptualized as young adults, not immature brains, with important implications for their roles, rights, and responsibilities.

  8. Mechanistic rationalization of unusual sigmoidal kinetic profiles in the Machetti-De Sarlo cycloaddition reaction.

    Science.gov (United States)

    Mower, Matthew P; Blackmond, Donna G

    2015-02-18

    Unusual sigmoidal kinetic profiles in the Machetti-De Sarlo base-catalyzed 1,3-dipolar cycloaddition of acrylamide to N-methylnitroacetamide are rationalized by detailed in situ kinetic analysis. A dual role is uncovered in which a substrate acts as a precursor to catalyze its own reaction. Such kinetic studies provide a general protocol for distinguishing among different mechanistic origins of induction periods in complex organic reactions.

  9. Love and rationality: on some possible rational effects of love

    Directory of Open Access Journals (Sweden)

    Gustavo Ortiz-Millán

    Full Text Available In this paper I defend the idea that rather than disrupting rationality, as the common-sense conception has done it, love may actually help us to develop rational ways of thinking and acting. I make the case for romantic or erotic love, since this is the kind of love that is more frequently associated with irrationality in acting and thinking. I argue that this kind of love may make us develop epistemic and practical forms of rationality. Based on an analysis of its characteristic action tendencies, I argue that love may help us to develop an instrumental form of rationality in determining the best means to achieve the object of love. It may also narrow down the number of practical considerations that may help us to achieve our goals. Finally, love may generate rational ways of belief-formation by framing the parameters taken into account in perception and attention, and by bringing into light only a small portion of the epistemic information available. Love may make us perceive reality more acutely.

  10. Public and private health-care financing with alternate public rationing rules.

    Science.gov (United States)

    Cuff, Katherine; Hurley, Jeremiah; Mestelman, Stuart; Muller, Andrew; Nuscheler, Robert

    2012-02-01

    We develop a model to analyze parallel public and private health-care financing under two alternative public sector rationing rules: needs-based rationing and random rationing. Individuals vary in income and severity of illness. There is a limited supply of health-care resources used to treat individuals, causing some individuals to go untreated. Insurers (both public and private) must bid to obtain the necessary health-care resources to treat their beneficiaries. Given individuals' willingnesses-to-pay for private insurance are increasing in income, the introduction of private insurance diverts treatment from relatively poor to relatively rich individuals. Further, the impact of introducing parallel private insurance depends on the rationing mechanism in the public sector. We show that the private health insurance market is smaller when the public sector rations according to need than when allocation is random. Copyright © 2010 John Wiley & Sons, Ltd.

  11. CONTRIBUTIONS TO RATIONAL APPROXIMATION,

    Science.gov (United States)

    Some of the key results of linear Chebyshev approximation theory are extended to generalized rational functions. Prominent among these is Haar’s...linear theorem which yields necessary and sufficient conditions for uniqueness. Some new results in the classic field of rational function Chebyshev...Furthermore a Weierstrass type theorem is proven for rational Chebyshev approximation. A characterization theorem for rational trigonometric Chebyshev approximation in terms of sign alternation is developed. (Author)

  12. Rational points, rational curves, and entire holomorphic curves on projective varieties

    CERN Document Server

    Gasbarri, Carlo; Roth, Mike; Tschinkel, Yuri

    2015-01-01

    This volume contains papers from the Short Thematic Program on Rational Points, Rational Curves, and Entire Holomorphic Curves and Algebraic Varieties, held from June 3-28, 2013, at the Centre de Recherches Mathématiques, Université de Montréal, Québec, Canada. The program was dedicated to the study of subtle interconnections between geometric and arithmetic properties of higher-dimensional algebraic varieties. The main areas of the program were, among others, proving density of rational points in Zariski or analytic topology on special varieties, understanding global geometric properties of rationally connected varieties, as well as connections between geometry and algebraic dynamics exploring new geometric techniques in Diophantine approximation.

  13. Implementation of the protocol on treatment of outpatients and hospitalized patients with iodine 131r

    International Nuclear Information System (INIS)

    Mildred De Mendoza, L.

    1996-01-01

    In Nuclear medicine different working protocols are used which are adequate for the treatment of patients with radioactive materials and which at the same time prevent the contamination of the occupationally exposed workers In Guatemala (the implementation of these protocols aims at keeping a records all the personal and centers that make use of iodine 131, improving the quality of diagnostic information; utilizing the necessary amount of radionuclide activity so as to ensure a good diagnosis and effectively utilizing economic resources

  14. Treatment plan in amelogenesis imperfecta: A structured literature review on treatment protocols and dedicating the best possible options

    Directory of Open Access Journals (Sweden)

    Azari A.

    2008-12-01

    Full Text Available "nAmelogenesis imperfecta is an inherited disease that disturbs the formation of the enamel. It occurs as two main categories, hypomineralized and hypoplastic. Both deciduous and permanent teeth are affected, and the disorder may create unaesthetic appearance, dental sensitivity, and severe attrition. In this article through performing a structured literature review, numerous treatment modalities which so far advocated in rehabilitation of amelogenesis imperfecta in adults and children is discussed. The progressive changes on open bite, the problem of bonding during restorative phase of treatment , the rehabilitation difficulties of deciduous as well as permanent teeth is also discussed in detail and finally the interdisciplinary approach for treatment of this disability is demonstrated and some points for decision making in treatment protocols are suggested.

  15. Irrational Rationality of Terrorism

    Directory of Open Access Journals (Sweden)

    Robert Nalbandov

    2013-12-01

    Full Text Available The present article deals with the ontological problem of applying the rational choice frameworks to the study of terrorism. It testing the application of the rational choice to the “old” (before the end of the Cold War and the “new” (after the end of the Cold War terrorisms. It starts with analyzing the fundamentals of rationality and applies it at two levels: the individual (actors and group (collective via two outlooks: tactical (short-term and strategic (long-term. The main argument of the article is that while the “old” terrorism can be explained by the rational choice theory its “new” version represents a substantial departure from rationality.

  16. Lying for Strategic Advantage: Rational and Boundedly Rational Misrepresentation of Intentions

    OpenAIRE

    Crawford, Vincent P.

    2001-01-01

    Starting from Hendricks and McAfee's (2000) example of the Allies' decision to feint at Calais and attack at Normandy on D-Day, this paper models misrepresentation of intentions to competitors or enemies. Allowing for the possibility of bounded strategic rationality and rational players' responses to it yields a sensible account of lying via costless, noiseless messages. In many cases the model has generically unique pure-strategy sequential equilibria, in which rational players exploit bound...

  17. Determinants of Actor Rationality

    DEFF Research Database (Denmark)

    Ellegaard, Chris

    Industrial companies must exercise influence on their suppliers (or supplier actors). Actor rationality is a central theme connected to this management task. In this article, relevant literature is studied with the purpose of shedding light on determinants of actor rationality. Two buyer-supplier...... relations are investigated in a multiple case study, leading to the proposal of various additional factors that determine and shape actor rationality. Moreover a conceptual model of rationality determinants in the buyer-supplier relation is proposed, a model that may help supply managers analyse...

  18. Two Concepts of Rationality

    Directory of Open Access Journals (Sweden)

    Danny Frederick

    2010-02-01

    Full Text Available The dominant tradition in Western philosophy sees rationality as dictating. Thus rationality may require that we believe the best explanation and simple conceptual truths and that we infer in accordance with evident rules of inference. I argue that, given what we know about the growth of knowledge, this authoritarian concept of rationality leads to absurdities and should be abandoned. I then outline a libertarian concept of rationality, derived from Popper, which eschews the dictates and which sees a rational agent as one who questions, criticises, conjectures and experiments. I argue that, while the libertarian approach escapes the absurdities of the authoritarian, it requires two significant developments and an important clarification to be made fully consistent with itself.

  19. Rationality and institutions : an inquiry into the normative implications of rational choice theory

    OpenAIRE

    Engelen, Bart

    2007-01-01

    I aim to analyze in this dissertation what a desirable basic institutional structure looks like from the perspective of rationality. While the main topic is thus normative in nature, I start by clarifying in the first part what the notion of rationality exactly entails. I do so by focusing explicitly on the economic conception of rationality, according to which a rational individual is motivated to serve his self-interest on the basis of cost-benefit calculations. Such a Homo Economicus is ch...

  20. The Dana Farber consortium protocol (DFCP) vs. classic Hyper-CVAD for treatment of acute lymphoblastic leukemia in patients <50 Y. Single institution experience.

    Science.gov (United States)

    Alabdulwahab, Amal S; Elsayed, Hussein G; Sherisher, Mohamed A; Zeeneldin, Ahmed; Alghamdi, Khalofa; Elbjeirami, Wafaa M

    2017-09-01

    The use of intensive pediatric protocols for the treatment of ALL is being extended to older adults. Analysis of the efficacy and toxicity results of pediatric DFCP vs. classic Hyper-CVAD protocol for the treatment of patients with ALL Hyper-CVAD for first line treatment of patients with ALL Hyper-CVAD protocol. CR rate was 90.7% for DFCP vs. 83.7 for Hyper-CVAD (p 0.7). 3 Y Leukemia free survival was 57.4% (70.9% for DFCP vs. 41.6% Hyper-CVAD P 0.1) while 3Y OS was 62.6%% for the whole group, 72.6% DFCP vs. 48.5% Hyper-CVAD, P 0.04. Those with age Hyper-CVAD related to gall stones. Osteonecrosis affected 5 patients on DFCP. pediatric protocols are feasible in patients younger than 50 Y and they are more active than classic adult protocols. Although modifications of adult protocols may improve their results, this had to be investigated in randomized controlled trials. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Rationing medical education.

    African Journals Online (AJOL)

    This paper discussed the pros and cons of the application of rationing to medical education and the different ... Different types of rationing exist in healthcare professional education. ... state-of-the-art resources, technology and tutors con-.

  2. The Cost-Effectiveness of an Intensive Treatment Protocol for Severe Dyslexia in Children

    Science.gov (United States)

    Hakkaart-van Roijen, Leona; Goettsch, Wim G.; Ekkebus, Michel; Gerretsen, Patty; Stolk, Elly A.

    2011-01-01

    Studies of interventions for dyslexia have focused entirely on outcomes related to literacy. In this study, we considered a broader picture assessing improved quality of life compared with costs. A model served as a tool to compare costs and effects of treatment according to a new protocol and care as usual. Quality of life was measured and valued…

  3. Rationality problem for algebraic tori

    CERN Document Server

    Hoshi, Akinari

    2017-01-01

    The authors give the complete stably rational classification of algebraic tori of dimensions 4 and 5 over a field k. In particular, the stably rational classification of norm one tori whose Chevalley modules are of rank 4 and 5 is given. The authors show that there exist exactly 487 (resp. 7, resp. 216) stably rational (resp. not stably but retract rational, resp. not retract rational) algebraic tori of dimension 4, and there exist exactly 3051 (resp. 25, resp. 3003) stably rational (resp. not stably but retract rational, resp. not retract rational) algebraic tori of dimension 5. The authors make a procedure to compute a flabby resolution of a G-lattice effectively by using the computer algebra system GAP. Some algorithms may determine whether the flabby class of a G-lattice is invertible (resp. zero) or not. Using the algorithms, the suthors determine all the flabby and coflabby G-lattices of rank up to 6 and verify that they are stably permutation. The authors also show that the Krull-Schmidt theorem for G-...

  4. The Supplementation of Virgin Coconut Oil (VCO in The Ration To Increase Carcass Weight and Decrease Duck Meat Cholesterol

    Directory of Open Access Journals (Sweden)

    Ni Wayan Siti

    2012-02-01

    Full Text Available An experiment was carried out at Kediri, Tabanan Regency and Animal Nutrition Laboratory to study the effect of the supplementation VCO in the ration to increase carcass weight and decrease duck meat cholesterol. The experiment used a completely randomized design (CRD with five treatments and four replicates. Each of the replicate used five male Balinese ducks with the same weight. The five treatments were diets without VCO as a control (A, ration with 1% VCO (B, ration with 2% VCO (C, ration with 3% VCO (D and ration with 4% VCO (E respectively. Ration and water offered ad libitum. The variables measured were carcass weight, physical carcass composition and meat cholesterol. The result of this experiment showed that the carcass weight, the carcass percentage, the percentage of carcass meat in the B, C, D and E treatments were not significantly (P>0.05 higher than the control, so the percentage of fat carcass subcutan (including skin and carcass bone percentage were not significantly (P>0.05 lower than the control. Triglyceride in treatment 3% VCO in diets (D was significantly (P0.05 higher than the control. The total cholesterol content and LDL in those four treatments were not significantly (P>0.05 lower than the control. From the result of this experiment can be concluded that the supplementation of 1-4% VCO in the ration has not increased to the carcass weight and decreased the duck meat cholesterol.   Keywords : VCO, duck, carcass weight, and  meat cholesterol

  5. Rational Approximations to Rational Models: Alternative Algorithms for Category Learning

    Science.gov (United States)

    Sanborn, Adam N.; Griffiths, Thomas L.; Navarro, Daniel J.

    2010-01-01

    Rational models of cognition typically consider the abstract computational problems posed by the environment, assuming that people are capable of optimally solving those problems. This differs from more traditional formal models of cognition, which focus on the psychological processes responsible for behavior. A basic challenge for rational models…

  6. [Neurofeedback for the treatment of chronic tinnitus : Review and future perspectives].

    Science.gov (United States)

    Kleinjung, T; Thüring, C; Güntensperger, D; Neff, P; Meyer, M

    2018-03-01

    Neurofeedback is a noninvasive neuromodulation technique employing real-time display of brain activity in terms of electroencephalography (EEG) signals to teach self-regulation of distinct patterns of brain activity or influence brain activity in a targeted manner. The benefit of this approach for control of symptoms in attention deficit disorders, hyperactivity, depression, and migraine has been proven. Studies in recent years have also repeatedly shown this treatment to improve tinnitus symptoms, although it has not become established as routine therapy. The primary focus of this review is the rational of EEG neurofeedback for tinnitus treatment and the currently available data from published studies. Furthermore, alternative neurofeedback protocols using real-time functional magnetic resonance imaging (fMRI) measurements for tinnitus control are considered. Finally, this article highlights how modern EEG analysis (source localization, connectivity) and the improving understanding of tinnitus pathology can contribute to development of more focused neurofeedback protocols for more sustainable control of tinnitus.

  7. Successful treatment of methotrexate intolerance in juvenile idiopathic arthritis using eye movement desensitization and reprocessing - treatment protocol and preliminary results.

    Science.gov (United States)

    Höfel, Lea; Eppler, Bruno; Storf, Magdalena; Schnöbel-Müller, Elizabeth; Haas, Johannes-Peter; Hügle, Boris

    2018-02-13

    Methotrexate (MTX), commonly used in juvenile idiopathic arthritis (JIA), frequently has to be discontinued due to intolerance with anticipatory and associative gastrointestinal adverse effects. Eye Movement Desensitization and Reprocessing (EMDR) is a psychological method where dysfunctional experiences and memories are reprocessed by recall combined with bilateral eye movements. The objective of this study was to assess efficacy of EMDR for treatment of MTX intolerance in JIA patients. We performed an open prospective study on consecutive JIA patients with MTX intolerance. Intolerance was determined using the Methotrexate Intolerance Severity Score (MISS) questionnaire prior to treatment, directly after treatment and after four months. Health-related quality of life was determined using the PedsQL prior to and four months after treatment. Patients were treated according to an institutional EMDR protocol with 8 sessions over two weeks. Changes in MISS and PedsQL were analyzed using non-parametric statistics. Eighteen patients with MTX intolerance (median MISS at inclusion 16.5, IQR = 11.75-20.25) were included. Directly after treatment, MTX intolerance symptoms were significantly improved (median MISS 1 (IQR = 0-2). After four months, median MISS score was at 6.5 (IQR = 2.75-12.25, p = 0.001), with 9/18 patients showing MISS scores ≥6. Median PedsQL after 4 months improved significantly from 77.6% to 85.3% (p = 0.008). MTX intolerance in children with JIA was effectively treated using an EMDR protocol, with lasting effect over a period of 4 months. EMDR treatment can potentially increase quality of life of affected patients and enable continued MTX treatment.

  8. Suicide: rationality and responsibility for life.

    Science.gov (United States)

    Ho, Angela Onkay

    2014-03-01

    Death by suicide is widely held as an undesirable outcome. Most Western countries place emphasis on patient autonomy, a concept of controversy in relation to suicide. This paper explores the tensions between patients' rights and many societies' overarching desire to prevent suicide, while clarifying the relations between mental disorders, mental capacity, and rational suicide. A literature search was conducted using search terms of suicide and ethics in the PubMed and LexisNexis Academic databases. Article titles and abstracts were reviewed and deemed relevant if the paper addressed topics of rational suicide, patient autonomy or rights, or responsibility for life. Further articles were found from reference lists and by suggestion from preliminary reviewers of this paper. Suicidal behaviour in a person cannot be reliably predicted, yet various associations and organizations have developed standards of care for managing patients exhibiting suicidal behaviour. The responsibility for preventing suicide tends to be placed on the treating clinician. In cases where a person is capable of making treatment decisions--uninfluenced by any mental disorder--there is growing interest in the concept of rational suicide. There is much debate about whether suicide can ever be rational. Designating suicide as an undesirable event that should never occur raises the debate of who is responsible for one's life and runs the risk of erroneously attributing blame for suicide. While upholding patient rights of autonomy in psychiatric care is laudable, cases of suicidality warrant a delicate consideration of clinical judgment, duty of care, and legal obligations.

  9. Medicine, ethics and religion: rational or irrational?

    Science.gov (United States)

    Orr, R D; Genesen, L B

    1998-12-01

    Savulescu maintains that our paper, which encourages clinicians to honour requests for "inappropriate treatment" is prejudicial to his atheistic beliefs, and therefore wrong. In this paper we clarify and expand on our ideas, and respond to his assertion that medicine, ethics and atheism are objective, rational and true, while religion is irrational and false.

  10. Navigating the poverty of heroin addiction treatment and recovery opportunity in Kenya: access work, self-care and rationed expectations.

    Science.gov (United States)

    Rhodes, Tim; Ndimbii, James; Guise, Andy; Cullen, Lucy; Ayon, Sylvia

    2015-01-01

    Drawing on the analyses of qualitative interview accounts of people who inject heroin in Kenya, we describe the narration of addiction treatment access and recovery desire in conditions characterised by a 'poverty of drug treatment opportunity'. We observe the performance of addiction recovery narrative in the face of heavy social constraints limiting access to care. Fee-based residential rehabilitation ('rehab') is the only treatment locally available and inaccessible to most. Its recovery potential is doubted, given normative expectations of relapse. Treating drug use is a product of tightly bounded agency. Individuals enact strategies to maximise their slim chances of treatment access ('access work'), develop self-care alternatives when these fail to materialise and ration their care expectations. The use of rehab as a primary means of respite and harm reduction rather than recovery and the individuation of care in the absence of an enabling recovery environment are key characteristics of drug treatment experience. The recent incorporation of 'harm reduction' into policy discourses may trouble the primacy of recovery narrative in addiction treatment and in how treatment desires are voiced. The diversification of drug treatments in combination with social interventions enabling their access are fundamental.

  11. Rationing in the NHS: the dance of the seven veils-in reverse.

    Science.gov (United States)

    Klein, R; Day, P; Redmayne, S

    1995-10-01

    The 1991 reforms of the National Health Service set up the expectation that rationing would in future be explicit instead of, as in the past, implicit. This has not happened. Research carried out at the University of Bath shows that very few health authorities are rationing by exclusion on the Oregon model. Instead, both central Government and health authorities are continuing to diffuse responsibility among the medical profession. This paper analyses the reasons why. Rationing by delay and dilution are more significant-as well as less visible-than rationing by exclusion. And it is the medical profession which controls the flow of patients through waiting lists and the way in which resources are used during treatment. Similarly, it is in the self-interest of both central Government and health authorities that their resource decisions should continue to be disguised behind the veils of clinical discretion. Despite pressures for greater transparency, Britain's opaque form of rationing may therefore survive.

  12. A Call for sting treatment protocol: Case report of a 3 year old with ...

    African Journals Online (AJOL)

    Acute Kidney Injury in children following bee sting envenomation is rare and survival is hinged on early recognition and prompt appropriate management. This report is aimed at raising awareness among healthcare workers, of one of the systemic effects of massive bee sting and the need to develop sting treatment protocol.

  13. Exploring rationality in schizophrenia

    DEFF Research Database (Denmark)

    Revsbech, Rasmus; Mortensen, Erik Lykke; Owen, Gareth

    2015-01-01

    Background Empirical studies of rationality (syllogisms) in patients with schizophrenia have obtained different results. One study found that patients reason more logically if the syllogism is presented through an unusual content. Aims To explore syllogism-based rationality in schizophrenia. Meth...... differences became non-significant. Conclusions When taking intelligence and neuropsychological performance into account, patients with schizophrenia and controls perform similarly on syllogism tests of rationality.......Background Empirical studies of rationality (syllogisms) in patients with schizophrenia have obtained different results. One study found that patients reason more logically if the syllogism is presented through an unusual content. Aims To explore syllogism-based rationality in schizophrenia. Method...... Thirty-eight first-admitted patients with schizophrenia and 38 healthy controls solved 29 syllogisms that varied in presentation content (ordinary v. unusual) and validity (valid v. invalid). Statistical tests were made of unadjusted and adjusted group differences in models adjusting for intelligence...

  14. Respect for rational autonomy.

    Science.gov (United States)

    Walker, Rebecca L

    2009-12-01

    The standard notion of autonomy in medical ethics does not require that autonomous choices not be irrational. The paper gives three examples of seemingly irrational patient choices and discusses how a rational autonomy analysis differs from the standard view. It then considers whether a switch to the rational autonomy view would lead to overriding more patient decisions but concludes that this should not be the case. Rather, a determination of whether individual patient decisions are autonomous is much less relevant than usually considered in determining whether health care providers must abide by these decisions. Furthermore, respect for rational autonomy entails strong positive requirements of respect for the autonomy of the person as a rational decision maker. The rationality view of autonomy is conceptually stronger than the standard view, allows for a more nuanced understanding of the practical moral calculus involved in respecting patient autonomy, and promotes positive respect for patient autonomy.

  15. Clinical outcome comparison of immediate blanket treatment versus a delayed pathogen-based treatment protocol for clinical mastitis in a New York dairy herd.

    Science.gov (United States)

    Vasquez, A K; Nydam, D V; Capel, M B; Eicker, S; Virkler, P D

    2017-04-01

    The purpose was to compare immediate intramammary antimicrobial treatment of all cases of clinical mastitis with a selective treatment protocol based on 24-h culture results. The study was conducted at a 3,500-cow commercial farm in New York. Using a randomized design, mild to moderate clinical mastitis cases were assigned to either the blanket therapy or pathogen-based therapy group. Cows in the blanket therapy group received immediate on-label intramammary treatment with ceftiofur hydrochloride for 5 d. Upon receipt of 24 h culture results, cows in the pathogen-based group followed a protocol automatically assigned via Dairy Comp 305 (Valley Agricultural Software, Tulare, CA): Staphylococcus spp., Streptococcus spp., or Enterococcus spp. were administered on-label intramammary treatment with cephapirin sodium for 1 d. Others, including cows with no-growth or gram-negative results, received no treatment. A total of 725 cases of clinical mastitis were observed; 114 cows were not enrolled due to severity. An additional 122 cases did not meet inclusion criteria. Distribution of treatments for the 489 qualifying events was equal between groups (pathogen-based, n = 246; blanket, n = 243). The proportions of cases assigned to the blanket and pathogen-based groups that received intramammary therapy were 100 and 32%, respectively. No significant differences existed between blanket therapy and pathogen-based therapy in days to clinical cure; means were 4.8 and 4.5 d, respectively. The difference in post-event milk production between groups was not statistically significant (blanket therapy = 34.7 kg; pathogen-based = 35.4 kg). No differences were observed in test-day linear scores between groups; least squares means of linear scores was 4.3 for pathogen-based cows and 4.2 for blanket therapy cows. Odds of survival 30 d postenrollment was similar between groups (odds ratio of pathogen-based = 1.6; 95% confidence interval: 0.7-3.7) as was odds of survival to 60 d (odds ratio

  16. Embodying rationality

    OpenAIRE

    Mastrogiorgio, Antonio; Petracca, Enrico

    2016-01-01

    The current notions of bounded rationality in economics share distinctive features with Simon’s original notion, which still influences the theoretical and experimental research in the fields of choice, judgment, decision making, problem solving, and social cognition. All these notions of bounded rationality are in fact equally rooted in the information-processing approach to human cognition, expressing the view that reasoning is disembodied and that it can be reduced to the processing of abs...

  17. Capital Requirements and Credit Rationing

    OpenAIRE

    Itai Agur

    2010-01-01

    This paper analyzes the trade-off between financial stability and credit rationing that arises when increasing capital requirements. It extends the Stiglitz-Weiss model of credit rationing to allow for bank default. Bank capital structure then matters for lending incentives. With default and rationing endogenous, optimal capital requirements can be analyzed. Introducing bank financiers, the paper also shows that uninsured funding raises the sensitivity of rationing to capital requirements. In...

  18. [Rationalization and rationing at the bedside. A normative and empirical status quo analysis].

    Science.gov (United States)

    Strech, D

    2014-02-01

    The topic of bedside rationing is increasingly discussed in Germany. Further need for clarification exists for the question how bedside rationing (e.g., in the area of overcare) can be justified despite coexistent inefficiencies. This paper outlines and analyses the relationship of waste avoidance and rationing from an ethical perspective. Empirical findings regarding the status quo of bedside rationing and rationalization are presented. These normative and empirical explorations will then be further specified regarding opportunities for future physician-driven activities to tackle overuse. The self-government partners in Germany should communicate more explicitly within their communities and to the public how and with which benchmarks they aim to reduce inefficient health care (overuse) in an appropriate manner. Physician-driven activities such as the "Choosing Wisely®" initiative in the USA could provide a first step to raise the awareness for overuse among physicians as well as in the public.

  19. Neurofeedback Treatment and Posttraumatic Stress Disorder: Effectiveness of Neurofeedback on Posttraumatic Stress Disorder and the Optimal Choice of Protocol.

    Science.gov (United States)

    Reiter, Karen; Andersen, Søren Bo; Carlsson, Jessica

    2016-02-01

    Neurofeedback is an alternative, noninvasive approach used in the treatment of a wide range of neuropsychiatric disorders, including posttraumatic stress disorder (PTSD). Many different neurofeedback protocols and methods exist. Likewise, PTSD is a heterogeneous disorder. To review the evidence on effectiveness and preferred protocol when using neurofeedback treatment on PTSD, a systematic search of PubMed, PsychInfo, Embase, and Cochrane databases was undertaken. Five studies were included in this review. Neurofeedback had a statistically significant effect in three studies. Neurobiological changes were reported in three studies. Interpretation of results is, however, limited by differences between the studies and several issues regarding design. The optimistic results presented here qualify neurofeedback as probably efficacious for PTSD treatment.

  20. Clinical benefits of incorporating doxycycline into a canine heartworm treatment protocol.

    Science.gov (United States)

    Nelson, C Thomas; Myrick, Elizabeth S; Nelson, Thomas A

    2017-11-09

    The objective of heartworm treatment is to improve the clinical condition of the patient and to eliminate pre-cardiac, juvenile, and adult worm stages with minimal complications. Pulmonary thromboembolisms are an inevitable consequence of worm death and can result in severe pulmonary reactions and even death of the patient. To minimize these reactions, various treatment protocols involving melarsomine, the only adulticidal drug approved by the US Food and Drug Administrations (FDA), in conjunction with macrocyclic lactone heartworm preventives and glucocorticosteroids have been advocated. The discovery of the bacterial endosymbiont Wolbachia in Dirofilaria immitis has led to several experimental studies examining the effects of administering doxycycline to reduce or eliminate Wolbachia organism. These studies have shown a decrease in gross and microscopic pathology of pulmonary parenchyma in experimental heartworm infections pretreated with doxycycline before melarsomine administration. Electronic medical records from a large veterinary practice in northeast Alabama were searched to identify dogs treated for heartworms with melarsomine from January 2005 through December 2012. The search was refined further to select for dogs that met the following criteria: 1) received two or three doses of ivermectin heartworm preventive prior to melarsomine injections, 2) received one injection of melarsomine followed by two injections 4 to 8 weeks later, and 3) were treated with prednisone following melarsomine injections. The dogs were then divided into those that also were treated with doxycycline 10 mg/kg BID for 4 weeks (Group A, n = 47) and those that did not receive doxycycline (Group B, n = 47). The medical notes of all 94 cases were then reviewed for comments concerning coughing, dyspnea, or hemoptysis in the history, physical exam template, or from telephone conversations with clients the week following each visit. Any dog that died within one year of treatment

  1. Clinical benefits of incorporating doxycycline into a canine heartworm treatment protocol

    Directory of Open Access Journals (Sweden)

    C. Thomas Nelson

    2017-11-01

    Full Text Available Abstract Background The objective of heartworm treatment is to improve the clinical condition of the patient and to eliminate pre-cardiac, juvenile, and adult worm stages with minimal complications. Pulmonary thromboembolisms are an inevitable consequence of worm death and can result in severe pulmonary reactions and even death of the patient. To minimize these reactions, various treatment protocols involving melarsomine, the only adulticidal drug approved by the US Food and Drug Administrations (FDA, in conjunction with macrocyclic lactone heartworm preventives and glucocorticosteroids have been advocated. The discovery of the bacterial endosymbiont Wolbachia in Dirofilaria immitis has led to several experimental studies examining the effects of administering doxycycline to reduce or eliminate Wolbachia organism. These studies have shown a decrease in gross and microscopic pathology of pulmonary parenchyma in experimental heartworm infections pretreated with doxycycline before melarsomine administration. Methods Electronic medical records from a large veterinary practice in northeast Alabama were searched to identify dogs treated for heartworms with melarsomine from January 2005 through December 2012. The search was refined further to select for dogs that met the following criteria: 1 received two or three doses of ivermectin heartworm preventive prior to melarsomine injections, 2 received one injection of melarsomine followed by two injections 4 to 8 weeks later, and 3 were treated with prednisone following melarsomine injections. The dogs were then divided into those that also were treated with doxycycline 10 mg/kg BID for 4 weeks (Group A, n = 47 and those that did not receive doxycycline (Group B, n = 47. The medical notes of all 94 cases were then reviewed for comments concerning coughing, dyspnea, or hemoptysis in the history, physical exam template, or from telephone conversations with clients the week following each visit. Any

  2. Rational BRDF.

    Science.gov (United States)

    Pacanowski, Romain; Salazar Celis, Oliver; Schlick, Christophe; Granier, Xavier; Poulin, Pierre; Cuyt, Annie

    2012-11-01

    Over the last two decades, much effort has been devoted to accurately measuring Bidirectional Reflectance Distribution Functions (BRDFs) of real-world materials and to use efficiently the resulting data for rendering. Because of their large size, it is difficult to use directly measured BRDFs for real-time applications, and fitting the most sophisticated analytical BRDF models is still a complex task. In this paper, we introduce Rational BRDF, a general-purpose and efficient representation for arbitrary BRDFs, based on Rational Functions (RFs). Using an adapted parametrization, we demonstrate how Rational BRDFs offer 1) a more compact and efficient representation using low-degree RFs, 2) an accurate fitting of measured materials with guaranteed control of the residual error, and 3) efficient importance sampling by applying the same fitting process to determine the inverse of the Cumulative Distribution Function (CDF) generated from the BRDF for use in Monte-Carlo rendering.

  3. Treatment of peri-implant diseases: a review of the literature and protocol proposal.

    Science.gov (United States)

    Armas, Joshé; Culshaw, Shauna; Savarrio, Lee

    2013-01-01

    Over 100,000 implants were placed in the UK in 2010. As the numbers of patients with implant-retained prostheses increases, operators are encountering an increasing number of biological implant complications, most commonly peri-implant mucositis and peri-implantitis. The effective management of these complications is crucial to maintain patients' oral health. In particular, in contrast to common periodontal infections, some peri-implant infections may benefit from surgical intervention as a first line approach. This article reviews the literature on the treatment options for peri-implant mucositis and peri-implantitis and proposes a protocol for their treatment.

  4. Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial

    OpenAIRE

    Zarski, Anna-Carlotta; Berking, Matthias; Ebert, David Daniel

    2018-01-01

    Introduction Genito-pelvic pain/penetration disorder (GPPPD) not only adversely affects women’s sexuality and sexual satisfaction but is also associated with a wide range of psychosocial consequences such as reduced quality of life and well-being, mental health comorbidities, and relationship distress. Evidence for effective treatment options is scarce. Aim This article describes the rationale, treatment protocol, and study design for a randomized controlled trial examining the efficacy of an...

  5. Cure Cycle Design Methodology for Fabricating Reactive Resin Matrix Fiber Reinforced Composites: A Protocol for Producing Void-free Quality Laminates

    Science.gov (United States)

    Hou, Tan-Hung

    2014-01-01

    For the fabrication of resin matrix fiber reinforced composite laminates, a workable cure cycle (i.e., temperature and pressure profiles as a function of processing time) is needed and is critical for achieving void-free laminate consolidation. Design of such a cure cycle is not trivial, especially when dealing with reactive matrix resins. An empirical "trial and error" approach has been used as common practice in the composite industry. Such an approach is not only costly, but also ineffective at establishing the optimal processing conditions for a specific resin/fiber composite system. In this report, a rational "processing science" based approach is established, and a universal cure cycle design protocol is proposed. Following this protocol, a workable and optimal cure cycle can be readily and rationally designed for most reactive resin systems in a cost effective way. This design protocol has been validated through experimental studies of several reactive polyimide composites for a wide spectrum of usage that has been documented in the previous publications.

  6. Is It Rational to Assume that Infants Imitate Rationally? A Theoretical Analysis and Critique

    Science.gov (United States)

    Paulus, Markus

    2012-01-01

    It has been suggested that preverbal infants evaluate the efficiency of others' actions (by applying a "principle of rational action") and that they imitate others' actions rationally. The present contribution presents a conceptual analysis of the claim that preverbal infants imitate rationally. It shows that this ability rests on at least three…

  7. Bounded Rationality and Budgeting

    OpenAIRE

    Ibrahim, Mukdad

    2016-01-01

    This article discusses the theory of bounded rationality which had been introduced by Herbert Simon in the 1950s. Simon introduced the notion of bounded rationality stating that while decision-makers strive for rationality, they are limited by the effect of the environment, their information process capacity and by the constraints on their information storage and retrieval capabilities. Moreover, this article tries to specifically blend this notion into budgeting, using the foundations of inc...

  8. First-line treatment of acute lymphoblastic leukemia with pegasparaginase

    Directory of Open Access Journals (Sweden)

    Riccardo Masetti

    2009-07-01

    Full Text Available Riccardo Masetti, Andrea PessionPediatric Oncology and Hematology Unit “Lalla Seràgnoli”, University of Bologna, Bologna, ItalyAbstract: Acute lymphoblastic leukemia (ALL accounts for almost 4000 cases annually in the United States, approximately two thirds of which are in children and adolescents. Treatment results of ALL have improved considerably in the past decade, due to an optimal stratification of patients and a rational use of different antileukemic agents among which L-asparaginase (L-ASNase plays a fundamental role. This drug has been used in pediatric ALL chemotherapy protocols for almost 3 decades. In the 1970s and 1980s a chemically modified form of this enzyme called pegasparaginase (PEG-ASNase was rationally synthesized to decrease immunogenicity of the enzyme and prolong its half-life. The different advantages of PEG-ASNase have been demonstrated in many clinical studies, the last of which underline the utility of this drug in front-line therapy of ALL. In this review, we discuss the pharmacological advantages and clinical potential of PEG-ASNase and its important use in first-line treatment of ALL.Keywords: pegasparaginase, acute, lymphoblastic leukemia, pegylation

  9. RESULTS OF ACUTE LYMPHOBLASTIC LEUKEMIA TREATMENT WITH INTENSIVE CHEMOTHERAPY IN CHILDREN IN ST.-PETERSBURG: RETROSPECTIVE EVALUATION OF TWO VERSIONS OF COALL-92 PROTOCOL

    Directory of Open Access Journals (Sweden)

    E.G. Boichenko

    2011-01-01

    Full Text Available Regardless the success gained in treatment of acute lymphoblastic leukaemia, several problems still remain to be solved, such as: overcoming primary drug resistance and minimizing the amount of relapses as well as decreasing of chemotherapy toxicity without detriment to the final outcome of the treatment. Development of an optimal chemotherapeutical strategy still remains a hot issue. Objective: to evaluate an efficacy of two modifications of German protocol COALL-92 in treatment of ALL in children in St.-Petersburg. Methods: the retrospective analysis of results of treatment in patients under 18 years old with ALL was performed. The diagnosis was confirmed according to international criteria. The treatment was performed via protocols PECO-92 and COALL-St.-Petersburg-92. Results: 438 initial patients with ALL were treated in St.-Petersburg clinics during the period from 01.01.1993 to 01.01.2007. At the time of analysis the probability of event-free survival (pEFS was 60% in group of PECO-92 protocol and 70% — in COALL group (plog-rank = 0,048, probability of relapse-free survival (рRFS was 65 and 74% (plog-rank = 0,002, probability of overall survival was (pOS 78 and 70%, correspondingly (plog-rank = 0,079. Conclusion: inclusion of protocol treatment in practice of St.-Petersburg hospitals resulted in significant improvement of treatment results in children with ALL. The problem of both versions of COALL protocol is high rate of postremission mortality due to high toxicity of intensive stage if chemotherapy.Key words: children, acute lymphoblastic leukemia, intensive chemotherapy.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3: 33–42

  10. Rational valuations

    Directory of Open Access Journals (Sweden)

    Georg Spielthenner

    2007-01-01

    Full Text Available Valuations are ubiquitous. We may be for or against genetically modified food; we find some politicians irresponsible; we prefer Beethoven to rock ‘n’ roll or vice versa; some enjoy bird-watching while others find it boring; and we may think that we have to tighten up on green-house gas emissions. Valuing is pervasive and often we are not even aware that we are valuing. However, many of ourvaluations are ill grounded and rationally defective. They are frequently based on misinformation, sloppy thinking, prejudice, and are biased in many ways as psychological research shows. For this reason there is widespread agreement among phi-losophers that we need an account of substantive valuational rationality, both for the theory of practical reasoning and for ethics as well. My main objectin this paper is to outline such an account and to present a principle that allows a non-technical rational criticism of valuations

  11. Rational emotions.

    Science.gov (United States)

    Meshulam, Meir; Winter, Eyal; Ben-Shakhar, Gershon; Aharon, Itzhak

    2012-01-01

    We present here the concept of rational emotions: Emotions may be directly controlled and utilized in a conscious, analytic fashion, enabling an individual to size up a situation, to determine that a certain "mental state" is strategically advantageous and adjust accordingly. Building on the growing body of literature recognizing the vital role of emotions in determining decisions, we explore the complementary role of rational choice in choosing emotional states. Participants played the role of "recipient" in the dictator game, in which an anonymous "dictator" decides how to split an amount of money between himself and the recipient. A subset of recipients was given a monetary incentive to be angry at low-split offers. That subset demonstrated increased physiological arousal at low offers relative to high offers as well as more anger than other participants. These results provide a fresh outlook on human decision-making and contribute to the continuing effort to build more complete models of rational behavior.

  12. Models for Rational Number Bases

    Science.gov (United States)

    Pedersen, Jean J.; Armbruster, Frank O.

    1975-01-01

    This article extends number bases to negative integers, then to positive rationals and finally to negative rationals. Methods and rules for operations in positive and negative rational bases greater than one or less than negative one are summarized in tables. Sample problems are explained and illustrated. (KM)

  13. Update on the principles and novel local and systemic therapies for the treatment of non-infectious uveitis.

    Science.gov (United States)

    Gallego-Pinazo, Roberto; Dolz-Marco, Rosa; Martínez-Castillo, Sebastián; Arévalo, J Fernando; Díaz-Llopis, Manuel

    2013-02-01

    Ocular inflammatory disorders constitute a sight-threatening group of diseases that might be managed according to their severity. Their treatment guidelines experience constant changes with new agents that improve the results obtained with former drugs. Nowadays we can make use of a five step protocol in which topical, periocular and systemic corticosteroids remain as the main therapy for non-infectious uveitis. In addition, immunosuppresive drugs can be added in order to enhance the anti-inflammatory effects and to play the role of corticosteroid-sparing agents. These can be organized in four other steps: cyclosporine and methotrexate in a second one; azathioprine, mycophenolate and tacrolimus in a third step; biological anti-TNF drugs in fourth position; and a last one with cyclophosphamide and chlorambucil. In the present review we go through the main characteristics and complications of all these treatments and make a rational of this five-step treatment protocol for non-infectious posterior uveitis.

  14. Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial

    OpenAIRE

    Anna-Carlotta Zarski; Anna-Carlotta Zarski; Matthias Berking; David Daniel Ebert

    2018-01-01

    IntroductionGenito-pelvic pain/penetration disorder (GPPPD) not only adversely affects women’s sexuality and sexual satisfaction but is also associated with a wide range of psychosocial consequences such as reduced quality of life and well-being, mental health comorbidities, and relationship distress. Evidence for effective treatment options is scarce.AimThis article describes the rationale, treatment protocol, and study design for a randomized controlled trial examining the efficacy of an In...

  15. Are security analysts rational? a literature review

    OpenAIRE

    Peixinho, Rúben; Coelho, Luís; Taffler, Richard J.

    2005-01-01

    Rational choice theory and bounded rationality constitute the basis for the discussion in several areas regarding human rationality. In finance, this discussion has been made between traditional finance and behavioural finance approach, which have different perspectives concerning market agents’ rationality. This paper reviews several studies addressing rationality among security analysts. The analysis shows that analysts’systematic optimism seems to be inconsistent with rationality....

  16. Effects of forage ensiling and ration fermentation on total mixed ration pH, ruminal fermentation and performance of growing Holstein-Zebu cross steers.

    Science.gov (United States)

    Meenongyai, Watcharawit; Pattarajinda, Virote; Stelzleni, Alexander M; Sethakul, Jutarat; Duangjinda, Monchai

    2017-09-01

    Our objective was to determine the effect of forage ensiling and ration fermentation on total mixed ration pH, ruminal fermentation and animal performance. Thirty Holstein-Zebu cross steers were allotted to feeding treatments for 188 days in a randomized complete block design including: fresh grass-total mixed ration (GTMR; pH 4.7), grass silage-TMR (STMR; pH 4.0) and fermented-TMR (FTMR; pH 3.5). Average daily gain for STMR was greatest during the first 3 months period; however, that for FTMR tended to be greater than GTMR during the second 3 months period (P ruminal NH 3 -N content than STMR. Total volatile fatty acids post-feeding was greatest for GTMR (P Ruminal proportions of acetic and butyric acids were greater for FTMR than GTMR (P ruminal pH. STMR and FTMRs can be used to maintain performance of growing crossbred Holstein steers. © 2017 Japanese Society of Animal Science.

  17. Protocol for the specialist supervised individualised multifactorial treatment of new clinically diagnosed type 2 diabetes in general practice (IDA)

    DEFF Research Database (Denmark)

    Stidsen, Jacob Volmer; Nielsen, Jens Steen; Henriksen, Jan Erik

    2017-01-01

    INTRODUCTION: We present the protocol for a multifactorial intervention study designed to test whether individualised treatment, based on pathophysiological phenotyping and individualised treatment goals, improves type 2 diabetes (T2D) outcomes. METHODS AND ANALYSIS: We will conduct a prospective...

  18. Efficiency of modified therapeutic protocol in the treatment of some varieties of canine cardiovascular dirofilariasis

    Directory of Open Access Journals (Sweden)

    Stepanović

    2015-12-01

    Full Text Available The paper presents clinical diagnostic approaches and therapeutic effects of a specific protocol for the treatment of dogs with cardiovascular dirofilariasis in the Belgrade City (Serbia territory. The study involved 50 privately owned dogs of different breeds, gender, and age, all showing signs of cardio - respiratory disorders. In addition to a general physical examination, blood tests were done to detect microfilaria and adult forms, and X-ray, ECG, and echocardiography were performed as well. At the first examination, 34 out of 50 examined dogs were positive for microfilaria and adult forms. Because of a lack of drug used as „the golden standard“ in dirofilariasis treatment, it involved a combination of doxycycline (10 mg/kg and ivermectin (6 μg/kg supported with Advocate - Bayer spot-on. After six months, the first control was performed while continuing treatment with the aforesaid protocol, and the second control was performed after 12 months. Of the 34 treated dogs, all were negative for microfilaria, as early as after the first six months of the treatment (100%. One dog was positive for adult forms of the parasite after six and 12 months. In echocardiography and X-ray examination after 12 months, six dogs showed evident chronic changes. At controls conducted at sixth month and at one year, the implemented therapy was successful in 97.05% (33/34 of primarily infected dogs.

  19. Limited rationality and strategic interaction

    DEFF Research Database (Denmark)

    Fehr, Ernst; Tyran, Jean-Robert

    2008-01-01

    Much evidence suggests that people are heterogeneous with regard to their abilities to make rational, forward-looking decisions. This raises the question as to when the rational types are decisive for aggregate outcomes and when the boundedly rational types shape aggregate results. We examine...... this question in the context of a long-standing and important economic problem: the adjustment of nominal prices after an anticipated monetary shock. Our experiments suggest that two types of bounded rationality-money illusion and anchoring-are important behavioral forces behind nominal inertia. However......, depending on the strategic environment, bounded rationality has vastly different effects on aggregate price adjustment. If agents' actions are strategic substitutes, adjustment to the new equilibrium is extremely quick, whereas under strategic complementarity, adjustment is both very slow and associated...

  20. [Theoretical and practical considerations in rational polytherapy for epilepsy].

    Science.gov (United States)

    Rajna, Péter

    2011-11-30

    Author analyses the consideration of rational polytherapy for epilepsy. Among the theoretical aspects he points the different effect of seizure inhibitory drugs on the epilepsy models but didn't find data enough for the basis of any successful combination. Combinations of compounds having different way of action are more promising. Rational polytherapy can serve also the epileptic patients' tailored therapy in the daily routine. There have already been some proved synergisms concerning drug interactions. Based on detailed analysis of side effects a possibility occurs for neutralization of side effects when anticonvulsants with side effects of opposite nature are combined. Considering both the side effect profiles and the different (somatic and psychic) habits of the patients we can create a special list of favourable combinations. Co-morbid states and their treatments play a significant role in the application of rational polytherapy. Combination of anticonvulsants of lower potential but without drug-interactions can be the choice in these cases. The non-epileptic indications of the anticonvulsants can also be utilized in polymorbid patients. Based on the theoretical and practical considerations the author defines the ten-step-cognitive-preparation-process in planning the optimal (poly)therapy. On speculative basis he suggests eight beneficial versions of seizure inhibitory rational polytherapy.

  1. Interpolation of rational matrix functions

    CERN Document Server

    Ball, Joseph A; Rodman, Leiba

    1990-01-01

    This book aims to present the theory of interpolation for rational matrix functions as a recently matured independent mathematical subject with its own problems, methods and applications. The authors decided to start working on this book during the regional CBMS conference in Lincoln, Nebraska organized by F. Gilfeather and D. Larson. The principal lecturer, J. William Helton, presented ten lectures on operator and systems theory and the interplay between them. The conference was very stimulating and helped us to decide that the time was ripe for a book on interpolation for matrix valued functions (both rational and non-rational). When the work started and the first partial draft of the book was ready it became clear that the topic is vast and that the rational case by itself with its applications is already enough material for an interesting book. In the process of writing the book, methods for the rational case were developed and refined. As a result we are now able to present the rational case as an indepe...

  2. Effects of a screening and treatment protocol with haloperidol on post-cardiotomy delirium

    DEFF Research Database (Denmark)

    Schrøder Pedersen, Sofie; Kirkegaard, Thomas; Balslev Jørgensen, Martin

    2014-01-01

    OBJECTIVES: Post-cardiotomy delirium is common and associated with increased morbidity and mortality. No gold standard exists for detecting delirium, and evidence to support the choice of treatment is needed. Haloperidol is widely used for treating delirium, but indication, doses and therapeutic...... targets vary. Moreover, doubt has been raised regarding overall efficacy. The purpose of this study was to assess the effect of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium, with the hypothesis that the proportion of delirium- and coma-free days...... could be increased. Length of stay (LOS), complications and 180-day mortality are reported. METHODS: Prospective interventional cohort study. One hundred and seventeen adult patients undergoing cardiac surgery were included before introduction of a screening and treatment protocol with haloperidol...

  3. History of Economic Rationalities

    DEFF Research Database (Denmark)

    This book concentrates upon how economic rationalities have been embedded into particular historical practices, cultures, and moral systems. Through multiple case-studies, situated in different historical contexts of the modern West, the book shows that the development of economic rationalities...... takes place in the meeting with other regimes of thought, values, and moral discourses. The book offers new and refreshing insights, ranging from the development of early economic thinking to economic aspects and concepts in the works of classical thinkers such as Thomas Hobbes, John Locke and Karl Marx......, to the role of economic reasoning in contemporary policies of art and health care. With economic rationalities as the read thread, the reader is offered a unique chance of historical self-awareness and recollection of how economic rationality became the powerful ideological and moral force that it is today....

  4. Production and Energy Partition of Lactating Dairy Goats Fed Rations Containing Date Fruit Waste

    Directory of Open Access Journals (Sweden)

    E. Yuniarti

    2016-04-01

    Full Text Available Dates fruit waste (DFW is a by-product of dates juice industry that contains high energy. So, it is suitable for an energy source in dairy goat ration. This study was conducted to observe the effect of DFW utilization in the ration on energy partition and productivity of lactating dairy goats. The experimental design was randomized block design using 9 primiparous lactating dairy goats. There were three types of ration as treatments used in this study, i.e. R0= 35% forage + 65% concentrate, R1= 35% forage + 55% concentrate + 10% DFW, and R2= 35% forage + 45% concentrate + 20% DFW. Data were analyzed using ANOVA and polynomial orthogonal test. The evaluated variables were dry matter intake (DMI, energy partition including energy intake, digestible and metabolizable energy, fecal and urine energy, energy in methane gas, and energy in milk, milk production and quality. The results showed that the linear decreased of DMI, energy intake, digestible energy, metabolizable energy, and urine energy with the increased of DFW level in the rations. The use of 10% DFW (R1 showed the lowest energy loss through feces and methane gas of all treatments about 1089.57 kcal/head/d and 2.36 kcal/head/d, respectively. The use of DFW did not affect energy retention in milk. The utilization of DFW in ration did not significantly prevent the decline of milk production and milk quality. It can be concluded that DFW can be used as an alternative feed for the lactating dairy goat up to 10% in the ration.

  5. Segmented arch or continuous arch technique? A rational approach

    Directory of Open Access Journals (Sweden)

    Sergei Godeiro Fernandes Rabelo Caldas

    2014-04-01

    Full Text Available This study aims at revising the biomechanical principles of the segmented archwire technique as well as describing the clinical conditions in which the rational use of scientific biomechanics is essential to optimize orthodontic treatment and reduce the side effects produced by the straight wire technique.

  6. [Multidisciplinary protocol for computed tomography imaging and angiographic embolization of splenic injury due to trauma: assessment of pre-protocol and post-protocol outcomes].

    Science.gov (United States)

    Koo, M; Sabaté, A; Magalló, P; García, M A; Domínguez, J; de Lama, M E; López, S

    2011-11-01

    To assess conservative treatment of splenic injury due to trauma, following a protocol for computed tomography (CT) and angiographic embolization. To quantify the predictive value of CT for detecting bleeding and need for embolization. The care protocol developed by the multidisciplinary team consisted of angiography with embolization of lesions revealed by contrast extravasation under CT as well as embolization of grade III-V injuries observed, or grade I-II injuries causing hemodynamic instability and/or need for blood transfusion. We collected data on demographic variables, injury severity score (ISS), angiographic findings, and injuries revealed by CT. Pre-protocol and post-protocol outcomes were compared. The sensitivity and specificity of CT findings were calculated for all patients who required angiographic embolization. Forty-four and 30 angiographies were performed in the pre- and post-protocol periods, respectively. The mean (SD) ISSs in the two periods were 25 (11) and 26 (12), respectively. A total of 24 (54%) embolizations were performed in the pre-protocol period and 28 (98%) after implementation of the protocol. Two and 7 embolizations involved the spleen in the 2 periods, respectively; abdominal laparotomies numbered 32 and 25, respectively, and 10 (31%) vs 4 (16%) splenectomies were performed. The specificity and sensitivity values for contrast extravasation found on CT and followed by embolization were 77.7% and 79.5%. The implementation of this multidisciplinary protocol using CT imaging and angiographic embolization led to a decrease in the number of splenectomies. The protocol allows us to take a more conservative treatment approach.

  7. Psychology and the Rationality of Emotion.

    Science.gov (United States)

    Clore, Gerald L

    2011-04-01

    Questions addressed by recent psychological research on emotion include questions about how thought shapes emotion and how emotion, in turn, shapes thought. Research on emotion and cognition paints a somewhat different picture than that seen in traditional discussions of passion and reason. This article reviews several aspects of this research, concentrating specifically on three views of rationality: Rationality as Process, Rationality as Product, and Rationality as Outcome.

  8. Psychology and the Rationality of Emotion*

    OpenAIRE

    Clore, Gerald L.

    2011-01-01

    Questions addressed by recent psychological research on emotion include questions about how thought shapes emotion and how emotion, in turn, shapes thought. Research on emotion and cognition paints a somewhat different picture than that seen in traditional discussions of passion and reason. This article reviews several aspects of this research, concentrating specifically on three views of rationality: Rationality as Process, Rationality as Product, and Rationality as Outcome.

  9. Evaluation of the relationship between compliance with the follow-up and treatment protocol and health literacy in bladder tumor patients.

    Science.gov (United States)

    Turkoglu, Ali Riza; Demirci, Hakan; Coban, Soner; Guzelsoy, Muhammet; Toprak, Erdem; Aydos, Mustafa Murat; Ture, Deniz Azkan; Ustundag, Yasemin

    2018-03-07

    To investigate the relationship between the compliance of bladder cancer patients with cystoscopic follow-up and the treatment protocol, and their health literacy. Patients who underwent transurethral resection surgery for bladder tumor were found to have non-muscular invasive bladder carcinoma on pathology examination and then underwent cystoscopic follow-up for 1 year or more were included in the study. Cystoscopic follow-up was recommended to the low- and high-risk groups in terms of progression and recurrence. The patients were evaluated with the Health Literacy Survey-European Union scale. The mean age of the patients was 67.13 ± 10.77 years. The treatment continuity rate was 80.50% (n = 33) in the adequate health literacy group (n = 41) and significantly higher than the 56.50% (n = 48) rate in the inadequate health literacy group (n = 85) (p = .008). The health literacy results revealed that the health promotion and general index score was higher in the group of patients under the age of 65. Adequate health literacy in bladder cancer patients is associated with better compliance with the treatment protocol. Young patients show better compliance with the follow-up protocol recommended by the physician. Increasing the follow-up protocol compliance of elderly patients with inadequate health literacy is necessary.

  10. Radio and chemioinduced oral mucositis treatment: comparison between conventional drug protocol and treatments with low intensity lasers

    International Nuclear Information System (INIS)

    Alencar, Anelise Ribeiro Peixoto

    2011-01-01

    In this clinical study verified the effects of low intensity laser in the prevention and treatment of oral mucositis radio and/or chemical induced. Thirty one patients with head and neck cancer were selected before being submitted to cancer exclusive radiotherapy or radio and associated chemotherapy. The patients were distributed into three randomly groups as follows: group 1- (control) conventional medicine treatment; group 2 - conventional medicine treatment and daily laser therapy as soon as grade two oral mucositis appeared; group 3 - conventional medicine treatment and daily laser therapy to be initiated immediately before radiotherapy sessions.The irradiation parameters were: wavelength of 660nm, potency of 100mW, continuous mode, punctual application, 2J energy on thirty pre-determined 30 points, with 20s of exposure per point. The control group received medical treatment which consisted in using a set of preventive and therapeutic approach for acute radiation-induced adverse effects. Results were evaluated observing occurrence and grade of oral mucositis, score of pain, loss of body mass, use of nasogastric sound line, internment and interruption of oncologic treatment due to oral mucositis. The results showed that the preventive protocol as used was the most effective in prevention and treatment of oral mucositis and that its daily application contributed in relieving the painful symptomatology so collaborating to maintain and/or bettering the life quality of oncologic patients. (author)

  11. TH-CD-BRA-11: Implementation and Evaluation of a New 3D Dosimetry Protocol for Validating MRI Guided Radiation Therapy Treatments

    International Nuclear Information System (INIS)

    Mein, S; Rankine, L; Adamovics, J; Li, H; Oldham, M

    2016-01-01

    Purpose: To develop, evaluate and apply a novel high-resolution 3D remote dosimetry protocol for validation of MRI guided radiation therapy treatments (MRIdian by ViewRay™). We demonstrate the first application of the protocol (including two small but required new correction terms) utilizing radiochromic 3D plastic PRESAGE™ with optical-CT readout. Methods: A detailed study of PRESAGE™ dosimeters (2kg) was conducted to investigate the temporal and spatial stability of radiation induced optical density change (ΔOD) over 8 days. Temporal stability was investigated on 3 dosimeters irradiated with four equally-spaced square 6MV fields delivering doses between 10cGy and 300cGy. Doses were imaged (read-out) by optical-CT at multiple intervals. Spatial stability of ΔOD response was investigated on 3 other dosimeters irradiated uniformly with 15MV extended-SSD fields with doses of 15cGy, 30cGy and 60cGy. Temporal and spatial (radial) changes were investigated using CERR and MATLAB’s Curve Fitting Tool-box. A protocol was developed to extrapolate measured ΔOD readings at t=48hr (the typical shipment time in remote dosimetry) to time t=1hr. Results: All dosimeters were observed to gradually darken with time (<5% per day). Consistent intra-batch sensitivity (0.0930±0.002 ΔOD/cm/Gy) and linearity (R2=0.9996) was observed at t=1hr. A small radial effect (<3%) was observed, attributed to curing thermodynamics during manufacture. The refined remote dosimetry protocol (including polynomial correction terms for temporal and spatial effects, CT and CR) was then applied to independent dosimeters irradiated with MR-IGRT treatments. Excellent line profile agreement and 3D-gamma results for 3%/3mm, 10% threshold were observed, with an average passing rate 96.5%± 3.43%. Conclusion: A novel 3D remote dosimetry protocol is presented capable of validation of advanced radiation treatments (including MR-IGRT). The protocol uses 2kg radiochromic plastic dosimeters read-out by

  12. TH-CD-BRA-11: Implementation and Evaluation of a New 3D Dosimetry Protocol for Validating MRI Guided Radiation Therapy Treatments

    Energy Technology Data Exchange (ETDEWEB)

    Mein, S [Duke University Medical Physics Graduate Program (United States); Rankine, L [Department of Radiation Oncology, University of North Carolina in Chapel Hill (United States); Department of Radiation Oncology, Washington University School of Medicine (United States); Adamovics, J [Department of Chemistry and Biology, Rider University, Lawrenceville, NJ (United States); Li, H [Department of Radiation Oncology, Washington University School of Medicine (United States); Oldham, M [Department of Radiation Oncology, Duke University Medical Center (United States)

    2016-06-15

    Purpose: To develop, evaluate and apply a novel high-resolution 3D remote dosimetry protocol for validation of MRI guided radiation therapy treatments (MRIdian by ViewRay™). We demonstrate the first application of the protocol (including two small but required new correction terms) utilizing radiochromic 3D plastic PRESAGE™ with optical-CT readout. Methods: A detailed study of PRESAGE™ dosimeters (2kg) was conducted to investigate the temporal and spatial stability of radiation induced optical density change (ΔOD) over 8 days. Temporal stability was investigated on 3 dosimeters irradiated with four equally-spaced square 6MV fields delivering doses between 10cGy and 300cGy. Doses were imaged (read-out) by optical-CT at multiple intervals. Spatial stability of ΔOD response was investigated on 3 other dosimeters irradiated uniformly with 15MV extended-SSD fields with doses of 15cGy, 30cGy and 60cGy. Temporal and spatial (radial) changes were investigated using CERR and MATLAB’s Curve Fitting Tool-box. A protocol was developed to extrapolate measured ΔOD readings at t=48hr (the typical shipment time in remote dosimetry) to time t=1hr. Results: All dosimeters were observed to gradually darken with time (<5% per day). Consistent intra-batch sensitivity (0.0930±0.002 ΔOD/cm/Gy) and linearity (R2=0.9996) was observed at t=1hr. A small radial effect (<3%) was observed, attributed to curing thermodynamics during manufacture. The refined remote dosimetry protocol (including polynomial correction terms for temporal and spatial effects, CT and CR) was then applied to independent dosimeters irradiated with MR-IGRT treatments. Excellent line profile agreement and 3D-gamma results for 3%/3mm, 10% threshold were observed, with an average passing rate 96.5%± 3.43%. Conclusion: A novel 3D remote dosimetry protocol is presented capable of validation of advanced radiation treatments (including MR-IGRT). The protocol uses 2kg radiochromic plastic dosimeters read-out by

  13. Experiential versus rational training: a comparison of student attitudes toward homosexuality.

    Science.gov (United States)

    Guth, Lorraine J; Lopez, David F; Rojas, Julio; Clements, Kimberly D; Tyler, J Michael

    2004-01-01

    Based on Epstein's (1994a) cognitive-experiential self-theory, two new training interventions were designed to teach students about gay, lesbian and bisexual issues. The efficacy of these theoretically based interventions was assessed in a short-term (7-week, three occasion) longitudinal study. Fifty undergraduate psychology students were randomly assigned to one of three treatment groups: Rational Training, Experiential Training, or Control Group. A residualized change score procedure was used to analyze change in levels of sexual prejudice and affect across the three types of measurement (pre-test, post-test, and follow-up). A 3 (Rational Training, Experiential Training, Control Group) x 2 (Low Sexual Prejudice, High Sexual Prejudice) MANOVA revealed that after the training, participants in the Experiential Group (affective training) had more accepting attitudes toward homosexuality compared to the Control Group. In addition, participants in the Experiential Group experienced more positive affect compared to the Rational and Control Groups and experienced more negative affect compared to the Rational Group. Findings are discussed and suggestions for future research are provided.

  14. Testing bounded rationality against full rationality in job changing behavior

    OpenAIRE

    Contini, Bruno; Morini, Matteo

    2007-01-01

    In this paper we question the hypothesis of full rationality in the context of job changing behaviour, via simple econometric explorations on microdata drawn from WHIP (Worker Histories Italian Panel). Workers' performance is compared at the end of a three-year time window that starts when choices are expressed, under the accepted notion that the main driving forces of job change are future real wages and expected job quality. Bounded rationality suggests that individuals will search for new ...

  15. Testing Bounded Rationality Against Full Rationality in Job Changing Behavior

    OpenAIRE

    Bruno Contini

    2008-01-01

    In this paper I question the hypothesis of full rationality in the context of job changing behaviour, via simple econometric explorations on microdata drawn from WHIP (Worker Histories Italian Panel). Workers’ performance is compared at the end of a three-year time window that starts when choices are expressed, under the accepted notion that the main driving forces of job change are future real wages and expected job quality. Bounded rationality suggests that individuals will search for new o...

  16. Toothpaste use protocol with dental bleaching for a conservative treatment: Case reports

    Directory of Open Access Journals (Sweden)

    Waldemir F. Vieira-Junior

    2017-01-01

    Full Text Available In-office bleaching is a treatment based on products that contain hydrogen peroxide (HP while demonstrating whitening effectiveness. HP could promote alterations to surface morphologies and properties of dental tissues. The objective was describe a toothpaste protocol associated to bleaching therapy to promote a safer approach. Patient 1 (male and Patient 2 (female were attended, and toothbrushing (twice a day with a dentifrice containing bioactive glass (BG (NovaMin™ and fluoride was indicated before and during the treatment. Three bleaching sessions were made in cases, at intervals of 7 days. The gels used were 35% HP (Patient 1 and 35% HP supplied with calcium (Patient 2. The effectiveness of bleaching treatment was observed in both cases (Vita scale, with an esthetic self-acceptance. Sensitivity associated with the procedure was not reported. The indication of BG-based toothpaste is relevant in relation to enamel properties and did not affect the whitening effectiveness of dental bleaching.

  17. [Treatment and follow up protocol in differentiated thyroid carcinomas of follicular origin].

    Science.gov (United States)

    Rodrigues, Fernando; Limbert, Edward; Marques, Ana Paula; Santos, Ana Paula; Lopes, Carlos; Rodrigues, Elizabete; Borges, Fátima; Carrilho, Francisco; Castro, João Jácome de; Neto, João; Salgado, Lucília; Oliveira, Maria João

    2005-01-01

    Differentiated thyroid carcinoma of follicular origin (DTCFO), although not very frequent, has registered a raising incidence in the last decades. In the majority of the cases, DTCFO is a curable disease when treated and monitored by experienced, multidisciplinary teams. These factors contribute to an increasing number of DTCFO survivors requiring life-long monitoring, due to the possibility of occurrence of recurrences many years after the initial treatment. Several aspects of the treatment and management of these patients are still controversial. The present protocol represents the consensus of the members of the Grupo de Estudo da Tiróide of the Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. It aims to define guidelines, in agreement with the current state of the art and contemplating the necessary adaptations to local constrains, that ensure decreased mortality and protection of patients' quality of life, avoiding unnecessarily aggressive or ineffective treatments, optimizing the use of the available resources.

  18. A stepwise protocol for the treatment of refractory gastroesophageal reflux-induced chronic cough

    Science.gov (United States)

    Xu, Xianghuai; Lv, Hanjing; Yu, Li; Chen, Qiang; Liang, Siwei

    2016-01-01

    Background Refractory gastroesophageal reflux-induced chronic cough (GERC) is difficult to manage. The purpose of the study is to evaluate the efficacy of a novel stepwise protocol for treating this condition. Methods A total of 103 consecutive patients with suspected refractory reflux-induced chronic cough failing to a standard anti-reflux therapy were treated with a stepwise therapy. Treatment commences with high-dose omeprazole and, if necessary, is escalated to subsequent sequential treatment with ranitidine and finally baclofen. The primary end-point was overall cough resolution, and the secondary end-point was cough resolution after each treatment step. Results High-dose omeprazole eliminated or improved cough in 28.1% of patients (n=29). Further stepwise of treatment with the addition of ranitide yielded a favorable response in an additional 12.6% (n=13) of patients, and subsequent escalation to baclofen provoked response in another 36.9% (n=38) of patients. Overall, this stepwise protocol was successful in 77.6% (n=80) of patients. The diurnal cough symptom score fell from 3 [1] to 1 [0] (Z=6.316, P=0.000), and the nocturnal cough symptom score decreased from 1 [1] to 0 [1] (Z=–4.511, P=0.000), with a corresponding reduction in the Gastroesophageal Reflux Diagnostic Questionnaire score from 8.6±1.7 to 6.8±0.7 (t=3.612, P=0.000). Conversely, the cough threshold C2 to capsaicin was increased from 0.49 (0.49) µmol/L to 1.95 (2.92) µmol/L (Z=–5.892, P=0.000), and the cough threshold C5 was increased from 1.95 (2.92) µmol/L to 7.8 (5.85) µmol/L (Z=–5.171, P=0.000). Conclusions Sequential stepwise anti-reflux therapy is a useful therapeutic strategy for refractory reflux-induced chronic cough. PMID:26904227

  19. Efficacy of a protocol including heparin ointment for treatment of multikinase inhibitor-induced hand-foot skin reactions.

    Science.gov (United States)

    Li, Jian-ri; Yang, Chi-rei; Cheng, Chen-li; Ho, Hao-chung; Chiu, Kun-yuan; Su, Chung-Kuang; Chen, Wen-Ming; Wang, Shian-Shiang; Chen, Chuan-Shu; Yang, Cheng-Kuang; Ou, Yen-chuan

    2013-03-01

    The purpose of this study is to evaluate the efficacy of a protocol including topical heparin therapy for hand-foot skin reactions (HFSR) during multikinase (MKI) treatment. We prospectively collected 26 patients who had HFSRs during treatment with the MKIs, sunitinib, sorafenib, or axitinib. The age distribution ranged from 46 to 87 years, with a mean of 66 years. The distribution of HFSR severity was 12 patients with grade 1, 12 with grade 2, and 2 with grade 3. A heparin-containing topical ointment treatment, combined with hand-foot shock absorbers and skin moisturizers, was used at the lesion sites. Changes in the grade of HFSR, MKI dosage, and interruptions of MKI therapy were recorded. The results showed that 66.7% of grade 1 patients were cured of disease, 83.3% of grade 2 patients had improved symptoms, and both grade 3 patients (100%) had improved symptoms and were downgraded to grade 2. Four (15.4%) patients required reduction of MKI dosage, but there were no treatment interruptions or dropouts. Our protocol is beneficial in promoting resolution of HFSRs induced by MKIs. Further validation in large control studies should be investigated.

  20. Psychology and the Rationality of Emotion*

    Science.gov (United States)

    Clore, Gerald L.

    2014-01-01

    Questions addressed by recent psychological research on emotion include questions about how thought shapes emotion and how emotion, in turn, shapes thought. Research on emotion and cognition paints a somewhat different picture than that seen in traditional discussions of passion and reason. This article reviews several aspects of this research, concentrating specifically on three views of rationality: Rationality as Process, Rationality as Product, and Rationality as Outcome. PMID:25125770

  1. Treatment of childhood encopresis: a randomized trial comparing three treatment protocols.

    Science.gov (United States)

    Borowitz, Stephen M; Cox, Daniel J; Sutphen, James L; Kovatchev, Boris

    2002-04-01

    To compare short- and long-term effectiveness of three additive treatment protocols in children experiencing chronic encopresis. Children, 6 to 15 years of age, who experienced at least weekly fecal soiling for 6 months or longer were eligible for the study. Children were randomly assigned to a group that received intensive medical therapy (IMT), a group that received intensive medical therapy plus a behavior management program called enhanced toilet training (ETT), or a group that received intensive medical therapy with enhanced toilet training and external anal sphincter electromyographic biofeedback (BF). Data concerning toileting habits were collected for 14 consecutive days before an initial visit, and at 3, 6, and 12 months after initiation of therapy. All data were collected using a computerized voice-mail system that telephoned the families each day. At 12 months, children were classified as significantly improved (reduction in soiling, P 0.90, P encopresis than either intensive medical therapy or anal sphincter biofeedback therapy. Although similar total cure rates at 1 year can be expected with these three forms of therapy, enhanced toilet training results in statistically significant decreases in the daily frequency of soiling for the greatest number of children.

  2. A comparison of more and less aggressive bone debridement protocols for the treatment of open supracondylar femur fractures.

    Science.gov (United States)

    Ricci, William M; Collinge, Cory; Streubel, Philipp N; McAndrew, Christopher M; Gardner, Michael J

    2013-12-01

    This study compared results of aggressive and nonaggressive debridement protocols for the treatment of high-energy, open supracondylar femur fractures after the primary procedure, with respect to the requirement for secondary bone grafting procedures, and deep infection. Retrospective review. Level I and level II trauma centers. Twenty-nine consecutive patients with high-grade, open (Gustilo types II and III) supracondylar femur fractures (OTA/AO 33A and C) treated with debridement and locked plating. Surgeons at 2 different level I trauma centers had different debridement protocols for open supracondylar femur fractures. One center used a more aggressive (MA) protocol in their patients (n = 17) that included removal of all devitalized bone and placement of antibiotic cement spacers to fill large segmental defects. The other center used a less aggressive (LA) protocol in their patients (n = 12) that included debridement of grossly contaminated bone with retention of other bone fragments and no use of antibiotic cement spacers. All other aspects of the treatment protocol at the 2 centers were similar: definitive fixation with locked plates in all cases, IV antibiotics were used until definitive wound closure, and weight bearing was advanced upon clinical and radiographic evidence of fracture healing. Healing after the primary procedure, requirement for secondary bone grafting procedures, and the presence of deep infection. Demographics were similar between included patients at each center with regard to age, gender, rate of open fractures, open fracture classification, mechanism, and smoking (P > 0.05). Patients at the MA center were more often diabetic (P debridement (35% vs. 0%, P debridement (71% vs. 8%, P debridement (92% vs. 35%, P debrided after a high-energy, high-grade, open supracondylar femur fracture is a matter of surgeon judgment and falls along a continuous spectrum. Based on the results of the current study, the theoretic trade-off between infection

  3. DISTRIBUTED RC NETWORKS WITH RATIONAL TRANSFER FUNCTIONS,

    Science.gov (United States)

    A distributed RC circuit analogous to a continuously tapped transmission line can be made to have a rational short-circuit transfer admittance and...one rational shortcircuit driving-point admittance. A subcircuit of the same structure has a rational open circuit transfer impedance and one rational ...open circuit driving-point impedance. Hence, rational transfer functions may be obtained while considering either generator impedance or load

  4. Calculation of uncertainties in the protocol of dosimetry for Co 60 beams in Radiotherapy; Calculo de incertidumbres en el protocolo de dosimetria para haces de Co 60 en Radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Velazquez M, S.; Carrera M, F.; Sanchez S, J. [Hospital Juan Ramon Jimenez, Ronda Norte s/n 21005 Huelva (Spain)

    1998-12-31

    The objective in this work is to show how the uncertainty is possible to know in the determination of the absorbed dose in Co 60 photon beams and to establish in a rational form, tolerance levels for this. It is took as base the spanish protocol of dosimetry in Radiotherapy. We have been centered in a Co 60 beam. We utilized the statistical theory of little samples. We allowed to suggest a new approach about the treatment of the tolerance levels and the uncertainty of the measurement. After two years of experience in the practical hospitable application we have gotten to put around 1 % uncertainty in the absolute dosimetry of the Co 60 beam. The presented protocol allows to execute the accuracy requirements in the determination of absorbed doses. (Author)

  5. Rational use of antibiotics: a quality improvement initiative in hospital setting

    International Nuclear Information System (INIS)

    Nausheen, S.; Hammad, R.; Khan, A.

    2013-01-01

    Objectives: To minimise irrational use of antibiotics by implementing guidelines for antibiotic usage in obstetrics and Gynaecology. Methods: The observational study was conducted from January to December 2010 at the maternity unit of Aga Khan Hospital for Women and children, Kharadar, a secondary care facility in Karachi, Pakistan. Data was collected from medical records related to the study period. Prophylactic antibiotics were given according to the American College of Obstetricians and Gynaecologists recommendation 2009. Surveillance was done by surgical site infection rates and infectious morbidity. Data was analysed on SPSS 13. Results: Therapeutic antibiotic use was rationalized, reducing the use of therapeutic antibiotics from 97% (n= 160/165) in January 2010 to 8% (n=10/125) in December 2010. Surgical site infection rates were less than 5%. Cost of antibiotics per patient decreased by 90%. Decrease in the length of stay and workload on nursing staff was also observed. Conclusion: Implementing guidelines for antibiotic use in obstetrics and gynaecology and translating it into our protocols was effective in decreasing the irrational antibiotic consumption and increasing the rational use of antibiotics in the hospital. (author)

  6. [Limiting factors in the class III camouflage treatment: a potential protocol].

    Science.gov (United States)

    Chaques Asensi, José

    2016-06-01

    The Class III skeletal malocclusion has been traditionally treated with a combined approach of orthodontics and orthognathic surgery or with a strategy of orthodontic camouflage. Some severe cases can be identified as ideal candidates for a surgical treatment whereas some others can be handled with orthodontics alone, with a reasonable expectation of an acceptable result. However, the problem remains for the borderline patient. In fact, limited information is available in the literature regarding the identification of the factors that can help in establishing the limits for one treatment modality or the other. Furthermore, the quantification of some of these factors, for practical purposes, is practically missing or very seldom suggested. Therefore, the decision making process remains a subjective reflection based on the "good clinical sense" of the orthodontist or just reduced to an "educated guess". In order to add some information, hopefully useful in deciding the most suitable treatment option for the individual patient, we propose a clinical protocol based on four different factors. Namely: the skeletal discrepancy, the occlusal discrepancy, the periodontal condition and facial aesthetics. For each one of these factors several parameters will be evaluated and, for some of them, an attempt to provide some reference numerical values will be made. Finally, clinical examples will be presented to illustrate the concepts discussed and the treatment alternatives, final treatment plan and treatment outcome will be analyzed for each one of them. © EDP Sciences, SFODF, 2016.

  7. Max Weber's Types of Rationality: Cornerstones for the Analysis of Rationalization Processes in History.

    Science.gov (United States)

    Kalberg, Stephen

    1980-01-01

    Explores rationality in Max Weber's works and identifies four types of rationality which play major roles in his writing--practical, theoretical, substantive, and formal. Implications for society and education are discussed. (DB)

  8. The concept of rational suicide.

    Science.gov (United States)

    Mayo, D J

    1986-05-01

    Suicide has been condemned in our culture in one way or another since Augustine offered theological arguments against it in the sixth century. More recently, theological condemnation has given way to the view that suicidal behavior must always be symptomatic of emotional disturbance and mental illness. However, suicide has not always been viewed so negatively. In other times and cultures, it has been held that circumstances might befall a person in which suicide would be a perfectly rational course of action, in the same sense that any other course of action could be rational: that it could be sensible, i.e., defensible by good reasons, or that it could be in keeping with the agent's fundamental interests. Indiscriminate use of modern life-sustaining technologies has renewed interest in the possibility of rational suicide. Today proponents of rational suicide tend to equate the rationality of suicide with the competence of the decision to commit suicide.

  9. Protocol for a systematic review of psychological interventions for cancer-related fatigue in post-treatment cancer survivors.

    Science.gov (United States)

    Corbett, Teresa; Devane, Declan; Walsh, Jane C; Groarke, AnnMarie; McGuire, Brian E

    2015-12-04

    Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase. Some evidence has been reported for interventions for fatigue during active treatment. However, to date, there is no systematic review on psychological interventions for fatigue after the completion of curative treatment for cancer. This is a protocol for a systematic review that aims to evaluate the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database. We will search the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library), PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and relevant sources of grey literature. Randomised controlled trials (RCTs) which have evaluated psychological interventions in adult cancer patients after the completion of treatment, with fatigue as an outcome measure, will be included. Two review authors will independently extract data from the selected studies and assess the methodological quality using the Cochrane Collaboration Risk of Bias Tool. Most existing evidence on cancer-related fatigue is from those in active cancer treatment. This systematic review and meta-analysis will build upon previous evaluations of psychological interventions in people during and after cancer treatment. With the growing need for stage-specific research in cancer, this review seeks to highlight a gap in current practice and to strengthen the evidence base of randomised controlled trials in the area. PROSPERO CRD42014015219.

  10. Treatment of Internet Addiction with Anxiety Disorders: Treatment Protocol and Preliminary Before-After Results Involving Pharmacotherapy and Modified Cognitive Behavioral Therapy.

    Science.gov (United States)

    Santos, Veruska Andrea; Freire, Rafael; Zugliani, Morená; Cirillo, Patricia; Santos, Hugo Henrique; Nardi, Antonio Egidio; King, Anna Lucia

    2016-03-22

    The growth of the Internet has led to significant change and has become an integral part of modern life. It has made life easier and provided innumerous benefits; however, excessive use has brought about the potential for addiction, leading to severe impairments in social, academic, financial, psychological, and work domains. Individuals addicted to the Internet usually have comorbid psychiatric disorders. Panic disorder (PD) and generalized anxiety disorder (GAD) are prevalent mental disorders, involving a great deal of damage in the patient's life. This open trial study describes a treatment protocol among 39 patients with anxiety disorders and Internet addiction (IA) involving pharmacotherapy and modified cognitive behavioral therapy (CBT). Of the 39 patients, 25 were diagnosed with PD and 14 with GAD, in addition to Internet addiction. At screening, patients responded to the MINI 5.0, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Clinical Global Impressions Scale, and the Young Internet Addiction Scale. At that time, IA was observed taking into consideration the IAT scale (cutoff score above 50), while anxiety disorders were diagnosed by a psychiatrist. Patients were forwarded for pharmacotherapy and a modified CBT protocol. Psychotherapy was conducted individually, once a week, over a period of 10 weeks, and results suggest that the treatment was effective for anxiety and Internet addiction. Before treatment, anxiety levels suggested severe anxiety, with an average score of 34.26 (SD 6.13); however, after treatment the mean score was 15.03 (SD 3.88) (Paddiction scores was observed, from 67.67 (SD 7.69) before treatment, showing problematic internet use, to 37.56 (SD 9.32) after treatment (Panxiety, the correlation between scores was .724. This study is the first research into IA treatment of a Brazilian population. The improvement was remarkable due to the complete engagement of patients in therapy, which contributed to the success of the

  11. The challenges of treating paraganglioma patients with 177Lu-DOTATATE PRRT: Catecholamine crises, tumor lysis syndrome and the need for modification of treatment protocols

    International Nuclear Information System (INIS)

    Makis, William; Mccann, Karey; Mcewan, Alexander J. B.

    2015-01-01

    A high percentage of paragangliomas express somatostatin receptors that can be utilized for targeted radioisotope therapy. The aim of this study was to describe and discuss the challenges of treating these tumors with 177 Lu-[DOTA0,Tyr3]octreotate (DOTATATE) radioisotope therapy using established protocols. Three paraganglioma patients were treated with 4–5 cycles of 177 Lu-DOTATATE and were evaluated for side effects and response to therapy. Two of the three patients developed severe adverse reactions following their first 177 Lu-DOTATATE treatment. One patient developed a catecholamine crisis and tumor lysis syndrome within hours of treatment, requiring intensive care unit (ICU) support, and another developed a catecholamine crisis 3 days after treatment, requiring hospitalization. The treatment protocols at our institution were subsequently modified by increasing the radioisotope infusion time from 15 to 30 min, as recommended in the literature, to 2–4 h and by reducing the administered dose of 177 Lu-DOTATATE. Subsequent 177 Lu-DOTATATE treatments utilizing the modified protocols were well tolerated, and response to therapy was achieved in all three patients, resulting in significantly improved quality of life. 177 Lu-DOTATATE is an exciting new therapeutic option in the management of paragangliomas; however, current treatment protocols described in the literature may need to be modified by lengthening the infusion time and/or lowering the initial treatment dose to prevent or reduce the severity of adverse reactions

  12. Milk Production, Physiological Condition and Performance of Etawa Crossbreed Goats Feed by Ration Supplemented with Mangosteen Peel Flour

    Science.gov (United States)

    Dzarnisa; Rachmadi, D.; Azhar, A.; Fakhrur Riza, R.; Hidayati, A.

    2018-02-01

    Study on the effect of the addition of mangosteen (Garcinia mangostana L.) peel flour on physiological condition and performance of Etawa crossbreed goats was done. This was to grant the use of mangosteen peel flour that rich of antioxidants and has variety good benefits for health as feed additive for cattle. This study used a Complete Randomized Block Design consisting of 4 treatment groups and 4 replications each. Subjects were 16 female Etawa crossbreed goats randomly designed into treatments group based on lactation periods. Subjects were feed with traditional rations (control, A), traditional rations and 2.5% mangosteen peel flour (B), tradition rations and 5% mangosteen peel flour (C), and traditional rations and 7,5 % mangosteen peel flour (D). Data on performance (milk production) and physiological condition (respiratory frequency, rectal temperature, and heart rate) obtained were analyzed using analysis of variance (ANOVA). The results showed that the addition of mangosteen peel flour as food additive in the rations resulted in variations in the milk production, physiological condition (rectal temperature, heart rate and respiration frequency) and performances (daily weigh gain, food consumption, ration conversion and breast volume) of Etawa crossbreed goats, but significant effect was only observed in the respiration frequency. The addition of 2.5% mangosteen peel flour in the ration caused the best, expected effects on milk production physiological condition and performance of Etawa crossbreed goats.

  13. The Formation of Rational and Irrational Behaviors in Risky Investment Decision Making: Laboratory Experiment of Coping Theory Implication in Investors’ Adaptation Model

    Directory of Open Access Journals (Sweden)

    Wendy Wendy

    2014-08-01

    Full Text Available This study analyzes the stock investor's rational and irrational behavior formation through Investor's Adaptation model. Hypotheses testings were conducted by manipulating four market conditions using between-subject experimental design. The results supported the hypotheses proposed in this study. When given treatment one (opportunity-high control, investors tended to adapt the profit maximizing strategy (rational. Meanwhile, when given treatment two (opportunity-low control, three (threat-high control and four (threat-low control, they tended to adapt the profit satisfying strategy (rational-emotional, bad news handling strategy (emotional-rational, and self-preserving strategy (irrational respectively. The application of rational strategies are intended to obtain personal benefits and profit, while adapting irrational strategy is intended to recover emotional stability and reduce some other tensions. Another finding showed that for the investors, the relatively irrational decision formation was "harder" than that of rational.

  14. RATGRAPH: Computer Graphing of Rational Functions.

    Science.gov (United States)

    Minch, Bradley A.

    1987-01-01

    Presents an easy-to-use Applesoft BASIC program that graphs rational functions and any asymptotes that the functions might have. Discusses the nature of rational functions, graphing them manually, employing a computer to graph rational functions, and describes how the program works. (TW)

  15. Rational design of biophysical imaging protocols to measure the level of intensity of massive delocalized infections under severe HIV-induced immunodeficiency: configuration of novel radioimmunoscintigraphy modalities with single-photon emission tomography (SPECT) and positron emission tomography (PET)

    International Nuclear Information System (INIS)

    Nazarea, A.D.

    1996-01-01

    Severe immunosupression brought about by critical depletion of CD4 + -lymphocytes in individuals suffering from HIV infection leads inevitably to the onset of multiple-agent opportunistic infections (ARC: the AIDS-related complex). Such opportunistic infections eventually become heterogeneously delocalized (disseminated) and an idea f their variety and number can be gleaned from the listing under clinical category C of the 1993 CDC Revised Classification System for HIV infections. This causes widespread oxygen free radical (principally superoxide and hydroxyl free radical) burst due to the up-switching of the hexose monophosphate (HMP) shunt as a result of the generalized activation, by the massive infection load, of NADPH oxidase, a constitutive enzyme that is present in the cell membranes of all granulocytes and mononuclear phagocytic cells. However the very short (reactive) lifetimes of superoxide and hydroxyl free radicals in the cellular milieu preclude their use as a convenient in vivo biomarkers if the level of phagocytosis (or HMP up-switching) were to be utilized as a correlative measure of the level of intensity of delocalized infections in ARC in any non-invasive whole-body imaging protocol. In the present contribution, we report a rational schema for a molecularly specific an self-consistent correlative measure of the intensity of multiple-agent, delocalized infections arising from severe HIV-induced immunodeficiency. The schema is based on the quantitative parametrization of the level of on-going degranulation activity of neutrophils in the granulocyte population. The rationally designed modalities rest on specificity inherent in radioimmunoscintigraphy, in particular on the ligand of radionuclide-tagged antibodies to the neutrophil proteinases HLE (human leukocytic elastase: EC.3.4.21.37) and cat G (cathepsin G: EC.3.4.21.20). In this work, these molecular probes are specifically configured to lend themselves as convenient in vivo biomarkers both in

  16. F-theory and all things rational: surveying U(1) symmetries with rational sections

    International Nuclear Information System (INIS)

    Lawrie, Craig; Schäfer-Nameki, Sakura; Wong, Jin-Mann

    2015-01-01

    We study elliptic fibrations for F-theory compactifications realizing 4d and 6d supersymmetric gauge theories with abelian gauge factors. In the fibration these U(1) symmetries are realized in terms of additional rational section. We obtain a universal characterization of all the possible U(1) charges of matter fields by determining the corresponding codimension two fibers with rational sections. In view of modelling supersymmetric Grand Unified Theories, one of the main examples that we analyze are U(1) symmetries for SU(5) gauge theories with 5̄ and 10 matter. We use a combination of constraints on the normal bundle of rational curves in Calabi-Yau three- and four-folds, as well as the splitting of rational curves in the fibers in codimension two, to determine the possible configurations of smooth rational sections. This analysis straightforwardly generalizes to multiple U(1)s. We study the flops of such fibers, as well as some of the Yukawa couplings in codimension three. Furthermore, we carry out a universal study of the U(1)-charged GUT singlets, including their KK-charges, and determine all realizations of singlet fibers. By giving vacuum expectation values to these singlets, we propose a systematic way to analyze the Higgsing of U(1)s to discrete gauge symmetries in F-theory.

  17. "Leaky" Rationality: How Research on Behavioral Decision Making Challenges Normative Standards of Rationality.

    Science.gov (United States)

    Keys, Daniel J; Schwartz, Barry

    2007-06-01

    For more than 30 years, decision-making research has documented that people often violate various principles of rationality, some of which are so fundamental that theorists of rationality rarely bother to state them. We take these characteristics of decision making as a given but argue that it is problematic to conclude that they typically represent departures from rationality. The very psychological processes that lead to "irrational" decisions (e.g., framing, mental accounting) continue to exert their influence when one experiences the results of the decisions. That is, psychological processes that affect decisions may be said also to "leak" into one's experience. The implication is that formal principles of rationality do not provide a good enough normative standard against which to assess decision making. Instead, what is needed is a substantive theory of rationality-one that takes subjective experience seriously, considers both direct and indirect consequences of particular decisions, considers how particular decisions fit into life as a whole, and considers the effects of decisions on others. Formal principles may play a role as approximations of the substantive theory that can be used by theorists and decision makers in cases in which the formal principles can capture most of the relevant considerations and leakage into experience is negligible. © 2007 Association for Psychological Science.

  18. Popper, Rationality and the Possibility of Social Science

    Directory of Open Access Journals (Sweden)

    Danny Frederick

    2013-02-01

    Full Text Available Social science employs teleological explanations which depend upon the rationality principle, according to which people exhibit instrumental rationality. Popper points out that people also exhibit critical rationality, the tendency to stand back from, and to question or criticise, their views. I explain how our critical rationality impugns the explanatory value of the rationality principle and thereby threatens the very possibility of social science. I discuss the relationship between instrumental and critical rationality and show how we can reconcile our critical rationality with the possibility of social science if we invoke Popper’s conception of limited rationality and his indeterminism.

  19. Automation in an addiction treatment research clinic: computerised contingency management, ecological momentary assessment and a protocol workflow system.

    Science.gov (United States)

    Vahabzadeh, Massoud; Lin, Jia-Ling; Mezghanni, Mustapha; Epstein, David H; Preston, Kenzie L

    2009-01-01

    A challenge in treatment research is the necessity of adhering to protocol and regulatory strictures while maintaining flexibility to meet patients' treatment needs and to accommodate variations among protocols. Another challenge is the acquisition of large amounts of data in an occasionally hectic environment, along with the provision of seamless methods for exporting, mining and querying the data. We have automated several major functions of our outpatient treatment research clinic for studies in drug abuse and dependence. Here we describe three such specialised applications: the Automated Contingency Management (ACM) system for the delivery of behavioural interventions, the transactional electronic diary (TED) system for the management of behavioural assessments and the Protocol Workflow System (PWS) for computerised workflow automation and guidance of each participant's daily clinic activities. These modules are integrated into our larger information system to enable data sharing in real time among authorised staff. ACM and the TED have each permitted us to conduct research that was not previously possible. In addition, the time to data analysis at the end of each study is substantially shorter. With the implementation of the PWS, we have been able to manage a research clinic with an 80 patient capacity, having an annual average of 18,000 patient visits and 7300 urine collections with a research staff of five. Finally, automated data management has considerably enhanced our ability to monitor and summarise participant safety data for research oversight. When developed in consultation with end users, automation in treatment research clinics can enable more efficient operations, better communication among staff and expansions in research methods.

  20. Casebook on rationalization of power use

    International Nuclear Information System (INIS)

    1986-06-01

    This book introduces the cases on rationalization of power use, which is divided into four parts. The first part refers the goal of rational use of energy and the result. The second part deals with the excellent cases on rationalization of domestic power use, which list the name of the company, hotel and factory according to the field such as building, textile and food. The third part contains the outstanding cases on rationalization of foreign power use, which were listed by the specific way to reduce electricity use each section. The fourth part is comprised of two chapters, which deals with the cases of domestic technical data and foreign technical data for rational use of energy.

  1. Rational kinematics

    CERN Document Server

    Angeles, Jorge

    1988-01-01

    A rational study of kinematics is a treatment of the subject based on invariants, i.e., quantities that remain essentially unchanged under a change of observer. An observer is understood to be a reference frame supplied with a clock (Truesdell 1966). This study will therefore include an introduction to invariants. The language of these is tensor analysis and multilinear algebra, both of which share many isomorphic relations, These subjects are treated in full detail in Ericksen (1960) and Bowen and Wang (1976), and hence will not be included here. Only a short account of notation and definitions will be presented. Moreover, definitions and basic concepts pertaining to the kinematics of rigid bodies will be also included. Although the kinematics of rigid bodies can be regarded as a particular case of the kinematics of continua, the former deserves attention on its own merits for several reasons. One of these is that it describes locally the motions undergone by continua. Another reason is that a whole area of ...

  2. Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures - postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate.

    Science.gov (United States)

    Paulsson, Johnny; Stig, Josefine Corin; Olsson, Ola

    2017-08-24

    In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database. All consecutive trochanteric fracture operations during 2011-2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications. The relative risk of intermediate or major technical complications was 4.2 (1.2-14) times higher in unstable pertrochanteric fractures and 4.6 (1.1-19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%. The

  3. Why are people with mental illness excluded from the rational suicide debate?

    Science.gov (United States)

    Hewitt, Jeanette

    2013-01-01

    The topic of rational suicide is often approached with some trepidation by mental health professionals. Suicide prevention strategies are more likely to be seen as the domain of psychiatry and a wealth of psychiatric literature is devoted to identifying and managing suicide risk. Whether or not suicide can be deemed permissible is ostensibly linked to discussions of autonomy and mental capacity, and UK legislation directs that a patient's wishes must be respected with regard to treatment refusal where decisional capacity is intact. In the context of the care and treatment of those with physical disorders, extreme and untreatable physical suffering is likely to be accepted as rational grounds for suicide, where the person possesses cognitive coherence and an ability to realistically appreciate the consequences of his or her actions. In the case of those with serious mental disorder, the grounds for accepting that suicide is rational are however less clear-cut. Serious mental illness is typically conceived of as a coercive pressure which prevents rational deliberation and as such, the suicides of those with serious mental illness are considered to be substantially non-voluntary acts arising from constitutive irrationality. Therefore, where an appropriate clinician judges that a person with serious mental disorder is non-autonomous, suicide prevention is likely to be thought legally and morally justified. There are arguably, two questionable assumptions in the position that psychiatry adopts: Firstly, that psychogenic pain is in some way less real than physical pain and secondly, that mental illness invariably means that a desire to die is irrational and inauthentic. If it can be shown that some people with serious mental illness can be rational with regard to suicide and that psychological pain is of equal significance as physical suffering, then it may be possible to conclude that some persons with serious mental illness should not by definition be excluded from the

  4. From rational creatures to the rational Creator: ancient and patristic analogies of the “fine-tuning” argument

    Directory of Open Access Journals (Sweden)

    Alexey Fokin

    2017-12-01

    Full Text Available In this article the author deals with the proofs of the existence of God, based on the fact of the presence of rational beings in the world. These proofs can be found in Greek and Roman Classical philosophy and early Patristics, and can be viewed as an analogue of the modern “fine-tuning argument”. The author considers the origins and development of this argument in the Greek and Roman philosophy: in Socrates, Plato, Cicero, Sextus Empiricus, and especially the Stoics, who gave to the argument a logical form, based on the relationship between “the parts and the whole”: if the world as a whole produces and contains rational beings as its parts, it should also be rational or contain a rational principle that generates all its parts and governs them, just as human soul governs human body. The correction of this argument was proposed by Sextus Empiricus, who introduced the concept of "spermatic logoi", or rational principles, to explain the generation of the rational beings by the world, so that if the world contains the spermatic logoi of rational and living beings, then the world as a whole is also rational. The author also investigates the reception of the argument based on the existence of rational beings in the world in Latin Patristics: in Minucius Felix, Tertullian and especially Lactantius, in whom this argument has reached the climax of its development. At the same time it was shown, that the ancient argument has undergone a transformation from the postulation of the rationality of the world as a whole or its equation with God himself to a genuine proof of the existence of the one God who is the Creator both of the world and human beings, superior to the both as the all-powerful and transcendent Mind.

  5. Rationing medical education | Walsh | African Health Sciences

    African Journals Online (AJOL)

    Even though some stakeholders in medical education might be taken aback at the prospect of rationing, the truth is that rationing has always occurred in one form or another in medical education and in healthcare more broadly. Different types of rationing exist in healthcare professional education. For example rationing may ...

  6. A rational approach for evaluation and screening of treatment and disposal options for the solar pond sludges at Rocky Flats

    International Nuclear Information System (INIS)

    Dickerson, K.S.

    1995-01-01

    This document consists of information about the treatment options for the sludge that is located in the evaporation ponds at the Rocky Flats Plant. The sludges are mixed low-level radioactive wastes whose composition and character were variable. Sludges similar to these are typically treated prior to ultimate disposal. Disposal of treated sludges includes both on-site and off-site options. The rational approach described in this paper is useful for technology evaluation and screening because it provides a format for developing objectives, listing alternatives, and weighing the alternatives against the objectives and against each other

  7. A rational approach for evaluation and screening of treatment and disposal options for the solar pond sludges at Rocky Flats

    Energy Technology Data Exchange (ETDEWEB)

    Dickerson, K.S.

    1995-12-31

    This document consists of information about the treatment options for the sludge that is located in the evaporation ponds at the Rocky Flats Plant. The sludges are mixed low-level radioactive wastes whose composition and character were variable. Sludges similar to these are typically treated prior to ultimate disposal. Disposal of treated sludges includes both on-site and off-site options. The rational approach described in this paper is useful for technology evaluation and screening because it provides a format for developing objectives, listing alternatives, and weighing the alternatives against the objectives and against each other.

  8. Rationality, practice variation and person-centred health policy: a threshold hypothesis.

    Science.gov (United States)

    Djulbegovic, Benjamin; Hamm, Robert M; Mayrhofer, Thomas; Hozo, Iztok; Van den Ende, Jef

    2015-12-01

    Variation in practice of medicine is one of the major health policy issues of today. Ultimately, it is related to physicians' decision making. Similar patients with similar likelihood of having disease are often managed by different doctors differently: some doctors may elect to observe the patient, others decide to act based on diagnostic testing and yet others may elect to treat without testing. We explain these differences in practice by differences in disease probability thresholds at which physicians decide to act: contextual social and clinical factors and emotions such as regret affect the threshold by influencing the way doctors integrate objective data related to treatment and testing. However, depending on a theoretical construct each of the physician's behaviour can be considered rational. In fact, we showed that the current regulatory policies lead to predictably low thresholds for most decisions in contemporary practice. As a result, we may expect continuing motivation for overuse of treatment and diagnostic tests. We argue that rationality should take into account both formal principles of rationality and human intuitions about good decisions along the lines of Rawls' 'reflective equilibrium/considered judgment'. In turn, this can help define a threshold model that is empirically testable. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

  9. Effects of Rational-Emotive Therapy, Rational Role Reversal, and Rational-Emotive Imagery on the Emotional Adjustment of Community Mental Health Center Patients.

    Science.gov (United States)

    Lipsky, Marc J.; And Others

    1980-01-01

    Results showed that rational-emotive therapy (RET), with the addition of rational role reversal, produced significantly better results than did relaxation training and support or no contact. This was the first study to demonstrate the efficacy of RET with multisymptomatic applicants to a community mental health center. (Author/BEF)

  10. Argumentation, rationality, and psychology of reasoning

    Directory of Open Access Journals (Sweden)

    David Godden

    2015-05-01

    Full Text Available This paper explicates an account of argumentative rationality by articulating the common, basic idea of its nature, and then identifying a collection of assumptions inherent in it. Argumentative rationality is then contrasted with dual-process theories of reasoning and rationality prevalent in the psychology of reasoning. It is argued that argumentative rationality properly corresponds only with system-2 reasoning in dual-process theories. This result challenges the prescriptive force of argumentative norms derives if they derive at all from their descriptive accuracy of our cognitive capacities. In response, I propose an activity-based account of reasoning which retains the assumptions of argumentative rationality while recontextualizing the relationship between reasoning as a justificatory activity and the psychological states and processes underlying that activity.

  11. Rational pharmacotherapy training for fourth-year medical students.

    Science.gov (United States)

    Gelal, Ayse; Gumustekin, Mukaddes; Arici, M Aylin; Gidener, Sedef

    2013-01-01

    In this study we aimed to evaluate the impact of Rational Pharmacotherapy (RPT) course program, reinforced by video footages, on the rational pharmacotherapy skills of the students. RPT course program has been conducted in Dokuz Eylul University School of Medicine since 2008/9. The course has been organised in accordance with World Health Organisation (WHO) Good Prescribing Guide. The aim of the course was to improve the problem solving skills (methodology for selection of the (p)ersonel-drug, prescription writing and informing patient about his illness and drugs) and communication skills of students. The impact of the course has been measured by pre/post-test design by an objective structured clinical examination (OSCE). In academic year 2010/11, to further improve OSCE score of the students we added doctor-patient communication video footages to the RPT course programme. During training, the students were asked to evaluate the doctor-patient communication and prescription on two video footages using a checklist followed by group discussions. Total post-test OSCE score was significantly higher for 2010/11 academic year students (n = 147) than it was for 2009/10 year students (n = 131). The 2010/11 academic year students performed significantly better than the 2009/10 academic year students on four steps of OSCE. These steps were "defining the patient's problem", "specifying the therapeutic objective", "specifying the non-pharmacological treatment" and "choosing a (drug) treatment, taking all relevant patient characteristics into account". The present study demonstrated that the implementation of video footages and group discussions to WHO/Good Prescribing Method improved the fourth-year medical students' performance in rational pharmacotherapy skills.

  12. The effects of rational stage directed imagery on self-concept and reduction of psychological stress in adolescent delinquent females.

    Science.gov (United States)

    Reardon, J P; Tosi, D J

    1977-10-01

    This study examined the effect of four treatment conditions on self-concept and reduction of psychological stress in adolescent delinquent females. The treatments were Rational State Directed Imagery, a cognitive behavioral approach that utilized intensive muscle relaxation and vivid-emotive-imagery, a rational (cognitive) restructuring treatment, a placebo condition, and a no treatment control. Ss were assigned randomly to one of these treatment groups, which met 1 hour per week for 6 consecutive weeks, with in-vivo homework assignments also utilized. Statistically scale were noted for the RSDI group at the posttest and at a 2-month follow-up, which supports the therapeutic efficacy of this treatment. Support was found for the effectiveness of the rational (cognitive) restructuring approach immediately posttreatment; however these effects disappeared at the 2-month follow-up. The placebo and control groups showed no significant effects at either posttreatment or the follow-up. These results suggest that RSDI has potential for use as a short-term psychotherapeutic approach when self-concept modification is a primary goal.

  13. Rational Thinking in School-Based Practice

    Science.gov (United States)

    Clark, Mary Kristen; Flynn, Perry

    2011-01-01

    Purpose: We reflect on Alan Kamhi's (2011) prologue on balancing certainty and uncertainty as it pertains to school-based practice. Method: In schools, rational thinking depends on effective team processes, much like professional learning communities. We consider the conditions that are required for rational thinking and how rational team dialogue…

  14. Rational decision-making in medicine: implications for overuse and underuse

    OpenAIRE

    Djulbegovic, B.; Elqayam, Shira; Dale, W.

    2017-01-01

    open access article In spite of substantial spending and resource utilization, today's health care remains characterized by poor outcomes, largely due to overuse (over-testing/treatment) or underuse (under-testing/treatment) of services. To a significant extent, this is a consequence of low-quality decision-making that appears to violate various rationality criteria. Such sub-optimal decision-making is considered a leading cause of death and is responsible for more than 80% of health expen...

  15. Rationality in Machiavelli and in Kant

    Directory of Open Access Journals (Sweden)

    Vadim Chaly

    2016-11-01

    Full Text Available The paper contains interpretation and comparative analysis of Machiavelli’s and Kant’s conceptions on rationality as two prime examples of “realist” and “idealist” modes of agency. Kantian model of rationality is viewed as an augmentation of the Machiavellian one, not an opposition to it. To elaborate the point, Robert Aumann’s model of act-rationality and rulerationality is applied to the two philosophical models. Kantian practical reason is interpreted as an addition to Aumann’s instrumental rationality, providing rules for rules, or “rule-rule-rationality”.

  16. Alleviating Communication Apprehension through Rational Emotive Therapy: A Comparative Evaluation.

    Science.gov (United States)

    Watson, Arden K.; Dodd, Carley H.

    Albert Ellis's Rational Emotive Therapy (RET), which assumes that a person can change an emotional disturbance by discovering and disputing the irrational ideas giving rise to that emotion, has been used effectively in treating public speaking anxiety. To compare RET with other treatments for communication apprehension, 52 high communication…

  17. Effective Entrepreneurial Choice: The Role of Rationality and Non-Rationality in Three Entrepreneurs Success Stories

    OpenAIRE

    Chong, Anne Michele, Siang Yoon

    2007-01-01

    Good entrepreneurship is important for economic growth and productivity in any modern economy. The purpose of this dissertation is to research how good entrepreneurial decisions are made. In theory, optimal or rational decision making means choosing the best alternative in response to the problem. However, in reality, people do not act rationally because they often cannot make rational choices. The reason is that people do not have enough brain power, time or resources to process the compl...

  18. On the choice of a rational system of water economy of the industrial enterprice

    International Nuclear Information System (INIS)

    Tsikhelashvili, Z.; Khatiuri, Kh.; Verulava, G.; Zakutashvili, G.

    2009-01-01

    Rational systems and projects of water economy of the industrial enterprise (allowing for the development of waste-free production processes, industrial water recycling with water treatment or without it, and cooling recycling) are discussed. The analysis of rational systems is of primary importance when designing and/or reconstructing the industrial water economy. Such systems and projects must account for all local conditions determining the advantage of their employment from the sanitary and economic viewpoints. (author)

  19. Treatment of cervical cancer in HIV-seropositive women from developing countries: a protocol for a systematic review.

    Science.gov (United States)

    Mapanga, Witness; Chipato, Tsungai; Feresu, Shingairai A

    2018-01-25

    Cervical cancer has become the most common cancer affecting women in Africa. Significantly, 85% of these annual deaths occur in the developing world, with the majority being middle-aged women. Research has shown that in sub-Saharan Africa, cervical cancer trends are on the rise in the past two decades because of HIV and this has resulted in an increase in cervical cancer cases among young women. However, little or no information exists that has shown that any of the available treatment methods are more effective than others when it comes to treating cervical cancer in HIV-seropositive women. The aim of this protocol is to offer a plan on how to systematically review cervical cancer treatment methods available for HIV-seropositive women in developing countries. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement was used to develop the protocol for the systematic review which will be reported in accordance with the PRISMA guidelines. A number of databases, Embase, MEDLINE, PubMed, CINAHL and Cochrane Library, will be searched for relevant studies, and citation and reference list tracking will be used to search for additional studies. Prospective and retrospective cohort studies, case-control, randomised controlled trials and cross-sectional studies that were carried out in and for the developing world will be eligible for inclusion. Peer-reviewed studies and grey literature examining cervical cancer treatment modalities in HIV-seropositive women will be included. Descriptive statistics and tables will be used to summarise results, and meta-analysis will be used where appropriate. The review findings will provide the current picture of the existing treatment methods being used to treat cervical cancer in HIV-seropositive women in developing countries. The findings might be used for the establishment of evidence-based guidelines for treatment of cervical cancer in seropositive women as well as prompt policy-makers and

  20. The challenges of treating paraganglioma patients with {sup 177}Lu-DOTATATE PRRT: Catecholamine crises, tumor lysis syndrome and the need for modification of treatment protocols

    Energy Technology Data Exchange (ETDEWEB)

    Makis, William; Mccann, Karey; Mcewan, Alexander J. B. [Dept. of Diagnostic Imaging, Cross Cancer Institute, Alberta (China)

    2015-09-15

    A high percentage of paragangliomas express somatostatin receptors that can be utilized for targeted radioisotope therapy. The aim of this study was to describe and discuss the challenges of treating these tumors with {sup 177}Lu-[DOTA0,Tyr3]octreotate (DOTATATE) radioisotope therapy using established protocols. Three paraganglioma patients were treated with 4–5 cycles of {sup 177}Lu-DOTATATE and were evaluated for side effects and response to therapy. Two of the three patients developed severe adverse reactions following their first {sup 177}Lu-DOTATATE treatment. One patient developed a catecholamine crisis and tumor lysis syndrome within hours of treatment, requiring intensive care unit (ICU) support, and another developed a catecholamine crisis 3 days after treatment, requiring hospitalization. The treatment protocols at our institution were subsequently modified by increasing the radioisotope infusion time from 15 to 30 min, as recommended in the literature, to 2–4 h and by reducing the administered dose of {sup 177}Lu-DOTATATE. Subsequent {sup 177}Lu-DOTATATE treatments utilizing the modified protocols were well tolerated, and response to therapy was achieved in all three patients, resulting in significantly improved quality of life. {sup 177}Lu-DOTATATE is an exciting new therapeutic option in the management of paragangliomas; however, current treatment protocols described in the literature may need to be modified by lengthening the infusion time and/or lowering the initial treatment dose to prevent or reduce the severity of adverse reactions.

  1. Ananyeva Rational antibiotic use in rheumatology

    Directory of Open Access Journals (Sweden)

    Boris Sergeyevich Belov

    2012-06-01

    Full Text Available To control infections and infectious complications is one of the most urgent challenges in medicine under present-day conditions. At the same time, rational therapy with anti-infective drugs occupies a highly importance place. In rheumatology, the necessity of using antibiotics is associated with at least two factors, such as eradication of a pathogen trigger (an infectious agent that triggers the immunopathological mechanisms of inflammation and treatment of comorbid infection. The paper gives information on etiological agents and detailed antimicrobial therapy regimens for the major infections observed in modern rheumatology.

  2. Ananyeva Rational antibiotic use in rheumatology

    Directory of Open Access Journals (Sweden)

    Boris Sergeyevich Belov

    2012-01-01

    Full Text Available To control infections and infectious complications is one of the most urgent challenges in medicine under present-day conditions. At the same time, rational therapy with anti-infective drugs occupies a highly importance place. In rheumatology, the necessity of using antibiotics is associated with at least two factors, such as eradication of a pathogen trigger (an infectious agent that triggers the immunopathological mechanisms of inflammation and treatment of comorbid infection. The paper gives information on etiological agents and detailed antimicrobial therapy regimens for the major infections observed in modern rheumatology.

  3. Automation in an Addiction Treatment Research Clinic: Computerized Contingency Management, Ecological Momentary Assessment, and a Protocol Workflow System

    Science.gov (United States)

    Vahabzadeh, Massoud; Lin, Jia-Ling; Mezghanni, Mustapha; Epstein, David H.; Preston, Kenzie L.

    2009-01-01

    Issues A challenge in treatment research is the necessity of adhering to protocol and regulatory strictures while maintaining flexibility to meet patients’ treatment needs and accommodate variations among protocols. Another challenge is the acquisition of large amounts of data in an occasionally hectic environment, along with provision of seamless methods for exporting, mining, and querying the data. Approach We have automated several major functions of our outpatient treatment research clinic for studies in drug abuse and dependence. Here we describe three such specialized applications: the Automated Contingency Management (ACM) system for delivery of behavioral interventions, the Transactional Electronic Diary (TED) system for management of behavioral assessments, and the Protocol Workflow System (PWS) for computerized workflow automation and guidance of each participant’s daily clinic activities. These modules are integrated into our larger information system to enable data sharing in real time among authorized staff. Key Findings ACM and TED have each permitted us to conduct research that was not previously possible. In addition, the time to data analysis at the end of each study is substantially shorter. With the implementation of the PWS, we have been able to manage a research clinic with an 80-patient capacity having an annual average of 18,000 patient-visits and 7,300 urine collections with a research staff of five. Finally, automated data management has considerably enhanced our ability to monitor and summarize participant-safety data for research oversight. Implications and conclusion When developed in consultation with end users, automation in treatment-research clinics can enable more efficient operations, better communication among staff, and expansions in research methods. PMID:19320669

  4. Modification of Irrational Ideas and Test Anxiety through Rational Stage Directed Hypnotherapy (RSDH).

    Science.gov (United States)

    Boutin, Gerard E.; Tosi, Donald J.

    1983-01-01

    Examined the effects of four treatment conditions on the modification of irrational ideas and test anxiety in female nursing students (N=48). The Rational Stage Directed Hypnotherapy (RSDH) treatment group was significantly more effective than the hypnosis only group. The placebo and control groups showed no significant effects. (Author/JAC)

  5. Discrete Choice and Rational Inattention

    DEFF Research Database (Denmark)

    Fosgerau, Mogens; Melo, Emerson; de Palma, André

    2017-01-01

    This paper establishes a general equivalence between discrete choice and rational inattention models. Matejka and McKay (2015, AER) showed that when information costs are modelled using the Shannon entropy, the result- ing choice probabilities in the rational inattention model take the multinomial...... logit form. We show that when information costs are modelled using a class of generalized entropies, then the choice probabilities in any rational inattention model are observationally equivalent to some additive random utility discrete choice model and vice versa. This equivalence arises from convex...

  6. Rational top and its classical r-matrix

    International Nuclear Information System (INIS)

    Aminov, G; Arthamonov, S; Smirnov, A; Zotov, A

    2014-01-01

    We construct a rational integrable system (the rational top) on a co-adjoint orbit of SL N Lie group. It is described by the Lax operator with spectral parameter and classical non-dynamical skew-symmetric r-matrix. In the case of the orbit of minimal dimension the model is gauge equivalent to the rational Calogero–Moser (CM) system. To obtain the results we represent the Lax operator of the CM model in two different factorized forms—without spectral parameter (related to the spinless case) and another one with the spectral parameter. The latter gives rise to the rational top while the first one is related to generalized Cremmer–Gervais r-matrices. The gauge transformation relating the rational top and CM model provides the classical rational version of the IRF-Vertex correspondence. From the geometrical point of view it describes the modification of SL(N,C)-bundles over degenerated elliptic curve. In view of the Symplectic Hecke Correspondence the rational top is related to the rational spin CM model. Possible applications and generalizations of the suggested construction are discussed. In particular, the obtained r-matrix defines a class of KZB equations. (paper)

  7. Fiber sources for complete calf starter rations.

    Science.gov (United States)

    Murdock, F R; Wallenius, R W

    1980-11-01

    Complete calf starter rations containing either 1) alfalfa hay, 2) cottonseed hulls, or 3) alfalfa-beet pulp as sources of fiber were fed to Holstein heifer calves at two locations on a limited milk program from 3 days to 12 wk of age. Rations were isonitrogenous and similar in content of crude fiber and acid detergent fiber. Although growth and development were normal on all rations, calves fed the cottonseed hull ration consumed more starter and gained more body weight than calves fed the other sources of fiber. The similarity of feed efficiencies, rumen pH, and molar ratios of volatile fatty acids between rations indicated no appreciable differences in rumen development or function. The growth response of calves fed the cottonseed hull ration appeared to be a result of better ration acceptability for which no reason was evident. Calves raised at Puyallup gained more body weight than calves at Pullman, and these gains were made more efficiently. These location effects may be related to seasonal differences and greater demands for production of body heat. Although the incidence of scours was less for calves fed alfalfa hay starter, the incidence and severity of bloat were higher for that ration.

  8. Rational decision-making about treatment and care in dementia: a contradiction in terms?

    Science.gov (United States)

    Wolfs, Claire A G; de Vugt, Marjolein E; Verkaaik, Mike; Haufe, Marc; Verkade, Paul-Jeroen; Verhey, Frans R J; Stevens, Fred

    2012-04-01

    To gain caregivers' insights into the decision-making process in dementia patients with regard to treatment and care. Four focus group interviews (n=29). The decision-making process consists of three elementary components: (1) identifying an individual's needs; (2) exploring options; and (3) making a choice. The most important phase is the exploration phase as it is crucial for the acceptance of the disease. Furthermore, the decision is experienced more as an emotional choice than a rational one. It is influenced by personal preferences whereas practical aspects do not seem to play a substantial role. Several aspects make decision-making in dementia different from decision-making in the context of other chronic diseases: (1) the difficulty accepting dementia; (2) the progressive nature of dementia; (3) patient's reliance on surrogate decision-making; and (4) strong emotions. Due to these aspects, the decision-making process is very time-consuming, especially the crucial exploration phase. A more active role is required of both the caregiver and the health care professional especially in the exploration phase, enabling easier acceptance and adjustment to the disease. Acceptance is an important condition for reducing anxiety and resistance to care that may offer significant benefits in the future. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  9. Carcass percentage and quality of broilers given a ration containing probiotics and prebiotics

    Directory of Open Access Journals (Sweden)

    Muhammad Daud

    2007-10-01

    Full Text Available Probiotics is a feed additive in the form of life microorganisms that balance microorganism population in the digestive tract. While prebiotics is a feed substance which is not digested, and selectively improves growth and activity of useful microbes in large intestine. The objectives of this research were to study the carcass percentage and carcass quality of broilers given a ration containing probiotics and prebiotics. Four hundred eighty day-old chicks of broiler Arbor Acres strain were divided into four dietary treatments and three replications (40 birds / replicate. Ration used was consisted of: R1 = basal ration + 0.01% antibiotics (Zinc bacitracin, R2 = basal ration + 0.2% probiotics (Bacillus spp, R3 = basal ration + 0.2% probiotics + 0.5% prebiotics and R4 = basal ration + 0.5% prebiotics (katuk leaves. The variables observed were: carcass percentage, fat content in the abdomen, liver and carcass, cholesterol content in the liver, carcass and blood serum. The results showed that the carcass quality of broiler received probiotics and prebiotics either independently or the combination was significantly (P<0.05 different. The fat content of liver and thigh, and breast cholesterol of R3 was significantly (P<0.05 lower than that of the control (R1. It is concluded that combination of probiotics and prebiotics were able to decrease the carcass fat and cholesterol content at six week of age.

  10. Lessons from Learning to Have Rational Expectations

    OpenAIRE

    Lindh, Thomas

    1989-01-01

    This paper reviews a growing literature investigating how economic agents may learn rational expectations. Fully rational learning requires implausible initial information assumptions, therefore some form of bounded rationality has come into focus. Such learning models often converge to rational expectations equilibria within certain bounds. Convergence analysis has been much simplified by methods from adaptive control theory. Learning stability as a correspondence principle show some promise...

  11. Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: response to HLH-04 treatment protocol.

    Science.gov (United States)

    Jiménez-Hernández, Elva; Martínez-Villegas, Octavio; Sánchez-Jara, Berenice; Martínez-Martell, María Angélica; Hernández-Sánchez, Beatriz; Loza-Santiaguillo, Paloma Del Rocío; Pedro-Matías, Eduardo; Arellano-Galindo, José

    Hemophagocytic syndrome, macrophage activation syndrome, reactive histiocytosis or hemophagocytic lymphohistiocytosis (HLH) represent a group of diseases whose common thread is reactive or neoplastic mononuclear phagocytic system cells and dendritic cell proliferation. We present a case of an HLH probably associated with Epstein-Barr virus (EBV) in a 4-year-old male patient treated with HLH-04 protocol. Viral etiology in HLH is well accepted. In this case, clinical picture of HLH was assumed secondary to EBV infection because IgM serology at the time of clinical presentation was the only positive factor in the viral panel. Diagnosis of HLH is the critical first step to successful treatment. The earlier it is identified, the less the tissue damage and reduced risk of multiple organ failure, which favors treatment response. Copyright © 2016 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

  12. Strategy selection as rational metareasoning.

    Science.gov (United States)

    Lieder, Falk; Griffiths, Thomas L

    2017-11-01

    Many contemporary accounts of human reasoning assume that the mind is equipped with multiple heuristics that could be deployed to perform a given task. This raises the question of how the mind determines when to use which heuristic. To answer this question, we developed a rational model of strategy selection, based on the theory of rational metareasoning developed in the artificial intelligence literature. According to our model people learn to efficiently choose the strategy with the best cost-benefit tradeoff by learning a predictive model of each strategy's performance. We found that our model can provide a unifying explanation for classic findings from domains ranging from decision-making to arithmetic by capturing the variability of people's strategy choices, their dependence on task and context, and their development over time. Systematic model comparisons supported our theory, and 4 new experiments confirmed its distinctive predictions. Our findings suggest that people gradually learn to make increasingly more rational use of fallible heuristics. This perspective reconciles the 2 poles of the debate about human rationality by integrating heuristics and biases with learning and rationality. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. Should informed consent be based on rational beliefs?

    Science.gov (United States)

    Savulescu, J; Momeyer, R W

    1997-10-01

    Our aim is to expand the regulative ideal governing consent. We argue that consent should not only be informed but also based on rational beliefs. We argue that holding true beliefs promotes autonomy. Information is important insofar as it helps a person to hold the relevant true beliefs. But in order to hold the relevant true beliefs, competent people must also think rationally. Insofar as information is important, rational deliberation is important. Just as physicians should aim to provide relevant information regarding the medical procedures prior to patients consenting to have those procedures, they should also assist patients to think more rationally. We distinguish between rational choice/action and rational belief. While autonomous choice need not necessarily be rational, it should be based on rational belief. The implication for the doctrine of informed consent and the practice of medicine is that, if physicians are to respect patient autonomy and help patients to choose and act more rationally, not only must they provide information, but they should care more about the theoretical rationality of their patients. They should not abandon their patients to irrationality. They should help their patients to deliberate more effectively and to care more about thinking rationally. We illustrate these arguments in the context of Jehovah's Witnesses refusing life-saving blood transfusions. Insofar as Jehovah's Witnesses should be informed of the consequences of their actions, they should also deliberate rationally about these consequences.

  14. External phenome analysis enables a rational federated query strategy to detect changing rates of treatment-related complications associated with multiple myeloma.

    Science.gov (United States)

    Warner, Jeremy L; Alterovitz, Gil; Bodio, Kelly; Joyce, Robin M

    2013-01-01

    Electronic health records (EHRs) are increasingly useful for health services research. For relatively uncommon conditions, such as multiple myeloma (MM) and its treatment-related complications, a combination of multiple EHR sources is essential for such research. The Shared Health Research Information Network (SHRINE) enables queries for aggregate results across participating institutions. Development of a rational search strategy in SHRINE may be augmented through analysis of pre-existing databases. We developed a SHRINE query for likely non-infectious treatment-related complications of MM, based upon an analysis of the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC II) database. Using this query strategy, we found that the rate of likely treatment-related complications significantly increased from 2001 to 2007, by an average of 6% a year (p=0.01), across the participating SHRINE institutions. This finding is in keeping with increasingly aggressive strategies in the treatment of MM. This proof of concept demonstrates that a staged approach to federated queries, using external EHR data, can yield potentially clinically meaningful results.

  15. Product differentiation under bounded rationality

    NARCIS (Netherlands)

    Vermeulen, B.; Poutré, La J.A.; Kok, de A.G.; Pyka, A.; Handa, H.; Ishibuchi, H.; Ong, Y.-S.; Tan, K.-C.

    2015-01-01

    We study product differentiation equilibria and dynamics on the Salop circle under bounded rationality. Due to bounded rationality, firms tend to agglomerate in pairs. Upon adding a second tier of component suppliers, downstream assemblers may escape pairwise horizontal agglomeration. Moreover, we

  16. A rational-emotive stress management intervention for reducing job burnout and dysfunctional distress among special education teachers

    Science.gov (United States)

    Ugwoke, Samuel C.; Eseadi, Chiedu; Onuigbo, Liziana N.; Aye, Eucharia N.; Akaneme, Immaculata N.; Oboegbulem, Angie I.; Ezenwaji, Ifeyinwa O.; Nwobi, Anthonia U.; Nwaubani, Okechukwu O.; Ezegbe, Bernedeth N.; Ede, Moses O.; Orji, Chibueze T.; Onuoha, Joseph C.; Onu, Eucharia U.; Okeke, Francisca; Agu, Patricia; Omeje, Joachim C.; Omeke, Faith; Ugwu, Romanus; Arumede, Florence; Eneh, Annastasia

    2018-01-01

    Abstract Background: Job-related burnout and distress are adverse stress responses which affect individuals in their occupational environment. This study aimed at investigating the effect of a rational-emotive stress management program on job burnout and dysfunctional distress among special education teachers in Nigeria. Methods: A pretest–posttest randomized control group design was used. The participants in the study were 54 special education teachers. Data were collected using self-report questionnaires. Participants were allocated to either the treatment group (n = 28 [59.1%]) or the waitlist control group (n = 26 [48.1%]), respectively. A rational-emotive stress management manual was used to deliver the intervention. We statistically analyzed the data collected at three-time points with repeated-measures analysis of variance. Results: At baseline, the job-related burnout symptoms and distress scores of participants were high. However, an intention-to-treat analysis showed that the rational-emotive stress management intervention program was efficacious in reducing the levels of job-related burnout symptoms and dysfunctional distress among participants assigned to the treatment group, compared to a waitlisted group at post-treatment and follow-up meetings. Conclusion: Our study demonstrates the effectiveness of a rational-emotive stress management intervention in reducing the level of job-related burnout and distress in a sample of special education teachers in Nigeria. Occupational health counsellors and other clinicians with sufficient knowledge of rational-emotive behavior therapy framework are urged to employ this approach in assisting other employees in managing job burnout symptoms, and distress. PMID:29703004

  17. Rationing in health systems: A critical review.

    Science.gov (United States)

    Keliddar, Iman; Mosadeghrad, Ali Mohammad; Jafari-Sirizi, Mehdi

    2017-01-01

    Background: It is difficult to provide health care services to all those in need of such services due to limited resources and unlimited demands. Thus, priority setting and rationing have to be applied. This study aimed at critically examining the concept of rationing in health sector and identifying its purposes, influencing factors, mechanisms, and outcomes. Methods: The critical interpretive synthesis methodology was used in this study. PubMed, Cochrane, and Proquest databases were searched using the related key words to find related documents published between 1970 and 2015. In total, 161 published reports were reviewed and included in the study. Thematic content analysis was applied for data analysis. Results: Health services rationing means restricting the access of some people to useful or potentially useful health services due to budgetary limitation. The inherent features of the health market and health services, limited resources, and unlimited needs necessitate health services rationing. Rationing can be applied in 4 levels: health care policy- makers, health care managers, health care providers, and patients. Health care rationing can be accomplished through fixed budget, benefit package, payment mechanisms, queuing, copayments, and deductibles. Conclusion: This paper enriched our understanding of health services rationing and its mechanisms at various levels and contributed to the literature by broadly conceptualizing health services rationing.

  18. Research on Bounded Rationality of Fuzzy Choice Functions

    Directory of Open Access Journals (Sweden)

    Xinlin Wu

    2014-01-01

    Full Text Available The rationality of a fuzzy choice function is a hot research topic in the study of fuzzy choice functions. In this paper, two common fuzzy sets are studied and analyzed in the framework of the Banerjee choice function. The complete rationality and bounded rationality of fuzzy choice functions are defined based on the two fuzzy sets. An assumption is presented to study the fuzzy choice function, and especially the fuzzy choice function with bounded rationality is studied combined with some rationality conditions. Results show that the fuzzy choice function with bounded rationality also satisfies some important rationality conditions, but not vice versa. The research gives supplements to the investigation in the framework of the Banerjee choice function.

  19. Liberal rationalism and medical decision-making.

    Science.gov (United States)

    Savulescu, Julian

    1997-04-01

    I contrast Robert Veatch's recent liberal vision of medical decision-making with a more rationalist liberal model. According to Veatch, physicians are biased in their determination of what is in their patient's overall interests in favour of their medical interests. Because of the extent of this bias, we should abandon the practice of physicians offering what they guess to be the best treatment option. Patients should buddy up with physicians who share the same values -- 'deep value pairing'. The goal of choice is maximal promotion of patient values. I argue that if subjectivism about value and valuing is true, this move is plausible. However, if objectivism about value is true -- that there really are states which are good for people regardless of whether they desire to be in them -- then we should accept a more rationalist liberal alternative. According to this alternative, what is required to decide which course is best is rational dialogue between physicians and patients, both about the patient's circumstances and her values, and not the seeking out of people, physicians or others, who share the same values. Rational discussion requires that physicians be reasonable and empathic. I describe one possible account of a reasonable physician.

  20. Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability

    Directory of Open Access Journals (Sweden)

    Botella C

    2015-10-01

    Full Text Available Cristina Botella,1 Berenice Serrano,1 Rosa M Baños,2 Azucena Garcia-Palacios1 1Universitat Jaume I, Castellón de la Plana, Spain; 2Universitat de Valencia, Valencia, Spain Introduction: The essential feature of post-traumatic stress disorder (PTSD is the development of characteristic symptoms following exposure to one or more traumatic events. According to evidence-based intervention guidelines and empirical evidence, one of the most extensively researched and validated treatments for PTSD is prolonged exposure to traumatic events; however, exposure therapy can present some limitations. Virtual reality (VR can help to improve prolonged exposure because it creates fictitious, safe, and controllable situations that can enhance emotional engagement and acceptance. Objective: In addition to carrying out a review to evaluate the efficacy of VR exposure-based therapy (VR-EBT for the treatment of PTSD, the aim of this study was to contribute to analyzing the use of VR-EBT by: first, evaluating the adequacy of psychological treatment protocols that use VR-EBT to treat PTSD; and second, analyzing the acceptability of VR-EBT. Method: We performed a replica search with descriptors and databases used in two previous reviews and updated to April 2015. Next, we carried out an evaluation of the efficacy, adequacy, and acceptability of VR-EBT protocols. Results: Results showed that VR-EBT was effective in the treatment of PTSD. The findings related to adequacy showed that not all studies using VR-EBT reported having followed the clinical guidelines for evidence-based interventions in the treatment of PTSD. Regarding acceptability, few studies evaluated this subject. However, the findings are very promising, and patients reported high acceptability and satisfaction with the inclusion of VR in the treatment of PTSD. Conclusion: The main weaknesses identified in this review focus on the need for more controlled studies, the need to standardize treatment

  1. Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol.

    Science.gov (United States)

    Markland, A D; Jelovsek, J E; Whitehead, W E; Newman, D K; Andy, U U; Dyer, K; Harm-Ernandes, I; Cichowski, S; McCormick, J; Rardin, C; Sutkin, G; Shaffer, A; Meikle, S

    2017-01-01

    Standardized training and clinical protocols using biofeedback for the treatment of fecal incontinence (FI) are important for clinical care. Our primary aims were to develop, implement, and evaluate adherence to a standardized protocol for manometric biofeedback to treat FI. In a Pelvic Floor Disorders Network (PFDN) trial, participants were enrolled from eight PFDN clinical centers across the United States. A team of clinical and equipment experts developed biofeedback software on a novel tablet computer platform for conducting standardized anorectal manometry with separate manometric biofeedback protocols for improving anorectal muscle strength, sensation, and urge resistance. The training protocol also included education on bowel function, anal sphincter exercises, and bowel diary monitoring. Study interventionists completed online training prior to attending a centralized, standardized certification course. For the certification, expert trainers assessed the ability of the interventionists to perform the protocol components for a paid volunteer who acted as a standardized patient. Postcertification, the trainers audited interventionists during trial implementation to improve protocol adherence. Twenty-four interventionists attended the in-person training and certification, including 46% advanced practice registered nurses (11/24), 50% (12/24) physical therapists, and 4% physician assistants (1/24). Trainers performed audio audits for 88% (21/24), representing 84 audited visits. All certified interventionists met or exceeded the prespecified 80% pass rate for the audit process, with an average passing rate of 93%. A biofeedback protocol can be successfully imparted to experienced pelvic floor health care providers from various disciplines. Our process promoted high adherence to a standard protocol and is applicable to many clinical settings. © 2016 John Wiley & Sons Ltd.

  2. A 2004 view of the Kyoto Protocol

    International Nuclear Information System (INIS)

    Singer, F.

    2004-01-01

    It may not be a household word, but by now the Kyoto Protocol has become a well-known political slogan. It is either ''fundamentally flawed'' (George W. Bush) or it is essential for saving the climate and humanity (Al Gore). There seems to be no in between. The Kyoto Protocol is a treaty to limit (i.e., ration) the use of energy to satisfy the concerns of environmental groups and other believers in global warming catastrophes. This group includes not only certified kooks but also such notables as former Treasury Secretary Paul O'Neill and Sir David King, chief scientific adviser to Her Majesty's government who equates the threat of warming with that of international terrorism. But Kyoto is quite ineffective, that is, it cannot really affect climate or even change the composition of the atmosphere. It is costly. And it is probably also defunct. Where did this treaty come from? Why is it being adopted by some countries but not by others? And what is its likely future?

  3. Prescribing Pattern of Oral Antihyperglycaemic Drugs, Rationality and Adherence to American Diabetes Association (ADA) Treatment Guidelines among Type 2 Diabetes Mellitus (T2DM) Postmenopausal Women.

    Science.gov (United States)

    Sharma, Sudhaa; Tandon, Vishal R; Roshi; Mahajan, Annil

    2016-01-01

    Oral antihyperglycaemic prescription trends keep on changing and thus the drug prescription trend study may prove to be powerful exploratory tool for health care providers. To investigate trends in prescriptions of oral antihyperglycaemic drugs (OHDs) among postmenopausal women suffering from T2DM in India and evaluate the rationality and adherence to ADA treatment guidelines. An observational, cross-sectional descriptive prescription audit (n=500) was carried. Postmenopausal women were interviewed in their local language using pre-tested pre validated questionnaire after verbal informed consent at a teaching tertiary care hospital of north India. Oral antihyperglycaemic drugs (OHDs) drugs were categorized as per the pharmacological classification. Adherence to available clinical practice guidelines/recommendations issued under American Diabetes Association (ADA) 2015 Guidelines as well as rationality of these prescriptions were assessed using WHO Guide to Good Prescribing. Mean age of the study population was 58.14±12.86. Mean duration since menopause was 5.3 years and of T2DM was 9.5 years. A 93.4% of the prescriptions had only OHDs whereas 6.6% of the prescriptions had various insulin preprations + OHDs (pADA treatment guidelines was observed.

  4. Using Rational-Emotive Therapy to Prevent Classroom Problems.

    Science.gov (United States)

    Webber, Jo; Coleman, Maggie

    1988-01-01

    Teachers are encouraged to utilize rational-emotive therapy to prevent and deal with classroom behavior problems. Rational-emotive therapy is defined, the ABC model of rational thinking briefly explained, types of irrational thinking identified, and suggestions for becoming a rational thinker are offered. Classroom examples are given. (DB)

  5. Substantiation of the active ingredients rational concentration of ointment for treatment of allergic dermatitis complicated by fungal infection

    Directory of Open Access Journals (Sweden)

    O. A. Rukhmakova

    2015-08-01

    Full Text Available Aim. Due to the rapid growth of number of allergic skin diseases complicated by secondary fungal infection, creation of new drugs with an integrated anti-allergic and anti-fungal action for their local treatment is especially important. Methods and results. In the process of developing an ointment under conventional name “Allergolik” microbiological studies have been conducted to determine its rational composition. Concentrations of licorice root extract, terbinafine hydrochloride and lavender essential oil have been substantiated as parts of the studied medication. Study of acute toxicity of the developed dosage form has set that it belongs to the IV class of low-toxic substances due to the standard classification of K.K. Sidorova. Conclusion. This testifies the correctness of the choice of drug active ingredients and their concentrations.

  6. Impact of two early treatment protocols for anterior dental crossbite on children’s quality of life

    Science.gov (United States)

    Miamoto, Cristina Batista; Marques, Leandro Silva; Abreu, Lucas Guimarães; Paiva, Saul Martins

    2018-01-01

    ABSTRACT Objective: To assess the impact of two early treatment protocols for anterior dental crossbite on children’s quality of life. Methods: Thirty children, 8 to 10 years of age, with anterior dental crossbite, participated in this study. Individuals were divided into two groups: Group 1 - 15 children undergoing treatment with an upper removable appliance with digital springs; Group 2 - 15 children undergoing treatment with resin-reinforced glass ionomer cement bite pads on the lower first molars. Quality of life was evaluated using the Brazilian version of the Child Perceptions Questionnaire (CPQ8-10), which contains four subscales: oral symptoms (OS), functional limitations (FL), emotional well-being (EW), and social well-being (SW). A higher score denotes a greater negative impact on children’s quality of life. Children answered the questionnaire before treatment (T1) and twelve months after orthodontic treatment onset (T2). Descriptive statistics, the Wilcoxon test and analysis of covariance (ANCOVA) were performed. Results: Children’s mean age was 9.07 ± 0.79 years in Group 1 and 9.00 ± 0.84 years in Group 2. For Group 1, the FL and EW subscale scores and the overall CPQ8-10 were significantly higher in T1 as compared to T2 (p= 0.004, p= 0.012 and p= 0.015, respectively). For Group 2, there were no statistically significant differences. The ANCOVA showed no significant difference regarding quality of life at T2 between groups, after controlling for quality of life measures at T1. Conclusions: The difference regarding the impact on quality of life between groups is not related to the protocol used. PMID:29791690

  7. Differential Rationality and Personal Development.

    Science.gov (United States)

    Fincher, Cameron

    This publication discusses differential rationality; it asserts that the development of institutions, professions, and individuals involves the differentiation of forms and styles of thinking and knowing that are, in various ways, idiosyncratic. Based on this understanding, differential rationality can be seen as a developmental construct that…

  8. Rational reconstructions of modern physics

    CERN Document Server

    Mittelstaedt, Peter

    2013-01-01

    Newton’s classical physics and its underlying ontology are loaded with several metaphysical hypotheses that cannot be justified by rational reasoning nor by experimental evidence. Furthermore, it is well known that some of these hypotheses are not contained in the great theories of Modern Physics, such as the theory of Special Relativity and Quantum Mechanics. This book shows that, on the basis of Newton’s classical physics and by rational reconstruction, the theory of Special Relativity as well as Quantum Mechanics can be obtained by partly eliminating or attenuating the metaphysical hypotheses. Moreover, it is shown that these reconstructions do not require additional hypotheses or new experimental results. In the second edition the rational reconstructions are completed with respect to General Relativity and Cosmology. In addition, the statistics of quantum objects is elaborated in more detail with respect to the rational reconstruction of quantum mechanics. The new material completes the approach of t...

  9. Rational Choice and the Framing of Decisions.

    Science.gov (United States)

    1986-05-29

    survival in a competitive environment , and a minority of rational individuals can sometimes impose rationality on the whole market. Third, the...intuitive appeal of the axioms of rational choice makes it plausible that the theory derived from these axioms should provide an acceptable account of choice...rn-use U? RATIONAL CHOICE AMD THE FINNING OF KCISIOUS(U mi/ STANFORD UNIV CR A TYERSEY ET AL. 29 NAYN4-S4-K-S61SWICLASS IF lED FO 5/10S IL EEEEEEEE

  10. Intergroup conflict and rational decision making.

    Science.gov (United States)

    Martínez-Tur, Vicente; Peñarroja, Vicente; Serrano, Miguel A; Hidalgo, Vanesa; Moliner, Carolina; Salvador, Alicia; Alacreu-Crespo, Adrián; Gracia, Esther; Molina, Agustín

    2014-01-01

    The literature has been relatively silent about post-conflict processes. However, understanding the way humans deal with post-conflict situations is a challenge in our societies. With this in mind, we focus the present study on the rationality of cooperative decision making after an intergroup conflict, i.e., the extent to which groups take advantage of post-conflict situations to obtain benefits from collaborating with the other group involved in the conflict. Based on dual-process theories of thinking and affect heuristic, we propose that intergroup conflict hinders the rationality of cooperative decision making. We also hypothesize that this rationality improves when groups are involved in an in-group deliberative discussion. Results of a laboratory experiment support the idea that intergroup conflict -associated with indicators of the activation of negative feelings (negative affect state and heart rate)- has a negative effect on the aforementioned rationality over time and on both group and individual decision making. Although intergroup conflict leads to sub-optimal decision making, rationality improves when groups and individuals subjected to intergroup conflict make decisions after an in-group deliberative discussion. Additionally, the increased rationality of the group decision making after the deliberative discussion is transferred to subsequent individual decision making.

  11. Intergroup Conflict and Rational Decision Making

    Science.gov (United States)

    Martínez-Tur, Vicente; Peñarroja, Vicente; Serrano, Miguel A.; Hidalgo, Vanesa; Moliner, Carolina; Salvador, Alicia; Alacreu-Crespo, Adrián; Gracia, Esther; Molina, Agustín

    2014-01-01

    The literature has been relatively silent about post-conflict processes. However, understanding the way humans deal with post-conflict situations is a challenge in our societies. With this in mind, we focus the present study on the rationality of cooperative decision making after an intergroup conflict, i.e., the extent to which groups take advantage of post-conflict situations to obtain benefits from collaborating with the other group involved in the conflict. Based on dual-process theories of thinking and affect heuristic, we propose that intergroup conflict hinders the rationality of cooperative decision making. We also hypothesize that this rationality improves when groups are involved in an in-group deliberative discussion. Results of a laboratory experiment support the idea that intergroup conflict –associated with indicators of the activation of negative feelings (negative affect state and heart rate)– has a negative effect on the aforementioned rationality over time and on both group and individual decision making. Although intergroup conflict leads to sub-optimal decision making, rationality improves when groups and individuals subjected to intergroup conflict make decisions after an in-group deliberative discussion. Additionally, the increased rationality of the group decision making after the deliberative discussion is transferred to subsequent individual decision making. PMID:25461384

  12. Intergroup conflict and rational decision making.

    Directory of Open Access Journals (Sweden)

    Vicente Martínez-Tur

    Full Text Available The literature has been relatively silent about post-conflict processes. However, understanding the way humans deal with post-conflict situations is a challenge in our societies. With this in mind, we focus the present study on the rationality of cooperative decision making after an intergroup conflict, i.e., the extent to which groups take advantage of post-conflict situations to obtain benefits from collaborating with the other group involved in the conflict. Based on dual-process theories of thinking and affect heuristic, we propose that intergroup conflict hinders the rationality of cooperative decision making. We also hypothesize that this rationality improves when groups are involved in an in-group deliberative discussion. Results of a laboratory experiment support the idea that intergroup conflict -associated with indicators of the activation of negative feelings (negative affect state and heart rate- has a negative effect on the aforementioned rationality over time and on both group and individual decision making. Although intergroup conflict leads to sub-optimal decision making, rationality improves when groups and individuals subjected to intergroup conflict make decisions after an in-group deliberative discussion. Additionally, the increased rationality of the group decision making after the deliberative discussion is transferred to subsequent individual decision making.

  13. Change in Irrational Beliefs and the Outcome of Rational-Emotive Psychotherapy.

    Science.gov (United States)

    Smith, Timothy W.

    1983-01-01

    Examined correlations between pre- to posttreatment changes in beliefs and changes in treatment-outcome measures within the context of a previous study of rational-emotive therapy. Obtained reliable correlations between changes in beliefs and changes in emotional distress. This relationship occurred in control conditions as well as in treatment…

  14. Prolonged first-line PEG-asparaginase treatment in pediatric acute lymphoblastic leukemia in the NOPHO ALL2008 protocol-Pharmacokinetics and antibody formation

    DEFF Research Database (Denmark)

    Tram Henriksen, Louise; Gottschalk Højfeldt, Sofie; Schmiegelow, Kjeld

    2017-01-01

    BACKGROUND: As pegylated asparaginase is becoming the preferred first-line asparaginase preparation in the chemotherapy regimens of childhood acute lymphoblastic leukemia (ALL), there is a need to evaluate this treatment. METHODS: The aim of this study was to evaluate the pharmacokinetics...... of prolonged upfront biweekly PEG-asparaginase (where PEG is polyethylene glycol) treatment by measuring serum l-asparaginase activity and formation of anti-PEG-asparaginase antibodies. A total of 97 evaluable patients (1-17 years), diagnosed with ALL, and treated according to the NOPHO ALL2008 protocol (where...... NOPHO is Nordic Society of Paediatric Haematology and Oncology) were included. In the NOPHO ALL2008 protocol, patients are randomized to 8 or 15 doses of intramuscular PEG-asparaginase (Oncaspar(®) ) 1,000 IU/m²/dose, at 2-week or 6-week intervals with a total of 30-week treatment (Clinical trials...

  15. Rational customs clearance technology choice

    OpenAIRE

    Shramenko, N.; Andriets, V.

    2008-01-01

    Issues concerning cargo delivery efficiencyincrease by choice of rational customs clearance technology have been considered. Three possible variants of customs clearance andmethods which allow to define the most rational version of cargo delivery in international road communication based on main efficiency criteria for definite distance have been presented.

  16. Cognitive Rationality and Its Logic-Mathematical Language

    Science.gov (United States)

    Masalova, Svetlana

    2012-01-01

    The article deals with the cognitive (flexible) rationality, combining rational and irrational moments of the scientific search of the cognizing subject. Linguo-cognitive model of the concept as the flexible regulative rationality reveals the activity of the cognitive processes and the mentality of the epistemological-ontic subject, its leading…

  17. Effects of a screening and treatment protocol with haloperidol on post-cardiotomy delirium: a prospective cohort study†

    Science.gov (United States)

    Schrøder Pedersen, Sofie; Kirkegaard, Thomas; Balslev Jørgensen, Martin; Lind Jørgensen, Vibeke

    2014-01-01

    OBJECTIVES Post-cardiotomy delirium is common and associated with increased morbidity and mortality. No gold standard exists for detecting delirium, and evidence to support the choice of treatment is needed. Haloperidol is widely used for treating delirium, but indication, doses and therapeutic targets vary. Moreover, doubt has been raised regarding overall efficacy. The purpose of this study was to assess the effect of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium, with the hypothesis that the proportion of delirium- and coma-free days could be increased. Length of stay (LOS), complications and 180-day mortality are reported. METHODS Prospective interventional cohort study. One hundred and seventeen adult patients undergoing cardiac surgery were included before introduction of a screening and treatment protocol with haloperidol for delirium, and 123 patients were included after. Nurses screened patients using validated tools (the Delirium Observation Screening (DOS) scale and confusion assessment method for the intensive care unit (CAM-ICU)). In case of delirium, a checklist to eliminate precipitating/ inducing factors and a protocol for standardized dosing with haloperidol was applied. Group comparison was done using non-parametric tests and analysis of fractions, and associations between delirium and predefined covariates were analysed with logistic regression. RESULTS Incidence of delirium after cardiac surgery was 21 (14–29) and 22 (15–30) %, onset was on postoperative day 1 (1–4) and 1 (1–3), duration was 1 (1–4) day and 3 (1–5) days, respectively, with no significant difference (Period 1 vs 2, all values are given as the median and 95% confidence interval). The proportion of delirium- and coma-free days was 67 (61–73) and 65 (60–70) %, respectively (ns). There was no difference in LOS or complication rate. Delirium was associated to increasing age, increased length of stay and

  18. Jail-to-community treatment continuum for adults with co-occurring substance use and mental disorders: study protocol for a pilot randomized controlled trial.

    Science.gov (United States)

    Van Dorn, Richard A; Desmarais, Sarah L; Rade, Candalyn B; Burris, Elizabeth N; Cuddeback, Gary S; Johnson, Kiersten L; Tueller, Stephen J; Comfort, Megan L; Mueser, Kim T

    2017-08-04

    Adults with co-occurring mental and substance use disorders (CODs) are overrepresented in jails. In-custody barriers to treatment, including a lack of evidence-based treatment options and the often short periods of incarceration, and limited communication between jails and community-based treatment agencies that can hinder immediate enrollment into community care once released have contributed to a cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among this vulnerable and high-risk population. This paper describes a study that will develop research and communication protocols and adapt two evidence-based treatments, dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT), for delivery to adults with CODs across a jail-to-community treatment continuum. Adaptations to DDMI and IGT were guided by the Risk-Need-Responsivity model and the National Institute of Corrections' implementation competencies; the development of the implementation framework and communication protocols were guided by the Evidence-Based Interagency Implementation Model for community corrections and the Inter-organizational Relationship model, respectively. Implementation and evaluation of the protocols and adapted interventions will occur via an open trial and a pilot randomized trial. The clinical intervention consists of two in-jail DDMI sessions and 12 in-community IGT sessions. Twelve adults with CODs and four clinicians will participate in the open trial to evaluate the acceptability and feasibility of, and fidelity to, the interventions and research and communication protocols. The pilot controlled trial will be conducted with 60 inmates who will be randomized to either DDMI-IGT or treatment as usual. A baseline assessment will be conducted in jail, and four community-based assessments will be conducted during a 6-month follow-up period. Implementation, clinical, public health, and treatment preference outcomes will be evaluated

  19. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov's technique followed by the use of intramedullary locked nail

    Directory of Open Access Journals (Sweden)

    Po-Hsin Chou

    2017-06-01

    Conclusion: In the treatment of chronic femur osteomyelitis, the staged protocol of Ilizarov distraction osteogenesis followed by intramedullary nailing was safe and successful, and allowed for union, realignment, reorientation, and leg-length restoration. With regard to the soft tissue, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage.

  20. Rational modulation of neuronal processing with applied electric fields.

    Science.gov (United States)

    Bikson, Marom; Radman, Thomas; Datta, Abhishek

    2006-01-01

    Traditional approaches to electrical stimulation, using trains of supra-threshold pulses to trigger action potentials, may be replaced or augmented by using 'rational' sub-threshold stimulation protocols that incorporate knowledge of single neuron geometry, inhomogeneous tissue properties, and nervous system information coding. Sub-threshold stimulation, at intensities (well) below those sufficient to trigger action potentials, may none-the-less exert a profound effect on brain function through modulation of concomitant neuronal activity. For example, small DC fields may coherently polarize a network of neurons and thus modulate the simultaneous processing of afferent synaptic input as well as resulting changes in synaptic plasticity. Through 'activity-dependent plasticity', sub-threshold fields may allow specific targeting of pathological networks and are thus particularly suitable to overcome the poor anatomical focus of noninvasive (transcranial) electrical stimulation. Additional approaches to improve targeting in transcranial stimulation using novel electrode configurations are also introduced.

  1. An example of the treatment protocol in the case of a patient who has received a radioactive product

    International Nuclear Information System (INIS)

    Izambard, N.

    2011-01-01

    At the end of 2009, the Radiation Protection Unit at Rouen University Hospital (Rouen CHU), took part in discussions initiated by the hospital's protocol review board (Nursing Care Directorate) regarding management of all hospital waste produced during health care activities (including activities involving radioactive materials) with a view to complying with French National Authority for Health requirements. Moreover, these new provisions had to incorporate management procedures relative to radioactive waste from the radio analysis laboratory at the hospital's Clinical Biology Institute in accordance with the Order of 23 July 2008. To this end, a study was carried out on the university hospital departments in question, in conjunction with the nuclear medicine department of the neighbouring Henry-Becquerel Regional Cancer Centre (CRLCC), the major producer of radioactive waste. This document presents the new protocol that takes into account the feedback experience from Rouen CHU and the CRLCC. This protocol is based on a better writing down and availability of all the information concerning the treatment received by the patient during his stay at the hospital. This protocol will allow a better identification of the waste and as a consequence a better optimization of its disposal

  2. Technique on rationalization of using electricity and cases

    International Nuclear Information System (INIS)

    1988-04-01

    This book deals with rationalization of using electric and cases. It is divided into four parts. The first part introduces necessity and of progression rationalization of using electric. The second part describes the technique on rationalization of using electric with management of electric energy. The third part depicts domestic cases of rationalization on using of electric such as substation and motor. The last part also introduces foreign cases of rationalization on using of electric with measure of generator circuit, design of motor, design of lighting and design of other equipment.

  3. Rational emotive behavior therapy versus cognitive therapy versus pharmacotherapy in the treatment of major depressive disorder: Mechanisms of change analysis.

    Science.gov (United States)

    Szentagotai, Aurora; David, Daniel; Lupu, Viorel; Cosman, Doina

    2008-12-01

    Cognitive-behavioral psychotherapies (CBT) are among the first-line interventions for major depressive disorder (MDD), and a significant number of studies indicate their efficacy in the treatment of this disorder. However, differential effects of various forms of CBT have seldom been analyzed in the same experimental design. On the basis of data collected in a randomized clinical trial comparing the efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy (SSRI) in the treatment of MDD, the present article investigates the theory of change advanced by REBT and CT. Measures included to test the two theories of change assess three classes of cognitions: (a) automatic thoughts, (b) dysfunctional attitudes, and (c) irrational beliefs. The results indicate that REBT and CT (and also pharmacotherapy) indiscriminately affect the three classes of cognitions. On the long term (follow-up), a change in implicit demandingness seems more strongly associated with reduced depression and relapse prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  4. Digestion and ruminal fermentation of cocoa pod silage based ration enriched by gliricidia and calliandra leaves on goats

    Directory of Open Access Journals (Sweden)

    Puastuti W

    2015-03-01

    Full Text Available In term of availability, cacao pod is potential for ruminant feed. According to its nutrients content, cacao pod can be used as feed fiber source. Protein sources materials must be added when cacao pod was ensilaged due to low protein content of this material. The aim of this study was to investigate digestibility value and end products of rumen fermentation of goat fed grass or cacao pod based ration. Randomized block design and 20 heads of lambs (16.95±2.36 kg to evaluated 5 type of rations: R (50% grass + 50% concentrate; S (50% cacao pod silage + 50% concentrate; SG (50% cacao pod-gliricidia silage + 50% concentrate; SK (50% cacao pod-calliandra silage + 50% concentrate dan SC (50% cacao pod-mixture of gliricidia-calliandra silage + 50% concentrate. Feeding trial was conducted for over 15 weeks. Measurements were taken on feed digestibility and rumen-fermentation end-products after 3 weeks of treatments. Results shows that nutrients digestibility was different significantly among the groups of treatments (P<0.05. Digestibillity of organic matter, NDF and energy of R ration was those of higher significantly (P<0.05 than those of other groups. N-ammonia of rumen from goat feed R ration was higher (P<0.05 than other groups. Total VFA and each component were different among the groups (P<0.05, however the value was similar among the groups of cacao pod silage rations. It is concluded that cacao pod silaged based rations enriched by Gliricidia and Calliandra leaves did not produce similar digestibility value and end products of rumen fermentation with grass based ration.

  5. Book Selection, Collection Development, and Bounded Rationality.

    Science.gov (United States)

    Schwartz, Charles A.

    1989-01-01

    Reviews previously proposed schemes of classical rationality in book selection, describes new approaches to rational choice behavior, and presents a model of book selection based on bounded rationality in a garbage can decision process. The role of tacit knowledge and symbolic content in the selection process are also discussed. (102 references)…

  6. Love and rationality: on some possible rational effects of love

    Directory of Open Access Journals (Sweden)

    Gustavo Ortiz-Millán

    2007-01-01

    Full Text Available In this paper I defend the idea that rather than disrupting rationality, as the common-sense conception has done it, love may actually help us to develop rational ways of thinking and acting. I make the case for romantic or erotic love, since this is the kind of love that is more frequently associated with irrationality in acting and thinking. I argue that this kind of love may make us develop epistemic and practical forms of rationality. Based on an analysis of its characteristic action tendencies, I argue that love may help us to develop an instrumental form of rationality in determining the best means to achieve the object of love. It may also narrow down the number of practical considerations that may help us to achieve our goals. Finally, love may generate rational ways of belief-formation by framing the parameters taken into account in perception and attention, and by bringing into light only a small portion of the epistemic information available. Love may make us perceive reality more acutely.Neste artigo defendo a idéia de que, em vez de perturbar a racionalidade, como a concepção do senso comum o faz, o amor pode, na verdade, ajudar-nos a desenvolver modos racionais de pensar e agir. Dou bons argumentos para o amor romântico ou erótico, uma vez que esse é o tipo de amor que é mais freqüentemente associado à irracionalidade no agir e no pensar. Argumento que esse tipo de amor pode fazer-nos desenvolver formas epistêmicas e práticas de racionalidade. Com base em uma análise de suas tendências características para a ação, argumento que o amor pode ajudar-nos a desenvolver uma forma instrumental de racionalidade para se determinar o melhor meio de atingir o objeto de amor. Ele também pode limitar o número de considerações práticas que podem ajudar-nos a atingir os nossos objetivos. Finalmente, o amor pode gerar modos racionais de formação de crenças ao estruturar os parâmetros considerados na percepção e na aten

  7. A discussion of theoretical and practical rationality

    Energy Technology Data Exchange (ETDEWEB)

    Wahlstroem, B. [Technical Research Centre of Finland, Espoo (Finland). VTT Automation

    1999-12-01

    Theoretical rationality as defined in Expected Utility Theory and amended with other considerations gives a good basis for decision making. One should however always keep in mind that practical rationality often is far more complicated. People use their everyday experience when placed before new problems and this may lead to apparently irrational choices which on a closer scrutiny may be completely rational. Theories in human decision making unfortunately becomes untestable, firstly because a theory taking all considerations into account would be to complex to be practical and secondly because the data needed to test the theory cannot be collected. The benefit of EUT is that it is simple and straightforward as compared with competing theories. In the natural sciences rationality is often seen simply as a problem of optimisation. This view is practical, but it has to include also psychological and sociological considerations. The apparent controversy between natural and behavioural sciences could at least in principle be resolved by a better understanding of the complexity of human rationality. The human mind does not work in isolation, but it is adapted to a social community and a continuously changing environment. Understanding all components of human rationality is a challenge which cannot be solved on a short term basis. An important part of human rationality is connected to the intricate balance between individual and societal utility. The human mind has over thousands of years learnt to resolve that balance, but in the modern society there are decisions which may not be solvable with an intuitive approach and a strategy of trial and error. For these decisions more solid theories of rationality will be needed. EUT can in spite of its dismerits be used as the backbone for such a theory, but it has to be extended with better explanations of both individual and social rationality. If this understanding of the practical aspects of human rationality can be reached

  8. A discussion of theoretical and practical rationality

    International Nuclear Information System (INIS)

    Wahlstroem, B.

    1999-01-01

    Theoretical rationality as defined in Expected Utility Theory and amended with other considerations gives a good basis for decision making. One should however always keep in mind that practical rationality often is far more complicated. People use their everyday experience when placed before new problems and this may lead to apparently irrational choices which on a closer scrutiny may be completely rational. Theories in human decision making unfortunately becomes untestable, firstly because a theory taking all considerations into account would be to complex to be practical and secondly because the data needed to test the theory cannot be collected. The benefit of EUT is that it is simple and straightforward as compared with competing theories. In the natural sciences rationality is often seen simply as a problem of optimisation. This view is practical, but it has to include also psychological and sociological considerations. The apparent controversy between natural and behavioural sciences could at least in principle be resolved by a better understanding of the complexity of human rationality. The human mind does not work in isolation, but it is adapted to a social community and a continuously changing environment. Understanding all components of human rationality is a challenge which cannot be solved on a short term basis. An important part of human rationality is connected to the intricate balance between individual and societal utility. The human mind has over thousands of years learnt to resolve that balance, but in the modern society there are decisions which may not be solvable with an intuitive approach and a strategy of trial and error. For these decisions more solid theories of rationality will be needed. EUT can in spite of its dismerits be used as the backbone for such a theory, but it has to be extended with better explanations of both individual and social rationality. If this understanding of the practical aspects of human rationality can be reached

  9. A protocol proposition of cell therapy for the treatment of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    J.T. Ribeiro‐Paes

    2014-03-01

    Full Text Available The main feature of pulmonary emphysema is airflow obstruction resulting from the destruction of the alveolar walls distal to the terminal bronchioles. Existing clinical approaches have improved and extended the quality of life of emphysema patients. However, no treatment currently exists that can change the disease course and cure the patient. The different therapeutic approaches that are available aim to increase survival and/or enhance the quality of life of emphysema patients. In this context, cell therapy is a promising therapeutic approach with great potential for degenerative pulmonary diseases. In this protocol proposition, all patients will be submitted to laboratory tests, such as evaluation of heart and lung function and routine examinations. Stem cells will be harvested by means of 10 punctures on each anterior iliac crest, collecting a total volume of 200 mL bone marrow. After preparation, separation, counting and labeling (optional of the mononuclear cells, the patients will receive an intravenous infusion from the pool of Bone Marrow Mononuclear Cells (BMMC. This article proposes a rational and safe clinical cellular therapy protocol which has the potential for developing new projects and can serve as a methodological reference for formulating clinical application protocols related to the use of cellular therapy in COPD. This study protocol was submitted and approved by the Brazilian National Committee of Ethics in Research (CONEP – Brazil registration number 14764. It is also registered in ClinicalTrials.gov (NCT01110252. Resumo: O enfisema pulmonar apresenta como principal característica a obstrução do fluxo aéreo resultante da destruição das paredes alveolares distais ao bronquíolo terminal. As abordagens terapêuticas clínicas existentes têm contribuído para o prolongamento e melhora na qualidade de vida dos portadores de enfisema. Porém, até o momento nenhum tratamento cl

  10. THE HICKSIAN RATIONAL CONSUMER

    OpenAIRE

    Manuel FERNÁNDEZ-GRELA

    2005-01-01

    The aim of this paper is to trace the evolution of the concept of ''rational consumer'' in Hicks's writings. After being one of the pioneers in the introduction of rationality assumptions about consumer behaviour in economic models, Hicks gradually developed a sceptical view about some of the uses to which those assumptions were put into. The focus of the paper is on continuity in Hicksian views, providing a picture of gradual changes in the long series of Hicks's works

  11. The Formation of Rational and Irrational Behaviors in Risky Investment Decision Making: Laboratory Experiment of Coping Theory Implication in Investors' Adaptation Model

    OpenAIRE

    Wendy Wendy; Marwan Asri; Jogiyanto Hartono

    2012-01-01

    This study analyzes the stock investor's rational and irrational behavior formation through Investor's Adaptation model. Hypotheses testings were conducted by manipulating four market conditions using between-subject experimental design. The results supported the hypotheses proposed in this study. When given treatment one (opportunity-high control), investors tended to adapt the profit maximizing strategy (rational). Meanwhile, when given treatment two (opportunity-low control), three (threat-...

  12. Coping More Effectively Through Rational Self-Counseling.

    Science.gov (United States)

    Rogers, George W., Jr.

    1981-01-01

    Rational Self-Counseling, a variation of rational-emotive therapy, is a self-help therapeutic technique in which students are encouraged to be responsible for their own behavior and emotions. The primary function of self-counseling is to evaluate whether thoughts are rational. A list of questions which students might ask themselves is presented.…

  13. Resistance of the packing to attack of insects pest in irradiated ration

    International Nuclear Information System (INIS)

    Arthur, Paula B.; Arthur, Valter; Silva, Lucia C.A.S.; Franco, Suely S.H.

    2013-01-01

    The pests as beetles, acarids, moths and mushrooms among other, usually infest products stored as: grains, crumbs, flours, coffee, tobacco, dried fruits, animal rations, spices, dehydrated plants, causing the visual depreciation and promoting the deterioration of the products. The objective of the research was use the gamma radiation of Cobalt-60 in the disinfestation of some types of rations used for feeding of animals of small size. In the experiment packing measuring 10 cm x 20 cm with capacity of 70 grams of substrate (ration) with 4 types of existent marks in the trade: (1), (2), (3) and (4) of free samples were used. Each treatment had 10 repetitions, that were irradiated with doses of: 0 (control) 0,5; 1,0 and 2,0 kGy, to do the disinfestation of the ration samples. After the irradiation all the packing and the control were conditioned in plastic boxes of 80 cm x 50 cm with cover, where the insects: Lasioderma serricorne, Plodia interpuctella, Sitophilus zeamais and S. oryzae were liberated, in a total of 400 for each box. The boxes were maintained at room acclimatized with 27 ± 2 deg C and relative humidity of 70 ± 5%. The counting of the number of insects and holes in the packing were made after 60 days. The results showed that only the package of the ration type number 4, was susceptive to the attack of the species of insects. (author)

  14. Resistance of the packing to attack of insects pest in irradiated ration

    Energy Technology Data Exchange (ETDEWEB)

    Arthur, Paula B.; Arthur, Valter; Silva, Lucia C.A.S.; Franco, Suely S.H., E-mail: paula.arthur@hotmail.com [Centro de Energia Nuclear na Agricultura (CENA/USP), Piracicaba, SP (Brazil). Lab. de Radiobiologia e Ambiente; Franco, Jose G.; Villavicencio, Anna L.H.C., E-mail: gilmita@uol.com.br, E-mail: villavic@ipen.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2013-07-01

    The pests as beetles, acarids, moths and mushrooms among other, usually infest products stored as: grains, crumbs, flours, coffee, tobacco, dried fruits, animal rations, spices, dehydrated plants, causing the visual depreciation and promoting the deterioration of the products. The objective of the research was use the gamma radiation of Cobalt-60 in the disinfestation of some types of rations used for feeding of animals of small size. In the experiment packing measuring 10 cm x 20 cm with capacity of 70 grams of substrate (ration) with 4 types of existent marks in the trade: (1), (2), (3) and (4) of free samples were used. Each treatment had 10 repetitions, that were irradiated with doses of: 0 (control) 0,5; 1,0 and 2,0 kGy, to do the disinfestation of the ration samples. After the irradiation all the packing and the control were conditioned in plastic boxes of 80 cm x 50 cm with cover, where the insects: Lasioderma serricorne, Plodia interpuctella, Sitophilus zeamais and S. oryzae were liberated, in a total of 400 for each box. The boxes were maintained at room acclimatized with 27 ± 2 deg C and relative humidity of 70 ± 5%. The counting of the number of insects and holes in the packing were made after 60 days. The results showed that only the package of the ration type number 4, was susceptive to the attack of the species of insects. (author)

  15. Freedom and Rationality : Rousseau on Citizenship

    OpenAIRE

    Salvat, Christophe

    2008-01-01

    This paper deals with Rousseau's idea of freedom in terms of rationality and deliberation. It gives support to Berlin's interpretation of the general will as a rational and objective will but dismisses the idea that Rousseau's theory necessarily leads to authoritarianism. The general will, publicly expressed by the law, may be defined as the rational and self-regarding will agents would have if put in an independent and objective state, i.e. the state of nature. The general and the particular...

  16. Rational choice in field archaelology

    Directory of Open Access Journals (Sweden)

    Cătălin Pavel

    2011-11-01

    Full Text Available In the present article I attempt to apply advances in the study of instrumental and epistemic rationality to field archaeology in order to gain insights into the ways archaeologists reason. The cognitive processes, particularly processes of decision making, that enable archaeologists to conduct the excavation in the trench have not been adequately studied so far. I take my cues from two different bodies of theory. I first inquire into the potential that rational choice theory (RCT may have in modeling archaeological behaviour, and I define subjective expected utility, which archaeologists attempt to maximize, in terms of knowledge acquisition and social gain. Following Elster’s criticism of RCT, I conclude that RCT’s standards for rational action do not correspond with those ostensibly used in field archaeology, but that instrumental rationality has a prominent role in the “archaeological experiment”. I further explore if models proposed as reaction to RCT may account for archaeological decision making. I focus on fast and frugal heuristics, and search for archaeological illustrations for some of the cognitive biases that are better documented in psychological literature. I document confirmation and congruence biases, the endowment effect, observer-expectancy bias, illusory correlation, clustering illusion, sunk cost bias, and anchoring, among others and I propose that some of these biases are used as cognitive tools by archaeologists at work and retain epistemic value. However, I find formal logic to be secondary in the development of archaeological reasoning, with default logic and defeasible logic being used instead. I emphasize scientific knowledge as an actively negotiated social product of human inquiry, and conclude that to describe rationality in field archaeology a bounded rationality model is the most promising avenue of investigation.

  17. The rational maps Fλ(z)

    Indian Academy of Sciences (India)

    It is proved that the rational maps in the family {z → zm +λ/zd : λ ∈ C\\{0}} for integers m, d ≥ 2 ... The problem of the existence of Herman rings of a rational map has been studied by. Lyubich in [9] ..... Surveys 41(4) (1986) 35–95. [10] Milnor J ...

  18. Heterogeneity and the (de)stabilizing role of rationality

    International Nuclear Information System (INIS)

    Cavalli, Fausto; Naimzada, Ahmad; Pireddu, Marina

    2015-01-01

    Highlights: • We analyze Cournot oligopolies with heterogeneous firms of generic size. • Rational and naive players are considered. • Stability with respect to oligopoly composition is studied. • In some settings, increasing the rational firms fraction introduces instability. - Abstract: In this paper we study oligopolies of generic size consisting of heterogeneous firms, which adopt best response adjustment mechanisms with either perfect foresight (rational firms) or static expectations (naive firms). Assuming an isoelastic demand function and possibly different marginal costs for the two groups of firms, we focus on the local stability of the Nash equilibrium. We show that, with respect to the oligopoly composition, described in terms of the fraction of rational firms, different scenarios are possible. We find that a high rationality degree may not always guarantee stability, in particular when rational firms have sufficiently larger marginal costs. In fact, in this situation, increasing the fraction of rational firms can even introduce instability. Besides the usual scenarios in which replacing some naive firms with rational ones leads to a stabilization of (or at least keeps unchanged) the dynamics, we provide a family of situations, characterized by costs ratio favorable to naive firms, in which equilibrium loses its stability when naive firms are replaced by rational ones. The results we present are both analytical and simulative.

  19. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov's technique followed by the use of intramedullary locked nail.

    Science.gov (United States)

    Chou, Po-Hsin; Lin, Hsi-Hsien; Su, Yu-Pin; Chiang, Chao-Ching; Chang, Ming-Chau; Chen, Chuan-Mu

    2017-06-01

    Infected nonunion of the femoral shaft is uncommon, and usually presents with challenging therapeutic and reconstructive problems. There are still controversies over treating infected nonunion of the femoral shaft. The purposes of this retrospective study were to review the treatment outcomes and describe a staged protocol for spontaneous wound healing. Six patients with chronic femoral shaft infected-nonunion from October 2002 to September 2010 were included in this retrospective study. Serial plain films and triple films of lower legs were performed to evaluate the alignment of the treated femoral shaft and bony union following our staged protocol of Ilizarov distraction osteogenesis and intramedullary nailing. An average bone defect of 7 cm was noted after staged osteotomy. Mean follow-up was 87.5 (range, 38-133) months. Union was achieved in all six patients, with an average external fixation time of 6.8 (range, 5-11) months. There was no reinfection. One complication of a 4-cm leg discrepancy was noted, with an initial shortening of 15 cm. The mean knee ranges of motion (ROM) before staged protocols and at final follow-up were 64.2±8.6 (range, 60-75)° and 53.3±9.3 (range, 40-65)°, respectively. The ROM at the knee joint statistically decreased following staged protocols. In the treatment of chronic femur osteomyelitis, the staged protocol of Ilizarov distraction osteogenesis followed by intramedullary nailing was safe and successful, and allowed for union, realignment, reorientation, and leg-length restoration. With regard to the soft tissue, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage. Copyright © 2017. Published by Elsevier Taiwan LLC.

  20. Approximation by rational functions as processing method, analysis and transformation of neutron data

    International Nuclear Information System (INIS)

    Gaj, E.V.; Badikov, S.A.; Gusejnov, M.A.; Rabotnov, N.S.

    1988-01-01

    Possible applications of rational functions in the analysis of neutron cross sections, angular distributions and neutron constants generation are described. Results of investigations made in this direction, which have been obtained after the preceding conference in Kiev, are presented: the method of simultaneous treatment of several cross sections for one compound nucleus in the resonance range; the use of the Pade approximation for elastically scattered neutron angular distribution approximation; obtaining of subgroup constants on the basis of rational approximation of cross section functional dependence on dilution cross section; the first experience in function approximation by two variables

  1. Rationality and the Logic of Good Reasons.

    Science.gov (United States)

    Fisher, Walter R.

    This paper contends that the rationality of the logic of good reasons is constituted in its use. To support this claim, the paper presents an analysis of the relationship between being reasonable and being rational. It then considers how following the logic of good reasons leads to rationality in the behavior of individuals and groups; the latter…

  2. Rationality, mental causation and social sciences

    OpenAIRE

    Mladenović Ivan

    2009-01-01

    The aim of this paper is to investigate the role of mental causation in the context of rational choice theory. The author defends psychological aspect of rational explanation against the challenge of contemporary reductive materialism.

  3. Centralization of politrauma. Study of Ferrara’s reality and simulation of an agreed-upon protocol

    Directory of Open Access Journals (Sweden)

    Luigi Melcarne

    2011-09-01

    Full Text Available In a time in which everybody’s asked a big effort to use hospitals, resources and emergency departments in a rational way, the Centralization – that is sending the right patient to the right hospital at the right time – allows an optimization of the resources and a better management of medical patients. In this study we examined the actual state of Centralization in the city of Ferrara where an experimental protocol of “centralization” has been introduced. This study has the purpose of simulating reality if the protocol had been introduced in the years 2008/2009. The results confirm not only that an important number of patients that were meant to be sent to the CTZ of Ferrara where instead sent to the PST but also that, on the contrary, patients from the suburbs that didn’t require advanced treatments were sent to the Sant’Anna hospital of Ferrara. So if medical literature already points out the advantages of a correct Centralization for patients with polytraumas; the study, based on the reality in Ferrara , shows how the creation of an agreed protocol with the goal to guide health workers at sending polytrauma patients to the right destination , instead of creating an excessive flow th the main hub, can improve the overall organization of health services, with an equal distribution between hub and spoke. When considering First Aid not always speed and rapidity guarantee survival; this is so much more real in the case of patients with polytrauma, where quality of cures assumes more importance than time.

  4. Physiological responses to rational-emotive self-verbalizations.

    Science.gov (United States)

    Master, S; Gershman, L

    1983-12-01

    This study tested Albert Ellis' Rational Emotive Therapy (RET) theory which predicts that cognitive beliefs, not the stimulus situation, generate human emotions. According to RET, emotions created by rational beliefs are adaptive, while irrational beliefs result in an unadaptive anxiety level. Results demonstrated that at high levels of problem relevance there was (1) a significantly greater GSR in direct response to the stimulus situation, and also to irrational statements, than to rational and control statements, and (2) no significant difference between rational and neutral control statements. The authors argue that these results are more parsimoniously explained by conditioning theory than by RET theory.

  5. Towards a Characterization of Rational Expectations

    OpenAIRE

    Itai Arieli

    2008-01-01

    R. J. Aumann and J. H. Drèze (2008) define a rational expectation of a player i in a game G as the expected payo of some type of i in some belief system for G in which common knowledge of rationality and common priors obtain. Our goal is to characterize the set of rational expectations in terms of the game's payoff matrix. We provide such a characterization for a specific class of strategic games, called semi-elementary, which includes Myerson's "elementary" games.

  6. Rational drug use in acute pancreatitis: Case report

    Directory of Open Access Journals (Sweden)

    Rosić Nikola

    2011-01-01

    Full Text Available Acute pancreatitis is a sudden inflammation of pancreas where its enzymes autodigest the gland. Two main causes of acute pancreatitis are alcoholism and billiar calculosis. Treatment consists of preventing dehydration, analgesia, decrease of pancreatic exocrine function, enteral nutritional support , respiratory and renal function support and surgery. The patient presents with abdominal pain that lasts for few days and is followed by vomiting. Laboratory tests first revealed abnormal values of blood count and pancreas enzymes (leucocytes -19,7 x 109/L, hematocrit - 0,32, amylase - 52569 IU/L, lypase - 4750 IU/L, CRP - 152 IU/L, albumins - 25 g/L, followed by abnormal values of liver enzymes (AST - 80 IU/L, ALT - 127 IU/L, GGT - 362 IU/L. Further diagnostic procedures showed billiary calculosis, pleural effusion and acute pancreatitis with ascites. No surgery was performed, due to the lack of infect ion and the signs of the patient going into recovery. It was observed that not all diagnostic procedures that exist in the protocol of treatment, such as ERCP or biopsy of pancreatic t issue with microbiological investigation, were performed. Considering the rules of rat ional drug therapy, as well as the protocols that are to be applied in Clinical center 'Kragujevac' in Kragujevac, it was observed that some drugs (antibiotics and albumin were not used in a proper manner, i.e. in compliance with the protocol, which increased the cost of the treatment without improving the patient health or shortening the hospital stay.

  7. Safety and effectiveness of collagenase clostridium histolyticum in the treatment of Peyronie's disease using a new modified shortened protocol.

    Science.gov (United States)

    Abdel Raheem, Amr; Capece, Marco; Kalejaiye, Odunayo; Abdel-Raheem, Tarek; Falcone, Marco; Johnson, Mark; Ralph, Oliver G; Garaffa, Giulio; Christopher, Andrew N; Ralph, David J

    2017-11-01

    To evaluate the efficacy and safety of collagenase clostridium histolyticum (CCH; Xiapex ® , Xiaflex ® ) in the treatment of Peyronie's disease (PD) using a new modified treatment protocol that aims at reducing the number of injections needed and reducing patient visits, thus reducing the duration and cost of treatment. A prospective study of 53 patients with PD who had treatment with CCH at a single centre using a new modified protocol. The angle of curvature assessment after an intracavernosal injection of prostaglandin E1, the International Index of Erectile Function (IIEF) and Peyronie's Disease Questionnaire (PDQ) were completed at baseline and at week 12 (4 weeks after the last injection). The Global Assessment of Peyronie's disease (GAPD) questionnaire was completed at week 12. Under a penile block of 10 mL plain lignocaine 1%, a total of three intralesional injections of CCH (0.9 mg) were given at 4-weekly intervals using a new modified injection technique. In between injections patients used a combination of home modelling, stretching and a vacuum device on a daily basis to mechanically stretch the plaque. Investigator modelling was not performed. The mean (range) penile curvature at baseline was 54 (30-90)°. Of the 53 patients in the study, 51 patients (96.2%) had an improvement in the angel of curvature by a mean (range) of 17.36 (0-40)° or 31.4 (0-57)% from baseline after three CCH injections. The final mean (range) curvature was 36.9 (12-75)° (P effective, and cost efficient. The results of using only three CCH injections according to this modified protocol are comparable to those of the clinical trials that used eight CCH injections. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  8. Rational inattention or rational overreaction?

    DEFF Research Database (Denmark)

    Browning, Martin; Hansen, Lars Gårn; Smed, Sinne

    We investigate differences in how consumers of fish react to health information in the mass media. We specify a dynamic empirical model that allows for heterogeneity in all basic parameters of consumer behavior as well as in how consumers react to information. We estimate the model using a unique...... houshold panel tracking consumption, prices, news stories and media habits over 24 quarters. We fi nd that the consumers most likely to be ’rationally ignorant’ of health effects react more dramatically to health news than the consumers who most likely are well informed....

  9. A rational-emotive stress management intervention for reducing job burnout and dysfunctional distress among special education teachers: An effect study.

    Science.gov (United States)

    Ugwoke, Samuel C; Eseadi, Chiedu; Onuigbo, Liziana N; Aye, Eucharia N; Akaneme, Immaculata N; Oboegbulem, Angie I; Ezenwaji, Ifeyinwa O; Nwobi, Anthonia U; Nwaubani, Okechukwu O; Ezegbe, Bernedeth N; Ede, Moses O; Orji, Chibueze T; Onuoha, Joseph C; Onu, Eucharia A; Okeke, Francisca; Agu, Patricia; Omeje, Joachim C; Omeke, Faith; Ugwu, Romanus; Arumede, Florence; Eneh, Annastasia

    2018-04-01

    Job-related burnout and distress are adverse stress responses which affect individuals in their occupational environment. This study aimed at investigating the effect of a rational-emotive stress management program on job burnout and dysfunctional distress among special education teachers in Nigeria. A pretest-posttest randomized control group design was used. The participants in the study were 54 special education teachers. Data were collected using self-report questionnaires. Participants were allocated to either the treatment group (n = 28 [59.1%]) or the waitlist control group (n = 26 [48.1%]), respectively. A rational-emotive stress management manual was used to deliver the intervention. We statistically analyzed the data collected at three-time points with repeated-measures analysis of variance. At baseline, the job-related burnout symptoms and distress scores of participants were high. However, an intention-to-treat analysis showed that the rational-emotive stress management intervention program was efficacious in reducing the levels of job-related burnout symptoms and dysfunctional distress among participants assigned to the treatment group, compared to a waitlisted group at post-treatment and follow-up meetings. Our study demonstrates the effectiveness of a rational-emotive stress management intervention in reducing the level of job-related burnout and distress in a sample of special education teachers in Nigeria. Occupational health counsellors and other clinicians with sufficient knowledge of rational-emotive behavior therapy framework are urged to employ this approach in assisting other employees in managing job burnout symptoms, and distress.

  10. Rationality, mental causation and social sciences

    Directory of Open Access Journals (Sweden)

    Mladenović Ivan

    2009-01-01

    Full Text Available The aim of this paper is to investigate the role of mental causation in the context of rational choice theory. The author defends psychological aspect of rational explanation against the challenge of contemporary reductive materialism.

  11. A Randomised Non-inferiority Trial on the Effect of an Antibiotic or Non-antibiotic Topical Treatment Protocol for Digital Dermatitis in Dairy Cattle : a knowledge summary

    NARCIS (Netherlands)

    Jorritsma, R.; Nielen, M.; Dotinga, Amarins

    2017-01-01

    Objective: Investigation of the therapeutic effect of a protocol using non-antibiotic Intra Epidine (IE) spray containing copper and zinc chelate on M2 digital dermatitis (DD) lesions compared to a treatment protocol using antibiotic chlortetracycline (CTC) spray for non-inferiority testing.

  12. Toward a rational understanding of migraine trigger factors.

    Science.gov (United States)

    Martin, V T; Behbehani, M M

    2001-07-01

    The typical migraine patient is exposed to a myriad of migraine triggers on a daily basis. These triggers potentially can act at various sites within the cerebral vasculature and the central nervous system to promote the development of migraine headache. The challenge to the physician is in the identification and avoidance of migraine trigger factors within patients suffering from migraine headache. Only through a rational approach to migraine trigger factors can physicians develop an appropriate treatment strategy for migraine patients.

  13. Pandemic ventilator rationing and appeals processes.

    Science.gov (United States)

    Patrone, Daniel; Resnik, David

    2011-06-01

    In a severe influenza pandemic, hospitals will likely experience serious and widespread shortages of patient pulmonary ventilators and of staff qualified to operate them. Deciding who will receive access to mechanical ventilation will often determine who lives and who dies. This prospect raises an important question whether pandemic preparedness plans should include some process by which individuals affected by ventilator rationing would have the opportunity to appeal adverse decisions. However, the issue of appeals processes to ventilator rationing decisions has been largely neglected in state pandemic planning efforts. If we are to devise just and effective plans for coping with a severe influenza pandemic, more attention to the issue of appeals processes for pandemic ventilator rationing decisions is needed. Arguments for and against appeals processes are considered, and some suggestions are offered to help efforts at devising more rational pandemic preparedness plans.

  14. The discrepancy between emotional vs. rational estimates of body size, actual size, and ideal body ratings: theoretical and clinical implications.

    Science.gov (United States)

    Thompson, J K; Dolce, J J

    1989-05-01

    Thirty-two asymptomatic college females were assessed on multiple aspects of body image. Subjects' estimation of the size of three body sites (waist, hips, thighs) was affected by instructional protocol. Emotional ratings, based on how they "felt" about their body, elicited ratings that were larger than actual and ideal size measures. Size ratings based on rational instructions were no different from actual sizes, but were larger than ideal ratings. There were no differences between actual and ideal sizes. The results are discussed with regard to methodological issues involved in body image research. In addition, a working hypothesis that differentiates affective/emotional from cognitive/rational aspects of body size estimation is offered to complement current theories of body image. Implications of the findings for the understanding of body image and its relationship to eating disorders are discussed.

  15. RATIONAL APPROXIMATIONS TO GENERALIZED HYPERGEOMETRIC FUNCTIONS.

    Science.gov (United States)

    Under weak restrictions on the various free parameters, general theorems for rational representations of the generalized hypergeometric functions...and certain Meijer G-functions are developed. Upon specialization, these theorems yield a sequency of rational approximations which converge to the

  16. Many faces of rationality: Implications of the great rationality debate for clinical decision-making

    OpenAIRE

    Djulbegovic, B.; Elqayam, Shira

    2017-01-01

    open access article Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings fromThe Great Rationality Debate from t...

  17. Rationalizing the Promotion of Non-Rational Behaviors in Organizations.

    Science.gov (United States)

    Smith, Peter A. C.; Sharma, Meenakshi

    2002-01-01

    Organizations must balance rational/technical efficiency and emotions. Action learning has been proven to be effective for developing emotional openness in the workplace. Facilitators of action learning should draw upon the disciplines of counseling, Gestalt, psychodynamics, and Eastern philosophies. (Contains 23 references.) (SK)

  18. Generalized NLS hierarchies from rational W algebras

    International Nuclear Information System (INIS)

    Toppan, F.

    1993-11-01

    Finite rational W algebras are very natural structures appearing in coset constructions when a Kac-Moody subalgebra is factored out. The problem of relating these algebras to integrable hierarchies of equations is studied by showing how to associate to a rational W algebra its corresponding hierarchy. Two examples are worked out, the sl(2)/U(1) coset, leading to the Non-Linear Schroedinger hierarchy, and the U(1) coset of the Polyakov-Bershadsky W algebra, leading to a 3-field representation of the KP hierarchy already encountered in the literature. In such examples a rational algebra appears as algebra of constraints when reducing a KP hierarchy to a finite field representation. This fact arises the natural question whether rational algebras are always associated to such reductions and whether a classification of rational algebras can lead to a classification of the integrable hierarchies. (author). 19 refs

  19. The effectiveness of Korean medicine treatment in male patients with infertility: a study protocol for a prospective observational pilot study.

    Science.gov (United States)

    Kim, Kwan-Ii; Jo, Junyoung

    2018-01-01

    Male factor subfertility has increasingly been considered the cause of infertility in couples. Many men with male infertility have sperm problems such as oligozoospermia, asthenozoospermia, or teratozoospermia. Because abnormal semen parameters are idiopathic to some extent, no standard therapy has been established to date. Herbal medicine has been reported to have beneficial properties in the treatment of subfertility, especially in improving semen quality both in vivo and in human studies. Therefore, we intend to investigate the effectiveness and safety of treatment using Korean medicine (KM) for infertile male patients with poor semen quality.This will be a single-center, prospective, case-only observational pilot study. About 20 male patients with infertility who visit Conmaul Hospital of Korean Medicine will be recruited. We will follow the standard treatment protocol, which has shown good results in the treatment of male infertility. The protocol is composed mainly of a 10-week herbal decoction treatment; acupuncture and/or pharmacopuncture are added when needed. Semen samples, quality of life, and the scrotal temperatures of infertile men will be observed before and after the 10-week treatment with KM.The study has received ethical approval from the Public Institutional Review Board (approval number: P01-201708-21-008). The findings will be disseminated to appropriate audiences via peer-reviewed publication and conference presentations. Korean Clinical Trial Registry (CRIS), Republic of Korea: KCT0002611.

  20. An open trial of a comprehensive anger treatment program on an outpatient sample.

    Science.gov (United States)

    Fuller, J Ryan; Digiuseppe, Raymond; O'Leary, Siobhan; Fountain, Tina; Lang, Colleen

    2010-07-01

    This pilot study was designed to investigate the efficacy of a cognitive behavioral treatment for anger. Twelve (5 men and 7 women) outpatient adults completed 2-hour group sessions for 16 sessions. Participants were diagnosed with 29 Axis I and 34 Axis II disorders with high rates of comorbidity. Empirically supported techniques of skills training, cognitive restructuring, and relaxation were utilized. In this protocol, cognitive restructuring emphasized the use of the ABC model to understand anger episodes and the Rational Emotive Behavior Therapy (REBT) techniques of disputing irrational beliefs and rehearsing rational coping statements, but additional cognitive techniques were used, e.g. self-instructional training (SIT). Skills training included problem-solving and assertiveness. Relaxation training was paced respiration. Motivational interviewing, imaginal exposure with coping, and relapse prevention were also included. Significant improvements were found from pre- to post-treatment on the following measures: the Trait Anger Scale of the State-Trait Anger Expression Inventory-II; and Anger Disorder Scale total scores; idiosyncratic anger measurements of situational intensity and symptom severity; and the Beck Depression Inventory-II. In order to extend the significant research findings of this pilot study, future investigations should involve larger sample sizes, populations drawn from various settings, and contact control groups.

  1. Lying for the Greater Good: Bounded Rationality in a Team

    Directory of Open Access Journals (Sweden)

    Oktay Sürücü

    2014-10-01

    Full Text Available This paper is concerned with the interaction between fully and boundedly rational agents in situations where their interests are perfectly aligned. The cognitive limitations of the boundedly rational agent do not allow him to fully understand the market conditions and lead him to take non-optimal decisions in some situations. Using categorization to model bounded rationality, we show that the fully rational agent can nudge, i.e., he can manipulate the information he sends and decrease the expected loss caused by the boundedly rational agent. Assuming different types for the boundedly rational agent, who differ only in the categories used, we show that the fully rational agent may learn the type of the boundedly rational agent along their interaction. Using this additional information, the outcome can be improved and the amount of manipulated information can be decreased. Furthermore, as the length of the interaction increases the probability that the fully rational agent learns the type of the boundedly rational agent grows

  2. Normative and descriptive rationality: from nature to artifice and back

    Science.gov (United States)

    Besold, T. R.; Uckelman, S. L.

    2018-03-01

    Rationality plays a key role in both the study of human reasoning and Artificial Intelligence (AI). Certain notions of rationality have been adopted in AI as guides for the development of intelligent machines and these notions have been given a normative function. The notions of rationality in AI are often taken to be closely related to conceptions of rationality in human contexts. In this paper, we argue that the normative role of rationality differs in the human and artificial contexts. While rationality in human-focused fields of study is normative, prescribing how humans ought to reason, the normative conception in AI is built on a notion of human rationality which is descriptive, not normative, in the human context, as AI aims at building agents which reason as humans do. In order to make this point, we review prominent notions of rationality used in psychology, cognitive science, and (the history of) philosophy, as well as in AI, and discuss some factors that contributed to rationality being assigned the differing normative statuses in the differing fields of study. We argue that while 'rationality' is a normative notion in both AI and in human reasoning, the normativity of the AI conception of 'rationality' is grounded in a descriptive account of human rationality.

  3. Momentum effect in stocks’ returns between the rational and the behavioural financial theories: Proposition of the progressive rationality

    Directory of Open Access Journals (Sweden)

    Faten Zoghlami

    2013-01-01

    Full Text Available     The puzzling momentum strategies’ payoffs defied the rational financial theory asserting the stocks returns’ unpredictability. Moreover, the momentum effect persist the main stocks returns’ anomaly escaping any risk-based explanation. The resilience of this phenomenon had favoured the development of behavioural financial field, which breaks with the investor’ full rationality hypothesis. This paper attempts to reconcile between the rational and behavioural financial theories, through the introduction of the progressive rationality concept. Especially, we argue that recognizing the temporary inappropriate investors’ reactions; can resolve the puzzling momentum anomaly. To fulfil our objective, we identify the appropriate autoregressive level that captures the significant autocorrelations involved by the investors’ over and under reactions. Then, we explore the profitability of the 6/6 momentum strategy implemented on the adjusted stocks’ returns. The adjusted momentum strategy is still profitable but no longer puzzling, since the related excess return is henceforth fully captured by a β and a size effect.Key words: Tunisian momentum effect, the rational finance theory, the behavioural finance theory, the three-factorial model and the autoregressive process.

  4. Neurophysiology and Rationality in Political Thinking.

    Science.gov (United States)

    Peterson, Steven A.

    Research both in cognitive psychology and psychobiology suggests that political behavior is often less rational than individuals believe it to be. Information processing, memory, and decision making are interlinked processes. Studies in cognitive psychology reveal that even though decision making requires rationality, individuals often adopt…

  5. Positroids Induced by Rational Dyck Paths

    OpenAIRE

    Gotti, Felix

    2017-01-01

    A rational Dyck path of type $(m,d)$ is an increasing unit-step lattice path from $(0,0)$ to $(m,d) \\in \\mathbb{Z}^2$ that never goes above the diagonal line $y = (d/m)x$. On the other hand, a positroid of rank $d$ on the ground set $[d+m]$ is a special type of matroid coming from the totally nonnegative Grassmannian. In this paper we describe how to naturally assign a rank $d$ positroid on the ground set $[d+m]$, which we name rational Dyck positroid, to each rational Dyck path of type $(m,d...

  6. Rationalization and the Role of the School Counselor.

    Science.gov (United States)

    Clark, Arthur J.

    1995-01-01

    Examines rationalization in counselors' interactions with students, parents, and teachers--provides examples of each kind of interaction. Describes the dynamics of rationalization in the schools and outlines interventions that may be used with students, parents, and teachers. Also explores counselors' use of rationalization and gives examples of…

  7. Proposed standby gasoline rationing plan: public comments

    Energy Technology Data Exchange (ETDEWEB)

    1978-12-01

    Under the proposed plan, DOE would allocate ration rights (rights to purchase gasoline) to owners of registered vehicles. All vehicles in a given class would receive the same entitlement. Essential services would receive supplemental allotments of ration rights as pririty firms. Once every 3 months, ration checks would be mailed out to all vehicle registrants, allotting them a certain amount of ration rights. These checks would then be cashed at Coupon Issuance Points, where the bearer would receive ration coupons to be used at gasoline stations. Large users of gasoline could deposit their allotment checks in accounts at ration banks. Coupons or checks would be freely exchangeable in a white market. A certain percentage of the gasoline supply would be set aside in reserve for use in national emergencies. When the plan was published in the Federal Register, public comments were requested. DOE also solicited comments from private citizens, public interest groups, business and industry, state and local governments. A total of 1126 responses were reveived and these are analyzed in this paper. The second part of the report describes how the comments were classified, and gives a statistical breakdown of the major responses. The last section is a discussion and analysis of theissue raised by commenting agencies, firms, associations, and individuals. (MCW)

  8. What are the arguments for and against rational therapy for epilepsy?

    Science.gov (United States)

    Barker-Haliski, Melissa; Sills, Graeme J; White, H Steve

    2014-01-01

    Although more than a dozen new anti-seizure drugs (ASDs) have entered the market since 1993, a substantial proportion of patients (~30 %) remain refractory to current treatments. Thus, a concerted effort to identify and develop new therapies that will help these patients continues. Until this effort succeeds, it is reasonable to re-assess the use of currently available therapies and to consider how these therapies might be utilized in a more efficacious manner. This applies to the selection of monotherapies in newly-diagnosed epilepsy, but perhaps, more importantly, to the choice of combination treatments in otherwise drug-refractory epilepsy. Rational polytherapy is a concept that is predicated on the combination of drugs with complementary mechanisms of action (MoAs) that work synergistically to maximize efficacy and minimize the potential for adverse events. Furthermore, rational polytherapy requires a detailed understanding of the MoA subclasses amongst available ASDs and an appreciation of the empirical evidence that supports the use of specific combinations. The majority of ASDs can be loosely categorized into those that target neurotransmission and network hyperexcitability, modulate intrinsic neuronal properties through ion channels, or possess broad-spectrum efficacy as a result of multiple mechanisms. Within each of these categories, there are discrete pharmacological profiles that differentiate individual ASDs. This chapter will consider how knowledge of MoA can help guide therapy in a rational manner, both in the selection of monotherapies for specific seizure types and syndromes, but also in the choice of drug combinations for patients whose epilepsy is not optimally controlled with a single ASD.

  9. The effects of feeding rations that differ in fiber and fermentable starch within a day on milk production and the daily rhythm of feed intake and plasma hormones and metabolites in dairy cows.

    Science.gov (United States)

    Niu, M; Ying, Y; Bartell, P A; Harvatine, K J

    2017-01-01

    A daily pattern of feed intake, milk synthesis, and plasma metabolites and hormones occurs in dairy cows fed a total mixed ration once or twice a day. The objective of this study was to determine if feeding multiple rations within a day, complementing these rhythms, would improve milk production. Twelve Holstein cows were used in a replicated 3×3 Latin square design with 21-d periods. Cows were housed in tie stalls with feed tubs, and feed weight was recorded every 10 s for observation of feeding behavior. Rations were a low fiber and high fermentable starch ration [LFHS; 27.4% neutral detergent fiber (NDF) and 31.7% starch based on 55.7% corn silage and 14.1% steam-flaked corn], a high fiber and low fermentable starch ration (HFLS; 31.7% NDF and 22.3% starch based on 44% corn silage, 26.3% alfalfa haylage, and no steam-flaked corn), and a total mixed ration that was a 1:3 ratio of LFHS and HFLS (30.7% NDF, 24.5% starch). The control treatment (CON) cows were fed the total mixed ration at 0700h, the high/low treatment (HL) fed HFLS ration at 0700h and LFHS ration at 2200h, and the low/high (LH) treatment fed LFHS ration at 0700h and HFLS ration at 1100h (LFHS and HFLS rations fed at a 1:3 ratio). No effect was found of treatment on daily milk, but LH decreased milk fat concentration and yield compared with HL (0.2 percentage units and 0.24kg, respectively). Daily dry matter and NDF intake and total-tract digestibility did not differ between treatments. The HL treatment reduced intake at the morning-conditioned meal after feeding and reduced intake before the evening feeding. A treatment by time of day interaction was found for fecal NDF and indigestible NDF concentration, blood urea nitrogen (BUN), plasma insulin, and fatty acid concentration, and body temperature. The CON and LH treatments increased the daily amplitude of fecal NDF by 1.0 and 1.1 percentage units compared with HL. Plasma insulin was higher in HL than CON at 0100 and 0400h, but lower at 1300 and

  10. State-dependent decisions cause apparent violations of rationality in animal choice.

    Directory of Open Access Journals (Sweden)

    Cynthia Schuck-Paim

    2004-12-01

    Full Text Available Normative models of choice in economics and biology usually expect preferences to be consistent across contexts, or "rational" in economic language. Following a large body of literature reporting economically irrational behaviour in humans, breaches of rationality by animals have also been recently described. If proven systematic, these findings would challenge long-standing biological approaches to behavioural theorising, and suggest that cognitive processes similar to those claimed to cause irrationality in humans can also hinder optimality approaches to modelling animal preferences. Critical differences between human and animal experiments have not, however, been sufficiently acknowledged. While humans can be instructed conceptually about the choice problem, animals need to be trained by repeated exposure to all contingencies. This exposure often leads to differences in state between treatments, hence changing choices while preserving rationality. We report experiments with European starlings demonstrating that apparent breaches of rationality can result from state-dependence. We show that adding an inferior alternative to a choice set (a "decoy" affects choices, an effect previously interpreted as indicating irrationality. However, these effects appear and disappear depending on whether state differences between choice contexts are present or not. These results open the possibility that some expressions of maladaptive behaviour are due to oversights in the migration of ideas between economics and biology, and suggest that key differences between human and nonhuman research must be recognised if ideas are to safely travel between these fields.

  11. State-dependent decisions cause apparent violations of rationality in animal choice.

    Science.gov (United States)

    Schuck-Paim, Cynthia; Pompilio, Lorena; Kacelnik, Alex

    2004-12-01

    Normative models of choice in economics and biology usually expect preferences to be consistent across contexts, or "rational" in economic language. Following a large body of literature reporting economically irrational behaviour in humans, breaches of rationality by animals have also been recently described. If proven systematic, these findings would challenge long-standing biological approaches to behavioural theorising, and suggest that cognitive processes similar to those claimed to cause irrationality in humans can also hinder optimality approaches to modelling animal preferences. Critical differences between human and animal experiments have not, however, been sufficiently acknowledged. While humans can be instructed conceptually about the choice problem, animals need to be trained by repeated exposure to all contingencies. This exposure often leads to differences in state between treatments, hence changing choices while preserving rationality. We report experiments with European starlings demonstrating that apparent breaches of rationality can result from state-dependence. We show that adding an inferior alternative to a choice set (a "decoy") affects choices, an effect previously interpreted as indicating irrationality. However, these effects appear and disappear depending on whether state differences between choice contexts are present or not. These results open the possibility that some expressions of maladaptive behaviour are due to oversights in the migration of ideas between economics and biology, and suggest that key differences between human and nonhuman research must be recognised if ideas are to safely travel between these fields.

  12. Principles of Economic Rationality in Mice.

    Science.gov (United States)

    Rivalan, Marion; Winter, York; Nachev, Vladislav

    2017-12-12

    Humans and non-human animals frequently violate principles of economic rationality, such as transitivity, independence of irrelevant alternatives, and regularity. The conditions that lead to these violations are not completely understood. Here we report a study on mice tested in automated home-cage setups using rewards of drinking water. Rewards differed in one of two dimensions, volume or probability. Our results suggest that mouse choice conforms to the principles of economic rationality for options that differ along a single reward dimension. A psychometric analysis of mouse choices further revealed that mice responded more strongly to differences in probability than to differences in volume, despite equivalence in return rates. This study also demonstrates the synergistic effect between the principles of economic rationality and psychophysics in making quantitative predictions about choices of healthy laboratory mice. This opens up new possibilities for the analyses of multi-dimensional choice and the use of mice with cognitive impairments that may violate economic rationality.

  13. A Randomized Trial of Comparing the Efficacy of Two Neurofeedback Protocols for Treatment of Clinical and Cognitive Symptoms of ADHD: Theta Suppression/Beta Enhancement and Theta Suppression/Alpha Enhancement

    Directory of Open Access Journals (Sweden)

    Arash Mohagheghi

    2017-01-01

    Full Text Available Introduction. Neurofeedback (NF is an adjuvant or alternative therapy for children with Attention Deficit Hyperactivity Disorder (ADHD. This study intended to compare the efficacy of two different NF protocols on clinical and cognitive symptoms of ADHD. Materials and Methods. In this clinical trial, sixty children with ADHD aged 7 to 10 years old were randomly grouped to receive two different NF treatments (theta suppression/beta enhancement protocol and theta suppression/alpha enhancement protocol. Clinical and cognitive assessments were conducted prior to and following the treatment and also after an eight-week follow-up. Results. Both protocols alleviated the symptoms of ADHD in general (p<0.001, hyperactivity (p<0.001, inattention (p<0.001, and omission errors (p<0.001; however, they did not affect the oppositional and impulsive scales nor commission errors. These effects were maintained after an eight-week intervention-free period. The only significant difference between the two NF protocols was that high-frequency alpha enhancement protocol performed better in suppressing omission errors (p<0.001. Conclusion. The two NF protocols with theta suppression/beta enhancement and theta suppression/alpha enhancement have considerable and comparable effect on clinical symptoms of ADHD. Alpha enhancement protocol was more effective in suppressing omission errors.

  14. Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study.

    Science.gov (United States)

    Quanbeck, Andrew R; Gustafson, David H; Marsch, Lisa A; McTavish, Fiona; Brown, Randall T; Mares, Marie-Louise; Johnson, Roberta; Glass, Joseph E; Atwood, Amy K; McDowell, Helene

    2014-05-29

    Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers's diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods - pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance - with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation protocol) methods, and assessment of

  15. Rational Clinical Use of Blood and Blood products – A summary

    Directory of Open Access Journals (Sweden)

    D Ghartimagar

    2017-03-01

    Full Text Available Blood transfusion is an essential therapeutic intervention. The main role of the blood centre is to provide safe and timely blood and blood component(s to the patients that will improve the physiological status of the patient. Various blood components can be harvested from a single donation of whole blood. The blood centre ensures that there is an adequate inventory of all blood types and blood components to meet the needs of the patients. The blood centre does donor selection, blood collection, component preparation, screening for transfusion – transmitted infections and blood processing. Serologically compatible blood and components are provided to the patients after meticulous pre-transfusion testing as per the standard protocol. Rational use of blood and blood products means right product is used with the right dose on right time for the right reason.

  16. Decision Making: Rational, Nonrational, and Irrational.

    Science.gov (United States)

    Simon, Herbert A.

    1993-01-01

    Describes the current state of knowledge about human decision-making and problem-solving processes, explaining recent developments and their implications for management and management training. Rational goal-setting is the key to effective decision making and accomplishment. Bounded rationality is a realistic orientation, because the world is too…

  17. The Intensive Care Lifeboat: a survey of lay attitudes to rationing dilemmas in neonatal intensive care.

    Science.gov (United States)

    Arora, C; Savulescu, J; Maslen, H; Selgelid, M; Wilkinson, D

    2016-11-08

    Resuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit (NICU), meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people (non-health professionals) regarding resource allocation decisions in the NICU. The study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing. The majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival (P = 0.001), life expectancy (P = 0.0001), and cost of treatment (P = 0.01). In the classic 'lifeboat' scenario, all but two respondents were utilitarian. This survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very

  18. Toxoplasma gondii and pre-treatment protocols for polymerase chain reaction analysis of milk samples: a field trial in sheep from Southern Italy

    Directory of Open Access Journals (Sweden)

    Alice Vismarra

    2017-02-01

    Full Text Available Toxoplasmosis is a zoonotic disease caused by the protozoan Toxoplasma gondii. Ingestion of raw milk has been suggested as a risk for transmission to humans. Here the authors evaluated pre-treatment protocols for DNA extraction on T. gondii tachyzoite-spiked sheep milk with the aim of identifying the method that resulted in the most rapid and reliable polymerase chain reaction (PCR positivity. This protocol was then used to analyse milk samples from sheep of three different farms in Southern Italy, including real time PCR for DNA quantification and PCR-restriction fragment length polymorphism for genotyping. The pre-treatment protocol using ethylenediaminetetraacetic acid and Tris-HCl to remove casein gave the best results in the least amount of time compared to the others on spiked milk samples. One sample of 21 collected from sheep farms was positive on one-step PCR, real time PCR and resulted in a Type I genotype at one locus (SAG3. Milk usually contains a low number of tachyzoites and this could be a limiting factor for molecular identification. Our preliminary data has evaluated a rapid, cost-effective and sensitive protocol to treat milk before DNA extraction. The results of the present study also confirm the possibility of T. gondii transmission through consumption of raw milk and its unpasteurised derivatives.

  19. International Study to Predict Optimized Treatment for Depression (iSPOT-D, a randomized clinical trial: rationale and protocol

    Directory of Open Access Journals (Sweden)

    Cooper Nicholas J

    2011-01-01

    Full Text Available Abstract Background Clinically useful treatment moderators of Major Depressive Disorder (MDD have not yet been identified, though some baseline predictors of treatment outcome have been proposed. The aim of iSPOT-D is to identify pretreatment measures that predict or moderate MDD treatment response or remission to escitalopram, sertraline or venlafaxine; and develop a model that incorporates multiple predictors and moderators. Methods/Design The International Study to Predict Optimized Treatment - in Depression (iSPOT-D is a multi-centre, international, randomized, prospective, open-label trial. It is enrolling 2016 MDD outpatients (ages 18-65 from primary or specialty care practices (672 per treatment arm; 672 age-, sex- and education-matched healthy controls. Study-eligible patients are antidepressant medication (ADM naïve or willing to undergo a one-week wash-out of any non-protocol ADM, and cannot have had an inadequate response to protocol ADM. Baseline assessments include symptoms; distress; daily function; cognitive performance; electroencephalogram and event-related potentials; heart rate and genetic measures. A subset of these baseline assessments are repeated after eight weeks of treatment. Outcomes include the 17-item Hamilton Rating Scale for Depression (primary and self-reported depressive symptoms, social functioning, quality of life, emotional regulation, and side-effect burden (secondary. Participants may then enter a naturalistic telephone follow-up at weeks 12, 16, 24 and 52. The first half of the sample will be used to identify potential predictors and moderators, and the second half to replicate and confirm. Discussion First enrolment was in December 2008, and is ongoing. iSPOT-D evaluates clinical and biological predictors of treatment response in the largest known sample of MDD collected worldwide. Trial registration International Study to Predict Optimised Treatment - in Depression (iSPOT-D ClinicalTrials.gov Identifier

  20. Simplifications of rational matrices by using UML

    OpenAIRE

    Tasić, Milan B.; Stanimirović, Ivan P.

    2013-01-01

    The simplification process on rational matrices consists of simplifying each entry represented by a rational function. We follow the classic approach of dividing the numerator and denominator polynomials by their common GCD polynomial, and provide the activity diagram in UML for this process. A rational matrix representation as the quotient of a polynomial matrix and a polynomial is also discussed here and illustrated via activity diagrams. Also, a class diagram giving the links between the c...

  1. Echinocandins for candidemia: a rational choice

    Directory of Open Access Journals (Sweden)

    Francesco Menichetti

    2013-08-01

    Full Text Available Among antifungal drugs, echinocandins (micafungin, caspofungin and anidulafungin represent a rational choice for the first-line therapy of candidemia/invasive candidiasis in critically ill patients. Among other properties characterizing echinocandins, it’s important to emphasize the broad spectrum of activity, the fungicidal activity against the majority of Candida spp., and the activity against the biofilm. Furthermore, echinocandins show greater efficacy than conventional amphotericin B and fluconazole, and similar efficacy to liposomal amphotericin B (but they are less toxic. Finally, echinocandins are recommended at the highest level of evidence (AI for the treatment of invasive candidiasis by IDSA and ESCMID guidelines.http://dx.doi.org/10.7175/rhc.v4i2s.872

  2. Local Choices: Rationality and the Contextuality of Decision-Making

    Science.gov (United States)

    Vlaev, Ivo

    2018-01-01

    Rational explanation is ubiquitous in psychology and social sciences, ranging from rational analysis, expectancy-value theories, ideal observer models, mental logic to probabilistic frameworks, rational choice theory, and informal “folk psychological” explanation. However, rational explanation appears to be challenged by apparently systematic irrationality observed in psychological experiments, especially in the field of judgement and decision-making (JDM). Here, it is proposed that the experimental results require not that rational explanation should be rejected, but that rational explanation is local, i.e., within a context. Thus, rational models need to be supplemented with a theory of contextual shifts. We review evidence in JDM that patterns of choices are often consistent within contexts, but unstable between contexts. We also demonstrate that for a limited, though reasonably broad, class of decision-making domains, recent theoretical models can be viewed as providing theories of contextual shifts. It is argued that one particular significant source of global inconsistency arises from a cognitive inability to represent absolute magnitudes, whether for perceptual variables, utilities, payoffs, or probabilities. This overall argument provides a fresh perspective on the scope and limits of human rationality. PMID:29301289

  3. Local Choices: Rationality and the Contextuality of Decision-Making.

    Science.gov (United States)

    Vlaev, Ivo

    2018-01-02

    Rational explanation is ubiquitous in psychology and social sciences, ranging from rational analysis, expectancy-value theories, ideal observer models, mental logic to probabilistic frameworks, rational choice theory, and informal "folk psychological" explanation. However, rational explanation appears to be challenged by apparently systematic irrationality observed in psychological experiments, especially in the field of judgement and decision-making (JDM). Here, it is proposed that the experimental results require not that rational explanation should be rejected, but that rational explanation is local , i.e., within a context. Thus, rational models need to be supplemented with a theory of contextual shifts. We review evidence in JDM that patterns of choices are often consistent within contexts, but unstable between contexts. We also demonstrate that for a limited, though reasonably broad, class of decision-making domains, recent theoretical models can be viewed as providing theories of contextual shifts. It is argued that one particular significant source of global inconsistency arises from a cognitive inability to represent absolute magnitudes, whether for perceptual variables, utilities, payoffs, or probabilities. This overall argument provides a fresh perspective on the scope and limits of human rationality.

  4. Techno-Optimism and Rational Superstition

    DEFF Research Database (Denmark)

    Wilson, Alexander

    2017-01-01

    our common understanding of reason and rationality? To adopt rational expectations about the world, after all, should we not attempt to avoid the emotional over-determination of our assessments? I show that applied reason is conceptually entangled with this superstitious optimism in the continued...... of retro-causation, where the future is held to somehow have a retroactive effect on the past. This suggests, I argue, that the underlying mechanism by which techno-optimism is supposed to be instrumental in bringing about the future is fundamentally superstitious. But does this superstition not go against...... successes of technology. The article thus reveals a curious sense in which reason is intrinsically superstitious. I offer an evolutionary explanation for this, showing that the biological origins of reason will by nature tend to produce rational agents which are superstitiously bound to realism...

  5. Information-Theoretic Bounded Rationality and ε-Optimality

    Directory of Open Access Journals (Sweden)

    Daniel A. Braun

    2014-08-01

    Full Text Available Bounded rationality concerns the study of decision makers with limited information processing resources. Previously, the free energy difference functional has been suggested to model bounded rational decision making, as it provides a natural trade-off between an energy or utility function that is to be optimized and information processing costs that are measured by entropic search costs. The main question of this article is how the information-theoretic free energy model relates to simple ε-optimality models of bounded rational decision making, where the decision maker is satisfied with any action in an ε-neighborhood of the optimal utility. We find that the stochastic policies that optimize the free energy trade-off comply with the notion of ε-optimality. Moreover, this optimality criterion even holds when the environment is adversarial. We conclude that the study of bounded rationality based on ε-optimality criteria that abstract away from the particulars of the information processing constraints is compatible with the information-theoretic free energy model of bounded rationality.

  6. Rationing critical care medicine: recent studies and current trends.

    Science.gov (United States)

    Ward, Nicholas S

    2005-12-01

    This paper reviews the literature on the rationing of critical care resources. Although much has been written about the concept of rationing, there have been few scientific studies as to its prevalence. A recent meta-analysis reviewed all previously published studies on rationing access to intensive care units but little is known about practices within the intensive care unit. Much literature in the past few years has focused on the growing use of critical care resources and projections for the future. Several authors suggest there may be a crisis in financial or personnel resources if some rationing does not take place. Other papers have argued that the methods of rationing critical care previously proposed, such as limiting the care of dying patients or using cost-effectiveness analysis to determine care, may not be effective or viewed as ethical by some. Finally, several recent papers review how critical care is practiced and allocated in India and Asian countries that already practice open rationing in their health care systems. There is currently no published evidence that overt rationing is taking place in critical care medicine. There is growing evidence that in the future, the need for critical care may outstrip financial resources unless some form of rationing takes place. It is also clear from the literature that choosing how to ration critical care will be a difficult task.

  7. Decision rules and group rationality: cognitive gain or standstill?

    Directory of Open Access Journals (Sweden)

    Petru Lucian Curşeu

    Full Text Available Recent research in group cognition points towards the existence of collective cognitive competencies that transcend individual group members' cognitive competencies. Since rationality is a key cognitive competence for group decision making, and group cognition emerges from the coordination of individual cognition during social interactions, this study tests the extent to which collaborative and consultative decision rules impact the emergence of group rationality. Using a set of decision tasks adapted from the heuristics and biases literature, we evaluate rationality as the extent to which individual choices are aligned with a normative ideal. We further operationalize group rationality as cognitive synergy (the extent to which collective rationality exceeds average or best individual rationality in the group, and we test the effect of collaborative and consultative decision rules in a sample of 176 groups. Our results show that the collaborative decision rule has superior synergic effects as compared to the consultative decision rule. The ninety one groups working in a collaborative fashion made more rational choices (above and beyond the average rationality of their members than the eighty five groups working in a consultative fashion. Moreover, the groups using a collaborative decision rule were closer to the rationality of their best member than groups using consultative decision rules. Nevertheless, on average groups did not outperformed their best member. Therefore, our results reveal how decision rules prescribing interpersonal interactions impact on the emergence of collective cognitive competencies. They also open potential venues for further research on the emergence of collective rationality in human decision-making groups.

  8. Decision rules and group rationality: cognitive gain or standstill?

    Science.gov (United States)

    Curşeu, Petru Lucian; Jansen, Rob J G; Chappin, Maryse M H

    2013-01-01

    Recent research in group cognition points towards the existence of collective cognitive competencies that transcend individual group members' cognitive competencies. Since rationality is a key cognitive competence for group decision making, and group cognition emerges from the coordination of individual cognition during social interactions, this study tests the extent to which collaborative and consultative decision rules impact the emergence of group rationality. Using a set of decision tasks adapted from the heuristics and biases literature, we evaluate rationality as the extent to which individual choices are aligned with a normative ideal. We further operationalize group rationality as cognitive synergy (the extent to which collective rationality exceeds average or best individual rationality in the group), and we test the effect of collaborative and consultative decision rules in a sample of 176 groups. Our results show that the collaborative decision rule has superior synergic effects as compared to the consultative decision rule. The ninety one groups working in a collaborative fashion made more rational choices (above and beyond the average rationality of their members) than the eighty five groups working in a consultative fashion. Moreover, the groups using a collaborative decision rule were closer to the rationality of their best member than groups using consultative decision rules. Nevertheless, on average groups did not outperformed their best member. Therefore, our results reveal how decision rules prescribing interpersonal interactions impact on the emergence of collective cognitive competencies. They also open potential venues for further research on the emergence of collective rationality in human decision-making groups.

  9. Anxiety reduction through group instruction in rational therapy.

    Science.gov (United States)

    Maxwell, J W; Wilkerson, J

    1982-09-01

    This study investigated the effects of group Rational Therapy in promoting rational thinking and self-enhancing emotions among 24 college students. Each subject was administered the Sixteen Personality Factor Questionnaire as a pre- and post-test measurement. Results reveal that some aspects of personality are affected by Rational Therapy group programs while others are not.

  10. Thinking about acting logical foundations for rational decision making

    CERN Document Server

    Pollock, John L

    2006-01-01

    John Pollock aims to construct a theory of rational decision making for real agents--not ideal agents. Real agents have limited cognitive powers, but traditional theories of rationality have applied only to idealized agents that lack such constraints. Pollock argues that theories of ideal rationality are largely irrelevant to the decision making of real agents. Thinking about Acting aims to provide a theory of ""real rationality.""

  11. Choice, internal consistency, and rationality

    OpenAIRE

    Aditi Bhattacharyya; Prasanta K. Pattanaik; Yongsheng Xu

    2010-01-01

    The classical theory of rational choice is built on several important internal consistency conditions. In recent years, the reasonableness of those internal consistency conditions has been questioned and criticized, and several responses to accommodate such criticisms have been proposed in the literature. This paper develops a general framework to accommodate the issues raised by the criticisms of classical rational choice theory, and examines the broad impact of these criticisms from both no...

  12. Management between Rationality and Irrationality

    OpenAIRE

    Cene Bavec

    2012-01-01

    In the paper, we discuss theoretical and practical aspects of management and its rational and irrational behavior in the light of traditional management theories and contemporary social theories and theories of complexity. We exposed differences between middle and top management, where rationality is ascribed mainly to middle management, while top management often acts on seemingly irrational way. For the part of this irrationality, we cannot blame management because it originates from the na...

  13. Self-Reported Rationing Behavior Among US Physicians: A National Survey.

    Science.gov (United States)

    Sheeler, Robert D; Mundell, Tim; Hurst, Samia A; Goold, Susan Dorr; Thorsteinsdottir, Bjorg; Tilburt, Jon C; Danis, Marion

    2016-12-01

    Rationing is a controversial topic among US physicians. Understanding their attitudes and behaviors around rationing may be essential to a more open and sensible professional discourse on this important but controversial topic. To describe rationing behavior and associated factors among US physicians. Survey mailed to US physicians in 2012 to evaluate self-reported rationing behavior and variables related to this behavior. US physicians across a full spectrum of practice settings. A total of 2541 respondents, representing 65.6 % of the original mailing list of 3872 US addresses. The study was a cross-sectional analysis of physician attitudes and self-reported behaviors, with neutral language representations of the behaviors as well as an embedded experiment to test the influence of the word "ration" on perceived responsibility. Overall percentage of respondents reporting rationing behavior in various contexts and assessment of attitudes toward rationing. In total, 1348 respondents (53.1 %) reported having personally refrained within the past 6 months from using specific clinical services that would have provided the best patient care, because of health system cost. Prescription drugs (n = 1073 [48.3 %]) and magnetic resonance imaging (n = 922 [44.5 %]) were most frequently rationed. Surgical and procedural specialists were less likely to report rationing behavior (adjusted odds ratio [OR] [95 % CI], 0.8 [0.9-0.9] and 0.5 [0.4-0.6], respectively) compared to primary care. Compared with small or solo practices, those in medical school settings reported less rationing (adjusted OR [95 % CI], 0.4 [0.2-0.7]). Physicians who self-identified as very or somewhat liberal were significantly less likely to report rationing (adjusted OR [95 % CI], 0.7 [0.6-0.9]) than those self-reporting being very or somewhat conservative. A more positive opinion about rationing tended to align with greater odds of rationing. More than one-half of respondents engaged in

  14. Rational-driver approximation in car-following theory

    Science.gov (United States)

    Lubashevsky, Ihor; Wagner, Peter; Mahnke, Reinhard

    2003-11-01

    The problem of a car following a lead car driven with constant velocity is considered. To derive the governing equations for the following car dynamics a cost functional is constructed. This functional ranks the outcomes of different driving strategies, which applies to fairly general properties of the driver behavior. Assuming rational-driver behavior, the existence of the Nash equilibrium is proved. Rational driving is defined by supposing that a driver corrects continuously the car motion to follow the optimal path minimizing the cost functional. The corresponding car-following dynamics is described quite generally by a boundary value problem based on the obtained extremal equations. Linearization of these equations around the stationary state results in a generalization of the widely used optimal velocity model. Under certain conditions (the “dense traffic” limit) the rational car dynamics comprises two stages, fast and slow. During the fast stage a driver eliminates the velocity difference between the cars, the subsequent slow stage optimizes the headway. In the dense traffic limit an effective Hamiltonian description is constructed. This allows a more detailed nonlinear analysis. Finally, the differences between rational and bounded rational driver behavior are discussed. The latter, in particular, justifies some basic assumptions used recently by the authors to construct a car-following model lying beyond the frameworks of rationality.

  15. Rationality and ritual

    International Nuclear Information System (INIS)

    Wynne, B.

    1982-01-01

    The book concerns the Windscale Public Inquiry, held to investigate the application by British Nuclear Fuels to build a 1200 tonne per year thermal oxide reprocessing plant (THORP) for spent nuclear fuels from Britain and overseas. The subject is discussed under the headings: introduction (international dimensions; the Windscale Inquiry; conflict resolution and social drama; public debate and the sociology of knowledge); the decision-making legacy; oxide reprocessing - the background; the public inquiry tradition - a comparative perspective; the emergence of THORP from a private to a public issue (local and national planning politics); the process and impact of the Inquiry (opposition groups); judicial rationality, expert conflict, and political authority); the rationality and politics of analysis (proliferation; radiation risks; relative risks; the Ravenglass issue; discharge targets; general radiation protection arrangements); conclusion. (U.K.)

  16. Rational accountability and rational autonomy in academic practice: An extended case study of the communicative ethic of interdisciplinary science

    Science.gov (United States)

    Robertson, Susan Margaret

    The dissertation investigates the interaction of rational accountability and rational autonomy in interdisciplinary science within the lifeworld of the university. It focuses on the cultural, social and motivational forces that university researchers draw on, and develop, to constitute and regulate interdisciplinary science. Findings are analyzed within an applied critical social theory framework that attends to the interaction of instrumental and communicative rational action within the public spaces that constitute the lifeworld of the university as a public sphere in society. The research raises questions of how academics practice interdisciplinary science and how these practices relate to the reproduction of the regulative ideal of the university as a community that practices public reason. The conceptual framework informing the research is Habermas' (1984) theory of communicative action. Using Burawoy's (1991) extended case study method as an operational strategy, two modes of constituting and regulating interdisciplinary science were found. Instrumental rational modes dominated in social contexts of interdisciplinary science where consensus on the normative goals and purposes of rational academic action were pre-existing and pre-supposed by participants. Communicative rational modes dominated in social contexts of interdisciplinary science where the normative goals and purposes of rational academic action entered a contested domain. Endorsements for interdisciplinary science policies are coinciding with demands for increased accountability and relevance of Canada's university system. At the same time that the university system must respond to external demands, it must reproduce itself as a public institution open to the discursive redemption of factual and normative validity claims. The study found that academics participate in, but also contest the instrumental regulation of academic inquiry and conduct by using their constitutional autonomy and freedom to

  17. Comparison of 2 comprehensive Class II treatment protocols including the bonded Herbst and headgear appliances: a double-blind study of consecutively treated patients at puberty.

    Science.gov (United States)

    Baccetti, Tiziano; Franchi, Lorenzo; Stahl, Franka

    2009-06-01

    The aim of this clinical trial was to compare the effects of 2 protocols for single-phase comprehensive treatment of Class II Division 1 malocclusion (bonded Herbst followed by fixed appliances [BH + FA] vs headgear followed by fixed appliances and Class II elastics [HG + FA]) at the pubertal growth spurt. Fifty-six Class II patients were enrolled in the trial and allocated by personal choice to 2 practices, where they underwent 1 of 2 treatment protocols (28 patients were treated consecutively with BH + FA, and 28 patients were treated consecutively with HG + FA). All patients started treatment at puberty (cervical stage [CS] 3 or CS 4) and completed treatment after puberty (CS 5 or CS 6). Lateral cephalograms were taken before therapy and 6 months after the end of comprehensive therapy, with an average interval of 28 months. Longitudinal observations of a matched group of 28 subjects with untreated Class II malocclusions were compared with the 2 treated groups. Analysis of variance (ANOVA) with post-hoc tests was used for statistical comparisons. Discriminant analysis was applied to identify preferential candidates for the BH + FA protocol on the basis of profile changes (advancement of the soft tissues of the chin). The success rate (full occlusal correction of the malocclusion after treatment) was 92.8% in both treatment groups. The BH + FA group showed a significant increase in mandibular protrusion. The increase in effective mandibular length (Co-Gn) was significantly greater in both treatment groups when compared with natural growth changes in the Class II controls. Significantly greater improvement in sagittal maxillomandibular relationships was found in the BH + FA group. Retrusion of maxillary incisors and mesial movement of mandibular molars were significant in the HG + FA group. The BH + FA group showed significantly greater forward movements of soft-tissue B-point and pogonion compared with both the HG + FA and the control groups. Two pretreatment

  18. Skeletal Class III and anterior open bite treatment with different retention protocols: a report of three cases.

    Science.gov (United States)

    Farret, Milton Meri Benitez; Farret, Marcel Marchiori; Farret, Alessandro Marchiori

    2012-09-01

    The treatment of skeletal class III and anterior open bite can be unstable and orthodontists frequently observe relapse. Here, we report on the management of three patients with skeletal class III profiles and open bites treated by orthodontic camouflage. Each received a retention protocol involving the use of two separate appliances during the night and day accompanied by myofunctional therapy. Long-term follow-up revealed a stable outcome.

  19. Protocol for the quality control systems of electronic portal imaging used in verification of radiotherapy treatment

    International Nuclear Information System (INIS)

    Silvestre, Ileana; Alfonso, Rodolfo; Garcia, Fernando

    2009-01-01

    Following the approach of quality control of radiotherapy equipment, conceived in the IAEA TECDOC-1151, we analyzed the different tests must be to an EPID to guarantee levels of accuracy required in the administration of radiation treatments, including the study of the impact of different parameters, geometric and dosimetric imaging, involved in the process. Established the types and frequency of checks, as well as procedures for their implementation, the allowable tolerances set of values records and forms for recording . Was carried out assessment protocol in various services based on amorphous silicon EPID for its applicability and scope. Was designed and validated in clinical practice protocol for EPID quality control, demonstrating its applicability with a minimum of material and human resources. It We concluded that with proper and systematic quality control program, tests including dosimetry, the EPID can provide valuable information about physico-beam dosimetry, and ensure adequate accuracy geometric in the patient's location. (author)

  20. Rational emotive behavior therapy, cognitive therapy, and medication in the treatment of major depressive disorder: a randomized clinical trial, posttreatment outcomes, and six-month follow-up.

    Science.gov (United States)

    David, Daniel; Szentagotai, Aurora; Lupu, Viorel; Cosman, Doina

    2008-06-01

    A randomized clinical trial was undertaken to investigate the relative efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy in the treatment of 170 outpatients with nonpsychotic major depressive disorder. The patients were randomly assigned to one of the following: 14 weeks of REBT, 14 weeks of CT, or 14 weeks of pharmacotherapy (fluoxetine). The outcome measures used were the Hamilton Rating Scale for Depression and the Beck Depression Inventory. No differences among treatment conditions at posttest were observed. A larger effect of REBT (significant) and CT (nonsignificant) over pharmacotherapy at 6 months follow-up was noted on the Hamilton Rating Scale for Depression only. (c) 2008 Wiley Periodicals, Inc.

  1. RATIONAL-IRRATIONAL ELECTORAL PREFERENCES, ALTRUISM AND EXPRESSIVE BEHAVIOR

    Directory of Open Access Journals (Sweden)

    Mihai Ungureanu

    2015-01-01

    Full Text Available Caplan (2000, 2001, 2006 proposed the rational-irrationality model arguing that irrationality is a good as any other, whose consumption is maximized in relation to its costs and benefits. Applying this model to the problem of electoral behavior Caplan implies that voters ‘afford’ many irrational beliefs, because the lack of individual decisiveness renders vote as a consequenceless act. This paper contributes to the development of knowledge by analyzing the compatibility of rational irrationality with active electoral behavior. Two important arguments are being proposed: First, Wittman’s (2008 intuition that rational irrationality is incompatible with voting could be supported only about a particular type of altruism, which Caplan actually seems to reject. Second, rational irrationality seems to be compatible with expressive motivations, reinforcing the conclusion that rational-irrational individuals are active voters in mass elections.

  2. The Problem of Rational Moral Enlistment

    Science.gov (United States)

    Tillson, John

    2017-01-01

    How can one bring children to recognize the requirements of morality without resorting only to non-rational means of persuasion (i.e. what rational ground can be offered to children for their moral enlistment)? Michael Hand has recently defended a foundationalist approach to answering this question and John White has responded by (a) criticizing…

  3. A critique of using age to ration health care.

    OpenAIRE

    Hunt, R W

    1993-01-01

    Daniel Callahan has argued that economic and social benefits would result from a policy of withholding medical treatments which prolong life in persons over a certain age. He claims 'the real goal of medicine' is to conquer death and prolong life with the use of technology, regardless of the age and quality of life of the patient, and this has been responsible for the escalation of health care expenditure. Callahan's proposal is based on economic rationalism but there is little evidence to su...

  4. Confucian Rationalism

    Science.gov (United States)

    Lam, Chi-Ming

    2014-01-01

    Nowadays, there is still a widely held view that the Chinese and Western modes of thought are quite distinct from each other. In particular, the Chinese mode of thought derived from Confucianism is considered as comparatively less rational than the Western one. In this article, I first argue that although the analogical mode of argumentation,…

  5. Cognitive distance, absorptive capacity and group rationality: a simulation study.

    Directory of Open Access Journals (Sweden)

    Petru Lucian Curşeu

    Full Text Available We report the results of a simulation study in which we explore the joint effect of group absorptive capacity (as the average individual rationality of the group members and cognitive distance (as the distance between the most rational group member and the rest of the group on the emergence of collective rationality in groups. We start from empirical results reported in the literature on group rationality as collective group level competence and use data on real-life groups of four and five to validate a mathematical model. We then use this mathematical model to predict group level scores from a variety of possible group configurations (varying both in cognitive distance and average individual rationality. Our results show that both group competence and cognitive distance are necessary conditions for emergent group rationality. Group configurations, in which the groups become more rational than the most rational group member, are groups scoring low on cognitive distance and scoring high on absorptive capacity.

  6. Cognitive distance, absorptive capacity and group rationality: a simulation study.

    Science.gov (United States)

    Curşeu, Petru Lucian; Krehel, Oleh; Evers, Joep H M; Muntean, Adrian

    2014-01-01

    We report the results of a simulation study in which we explore the joint effect of group absorptive capacity (as the average individual rationality of the group members) and cognitive distance (as the distance between the most rational group member and the rest of the group) on the emergence of collective rationality in groups. We start from empirical results reported in the literature on group rationality as collective group level competence and use data on real-life groups of four and five to validate a mathematical model. We then use this mathematical model to predict group level scores from a variety of possible group configurations (varying both in cognitive distance and average individual rationality). Our results show that both group competence and cognitive distance are necessary conditions for emergent group rationality. Group configurations, in which the groups become more rational than the most rational group member, are groups scoring low on cognitive distance and scoring high on absorptive capacity.

  7. Treatment of Childhood Depression: The State of the Art.

    Science.gov (United States)

    Clarizio, Harvey F.

    1986-01-01

    This article reviews various aspects of seven approaches to the treatment of childhood depression--psychoanalytic, behavioral, cognitive, familial, rational-emotive, multimodal, and drug interventions. Implications for practitioners are considered in terms of target selection, choice of treatment methods, rational evaluation based on developmental…

  8. Emotions as a Vehicle for Rationality: Rational Decision Making Models Based on Emotion-Related Valuing and Hebbian Learning

    NARCIS (Netherlands)

    Treur, J.; Umair, M.

    2015-01-01

    In this paper an adaptive decision model based on predictive loops through feeling states is analysed from the perspective of rationality. Hebbian learning is considered for different types of connections in the decision model. To assess the extent of rationality, a measure is introduced reflecting

  9. Re-visions of rationality?

    Science.gov (United States)

    Newell, Ben R

    2005-01-01

    The appeal of simple algorithms that take account of both the constraints of human cognitive capacity and the structure of environments has been an enduring theme in cognitive science. A novel version of such a boundedly rational perspective views the mind as containing an 'adaptive toolbox' of specialized cognitive heuristics suited to different problems. Although intuitively appealing, when this version was proposed, empirical evidence for the use of such heuristics was scant. I argue that in the light of empirical studies carried out since then, it is time this 'vision of rationality' was revised. An alternative view based on integrative models rather than collections of heuristics is proposed.

  10. Rationing medical education.

    African Journals Online (AJOL)

    This paper discussed the pros and cons of the application of rationing to medical education and the different ... Even though some stakeholders in medical education might be taken aback at .... Walsh K. Online educational tools to improve the.

  11. A weight loss protocol and owners participation in the treatment of canine obesity

    Directory of Open Access Journals (Sweden)

    Carciofi Aulus Cavalieri

    2005-01-01

    Full Text Available The success of a weight loss program for pets depends on the owners collaboration. Their compliance is fundamental in establishing the correct food management. The objective of this study was to compare the effectiveness of a weight loss program in two groups of dogs, one maintained under experimental conditions and the other with their owners. The same hypocaloric food was used to feed all animals, the amount being restricted to 60% of the estimated maintenance energy requirement for a 15% reduction of the present body weight of the dog. The animals were followed during 90 days. A standard questionnaire was used to study the owners' perception of obesity and its treatment. The protocol and the diet were found to be effective. The control dogs had an average weight loss of 1.39% per week. Dogs with owners lost on average 0.75% of their body weight per week, a statistically lower result (P<0.05, suggesting that the owners did not follow the treatment closely. The owners were clearly satisfied with the results that were obtained, even with this modest weight loss. The questionnaires were shown to be an important tool in determining the causes of canine obesity, as well as in the follow-up of the treatment.

  12. Rationality, perception, and the all-seeing eye.

    Science.gov (United States)

    Felin, Teppo; Koenderink, Jan; Krueger, Joachim I

    2017-08-01

    Seeing-perception and vision-is implicitly the fundamental building block of the literature on rationality and cognition. Herbert Simon and Daniel Kahneman's arguments against the omniscience of economic agents-and the concept of bounded rationality-depend critically on a particular view of the nature of perception and vision. We propose that this framework of rationality merely replaces economic omniscience with perceptual omniscience. We show how the cognitive and social sciences feature a pervasive but problematic meta-assumption that is characterized by an "all-seeing eye." We raise concerns about this assumption and discuss different ways in which the all-seeing eye manifests itself in existing research on (bounded) rationality. We first consider the centrality of vision and perception in Simon's pioneering work. We then point to Kahneman's work-particularly his article "Maps of Bounded Rationality"-to illustrate the pervasiveness of an all-seeing view of perception, as manifested in the extensive use of visual examples and illusions. Similar assumptions about perception can be found across a large literature in the cognitive sciences. The central problem is the present emphasis on inverse optics-the objective nature of objects and environments, e.g., size, contrast, and color. This framework ignores the nature of the organism and perceiver. We argue instead that reality is constructed and expressed, and we discuss the species-specificity of perception, as well as perception as a user interface. We draw on vision science as well as the arts to develop an alternative understanding of rationality in the cognitive and social sciences. We conclude with a discussion of the implications of our arguments for the rationality and decision-making literature in cognitive psychology and behavioral economics, along with suggesting some ways forward.

  13. Towards a classification of rational Hopf algebras

    International Nuclear Information System (INIS)

    Fuchs, J.; Ganchev, A.; Vecsernyes, P.

    1994-02-01

    Rational Hopf algebras, i.e. certain quasitriangular weak quasi-Hopf *-algebras, are expected to describe the quantum symmetry of rational field theories. In this paper methods are developed which allow for a classification of all rational Hopf algebras that are compatible with some prescribed set of fusion rules. The algebras are parametrized by the solutions of the square, pentagon and hexagon identities. As examples, we classify all solutions for fusion rules with not more than three sectors, as well as for the level three affine A 1 (1) fusion rules. We also establish several general properties of rational Hopf algebras and present a graphical description of the coassociator in terms of labelled tetrahedra. The latter construction allows to make contact with conformal field theory fusing matrices and with invariants of three-manifolds and topological lattice field theory. (orig.)

  14. Bounded rational choice behaviour: applications in transport

    DEFF Research Database (Denmark)

    Jensen, Anders Fjendbo

    2016-01-01

    Even though the theory of rational behaviour has been challenged for almost 100 years, the dominant approach within the field of transport has been based upon the assumptions of neoclassical economics that we live in a world of rational decision makers who always have perfect knowledge and aim...... rational choice behaviour focuses on how the latter approach can be seriously taken into account within transport applications. As the editors discuss in the introduction, a true optimal choice can only be made if an individual has full and perfect information of all relevant attributes in his/her choice...... set. An individual is said to demonstrate bounded rational behaviour if he/she does not systematically consider all attributes deemed relevant for the decision problem at hand, does not consider all choice options and/or does not choose the best choice alternative. Such simplified representation...

  15. Economic Rationality in the Ultimatum Game

    Directory of Open Access Journals (Sweden)

    Jan Fiala

    2017-03-01

    Full Text Available Rigorous application of experimental methodology to the interdisciplinary research of economic decision making is the main purpose of our work. In this paper, we introduce the main decisionmaking theories and outline economic rationality. We explain why we find it useful to discriminate between the “irrational” and “non-rational” components of decision making. We offer an oriented interdisciplinary point of view on economic rationality. In the applied section, we describe the main features of the Ultimatum game and summarize the up-to-date theories explaining the non-rational course of the game. We discuss in detail the reported relations between the nominal value of the stakes and the distribution of the offers and responses. We introduce the blinded, randomized Ultimatum game experiment that we conducted in our laboratory. We stress the importance of anonymity of the study subjects and the difference in salience of a factual reward against a  hypothetical reward. We present the results of our study, showing that a  duly chosen non-monetary reward, directly inconvertible into money, leads to a different offer distribution in the Ultimatum game without the necessity to invest excessive sums of money in the rewards. We compare our results to research published by other authors. According to our theory, the rational, non-rational and irrational components contribute to the decision making in Ultimatum differently depending on the different reward stakes.

  16. Rational use of inotropic therapy in heart failure.

    Science.gov (United States)

    Felker, G M; O'Connor, C M

    2001-03-01

    Despite their theoretic appeal, agents that increase cardiac contractility (positive inotropes) have consistently been shown to increase mortality when given chronically to patients with heart failure. The routine use of inotropes as heart failure therapy in either the acute or the chronic setting is not supported by the available data. Some appropriate uses of inotropes are as temporary treatment of diuretic-refractory acute heart failure decompensations, or as a bridge to definitive treatment such as revascularization or cardiac transplantation. Although controversial, the use of inotropes as a palliative measure in the small subset of patients with truly end-stage heart failure may be appropriate. An understanding of the appropriate goals of therapy is important for both patients and physicians if rational decisions about the use of inotropes are to be made.

  17. The anchoring bias reflects rational use of cognitive resources

    OpenAIRE

    Goodman, Noah; Huys, Quentin; Griffiths, Tom; Lieder, Falk

    2017-01-01

    © 2017, Psychonomic Society, Inc. Cognitive biases, such as the anchoring bias, pose a serious challenge to rational accounts of human cognition. We investigate whether rational theories can meet this challenge by taking into account the mind’s bounded cognitive resources. We asked what reasoning under uncertainty would look like if people made rational use of their finite time and limited cognitive resources. To answer this question, we applied a mathematical theory of bounded rationality to...

  18. Results of ERAS protocol in patients with colorectal cancer

    Directory of Open Access Journals (Sweden)

    A. O. Rasulov

    2016-01-01

    Full Text Available Objective: explore the use of enhanced recovery after surgery (ERAS in the treatment of patients with colorectal cancer, evaluate its efficacy and safety.Materials and methods. Prospective, single-site, randomized study for the implementation of enhanced recovery after surgery in patients with colorectal cancer has been conducted from October 2014 till the present time. All patients after laparoscopic surgeries undergo treatment according to ERAS protocol, patients after open surgeries are randomized (1:1 in groups of the standard treatment or treatment according to ERAS protocol. The study included patients with localized and locally disseminated colorectal cancer aged from 18 to 75 years, ECOG score ≤ 2. The primary evaluated parameters were the following: the number of postoperative complications (according to Clavien– Dindo classification, postoperative hospital days, incidence of complications and mortality in the 30-day period, timing of activation.Results. Up to date, the study includes 105 patients: laparoscopic group – 51 patients, open-surgery group of patients treated by ERAS protocol – 27 patients, open-surgery group of patients with the standard post-op treatment – 26 patients. Complications requiring emergency surgery for anastomotic leak (p = 0.159 developed in 3.7 % of patients with the standard post-op treatment and in 3.9 % of patients after laparoscopic surgery, while 1 patient required repeat hospitalization. The total number of complications was significantly lower in opensurgery group of patients treated by ERAS protocol compared with the standard post-op treatment (p = 0.021. However, there were no differences between laparoscopic and open-surgery group with the standard post-op treatment (p = 0.159. An average hospitalization stay in patients with the standard post-op treatment was equal to 10 days compared to 7 days in patients treated by ERAS protocol (p = 0.067 and 6 days after laparoscopic

  19. Rational points on elliptic curves

    CERN Document Server

    Silverman, Joseph H

    2015-01-01

    The theory of elliptic curves involves a pleasing blend of algebra, geometry, analysis, and number theory. This book stresses this interplay as it develops the basic theory, thereby providing an opportunity for advanced undergraduates to appreciate the unity of modern mathematics. At the same time, every effort has been made to use only methods and results commonly included in the undergraduate curriculum. This accessibility, the informal writing style, and a wealth of exercises make Rational Points on Elliptic Curves an ideal introduction for students at all levels who are interested in learning about Diophantine equations and arithmetic geometry. Most concretely, an elliptic curve is the set of zeroes of a cubic polynomial in two variables. If the polynomial has rational coefficients, then one can ask for a description of those zeroes whose coordinates are either integers or rational numbers. It is this number theoretic question that is the main subject of this book. Topics covered include the geometry and ...

  20. A Preliminary Investigation of the Long-Term Outcome of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders

    Science.gov (United States)

    Bullis, Jacqueline R.; Fortune, Meghan R.; Farchione, Todd J.; Barlow, David H.

    2014-01-01

    Objective To conduct a preliminary examination of long-term outcomes on a broad range of affective disorder symptoms treated with a newly developed intervention: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). Method Maintenance of treatment gains at long-term follow-up (LTFU) were explored in patients (n = 15, mean age = 32.27; 60% female) who completed a clinical trial of the UP. Results Treatment gains observed at 6-month follow-up (6MFU) on measures of clinical severity, general symptoms of depression and anxiety, and a measure of symptom interference in daily functioning were largely maintained 12 months later (at an average of 18 months posttreatment), and any significant changes from 6MFU to LTFU reflected small increases in symptoms that remained, on average, in the subclinical range. Conclusions These findings provide the first initial support for the durability of broad treatment gains following transdiagnostic treatment. PMID:25113056

  1. Assistance protocol for venous ulcers patients: validation of contents

    Directory of Open Access Journals (Sweden)

    Daniele Vieira Dantas

    2013-07-01

    Full Text Available Venous ulcers require complex treatment and are responsible for significant morbidity and mortality rates. This study aims at identifying aspects validated by the jury for the preparation of an assistance protocol for venous ulcer sufferers. It is a descriptive and quantitative research, with 39 professionals (30 nurses, 7 doctors and two physiotherapists, held at the Onofre Lopes University Hospital, between April and July/2010. Data collection began through a questionnaire checklist. Analysis was performed through Statistical Package for Social Science 15.0, assessing compliance with guidelines. Results were the compositional aspects of the protocol: assessment of patient and lesion history/documentation, wound care/perilesional skin, dressing suggestion, use of antibiotics and pain treatment, surgical treatment/medication, improving venous return and relapse prevention, patient referral, professional training and referral/counter-referral. It was concluded that to compose the protocol, aspects related to diagnosis, treatment and injury prevention must be considered.

  2. Milk production is unaffected by replacing barley or sodium hydroxide wheat with maize cob silage in rations for dairy cows

    DEFF Research Database (Denmark)

    Hymøller, Lone; Hellwing, Anne Louise Frydendahl; Lund, Peter

    2014-01-01

    . The energy-corrected milk yield was unaffected by treatment. The fat content of the milk on the MCS ration was not different from the SHW ration, whereas it was higher on the barley ration. The protein content of the milk decreased when MCS was used in the ration compared with barley and SHW. From ruminal......Starch is an important energy-providing nutrient for dairy cows that is most commonly provided from cereal grains. However, ruminal fermentation of large amounts of easily degradable starch leads to excessive production and accumulation of volatile fatty acids (VFA). VFA not only play a vital role...... in the energy metabolism of dairy cows but are also the main cause of ruminal acidosis and depressed feed intake. The aim of the present study was to compare maize cob silage (MCS) as an energy supplement in rations for dairy cows with highly rumen-digestible rolled barley and with sodium hydroxide wheat (SHW...

  3. Latest approaches of Kyoto protocol

    International Nuclear Information System (INIS)

    Matei, M.; Matei, L.

    2005-01-01

    Recently EURELECTRIC welcome the proposal of new EC Directive concerning the inclusion in the EU Emissions Trading Scheme (ETS) of credits from the project mechanisms - Joint Implementation (JI) and Clean Development Mechanism (CDM). The proposed Directive is an amendment to the EU Emissions Trading Directive adopted in June 2003. EURELECTRIC calls for unlimited use of credits in ETS. The draft Directive provides for the application of these mechanisms to begin as of 2008, on condition that the Kyoto Protocol does actually enter into force, an event which is still dependent on Russia's ratification. Such ratification has been subject to contradictory statements from the Russian Government, and the question of whether their signature to the Protocol is forthcoming is still fraught with uncertainty. Although it is not anticipated that significant quantities of JI or CDM certified credits will be available in the period 2005-2007, those that do become available would provide some additional liquidity in the emissions trading market. There is a direct relation between the coming ETS and electricity pricing: environmental policy is the driver, based on the need to switch to a low-carbon future and manage the necessary investments in a rational manner - and emissions trading is the best solution available. Romania has good opportunities to be involved in the greenhouse gases market, both in ETS and JI mechanisms. Some JI projects between Romanian and The Netherlands are already done or underway. (author)

  4. Rationality, perception, and the all-seeing eye

    NARCIS (Netherlands)

    Felin, Teppo; Koenderink, Jan|info:eu-repo/dai/nl/070864543; Krueger, Joachim I

    Seeing-perception and vision-is implicitly the fundamental building block of the literature on rationality and cognition. Herbert Simon and Daniel Kahneman's arguments against the omniscience of economic agents-and the concept of bounded rationality-depend critically on a particular view of the

  5. Dimension counts for singular rational curves via semigroups

    OpenAIRE

    Cotterill, Ethan; Feital, Lia; Martins, Renato Vidal

    2015-01-01

    We study singular rational curves in projective space, deducing conditions on their parametrizations from the value semigroups $\\sss$ of their singularities. In particular, we prove that a natural heuristic for the codimension of the space of nondegenerate rational curves of arithmetic genus $g>0$ and degree $d$ in $\\mb{P}^n$, viewed as a subspace of all degree-$d$ rational curves in $\\mb{P}^n$, holds whenever $g$ is small.

  6. Improving protein mass and cumulative body weight gain of local chicken fed ration fortified with a combination of Lactobacillus sp. and dahlia inulin

    Science.gov (United States)

    Wahyuni, H. I.; Suthama, N.; Mangisah, I.; Krismiyanto, L.

    2018-01-01

    The research aimed to evaluate meat calcium and protein content of local chicken fed diet fortified with a combination of Lactobacillus sp and Dahlia Inulin. One hundred and twenty birds of 4 months old local chicken with average body weight of 1001 g were assigned in a completely randomized design with 4 treatments and 5 replications. The treatments were the farmer formulated ration (FF) and the improved ration (IR), fortified with 1.2% inulin and 1.2 ml Lactobacillus sp. (FFIL and IRIL). Parameters were calcium retention, protein coefficient digestibility, meat calcium and protein mass, and cumulative body weight gain. The results showed that all parameters were significantly affected by dietary treatments. The improved ration resulted in higher calcium retention and protein coefficient digestibility than the farmer formulated ration when fed by both with and without fortification of dahlia inulin and Lactobacillus sp. Meat protein mass of chicken fed by both FR and IR fortified with dahlia inulin and Lactobacillus sp. showed higher value than chicken fed by unfortified FR and IR. Cumulative body weight gain of chicken fed by both FR and IR fortified with dahlia inulin and Lactobacillus sp. also showed higher value than chicken fed by without fortification. In conclusion, both FR and IR fortified with dahlia inulin and Lactobacillus sp. improved meat protein mass and cumulative body weight gain, especially the farmer formulated ration was pronouncedly improved by fortification of Lactobacillus sp. and dahlia inulin.

  7. The anchoring bias reflects rational use of cognitive resources.

    Science.gov (United States)

    Lieder, Falk; Griffiths, Thomas L; M Huys, Quentin J; Goodman, Noah D

    2018-02-01

    Cognitive biases, such as the anchoring bias, pose a serious challenge to rational accounts of human cognition. We investigate whether rational theories can meet this challenge by taking into account the mind's bounded cognitive resources. We asked what reasoning under uncertainty would look like if people made rational use of their finite time and limited cognitive resources. To answer this question, we applied a mathematical theory of bounded rationality to the problem of numerical estimation. Our analysis led to a rational process model that can be interpreted in terms of anchoring-and-adjustment. This model provided a unifying explanation for ten anchoring phenomena including the differential effect of accuracy motivation on the bias towards provided versus self-generated anchors. Our results illustrate the potential of resource-rational analysis to provide formal theories that can unify a wide range of empirical results and reconcile the impressive capacities of the human mind with its apparently irrational cognitive biases.

  8. Autogenerator-based modelling framework for development of strategic games simulations: rational pigs game extended.

    Science.gov (United States)

    Fabac, Robert; Radošević, Danijel; Magdalenić, Ivan

    2014-01-01

    When considering strategic games from the conceptual perspective that focuses on the questions of participants' decision-making rationality, the very issues of modelling and simulation are rarely discussed. The well-known Rational Pigs matrix game has been relatively intensively analyzed in terms of reassessment of the logic of two players involved in asymmetric situations as gluttons that differ significantly by their attributes. This paper presents a successful attempt of using autogenerator for creating the framework of the game, including the predefined scenarios and corresponding payoffs. Autogenerator offers flexibility concerning the specification of game parameters, which consist of variations in the number of simultaneous players and their features and game objects and their attributes as well as some general game characteristics. In the proposed approach the model of autogenerator was upgraded so as to enable program specification updates. For the purpose of treatment of more complex strategic scenarios, we created the Rational Pigs Game Extended (RPGE), in which the introduction of a third glutton entails significant structural changes. In addition, due to the existence of particular attributes of the new player, "the tramp," one equilibrium point from the original game is destabilized which has an influence on the decision-making of rational players.

  9. Adaptive Rationality, Adaptive Behavior and Institutions

    Directory of Open Access Journals (Sweden)

    Volchik Vyacheslav, V.

    2015-12-01

    Full Text Available The economic literature focused on understanding decision-making and choice processes reveals a vast collection of approaches to human rationality. Theorists’ attention has moved from absolutely rational, utility-maximizing individuals to boundedly rational and adaptive ones. A number of economists have criticized the concepts of adaptive rationality and adaptive behavior. One of the recent trends in the economic literature is to consider humans irrational. This paper offers an approach which examines adaptive behavior in the context of existing institutions and constantly changing institutional environment. It is assumed that adaptive behavior is a process of evolutionary adjustment to fundamental uncertainty. We emphasize the importance of actors’ engagement in trial and error learning, since if they are involved in this process, they obtain experience and are able to adapt to existing and new institutions. The paper aims at identifying relevant institutions, adaptive mechanisms, informal working rules and practices that influence actors’ behavior in the field of Higher Education in Russia (Rostov Region education services market has been taken as an example. The paper emphasizes the application of qualitative interpretative methods (interviews and discourse analysis in examining actors’ behavior.

  10. The effectiveness of rational emotive therapy on achievement ...

    African Journals Online (AJOL)

    The effectiveness of rational emotive therapy on achievement motivation of students. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... the effectiveness of Rational Emotive Behaviour Therapy on Students Achievement Motivation.

  11. Cognitive rationalizations for tanning-bed use: a preliminary exploration.

    Science.gov (United States)

    Banerjee, Smita C; Hay, Jennifer L; Greene, Kathryn

    2013-09-01

    To examine construct and predictive utility of an adapted cognitive rationalization scale for tanning-bed use. Current/former tanning-bedusing undergraduate students (N = 216; 87.6% females; 78.4% white) at a large northeastern university participated in a survey. A cognitive rationalization for tanning-bed use scale was adapted. Standardized self-report measures of past tanning-bed use, advantages of tanning, perceived vulnerability to photoaging, tanning-bed use dependence, and tanning-bed use intention were also administered. The cognitive rationalization scale exhibited strong construct and predictive validity. Current tanners and tanning-bed-use-dependent participants endorsed rationalizations more strongly than did former tanners and not-tanning-bed-use-dependent participants respectively. Findings indicate that cognitive rationalizations help explain discrepancy between inconsistent cognitions.

  12. Multivariate rational data fitting

    Science.gov (United States)

    Cuyt, Annie; Verdonk, Brigitte

    1992-12-01

    Sections 1 and 2 discuss the advantages of an object-oriented implementation combined with higher floating-point arithmetic, of the algorithms available for multivariate data fitting using rational functions. Section 1 will in particular explain what we mean by "higher arithmetic". Section 2 will concentrate on the concepts of "object orientation". In sections 3 and 4 we shall describe the generality of the data structure that can be dealt with: due to some new results virtually every data set is acceptable right now, with possible coalescence of coordinates or points. In order to solve the multivariate rational interpolation problem the data sets are fed to different algorithms depending on the structure of the interpolation points in then-variate space.

  13. Development and implementation of the Dutch protocol for rehabilitative management in amyotrophic lateral sclerosis.

    Science.gov (United States)

    van den Berg, J P; de Groot, I J M; Joha, B C; van Haelst, J M; van Gorcom, P; Kalmijn, S

    2004-12-01

    In the Netherlands, rehabilitation care plays an important role in the symptomatic and palliative treatment of ALS patients. However, until 1999 there were no guidelines or practice parameters available for the management of ALS. Therefore, the Dutch protocol for rehabilitative management in ALS was developed. We describe the development process, the outcome and implementation of the protocol. A concept management protocol was written and the Delphi method was selected to develop the protocol further. This method comprises repetitive discussion sessions from postulates, using a combination of written questionnaires and work-conferences. Between 80 and 90 persons (rehabilitation team members of different professional backgrounds and neurologists) were involved in this process. The protocol was implemented by sending it to all consultants in rehabilitation medicine in the Netherlands; they were asked to inform all the treatment team members about the final protocol and to implement it in their treatment of ALS patients. The protocol was developed in 1999, implemented in 2000 and evaluated in 2001. Recommendations for improvement were made during the evaluation and improvements are currently being developed by an expert group. The protocol is widely used (88.9%) by consultants in rehabilitation medicine and their treatment teams in the Netherlands. The Dutch protocol for rehabilitative management was developed to provide an optimal and adequate care plan for patients with ALS. It is widely used in the Netherlands.

  14. Positivity Preserving Interpolation Using Rational Bicubic Spline

    Directory of Open Access Journals (Sweden)

    Samsul Ariffin Abdul Karim

    2015-01-01

    Full Text Available This paper discusses the positivity preserving interpolation for positive surfaces data by extending the C1 rational cubic spline interpolant of Karim and Kong to the bivariate cases. The partially blended rational bicubic spline has 12 parameters in the descriptions where 8 of them are free parameters. The sufficient conditions for the positivity are derived on every four boundary curves network on the rectangular patch. Numerical comparison with existing schemes also has been done in detail. Based on Root Mean Square Error (RMSE, our partially blended rational bicubic spline is on a par with the established methods.

  15. Probability and rational choice

    Directory of Open Access Journals (Sweden)

    David Botting

    2014-05-01

    Full Text Available http://dx.doi.org/10.5007/1808-1711.2014v18n1p1 In this paper I will discuss the rationality of reasoning about the future. There are two things that we might like to know about the future: which hypotheses are true and what will happen next. To put it in philosophical language, I aim to show that there are methods by which inferring to a generalization (selecting a hypothesis and inferring to the next instance (singular predictive inference can be shown to be normative and the method itself shown to be rational, where this is due in part to being based on evidence (although not in the same way and in part on a prior rational choice. I will also argue that these two inferences have been confused, being distinct not only conceptually (as nobody disputes but also in their results (the value given to the probability of the hypothesis being not in general that given to the next instance and that methods that are adequate for one are not by themselves adequate for the other. A number of debates over method founder on this confusion and do not show what the debaters think they show.

  16. Competition Law and the Bounded Rationality of Firms

    OpenAIRE

    Bhattacharya, Shilpi

    2016-01-01

    Firm rationality plays a role in several aspects of competition law. Yet, the conception of the firm as a rational, profit maximizing entity has been disputed in different disciplines. This literature shows that neoclassical economic assumptions on which competition law is based can fall short of explaining the full range of observed firm behaviour. Accordingly, an alternative conception of the firm as boundedly rational can impact the understanding of firm conduct in competition law. Be...

  17. The Development of Korea Additional Protocol System

    International Nuclear Information System (INIS)

    Shim, Hye Won; Yeo, Jin Kyun

    2008-01-01

    The Agreement between the Republic of Korea (ROK) and the IAEA for the Application of Safeguards in Connection with the Treaty on the Non-Proliferation of Nuclear Weapons (the Safeguards Agreement) entered into force on 14 November 1975. The Additional Protocol to the Safeguards Agreement (the Additional Protocol) was signed on 21 June 1999 and entered into force on 19 February 2004. ROK has been submitting annual updated reports of initial declaration on every May 15th since August 2004. Additional protocol reports were submitted through Protocol Reporter provided by IAEA. Annual declarations were simply uploaded and stored in the Accounting Information Treatment System of KINAC, which did not provide data analysis and management function. There have been demands for improvement to handle ever-increasing information. KAPS (Korea Additional Protocol System) has been developed to assist and administrate the additional protocol related works effectively. The new system enables integrated management including composition of additional protocol report and version control, periodical update of related information, results of IAEA complementary access to each facility

  18. Public policy, rationality and reason

    Directory of Open Access Journals (Sweden)

    Rodolfo Canto Sáenz

    2015-07-01

    Full Text Available This work suggests the incorporation of practical reason in the design, implementation and evaluation of public policies, alongside instrumental rationality. It takes two proposals that today point in this direction: Rawls distinction between reasonable (practical reason and rational (instrumental reason and what this author calls the CI Procedure (categorical imperative procedure and Habermas model of deliberative democracy. The main conclusion is that the analysis of public policies can not be limited to rather narrow limits of science, but requires the contribution of political and moral philosophy.

  19. Disclosure and rationality: comparative risk information and decision-making about prevention.

    Science.gov (United States)

    Schwartz, Peter H

    2009-01-01

    With the growing focus on prevention in medicine, studies of how to describe risk have become increasing important. Recently, some researchers have argued against giving patients "comparative risk information," such as data about whether their baseline risk of developing a particular disease is above or below average. The concern is that giving patients this information will interfere with their consideration of more relevant data, such as the specific chance of getting the disease (the "personal risk"), the risk reduction the treatment provides, and any possible side effects. I explore this view and the theories of rationality that ground it, and I argue instead that comparative risk information can play a positive role in decision-making. The criticism of disclosing this sort of information to patients, I conclude, rests on a mistakenly narrow account of the goals of prevention and the nature of rational choice in medicine.

  20. MARSI: metabolite analogues for rational strain improvement

    DEFF Research Database (Denmark)

    Cardoso, João G. R.; Zeidan, Ahmad A; Jensen, Kristian

    2018-01-01

    reactions in an organism can be used to predict effects of MAs on cellular phenotypes. Here, we present the Metabolite Analogues for Rational Strain Improvement (MARSI) framework. MARSI provides a rational approach to strain improvement by searching for metabolites as targets instead of genes or reactions...

  1. Simple market equilibria with rationally inattentive consumers

    Czech Academy of Sciences Publication Activity Database

    Matějka, Filip; McKay, A.

    2012-01-01

    Roč. 102, č. 3 (2012), s. 24-29 ISSN 0002-8282 R&D Projects: GA ČR(CZ) GPP402/11/P236 Institutional support: RVO:67985998 Keywords : rational choice theory * bounded rationality * consumer research Subject RIV: AH - Economics Impact factor: 2.792, year: 2012

  2. Rational drug therapy education in clinical phase carried out by task-based learning

    Science.gov (United States)

    Bilge, S. Sırrı; Akyüz, Bahar; Ağrı, Arzu Erdal; Özlem, Mıdık

    2017-01-01

    Objectives: Irrational drug use results in drug interactions, treatment noncompliance, and drug resistance. Rational pharmacotherapy education is being implemented in many faculties of medicine. Our aim is to introduce rational pharmacotherapy education by clinicians and to evaluate task-based rational drug therapy education in the clinical context. Methods: The Kirkpatrick's evaluation model was used for the evaluation of the program. The participants evaluated the program in terms of constituents of the program, utilization, and contribution to learning. Voluntary participants responded to the evaluation forms after the educational program. Data are evaluated using both quantitative and qualitative tools. SPSS (version 21) used for quantitative data for determining mean and standard deviation values. Descriptive qualitative analysis approach is used for the analysis of open-ended questions. Results: It was revealed that the program and its components have been favorable. A total 95.9% of the students consider the education to be beneficial. Simulated patients practice and personal drug choice/problem-based learning sessions were appreciated by the students in particular. 93.9% of the students stated that all students of medicine should undergo this educational program. Among the five presentations contained in the program, “The Principles of Prescribing” received the highest points (9 ± 1.00) from participating students in general evaluation of the educational program. Conclusion: This study was carried out to improve task-based rational drug therapy education. According to feedback from the students concerning content, method, resource, assessment, and program design; some important changes, especially in number of facilitators and indications, are made in rational pharmacotherapy education in clinical task-based learning program. PMID:28458432

  3. Draft Technical Protocol: A Treatability Test for Evaluating the Potential Applicability of the Reductive Anaerobic Biological in Situ Treatment Technology (Rabitt) to Remediate Chloroethenes

    National Research Council Canada - National Science Library

    Morse, Jeff

    1998-01-01

    This draft, unvalidated protocol describes a comprehensive approach for conducting a phased treatability test to determine the potential for employing the Reductive Anaerobic Biological In Situ Treatment Technology (RABITT...

  4. Orthodontic treatment outcomes obtained by application of a finishing protocol

    Directory of Open Access Journals (Sweden)

    Alvaro Carvajal-Flórez

    2016-04-01

    Full Text Available ABSTRACT Objective: To evaluate the results of a finishing protocol implemented in patients treated in the Orthodontics graduate program at Universidad de Antioquia. Evaluation was carried out by means of the criteria set by the Objective Grading System (OGS of the American Board of Orthodontics (ABO. Methods: Cast models and panoramic radiographs of 34 patients were evaluated. The intervention group (IG consisted of 17 patients (19.88 ± 4.4 years old treated under a finishing protocol. This protocol included training in finishing, application of a finishing guide, brackets repositioning and patient's follow-up. Results of the IG were compared to a control group of 17 patients (21.88 ± 7.0 years old selected by stratified randomization without finishing intervention (CG. Results: The scores for both CG and IG were 38.00 ± 9.0 and 31.41 ± 9.6 (p = 0.048, respectively. The score improved significantly in the IG group, mainly regarding marginal ridges (CG: 5.59 ± 2.2; IG: 3.65 ± 1.8 (p = 0.009 and root angulation (CG: 7.59 ± 2.8; IG: 4.88 ± 2.6 (p = 0.007. Criteria that did not improve, but had the highest scores were: alignment (CG: 6.35 ± 2.7; IG: 6.82 ± 2.8 (p = 0.62 and buccolingual inclination (CG: 3.6 ± 5.88; IG: 5.29 ± 3.9 (p = 0.65. Conclusions: Standardization and implementation of a finishing protocol contributed to improve clinical performance in the Orthodontics graduate program, as expressed by occlusal outcomes. Greater emphasis should be given on the finishing phase to achieve lower scores in the ABO grading system.

  5. Oral breathing: new early treatment protocol

    Directory of Open Access Journals (Sweden)

    Gloria Denotti

    2014-01-01

    Full Text Available Oral breathing is a respiratory dysfunction that affects approximately 10-15% of child population. It is responsable of local effects and systemic effects, both immediate and long-term. They affect the growth of the subject and his physical health in many ways: pediatric, psycho-behavioral and cognitive. The etiology is multifactorial. It’s important the establishment of a vicious circle involving more areas and it is essential to stop it as soon as possible. In order to correct this anomaly, the pediatric dentist must be able to make a correct diagnosis to treat early the disfunction and to avoid the onset of cascade mechanisms. Who plays a central role is the pediatrician who first and frequently come into contact with little patients. He can identify the anomalies, and therefore collaborate with other specialists, including the dentist. The key aspect that guides us in the diagnosis, and allows us to identify the oral respirator, is the “adenoid facies”. The purpose of the study is to highlight the importance and benefits of an early and multidisciplinary intervention (pediatric, orthopedic-orthodontic-functional. A sample of 20 patients was selected with the following inclusion criteria: mouth breathing, transverse discrepancy > 4 mm, early mixed dentition, central and lateral permenent incisors, overjet increased, lip and nasal incompetence, snoring and/or sleep apnea episodes. The protocol of intervention includes the use of the following devices and procedures: a maxillary rapid expander (to correct the transverse discrepancy, to increase the amplitude of the upper respiratory airway and to reduce nasal resistances tract in association with myo-functional devices (nasal stimulator and oral obturator. They allow the reconstruction of a physiological balance between the perioral musculature and tongue, the acquisition of nasal and lips competence and the reduction of overjet. This protocol speeds up and stabilizes the results. The

  6. Fields of rational constants of cyclic factorizable derivations

    Directory of Open Access Journals (Sweden)

    Janusz Zielinski

    2015-12-01

    Full Text Available We describe all rational constants of a large family of four-variable cyclic factorizable derivations. Thus, we determine all rational first integrals of their corresponding systems of differential equations. Moreover, we give a characteristic of all four-variable Lotka-Volterra derivations with a nontrivial rational constant. All considerations are over an arbitrary field of characteristic zero. Our main tool is the investigation of the cofactors of strict Darboux polynomials. Factorizable derivations are important in derivation theory. Namely, we may associate the factorizable derivation with any given derivation of a polynomial ring and that construction helps to determine rational constants of arbitrary derivations. Besides, Lotka-Volterra systems play a significant role in population biology, laser physics and plasma physics.

  7. Crab Rationalization Permit Program

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Crab Rationalization Program (Program) allocates BSAI crab resources among harvesters, processors, and coastal communities. The North Pacific Fishery Management...

  8. Should informed consent be based on rational beliefs?

    OpenAIRE

    Savulescu, J; Momeyer, R W

    1997-01-01

    Our aim is to expand the regulative ideal governing consent. We argue that consent should not only be informed but also based on rational beliefs. We argue that holding true beliefs promotes autonomy. Information is important insofar as it helps a person to hold the relevant true beliefs. But in order to hold the relevant true beliefs, competent people must also think rationally. Insofar as information is important, rational deliberation is important. Just as physicians should aim to provide ...

  9. Positive Feedback Investment Strategies and Destabilizing Rational Speculation

    OpenAIRE

    J. Bradford De Long; Andrei Shleifer; Lawrence H. Summers; Robert J. Waldmann

    1989-01-01

    Analyses of the role of rational speculators in financial markets usually presume that such investors dampen price fluctuations by trading against liquidity or noise traders. This conclusion does not necessarily hold when noise traders follow positive-feedback investment strategies buy when prices rise and sell when prices fall. In such cases, it may pay rational speculators to try to jump on the bandwagon early and to purchase ahead of noise trader demand. If rational speculators' attempts t...

  10. Brief Report: Risk-Aversion and Rationality in Autism Spectrum Disorders.

    Science.gov (United States)

    Gosling, Corentin J; Moutier, Sylvain

    2018-05-30

    Risk-aversion and rationality have both been highlighted as core features of decision making in individuals with Autism Spectrum Disorders (ASD). This study tested whether risk-aversion is related to rational decision-making in ASD individuals. ASD and matched control adults completed a decision-making task that discriminated between the use of risk-averse and rational strategies. Results showed that overall, ASD participants were more risk-averse than control participants. Specifically, both groups made similar choices when risk-aversion was the less rational strategy but ASD participants chose more rational options than control participants when risk-aversion was the most rational strategy. This study confirmed that risk-aversion is a core feature of ASD and revealed that ASD individuals can switch their decision-making strategy adaptively to avoid negative consequences.

  11. The impact of economic rationalization, prioritization and rationing on job satisfaction, motivation and team cohesion in hospitals: a survey among retired physician executives in Germany.

    Science.gov (United States)

    Schnoor, Joerg; Braehler, Elmar; Ghanem, Mohamed; Heyde, Christoph E

    2017-01-01

    The growing economization of the health care system and implication of market principles in the medical field have risen new and serious questions on the meaning of the medical profession, the doctor-patient relationship and the orientation of medicine itself. The impact of the dynamic clinical structures on the doctor-doctor and the doctor-patient interaction appear even unpredictable. Therefore, the impact of market-based methods, i.e. rationalization, prioritization and rationing, on job satisfaction, motivation and team cohesion should be quantified. The experiences of former and now retired physician executives in numerous hospitals in Saxony were determined. For this purpose, an anonymously written survey using a standardized questionnaire was conducted in the first quarter of 2016. Rationalization measures were confirmed by 88% of respondents. In more than a third of cases, former executives also experienced prioritization and rationing. The impact of these management techniques on job satisfaction, motivation and team cohesion was carried out in a differentiated manner. There was a tendency to regard rationalization and prioritization measures indifferently to rather disadvantageous, while rationing was predominantly rated negatively. In addition to rationalization, prioritization and rationing measures have now been part of working strategy at the hospitals. On one hand, the conceptual distinction between the terms still seems imprecise; on the other hand, a creeping and imperceptible medico-ethical transgression of the prioritization to rationing seems to have already taken place.

  12. Rational Emotive Education

    Science.gov (United States)

    Knaus, William

    1977-01-01

    Rational Emotive Education--an outgrowth of theories developed by Albert Ellis--is a teaching design of mental health concepts and problem-solving activities designed to help students to approach and cope with their problems through experiential learning, via a structured, thematic sequence of emotive education lessons. (MJB)

  13. Self-deception as pseudo-rational regulation of belief.

    Science.gov (United States)

    Michel, Christoph; Newen, Albert

    2010-09-01

    Self-deception is a special kind of motivational dominance in belief-formation. We develop criteria which set paradigmatic self-deception apart from related phenomena of auto-manipulation such as pretense and motivational bias. In self-deception rational subjects defend or develop beliefs of high subjective importance in response to strong counter-evidence. Self-deceivers make or keep these beliefs tenable by putting prima-facie rational defense-strategies to work against their established standards of rational evaluation. In paradigmatic self-deception, target-beliefs are made tenable via reorganizations of those belief-sets that relate relevant data to target-beliefs. This manipulation of the evidential value of relevant data goes beyond phenomena of motivated perception of data. In self-deception belief-defense is pseudo-rational. Self-deceivers will typically apply a dual standard of evaluation that remains intransparent to the subject. The developed model of self-deception as pseudo-rational belief-defense is empirically anchored. So, we hope to put forward a promising candidate. Copyright © 2010 Elsevier Inc. All rights reserved.

  14. The Application of Rational-Emotive Behavior Therapy to Reduce Stress among Mother with Leukemia Children

    Directory of Open Access Journals (Sweden)

    Yuni Sufyanti Arief

    2016-09-01

    Full Text Available Introduction: A child who is diagnosed with Leukemia will undergo several procedures are long and painful action. During the process of hospitalization due to leukemia children and parents can experience a variety of events or actions handling according to various studies shown by the experience very traumatic and stressful (Supartini 2004 in Arif, SY, 2007. Some of the methods used to deal with anxiety is psikoprofilaksis, relaxation and imagination (Reeder et al., 2011. Rational-emotive behavior therapy by Albert Ellis in 1990 describes a unique man who is basically have a tendency to think rational and irrational. Methods: aim of this study is to explain the effect of Rational Emotive Behavior Therapy (REBT for stress levels of mothers with children suffering from Leukemia. The study design used was a pre-experiment Quasy-post control group design. The sample was 10 mothers of children diagnosed with leukemia are treated in a child hematology ward Soetomo hospital. Variable in this study is the level of depression and anxiety mothers with children suffering from leukemia. Result: Based on the results obtained Wilcoxon statistical test p = 0.025 in the treatment group and p = 0.32 in the control group. Mann Whitney test results obtained p = 0.012. Conclution: Rational-emotive behavior therapy can reduce levels of depression and anxiety (stress mothers with children suffering from leukemia. It is expected that the application of rational -emotive behavior therapy can be done to reduce depression and anxiety in women with chronic disease cases while maintaining the effectiveness the goal of REBT. Keywords: stress, anxiety, depression, rational-emotive behavior

  15. Gleaning Insights from Fecal Microbiota Transplantation and Probiotic Studies for the Rational Design of Combination Microbial Therapies

    Science.gov (United States)

    Hudson, Lauren E.; Anderson, Sarah E.; Corbett, Anita H.

    2016-01-01

    SUMMARY Beneficial microorganisms hold promise for the treatment of numerous gastrointestinal diseases. The transfer of whole microbiota via fecal transplantation has already been shown to ameliorate the severity of diseases such as Clostridium difficile infection, inflammatory bowel disease, and others. However, the exact mechanisms of fecal microbiota transplant efficacy and the particular strains conferring this benefit are still unclear. Rationally designed combinations of microbial preparations may enable more efficient and effective treatment approaches tailored to particular diseases. Here we use an infectious disease, C. difficile infection, and an inflammatory disorder, the inflammatory bowel disease ulcerative colitis, as examples to facilitate the discussion of how microbial therapy might be rationally designed for specific gastrointestinal diseases. Fecal microbiota transplantation has already shown some efficacy in the treatment of both these disorders; detailed comparisons of studies evaluating commensal and probiotic organisms in the context of these disparate gastrointestinal diseases may shed light on potential protective mechanisms and elucidate how future microbial therapies can be tailored to particular diseases. PMID:27856521

  16. Rational-Emotive Staff Development.

    Science.gov (United States)

    Forman, Susan G.; Forman, Bruce D.

    1980-01-01

    The application of Rational-Emotive Therapy principles and techniques in in-service education for school personnel is discussed. Teacher and counselor participation in a staff development program is described. (Author)

  17. Adaptive information-theoretic bounded rational decision-making with parametric priors

    OpenAIRE

    Grau-Moya, Jordi; Braun, Daniel A.

    2015-01-01

    Deviations from rational decision-making due to limited computational resources have been studied in the field of bounded rationality, originally proposed by Herbert Simon. There have been a number of different approaches to model bounded rationality ranging from optimality principles to heuristics. Here we take an information-theoretic approach to bounded rationality, where information-processing costs are measured by the relative entropy between a posterior decision strategy and a given fix...

  18. One-year results of the use of endovenous radiofrequency ablation utilising an optimised radiofrequency-induced thermotherapy protocol for the treatment of truncal superficial venous reflux.

    Science.gov (United States)

    Badham, George E; Dos Santos, Scott J; Lloyd, Lucinda Ba; Holdstock, Judy M; Whiteley, Mark S

    2018-06-01

    Background In previous in vitro and ex vivo studies, we have shown increased thermal spread can be achieved with radiofrequency-induced thermotherapy when using a low power and slower, discontinuous pullback. We aimed to determine the clinical success rate of radiofrequency-induced thermotherapy using this optimised protocol for the treatment of superficial venous reflux in truncal veins. Methods Sixty-three patients were treated with radiofrequency-induced thermotherapy using the optimised protocol and were followed up after one year (mean 16.3 months). Thirty-five patients returned for audit, giving a response rate of 56%. Duplex ultrasonography was employed to check for truncal reflux and compared to initial scans. Results In the 35 patients studied, there were 48 legs, with 64 truncal veins treated by radiofrequency-induced thermotherapy (34 great saphenous, 15 small saphenous and 15 anterior accessory saphenous veins). One year post-treatment, complete closure of all previously refluxing truncal veins was demonstrated on ultrasound, giving a success rate of 100%. Conclusions Using a previously reported optimised, low power/slow pullback radiofrequency-induced thermotherapy protocol, we have shown it is possible to achieve a 100% ablation at one year. This compares favourably with results reported at one year post-procedure using the high power/fast pullback protocols that are currently recommended for this device.

  19. Rational Verification in Iterated Electric Boolean Games

    Directory of Open Access Journals (Sweden)

    Youssouf Oualhadj

    2016-07-01

    Full Text Available Electric boolean games are compact representations of games where the players have qualitative objectives described by LTL formulae and have limited resources. We study the complexity of several decision problems related to the analysis of rationality in electric boolean games with LTL objectives. In particular, we report that the problem of deciding whether a profile is a Nash equilibrium in an iterated electric boolean game is no harder than in iterated boolean games without resource bounds. We show that it is a PSPACE-complete problem. As a corollary, we obtain that both rational elimination and rational construction of Nash equilibria by a supervising authority are PSPACE-complete problems.

  20. Does knowing that a suicide was "rational" influence grief?

    Science.gov (United States)

    Brazda, Geoffrey F; Range, Lillian M; Remley, Theodore P; White, Carolyn C

    2018-03-15

    Counseling professionals and graduate students (N = 117) recruited online read a randomly assigned one-paragraph vignette about either a non-rational or rational suicide involving an imaginary loved one. Then, they completed the Grief Experiences Questionnaire (GEQ) about how they would feel. The non-rational suicide group expected significantly more search for explanation than the rational suicide group, but were not significantly different on the other six GEQ subscales. All participants expected few distressing reactions to either vignette, suggesting a one-paragraph vignette may not be sufficient to induce the kind of grief many experience when a loved one dies by suicide.

  1. Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol.

    Science.gov (United States)

    Brillantino, A; Iacobellis, F; Robustelli, U; Villamaina, E; Maglione, F; Colletti, O; De Palma, M; Paladino, F; Noschese, G

    2016-10-01

    The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.

  2. Mecasin treatment in patients with amyotrophic lateral sclerosis: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Kim, Sungha; Kim, Jae Kyoun; Son, Mi Ju; Kim, Dongwoung; Song, Bongkeun; Son, Ilhong; Kang, Hyung Won; Lee, Jongdeok; Kim, Sungchul

    2018-04-13

    Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that causes paralysis of limb, swallowing, and breathing muscles. Riluzole, the Food and Drug Administration-approved drug for ALS, provides minimal benefit, prolonging patient life by only 2-3 months. Previous studies have found a neuro-protective and anti-neuroinflammatory effect of Mecasin, with retrospective studies providing suggestive evidence for a beneficial effect of Mecasin. The aim of this study was to develop a protocol to determine the proper dosage of Mecasin. This is a phase II-A, multi-center, randomized study with three arms. Thirty-six patients with ALS will be randomly assigned to one of three groups, each receiving the standard treatment with 100 mg of riluzole in addition to one of 1.6 g of Mecasin, 2.4 g of Mecasin, or a placebo. The Primary outcome is the Korean version of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised result after 12 weeks of treatment. Secondary outcomes include results of the Short Form Health Survey-8, Medical Research Council Scale, Visual Analogue Scale for Pain, Hamilton Rating Scale for Depression, Fatigue Severity Scale, Patient Global Impression of Change, pulmonary function test, forced expiratory volume in 1 s and its ratio to forced vital capacity, creatine kinase, and body weight. The frequencies of total adverse events and serious adverse events will be described and documented. The trial protocol has been approved by the Institutional Review Board of the Wonkwang University Gwangju and Sanbon Hospital (2016-5-4 and 2016-34-01, respectively). An Investigational New Drug status (30731) was granted by the Korea Food and Drug Administration. This trial will aim to identify the optimal dosage of Mecasin. Additionally, it will test the efficacy and safety of Mecasin in conjunction with standard treatment, riluzole, for alleviating the functional decline in patients with ALS. Korean National Clinical Trial Registry CRIS; KCT

  3. [Use of Cone Beam Computed Tomography in endodontics: rational case selection criteria].

    Science.gov (United States)

    Rosen, E; Tsesis, I

    2016-01-01

    To present rational case selection criteria for the use of CBCT (Cone Beam Computed Tomography) in endodontics. This article reviews the literature concerning the benefits of CBCT in endodontics, alongside its radiation risks, and present case selection criteria for referral of endodontic patients to CBCT. Up to date, the expected ultimate benefit of CBCT to the endodontic patient is yet uncertain, and the current literature is mainly restricted to its technical efficacy. In addition, the potential radiation risks of CBCT scan are stochastic in nature and uncertain, and are worrying especially in pediatric patients. Both the efficacy of CBCT in supporting the endodontic practitioner decision making and in affecting treatment outcomes, and its long term potential radiation risks are yet uncertain. Therefore, a cautious rational decision making is essential when a CBCT scan is considered in endodontics. Risk-benefit considerations are presented.

  4. Mate choice in fruit flies is rational and adaptive.

    Science.gov (United States)

    Arbuthnott, Devin; Fedina, Tatyana Y; Pletcher, Scott D; Promislow, Daniel E L

    2017-01-17

    According to rational choice theory, beneficial preferences should lead individuals to sort available options into linear, transitive hierarchies, although the extent to which non-human animals behave rationally is unclear. Here we demonstrate that mate choice in the fruit fly Drosophila melanogaster results in the linear sorting of a set of diverse isogenic female lines, unambiguously demonstrating the hallmark of rational behaviour, transitivity. These rational choices are associated with direct benefits, enabling males to maximize offspring production. Furthermore, we demonstrate that female behaviours and cues act redundantly in mate detection and assessment, as rational mate choice largely persists when visual or chemical sensory modalities are impaired, but not when both are impaired. Transitivity in mate choice demonstrates that the quality of potential mates varies significantly among genotypes, and that males and females behave in such a way as to facilitate adaptive mate choice.

  5. Rational speculative bubbles: A critical view

    Directory of Open Access Journals (Sweden)

    Radonjić Ognjen

    2007-01-01

    Full Text Available According to the theory of rational bubbles, the bubble is present whenever asset prices progressively diverge from their fundamental value, which occurs because agents expect that asset prices will continue to grow exponentially (self-fulfilling prophecies far in the future and consistently, which promises the realization of ever larger capital gains. In our opinion, the basic shortcoming of this theory refers to the assumption that all market agents are perfectly informed and rational and, accordingly, form homogeneous expectations. The model does not explain decision-making processes or expectation formation, nor does it detect potential psychological and institutional factors that might significantly influence decision making processes and market participants’ reactions to news. Since assumptions of the model critically determine its validity, we conclude that comprehensiveness of the rational bubble model is, to put it mildly, limited.

  6. Neuroethics transformation of economic rationality: implications for decision making in business

    Directory of Open Access Journals (Sweden)

    José-Félix Lozano

    2017-02-01

    Full Text Available The economy and business field has traditionally been dominated by a conception of calculator, strategic and profit-maximizing individual rationality. This model of rationality has important theoretical limitations and practical consequences. In recent decades the results of neuroethics´ research seems open new ways for understanding the practical rationality. These new routes, representing a revaluation of emotional and intuitive dimension in cognitive ability and have great relevance for business and economic decision making. The aim of this paper is to analyse the implications of a rational dialogic-friendly (cor-cordis concept for economic and business decision-making. Our work proposes a version of the dialogic-friendly practical rationality that integrate advances in neuroethics with the discursive rationality perspective in order to overcome the strategic rationality and emotivist intuitionism.

  7. Impact of treatment protocol on outcome of localized Ewing's sarcoma.

    Science.gov (United States)

    Nasaka, Srividya; Gundeti, Sadashivudu; Ganta, Ranga Raman; Arigela, Ravi Sankar; Linga, Vijay Gandhi; Maddali, Lakshmi Srinivas

    2016-01-01

    The outcome of localized Ewing's sarcoma has improved with multi-disciplinary approach. Survivals of Ewing's sarcoma from the Asian countries differed between centers. We retrospectively analyzed the records of newly diagnosed localized Ewing's sarcoma patients from 2002 to 2012. The patients were analyzed in three groups; Group 1(2002-2004) who received non-ifosfomide based regimens, Group 2(2005-2008) who received VDC/IE for 12 cycles, and Group 3(2009-2012), who received VDC/IE for 17 cycles. The groups were compared for their baseline characteristics, treatment protocol and outcome. Seventy three patients were included in the study. The median age of presentation was 15 years, with slight male predominance. Axial primary was seen in 62%. The median RFS of the three groups was 26.4, 31.4 and 36.8 months respectively ( P = 0.0018). The median OS was 27.9, 35 and 43 months respectively ( P = 0.0007). At a median follow-up of 35 months, the 3 year RFS and OS for the three treatment groups were 17%, 31%, 60% and 35%, 45% and 70% respectively. Larger tumor size, axial primary, high LDH were associated with poorer survival. Radiotherapy was associated with inferior local control and survival. We found that the survival of our ESFT patients improved over time with intensified multiagent chemotherapy and with lesser time to local therapy. But the results were still inferior to those reported in literature. We had majority of patients presenting in axial site and radiotherapy as the predominant mode of local control. The outcome may further improve with surgery as local control procedure.

  8. [Maintenance ration and conversion efficiency of Hyporhamphus sajori].

    Science.gov (United States)

    Guo, X; Tang, Q

    2001-04-01

    The maintenance ration and conversion efficiency of Japanese halfbeak, Hyporhamphus sajori were tested with enclosures installed in a shrimp raising pond. The results showed that there existed an evident relationship between daily ration(DR) and growth rate(GR) of the fish, GR = 140.37 DR - 24.03. The conversion efficiency was 13.96% in biomass or 16.12% in energy. The maintenance ration was 17.12% and 20.39% of body weight in terms of growth rate and specific growth rate, respectively, indicating that it could be deduced from growth rate quite differently from that from specific growth rate in the same experiment. The abnormal growth rate appeared when daily ration was below 3.30% of body weight, implied that Japanese halfbeak may get other food resources besides supplied net zooplankton.

  9. Comparison of Cue-Controlled Desensitization, Rational Restructuring, and a Credible Placebo in the Treatment of Speech Anxiety.

    Science.gov (United States)

    Lent, Robert W.; And Others

    1981-01-01

    The efficacy of cue-controlled desensitization and systematic rational restructuring was compared with a placebo method and a waiting-list control in reducing public speaking and nontargeted anxieties. Cue-controlled desensitization was generally more effective than the other groups in reducing subjective speech anxiety. (Author)

  10. Rational and moral action : a critical survey of rational choice theory

    NARCIS (Netherlands)

    de Jonge, J.P.R.

    2009-01-01

    This book is about rational choice theory from a different point of view. It is different for three reasons. First, it pays attention to the unintended consequences of intended actions. Second, it employs a non-instrumental approach to moral actions. And third, it argues that choice opportunities

  11. Economic rationality and health and lifestyle choices for people with diabetes.

    Science.gov (United States)

    Baker, Rachel Mairi

    2006-11-01

    Economic rationality is traditionally represented by goal-oriented, maximising behaviour, or 'instrumental rationality'. Such a consequentialist, instrumental model of choice is often implicit in a biomedical approach to health promotion and education. The research reported here assesses the relevance of a broader conceptual framework of rationality, which includes 'procedural' and 'expressive' rationality as complements to an instrumental model of rationality, in a health context. Q methodology was used to derive 'factors' underlying health and lifestyle choices, based on a factor analysis of the results of a card sorting procedure undertaken by 27 adult respondents with type 2 diabetes in Newcastle upon Tyne, UK. These factors were then compared with the rationality framework and the appropriateness of an extended model of economic rationality as a means of better understanding health and lifestyle choices was assessed. Taking a wider rational choice perspective, choices which are rendered irrational within a narrow-biomedical or strictly instrumental model, can be understood in terms of a coherent rationale, grounded in the accounts of respondents. The implications of these findings are discussed in terms of rational choice theory and diabetes management and research.

  12. The Role of Rationality in University Budgeting.

    Science.gov (United States)

    Chaffee, Ellen Earle

    1983-01-01

    Although empirical accounts of organizational decision making often show that the process is not a rational one, a study of budgeting at Stanford University during the 1970s, while not conclusive or comprehensive, supported the claim that the institution's process was rational and provided a procedure for testing a decision-making model. (MSE)

  13. Should Teachers Be Taught to Be Rational?

    Science.gov (United States)

    Floden, Robert E.; Feiman, Sharon

    1981-01-01

    Teacher education programs have long attempted to teach students to follow a rational mode of thinking. Recent research on teacher thinking has shown that a gap exists between how teachers think and the rational model. Such research should be used to give teacher educators insight into how their students think and learn. (JN)

  14. Heterogeneity, Bounded Rationality and Market Dysfunctionality

    OpenAIRE

    Xue-Zhong He; Lei Shi

    2008-01-01

    As the main building blocks of the modern finance theory, homogeneity and rational expectation have faced difficulty in explaining many market anomalies, stylized factors, and market inefficiency in empirical studies. As a result, heterogeneity and bounded rationality have been used as an alterative paradigm of asset price dynamics and this paradigm has been widely recognized recently in both academic and financial market practitioners. Within the framework of Chiarella, Dieci and He (2006a, ...

  15. Consumers' evaluations of ecological packaging - rational and emotional approaches

    OpenAIRE

    Koenig-Lewis, Nicole; Palmer, Adrian; Dermody, Janine; Urbye, Andreas

    2014-01-01

    Ecological marketing claims have been criticized for confusing or misleading buyers, leading to calls for more rationality in promoting and evaluating ‘green’ products. However, emotions are important drivers influencing pro-environmental purchase decisions. This study investigates consumers' emotional and rational evaluations of pro-environmental packaging. A conceptual model incorporates individuals' general environmental concerns, their rational beliefs about environmental effects of produ...

  16. Feeding of Total Mixed Ration on the Productivity of Friesian Holstein Cross-Grade Cattle

    Science.gov (United States)

    Sunarso; Christiyanto, M.; Nuswantara, L. K.

    2018-02-01

    An experiment was conducted to evaluate feeding of total mixed ration (TMR) on the productivity of Friesian Holstein (FH) male cross-grade cattle at Semarang Municipality. TMR was a ration formulated with agricultural and agro-industrial by-product (no grass and/or green forage were used) to fulfilled the nutrient requirement of beef cattle. Total mixed ration were formulated on iso-energy of 66% of total digestible nutrients (TDN) and different level of crude protein (CP) content of 11%, 12%, 13%, and 14%. Twenty (20) heads of FH male cross-grade cattle with initial body weight of 292.40+33.06 kg were used in this experiment, and were arranged into 5 treatments T0, T1, T2, T3, and T4), and 4 replications. Data collected were analysed statistically using analyses of variance (Anova) based on the completely randomized design (CRD), then followed by Duncan’s Multiple Range Test (DMRT) for different among treatments. Results of the experiment showed significantly different effect (P0.05) on feed conversion ratio (FCR), and feed efficiency. Others parameter showed that there were no significantly different (P>0.05) effect on the dry matter and organic matter digestibility in vitro, rumen ammonia concentration, and volatile fatty acid’s rumen concentration. It was concluded that feeding TMR was potentially prospected for fattening of beef cattle, particularly as feeding strategy when there was no grass and/or green forage anymore.

  17. Génération Y : much ado about nothing ? Le talent des jeunes

    OpenAIRE

    Wilkin, Luc

    2015-01-01

    Introduction Baby Boomers, Génération X, Génération Y, Génération du Millénaire, Génération Z, Génération Nintendo, Génération Wii, Génération Internet, Génération C, Génération Google, Génération Mobile, Génération Powerpoint, Génération couper/coller, natifs et immigrants digitaux, Homo sapiens digital ou Homo-zappiens, les vocables ne manquent pas pour désigner, séparer, opposer et segmenter les générations. Celles-ci évoluent, dans les discours, au gré des révolutions proclamées qui survi...

  18. Lying for the Greater Good: Bounded Rationality in a Team

    OpenAIRE

    Oktay Sürücü

    2014-01-01

    This paper is concerned with the interaction between fully and boundedly rational agents in situations where their interests are perfectly aligned. The cognitive limitations of the boundedly rational agent do not allow him to fully understand the market conditions and lead him to take non-optimal decisions in some situations. Using categorization to model bounded rationality, we show that the fully rational agent can nudge, i.e., he can manipulate the information he sends and decrease the exp...

  19. Bounded rationality alters the dynamics of paediatric immunization acceptance.

    Science.gov (United States)

    Oraby, Tamer; Bauch, Chris T

    2015-06-02

    Interactions between disease dynamics and vaccinating behavior have been explored in many coupled behavior-disease models. Cognitive effects such as risk perception, framing, and subjective probabilities of adverse events can be important determinants of the vaccinating behaviour, and represent departures from the pure "rational" decision model that are often described as "bounded rationality". However, the impact of such cognitive effects in the context of paediatric infectious disease vaccines has received relatively little attention. Here, we develop a disease-behavior model that accounts for bounded rationality through prospect theory. We analyze the model and compare its predictions to a reduced model that lacks bounded rationality. We find that, in general, introducing bounded rationality increases the dynamical richness of the model and makes it harder to eliminate a paediatric infectious disease. In contrast, in other cases, a low cost, highly efficacious vaccine can be refused, even when the rational decision model predicts acceptance. Injunctive social norms can prevent vaccine refusal, if vaccine acceptance is sufficiently high in the beginning of the vaccination campaign. Cognitive processes can have major impacts on the predictions of behaviour-disease models, and further study of such processes in the context of vaccination is thus warranted.

  20. Development of rations for the enhanced survival of salmon

    International Nuclear Information System (INIS)

    Ewing, R.D.; Lagasse, J.P.

    1990-12-01

    The nutritional quality of feed plays an important role in determining the health and ''fitness'' of smolts. Commercial fish meal, the major source of protein in salmon rations, may be reduced in quality from poor drying techniques during manufacture. Dietary stress in the hatchery may result. This investigation tests the hypothesis that protein quality of fish rations can influence the survival of smolts and the ultimate return of adults. The test involves a comparison between performances of coho (Oncorhynchus kisutch) and chinook salmon (O. tshawytscha) reared on rations containing very high quality protein derived from vacuum dried meals and those of fish reared on commercial rations, with commercial fish meal as a source of protein. Survival and return of several brood years of test and control fish are used to measure the influence of ration on survival. This report includes recovery data from these marked fish collected 1982 through September 1990

  1. Recommendations for Enhancing Implementation of Additional Protocol Declarations

    International Nuclear Information System (INIS)

    Niina, Toshiaki; Nidaira, Kazuo; Aono, Yosuke

    2010-01-01

    Japan signed the Additional Protocol (hereafter, AP) in December 1998. The domestic law and regulation had been revised to implement the initial and annual declarations for the Agency and the Additional Protocol came into force in December 1999. Since initial declaration in 2000, Japan has submitted the annual declaration in every May. Until 2010, Japan has made 10 annual declarations. This paper gives recommendations to enhance implementation of Additional Protocol declarations based on 10-year experience in Japan and addresses the following: Current status of additional protocol declaration in Japan; Outline of processing method; AP Information Management System; Recommendations for improving quality of declaration. Preparation of additional protocol declaration in NMCC has been conducted in the course of contract with Japan Safeguards Office (hereafter, JSGO) for safeguards information treatment. (author)

  2. Patient-centered care, nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study.

    Science.gov (United States)

    Bachnick, Stefanie; Ausserhofer, Dietmar; Baernholdt, Marianne; Simon, Michael

    2018-05-01

    Patient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care. The aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care. This is a sub-study of the cross-sectional multi-center "Matching Registered Nurse Services with Changing Care Demands" study. We included 123 units in 23 acute care hospitals from all three of Switzerland's language regions. The sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included. Patients' perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level. Patients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30-0.98]). Higher leadership ratings were associated with

  3. Rational emotive behaviour therapy: distinctive features

    OpenAIRE

    Dryden, Windy

    2008-01-01

    Rational emotive behaviour therapy (REBT) encourages the client to focus on their emotional problems in order to understand, challenge and change the irrational beliefs that underpin these problems. REBT can help clients to strengthen conviction in their alternative rational beliefs by acting in ways that are consistent with them and thus encourage a healthier outlook.\\ud \\ud This accessible and direct guide introduces the reader to REBT while indicating how it is different from other approac...

  4. Rationally Addicted to Drinking and Smoking?

    OpenAIRE

    Bask, Mikael; Melkersson, Maria

    2001-01-01

    When modeling demand for addictive consumption goods, the most widely used framework is the rational addiction model proposed by Becker and Murphy (1988). In the present paper, we extend the rational addiction model to include two addictive consumption goods, alcohol and cigarettes. We estimate the aggregate demand for alcohol and cigarettes in Sweden, using aggregate annual time series on sales volumes for the period 1955-1999. OLS estimates are compared to GMM estimates allowing for possibl...

  5. The Emotional and Moral Basis of Rationality

    Science.gov (United States)

    Boostrom, Robert

    2013-01-01

    This chapter explores the basis of rationality, arguing that critical thinking tends to be taught in schools as a set of skills because of the failure to recognize that choosing to think critically depends on the prior development of stable sentiments or moral habits that nourish a rational self. Primary among these stable sentiments are the…

  6. Performance, Carcass Production, and Meat Quality of Sumba Ongole Bulls Fed Ration Containing Velvet Bean (Mucuna pruriens

    Directory of Open Access Journals (Sweden)

    S. M. Yantika

    2016-04-01

    Full Text Available This research aimed to study performance, carcass production, meat quality, and economic feasibility of male Sumba Ongole cattle fed ration supplemented with velvet bean (M. pruriens. The research was designed in a completely randomized block design using 16 cattle with average body weight of 488+37.08 kg. The treatments were: T0= 15% straw + 85% concentrate; T1= T0 + 12% of velvet bean flour supplement; T2= T0 + 16% of velvet bean tempeh supplement; and T3= T0 + 200 mg/head/d of ractopamine hydrocloride. Data were analyzed by using analysis of variance with orthogonal contrast. The observed variables included feed consumption, average daily body weight gain (ADG, feed efficiency (FE, income over feed cost (IOFC, hot carcass weight (HCW, carcass percentage, subcutaneous fat thickness, meat pH, tenderness, cooking loss, and water holding capacity (WHC. The result revealed that the addition of 12% velvet bean flour into the rations increased dry matter consumption (P<0.05, but did not affect ADG, FE, IOFC, carcass production, and meat quality. The addition of 12% velvet bean flour produced the lowest cooking loss (P<0.05. The addition of 16% velvet bean tempeh into the rations significantly increased (P<0.05 dry matter consumption, however reduced (P<0.05 ADG, FE, and IOFC compared to control treatment. It is concluded that velvet bean flour at the level of 12% can be used as an alternative feed supplement in the ration of Sumba Ongole cattle and can replace the use of synthetic ß-agonist.

  7. 50 CFR 660.337 - Trawl rationalization program - data collection requirements.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Trawl rationalization program - data... COAST STATES West Coast Groundfish Fisheries § 660.337 Trawl rationalization program - data collection... guarantee that they will qualify for quota share under a future trawl rationalization program. The following...

  8. The two-model problem in rational decision making

    NARCIS (Netherlands)

    Boumans, Marcel

    2011-01-01

    A model of a decision problem frames that problem in three dimensions: sample space, target probability and information structure. Each specific model imposes a specific rational decision. As a result, different models may impose different, even contradictory, rational decisions, creating choice

  9. Realization and elimination in rational representations of behaviors

    NARCIS (Netherlands)

    Gottimukkala, Sasanka V.; Trentelman, Hendrikus; Fiaz, Shaik

    This article deals with the relationship between rational representations of linear differential systems and their state representations. In particular we study the relationship between rational representations on the one hand, and output nulling and driving variable representations on the other. In

  10. Rationality, Theory Acceptance and Decision Theory

    Directory of Open Access Journals (Sweden)

    J. Nicolas Kaufmann

    1998-06-01

    Full Text Available Following Kuhn's main thesis according to which theory revision and acceptance is always paradigm relative, I propose to outline some possible consequences of such a view. First, asking the question in what sense Bayesian decision theory could serve as the appropriate (normative theory of rationality examined from the point of view of the epistemology of theory acceptance, I argue that Bayesianism leads to a narrow conception of theory acceptance. Second, regarding the different types of theory revision, i.e. expansion, contraction, replacement and residuals shifts, I extract from Kuhn's view a series of indications showing that theory replacement cannot be rationalized within the framework of Bayesian decision theory, not even within a more sophisticated version of that model. Third, and finally, I will point to the need for a more comprehensive model of rationality than the Bayesian expected utility maximization model, the need for a model which could better deal with the different aspects of theory replacement. I will show that Kuhn's distinction between normal and revolutionary science gives us several hints for a more adequate theory of rationality in science. I will also show that Kuhn is not in a position to fully articulate his main ideas and that he well be confronted with a serious problem concerning collective choice of a paradigm.

  11. Relation of knowledge and level of education to the rationality of self-medication on childhood diarrhea on the Code River banks in Jogoyudan, Jetis, Yogyakarta

    Science.gov (United States)

    Dania, H.; Ihsan, M. N.

    2017-11-01

    Self-medication as an alternative is used to reduce the severity of diarrhea. Optimal treatment can be done by increasing the rationalization of self-medication on diarrhea. This can be achieved with good knowledge about self-medication, which is in turn influenced by level of education. The aim of this study was to determine the relationship of knowledge and education level to rationality of self-medication on childhood diarrhea around the Code River in Jogoyudan, Jetis, Yogyakarta. The study was conducted by cross-sectional analytical observational design. The subjects were mothers who had children aged 2-11 years who had experienced diarrhea and had self-medication. Questionnaires were used to assess the rationality of self-medication on children's diarrhea by the parents. The respondents were askeds to fill out about indications, right drugs, doses, time intervals and periods of drug administration. Data were analyzed using chi- square. It was showed that of 40 respondents, 14 respondents (35%) performed rational self-medication on children's diarrhea and 26 respondents (65%). did not rationalize the treatment. The results of a bivariate test obtained a chi-square value of 9.808 (> 3.841) and a p value of 0.002 ( 3.841) and a p value of 0.000 (<0.05) on relationship between knowledge and rationality of self- medication. The conclusion of this study is that there is a correlation between knowledge and level of education and rationality of self-medication on childhood diarrhea on the Code River banks in Jogoyudan, Jetis, Yogyakarta.

  12. A comparison of two treatments for childhood apraxia of speech: methods and treatment protocol for a parallel group randomised control trial

    Directory of Open Access Journals (Sweden)

    Murray Elizabeth

    2012-08-01

    Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment. This protocol was approved by the Human Research Ethics Committee, University of Sydney (#12924. Discussion This will be the first randomised control trial to test treatment for CAS. It will be valuable for clinical decision-making and providing evidence-based services for children with CAS. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12612000744853

  13. Designing institutions for climate change: Why rational design involves technology

    Energy Technology Data Exchange (ETDEWEB)

    Coninck, H. de [Energy Research Centre of the Netherlands, Petten (Netherlands)

    2008-09-30

    This paper aims to explore how to augment the institutional solutions offered by current political theory for addressing the unprecedented problem of climate change. Although steering directly at emission reductions in an international treaty has benefits in terms of cost-effectiveness, the paper arrives at the conclusion that considerations around technological development should be drawn into the treaty equation in order to generate sufficient reciprocity to have a politically feasible international regime. It then argues that the benefits of technology agreements for climate change mitigation may be larger than commonly assumed, as they - if properly designed - could lead to real emission reductions and provide more flexibility to reach agreement in post-2012 negotiations than proposals modelled exclusively on the Kyoto Protocol or other types of absolute emission targets. Based on rational design of international institutions for environmental governance, and attempting to take into account considerations of technological dynamics and the 'sociotechnical system', contours of a possible environmentally effective and politically feasible international climate change agreements are sketched.

  14. Rational first integrals of geodesic equations and generalised hidden symmetries

    International Nuclear Information System (INIS)

    Aoki, Arata; Houri, Tsuyoshi; Tomoda, Kentaro

    2016-01-01

    We discuss novel generalisations of Killing tensors, which are introduced by considering rational first integrals of geodesic equations. We introduce the notion of inconstructible generalised Killing tensors, which cannot be constructed from ordinary Killing tensors. Moreover, we introduce inconstructible rational first integrals, which are constructed from inconstructible generalised Killing tensors, and provide a method for checking the inconstructibility of a rational first integral. Using the method, we show that the rational first integral of the Collinson–O’Donnell solution is not inconstructible. We also provide several examples of metrics admitting an inconstructible rational first integral in two and four-dimensions, by using the Maciejewski–Przybylska system. Furthermore, we attempt to generalise other hidden symmetries such as Killing–Yano tensors. (paper)

  15. Physical activity as a treatment for depression: the TREAD randomised trial protocol.

    Science.gov (United States)

    Baxter, Helen; Winder, Rachel; Chalder, Melanie; Wright, Christine; Sherlock, Sofie; Haase, Anne; Wiles, Nicola J; Montgomery, Alan A; Taylor, Adrian H; Fox, Ken R; Lawlor, Debbie A; Peters, Tim J; Sharp, Deborah J; Campbell, John; Lewis, Glyn

    2010-11-12

    Depression is one of the most common reasons for consulting a General Practitioner (GP) within the UK. Whilst antidepressants have been shown to be clinically effective, many patients and healthcare professionals would like to access other forms of treatment as an alternative or adjunct to drug therapy for depression. A recent systematic review presented some evidence that physical activity could offer one such option, although further investigation is needed to test its effectiveness within the context of the National Health Service.The aim of this paper is to describe the protocol for a randomised, controlled trial (RCT) designed to evaluate an intervention developed to increase physical activity as a treatment for depression within primary care. The TREAD study is a pragmatic, multi-centre, two-arm RCT which targets patients presenting with a new episode of depression. Patients were approached if they were aged 18-69, had recently consulted their GP for depression and, where appropriate, had been taking antidepressants for less than one month. Only those patients with a confirmed diagnosis of a depressive episode as assessed by the Clinical Interview Schedule-Revised (CIS-R), a Beck Depression Inventory (BDI) score of at least 14 and informed written consent were included in the study. Eligible patients were individually randomised to one of two treatment groups; usual GP care or usual GP care plus facilitated physical activity. The primary outcome of the trial is clinical symptoms of depression assessed using the BDI four months after randomisation. A number of secondary outcomes are also measured at the 4-, 8- and 12-month follow-up points including quality of life, attitude to and involvement in physical activity and antidepressant use/adherence. Outcomes will be analysed on an intention-to-treat (ITT) basis and will use linear and logistic regression models to compare treatments. The results of the trial will provide information about the effectiveness of

  16. Physical activity as a treatment for depression: the TREAD randomised trial protocol

    Directory of Open Access Journals (Sweden)

    Lawlor Debbie A

    2010-11-01

    Full Text Available Abstract Background Depression is one of the most common reasons for consulting a General Practitioner (GP within the UK. Whilst antidepressants have been shown to be clinically effective, many patients and healthcare professionals would like to access other forms of treatment as an alternative or adjunct to drug therapy for depression. A recent systematic review presented some evidence that physical activity could offer one such option, although further investigation is needed to test its effectiveness within the context of the National Health Service. The aim of this paper is to describe the protocol for a randomised, controlled trial (RCT designed to evaluate an intervention developed to increase physical activity as a treatment for depression within primary care. Methods/design The TREAD study is a pragmatic, multi-centre, two-arm RCT which targets patients presenting with a new episode of depression. Patients were approached if they were aged 18-69, had recently consulted their GP for depression and, where appropriate, had been taking antidepressants for less than one month. Only those patients with a confirmed diagnosis of a depressive episode as assessed by the Clinical Interview Schedule-Revised (CIS-R, a Beck Depression Inventory (BDI score of at least 14 and informed written consent were included in the study. Eligible patients were individually randomised to one of two treatment groups; usual GP care or usual GP care plus facilitated physical activity. The primary outcome of the trial is clinical symptoms of depression assessed using the BDI four months after randomisation. A number of secondary outcomes are also measured at the 4-, 8- and 12-month follow-up points including quality of life, attitude to and involvement in physical activity and antidepressant use/adherence. Outcomes will be analysed on an intention-to-treat (ITT basis and will use linear and logistic regression models to compare treatments. Discussion The results of

  17. Milk Chemical Composition of Dairy Cows Fed Rations Containing Protected Omega-3 Fatty Acids and Fermented Rice Bran

    Directory of Open Access Journals (Sweden)

    Sudibya

    2013-12-01

    Full Text Available The research was conducted to investigate the effect of ration containing protected omega-3 and fermented rice bran on chemical composition of dairy milk. The research employed 10 female PFH dairy cows of 2-4 years old with body weight 300-375 kg. The research was assigned in randomized complete block design. The treatment consisted of P0= control ration, P1= P0 + 20% fermented rice bran, P2= P1 + 4% soya bean oil, P3= P1 + 4% protected tuna fish oil and P4= P1 + 4% protected lemuru fish oil. The results showed that the effects of fish oil supplementation in the rations significantly (P<0.01 decreased feed consumption, cholesterol, low density lipoprotein, lipids, and saturated fatty acids. Meanwhile, it increased milk production, content of high density lipoprotein, omega-3, omega-6 and unsaturated fatty acids in the dairy cows milk. It is concluded that the inclusion of 4% protected fish oil in the rations can produce healthy milk by decreasing milk cholesterol and increasing omega-3 fatty acids content.

  18. Mental health as rational autonomy.

    Science.gov (United States)

    Edwards, R B

    1981-08-01

    Rather than eliminate the terms "mental health and illness" because of the grave moral consequences of psychiatric labeling, conservative definitions are proposed and defended. Mental health is rational autonomy, and mental illness is the sustained loss of such. Key terms are explained, advantages are explored, and alternative concepts are criticized. The value and descriptive components of all such definitions are consciously acknowledged. Where rational autonomy is intact, mental hospitals and psychotherapists should not think of themselves as treating an illness. Instead, they are functioning as applied axiologists, moral educators, spiritual mentors, etc. They deal with what Szasz has called "personal, social, and ethical problems in living." But mental illness is real.

  19. Quantifying public radiation exposure related to lutetium-177 octreotate therapy for the development of a safe outpatient treatment protocol.

    Science.gov (United States)

    Olmstead, Craig; Cruz, Kyle; Stodilka, Robert; Zabel, Pamela; Wolfson, Robert

    2015-02-01

    Radionuclide therapies, including treatment of neuroendocrine tumors with lutetium-177 (Lu-177) octreotate, often involve hospital admission to minimize radiation exposure to the public. Overnight admission due to Lu-177 octreotate therapy incurs additional cost for the hospital and is an inconvenience for the patient. This study endeavors to characterize the potential radiation risk to caregivers and the public should Lu-177 octreotate therapies be performed on an outpatient basis. Dose rate measurements of radiation emanating from 10 patients were taken 30 min, 4, and 20 h after initiation of Lu-177 octreotate therapy. Instadose radiation dose measurement monitors were also placed around the patients' rooms to assess the potential cumulative radiation exposure during the initial 30 min-4 h after treatment (simulating the hospital-based component of the outpatient model) as well as 4-20 h after treatment (simulating the discharged outpatient portion). The mean recorded dose rate at 30 min, 4, and 20 h after therapy was 20.4, 14.0, and 6.6 μSv/h, respectively. The majority of the cumulative dose readings were below the minimum recordable threshold of 0.03 mSv, with a maximum dose recorded of 0.18 mSv. Given the low dose rate and cumulative levels of radiation measured, the results support that an outpatient Lu-177 octreotate treatment protocol would not jeopardize public safety. Nevertheless, the concept of ALARA still requires that detailed radiation safety protocols be developed for Lu-177 octreotate outpatients to minimize radiation exposure to family members, caregivers, and the general public.

  20. Design rationalization and the logic of design: a case study

    DEFF Research Database (Denmark)

    Galle, Per

    1996-01-01

    various ‘sources of credibility’ of premises, items of general background knowledge, and several (abductive and deductive) patterns of inference which suggest a possible ‘logic of design’. Rationalization of decisions is defined, and many decisions are found not to be fully rationalized, despite...... the apparent rationality of the reasoning....

  1. Emergence of scale-free characteristics in socio-ecological systems with bounded rationality

    OpenAIRE

    Kasthurirathna, Dharshana; Piraveenan, Mahendra

    2015-01-01

    Socio?ecological systems are increasingly modelled by games played on complex networks. While the concept of Nash equilibrium assumes perfect rationality, in reality players display heterogeneous bounded rationality. Here we present a topological model of bounded rationality in socio-ecological systems, using the rationality parameter of the Quantal Response Equilibrium. We argue that system rationality could be measured by the average Kullback?-Leibler divergence between Nash and Quantal Res...

  2. Game interrupted: The rationality of considering the future

    Directory of Open Access Journals (Sweden)

    Brandon Almy

    2013-09-01

    Full Text Available The ``problem of points'', introduced by Paccioli in 1494 and solved by Pascal and Fermat 160 years later, inspired the modern concept of probability. Incidentally, the problem also shows that rational decision-making requires the consideration of future events. We show that naive responses to the problem of points are more future oriented and thus more rational in this sense when the problem itself is presented in a future frame instead of the canonical past frame. A simple nudge is sufficient to make decisions more rational. We consider the implications of this finding for hypothesis testing and predictions of replicability.

  3. Teaching Rational Entitlement and Responsibility: A Socratic Exercise

    Directory of Open Access Journals (Sweden)

    David Godden

    2014-02-01

    Full Text Available The paper reports on a Socratic exercise that introduces participants to the norm of rational entitlement, as distinct from political entitlement, and the attendant norm of rational responsibility. The exercise demonstrates that, because participants are not willing to exchange their own opinion at random for another differing opinion to which the owner is, by the participants’ own admission, entitled, they treat their entitlement to their own opinion differently, giving it a special status. This gives rise to rational obligations such as the obligation to provide reasons, and a willingness to risk those opinions to the force of the better reason.

  4. Rational equity bubbles

    OpenAIRE

    Zhou, Ge

    2012-01-01

    This paper discusses the existence of a bubble in the pricing of an asset that pays positive dividends. I show that rational bubbles can exist in a growing economy. The existence of bubbles depends on the relative magnitudes of risk aversion to consumption and to wealth. Furthermore, I examine how an exogenous shock in technology might trigger bubbles.

  5. Rational design of nanomaterials for water treatment

    KAUST Repository

    Li, Renyuan; Zhang, Lianbin; Wang, Peng

    2015-01-01

    The ever-increasing human demand for safe and clean water is gradually pushing conventional water treatment technologies to their limits and it is now a popular perception that the solutions to the existing and future water challenges will highly

  6. Biologic comparison of partial breast irradiation protocols

    International Nuclear Information System (INIS)

    Rosenstein, Barry S.; Lymberis, Stella C.; Formenti, Silvia C.

    2004-01-01

    Purpose: To analyze the dose/fractionation schedules currently used in ongoing clinical trials of partial breast irradiation (PBI) by comparing their biologically effective dose (BED) values to those of three standard whole breast protocols commonly used after segmental mastectomy in the treatment of breast cancer. Methods and materials: The BED equation derived from the linear-quadratic model for radiation-induced cell killing was used to calculate the BEDs for three commonly used whole breast radiotherapy regimens, in addition to a variety of external beam radiotherapy, as well as high-dose-rate and low-dose-rate brachytherapy, PBI protocols. Results: The BED values of most PBI protocols resulted in tumor control BEDs roughly equivalent to a 50-Gy standard treatment, but consistently lower than the BEDs for regimens in which the tumor bed receives a total dose of either 60 Gy or 66 Gy. The BED values calculated for the acute radiation responses of erythema and desquamation were nearly all lower for the PBI schedules, and the late-response BEDs for most PBI regimens were in a similar range to the BEDs for the standard treatments. Conclusion: Biologically effective dose modeling raises the concern that inadequate doses might be delivered by PBI to ensure optimal in-field tumor control

  7. Development of a calibration protocol and identification of the most sensitive parameters for the particulate biofilm models used in biological wastewater treatment.

    Science.gov (United States)

    Eldyasti, Ahmed; Nakhla, George; Zhu, Jesse

    2012-05-01

    Biofilm models are valuable tools for process engineers to simulate biological wastewater treatment. In order to enhance the use of biofilm models implemented in contemporary simulation software, model calibration is both necessary and helpful. The aim of this work was to develop a calibration protocol of the particulate biofilm model with a help of the sensitivity analysis of the most important parameters in the biofilm model implemented in BioWin® and verify the predictability of the calibration protocol. A case study of a circulating fluidized bed bioreactor (CFBBR) system used for biological nutrient removal (BNR) with a fluidized bed respirometric study of the biofilm stoichiometry and kinetics was used to verify and validate the proposed calibration protocol. Applying the five stages of the biofilm calibration procedures enhanced the applicability of BioWin®, which was capable of predicting most of the performance parameters with an average percentage error (APE) of 0-20%. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Imagination and the Pursuit of a Rational Rhetoric.

    Science.gov (United States)

    Foster, David E.

    The works of certain rhetorical thinkers contain strategies directed at achieving assent or cooperation. Such writings demonstrate means by which readers' rational responses can be deliberately challenged and disrupted. While people often cite Aristotle's maxim "Man is a rational animal," critics have asserted that the statement…

  9. Cassapro in broiler ration : effect of halquinol Supplementation

    Directory of Open Access Journals (Sweden)

    I.P Kompiang

    1997-10-01

    Full Text Available A trial was conducted to determine the effect of various level of cassapro (fermented cassava and halquinol supplementation on the performance of broiler chickens . Experimental rations were formulated isoprotein and isoenergy with graded level of cassapro (0, 10, 20 and 30% . The 20 and 30% cassapro ration were prepared without and with halquinol supplementation (60 ppm. Each ration was fed to 40 of three day old broilers, divided into 4 cages ( 5 males and 5 females per cage for 4 weeks. Increasing the level of cassapro significantly reduced body weight gain (P < 0.005, increased feed conversion ratio (FCR (P < 0.0005 with no effect on feed intake (P < 0.10 . Halquinol supplementation has no effect on feed intake, but significantly increased body weight gain (P <0.05 and improved the FCR (P < 0.01 . It is concluded that high level of cassapro in the ration will cause poorer performance of the birds, however it can be alleviated by halquinolsupplementation.

  10. The rational complementarity problem

    NARCIS (Netherlands)

    Heemels, W.P.M.H.; Schumacher, J.M.; Weiland, S.

    1999-01-01

    An extension of the linear complementarity problem (LCP) of mathematical programming is the so-called rational complementarity problem (RCP). This problem occurs if complementarity conditions are imposed on input and output variables of linear dynamical input/state/output systems. The resulting

  11. Consumer rationality in choice

    NARCIS (Netherlands)

    Conlon, B.J.

    2001-01-01

    The dissertation concentrates on consumer choice and the ability of current modelling approaches to capture the underlying behaviour of the individual decision-makers. The standard assumption of a rational utility maximising individual and its implications for observed behaviour are examined and

  12. Universal and Relative Rationality

    Directory of Open Access Journals (Sweden)

    Nathaniel Goldberg

    2009-01-01

    Full Text Available In this paper I illustrate how a basic kind of universal rationality can be profitably combined with undeniable instances of relativism. I do so by engaging Michael Friedman’s recent response to a challenge from Thomas Kuhn.

  13. [Detailed methodological recommendations for the treatment of Clostridium difficile-associated diarrhea with faecal transplantation].

    Science.gov (United States)

    Nagy, Gergely György; Várvölgyi, Csaba; Balogh, Zoltán; Orosi, Piroska; Paragh, György

    2013-01-06

    The incidence of Clostridium difficile associated enteral disease shows dramatic increase worldwide, with appallingly high treatment costs, mortality figures, recurrence rates and treatment refractoriness. It is not surprising, that there is significant interest in the development and introduction of alternative therapeutic strategies. Among these only stool transplantation (or faecal bacteriotherapy) is gaining international acceptance due to its excellent cure rate (≈92%), low recurrence rate (≈6%), safety and cost-effectiveness. Unfortunately faecal transplantation is not available for most patients, although based on promising international results, its introduction into the routine clinical practice is well justified and widely expected. The authors would like to facilitate this process, by presenting a detailed faecal transplantation protocol prepared in their Institution based on the available literature and clinical rationality. Officially accepted national methodological guidelines will need to be issued in the future, founded on the expert opinion of relevant professional societies and upcoming advances in this field.

  14. Rational Emotive Education as a Short-Term Primary Prevention Technique.

    Science.gov (United States)

    Hooper, Stephen R.; Layne, C. Clinton

    1985-01-01

    Fifth- to seventh-grade students (N=586) who participated in one hour of Rational Emotive Education (a directive approach to teaching rational thinking skills) for six weeks scored higher in posttests of the Com oA Belief Inventory for Students than control Ss (N=738) who received no Rational Emotive Education. Findings suggested the utility of a…

  15. 'Ethical rationality': A subjective-objective concept of risk assessment

    International Nuclear Information System (INIS)

    Kaiser, H.

    1991-01-01

    'Ethical rationality' as a concept of risk assessment means that risks are assessed using an integrative, ethical-normative approach (taking values, world views and people's understanding of what it means to be a human being and of what makes life worth living into account). Thus risks cannot be assessed on a mathematical and statistical basis alone. It is much more important to reflect upon what makes life worth living. In order to answer this question, the rationality of probability calculus does not suffice. Instead, this form of rationality must be transformed into or replaced by ethical discourse (an open, iterative and complex process of making ethical judgement). Proposals for an ethical assessment of risk are made which are substantiated by the theoretical concept of ethical rationality comprising the following steps: - Consideration of the nature of ethics (understanding of the viewer's perspective); - A look at an ethical interpretation of the traditional mathematical concept of risk (description); - Scheme for an ethical conception of rationality (theoretical reflections); - Weighing risks from an ethical perspective in practice. (orig./HSCH) [de

  16. Cooperation, psychological game theory, and limitations of rationality in social interaction.

    Science.gov (United States)

    Colman, Andrew M

    2003-04-01

    Rational choice theory enjoys unprecedented popularity and influence in the behavioral and social sciences, but it generates intractable problems when applied to socially interactive decisions. In individual decisions, instrumental rationality is defined in terms of expected utility maximization. This becomes problematic in interactive decisions, when individuals have only partial control over the outcomes, because expected utility maximization is undefined in the absence of assumptions about how the other participants will behave. Game theory therefore incorporates not only rationality but also common knowledge assumptions, enabling players to anticipate their co-players' strategies. Under these assumptions, disparate anomalies emerge. Instrumental rationality, conventionally interpreted, fails to explain intuitively obvious features of human interaction, yields predictions starkly at variance with experimental findings, and breaks down completely in certain cases. In particular, focal point selection in pure coordination games is inexplicable, though it is easily achieved in practice; the intuitively compelling payoff-dominance principle lacks rational justification; rationality in social dilemmas is self-defeating; a key solution concept for cooperative coalition games is frequently inapplicable; and rational choice in certain sequential games generates contradictions. In experiments, human players behave more cooperatively and receive higher payoffs than strict rationality would permit. Orthodox conceptions of rationality are evidently internally deficient and inadequate for explaining human interaction. Psychological game theory, based on nonstandard assumptions, is required to solve these problems, and some suggestions along these lines have already been put forward.

  17. Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review.

    Science.gov (United States)

    Carrazzone, Oreste Lemos; Belloti, João Carlos; Matsunaga, Fabio Teruo; Mansur, Nacime Salomão Barbachan; Matsumoto, Marcelo Hide; Faloppa, Flavio; Tamaoki, Marcel Jun Sugawara

    2017-11-21

    The treatment of supracondylar humerus fracture in children (SHFC) is associated with complications such as functional deficit, residual deformity, and iatrogenic neurological damage. The standard treatment is closed reduction and percutaneous Kirschner wire fixation with different configurations. Despite this fact, there is still no consensus on the most effective technique for the treatment of these fractures. The aim of this systematic review will be to evaluate the effect of surgical interventions on the treatment of Gartland type II and III SHFC by assessing function, complications, and error as primary outcomes. Clinical outcomes such as range of motion and pain and radiographic outcomes will also be judged. A systematic review of randomized controlled trials or quasi-randomized controlled trials evaluating the surgical treatment of SHFC will be carried out in the Cochrane Central Register of Controlled Trials, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, and Excerpta Medica Database. The search will also occur at ongoing and recently completed clinical trials in selected databases. Data management and extraction will be performed using a data withdrawal form and by analyzing the following: study method characteristics, participant characteristics, intervention characteristics, results, methodological domains, and risk of bias. To assess the risk of bias of the included trials, the Cochrane Risk of Bias Tool will be used. Dichotomous outcome data will be analyzed as risk ratios, and continuous outcome data will be expressed as mean differences, both with 95% confidence intervals. Also, whenever possible, subgroup analysis, sensitivity analysis, and assessment of heterogeneity will be performed. Following the publication of this protocol, searches will be run and included studies will be deeply analyzed. We hope to obtain final results in the next few months and have the final paper published by the end of 2018. This study was funded

  18. A Qualitative Study of the Treatment Improvement Protocols (TIPs): An Assessment of the Use of TIPs by Individuals Affiliated with the Addiction Technology Transfer Centers (ATTCs).

    Science.gov (United States)

    Hayashi, Susan W.; Suzuki, Marcia; Hubbard, Susan M.; Huang, Judy Y.; Cobb, Anita M.

    2003-01-01

    Evaluated the Addiction Technology Transfer Centers (ATTCs) of the Center for Substance Abuse Treatment (CSAT) as a means of diffusion of innovations, focusing on use of the Treatment Improvement Protocols (TIPs). Qualitative studies at 6 ATTCs that included 57 interviews show that the CSAT is at the forefront of providing resources to the…

  19. Tinnitus in patients with temporo-mandibular joint disorder: Proposal for a new treatment protocol.

    Science.gov (United States)

    Attanasio, Giuseppe; Leonardi, Alessandra; Arangio, Paolo; Minni, Antonio; Covelli, Edoardo; Pucci, Resi; Russo, Francesca Yoshie; De Seta, Elio; Di Paolo, Carlo; Cascone, Piero

    2015-06-01

    The present study was designed to verify the correlation between tinnitus and temporomandibular joint dysfunction.86 consecutive patients were enrolled in the study, all affected by subjective tinnitus without hearing impairment, from both genders, age between 18 and 60 years old. The final number of patients included in the study was 55. All patients received a temporo-mandibular joint examination. All the patients were asked to rate the severity of their symptoms before and after treatment using a VAS scale and the Tinnitus Handicap Inventory (THI) and they followed a standardized protocol for the investigation of tinnitus. All the subjects were monitored by the same researcher and they underwent the same splint treatment. The comparison between pre- and posttreatment phase scores showed in patients with predisposition of TMD and with TMD a statistically significant decrease of THI and VAS values. The characteristics of tinnitus and the degree of response to treatment confirmed the relationship between tinnitus and TMD. The authors believe that, when the most common causes of tinnitus, such as otologic disorders and neurological diseases are excluded, it is correct to evaluate the functionality of the temporo-mandibular joint and eventually treat its pathology to obtain tinnitus improvement or even resolution. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  20. State-Dependent Decisions Cause Apparent Violations of Rationality in Animal Choice

    Science.gov (United States)

    Schuck-Paim, Cynthia; Pompilio, Lorena

    2004-01-01

    Normative models of choice in economics and biology usually expect preferences to be consistent across contexts, or “rational” in economic language. Following a large body of literature reporting economically irrational behaviour in humans, breaches of rationality by animals have also been recently described. If proven systematic, these findings would challenge long-standing biological approaches to behavioural theorising, and suggest that cognitive processes similar to those claimed to cause irrationality in humans can also hinder optimality approaches to modelling animal preferences. Critical differences between human and animal experiments have not, however, been sufficiently acknowledged. While humans can be instructed conceptually about the choice problem, animals need to be trained by repeated exposure to all contingencies. This exposure often leads to differences in state between treatments, hence changing choices while preserving rationality. We report experiments with European starlings demonstrating that apparent breaches of rationality can result from state-dependence. We show that adding an inferior alternative to a choice set (a “decoy”) affects choices, an effect previously interpreted as indicating irrationality. However, these effects appear and disappear depending on whether state differences between choice contexts are present or not. These results open the possibility that some expressions of maladaptive behaviour are due to oversights in the migration of ideas between economics and biology, and suggest that key differences between human and nonhuman research must be recognised if ideas are to safely travel between these fields. PMID:15550984

  1. A rational approach to decision making in toxicology.

    Science.gov (United States)

    Jackson, B A; Sass, N L

    1984-06-01

    The application of the Kepner-Tregoe (C. H. Kepner and B. B. Tregoe, 1981, The New Rational Manager, Princeton Res. Press, Princeton, N. J.) problem solving technique to the evaluation and interpretation of toxicological information is described. Data from a chronic study provide an illustrative example. In this study an excess in the number of urinary bladder neoplasms was observed in male rats exposed to diets containing the test chemical. No similar effect was seen in treated female rats. Both male and female mice exposed to treatment also exhibited no effect. Whether treatment was the cause of the observed increase should be based on all the scientific and technical information that is relevant to this decision. The Kepner-Tregoe method of problem analysis captures this information in a framework that makes it easily understood. This is especially desirable if the judgments that are a vital part of regulatory decision making are to be adequately communicated.

  2. Rational Drug Use of Nurses

    Directory of Open Access Journals (Sweden)

    Mehtap Sahingoz

    2013-02-01

    Full Text Available ABSTRACT Objective: At this study to be aimed to assess status of the knowledge of nurses who working in public and private health institutions in Sivas province use of medication fort he treatment during their illnesses and patients and the attitudes of rational drug application. Matherials and methods: the researc planned to attend 750 nurses but it has been completed with participation of 641 nurses (Reaching rate 85,5%. This is a descriptive and cross-sectional study. in the study data were collected with a questionaire, percentages stated and chi square test was used for analysis. Results: %95,3 of nurses were females and mean age of them 29.21±4.85 years. The rate of contacting a doktor in case of illness is higher in 39.1% of nurses in the 21-30 age group and 48.6% of nurses working in primary care institutions. The level of self-treating is higher in 45.5 % of nurses working less than a year in profession .In the case of illness, 53% of nurses stated that they had left the medicine when signs of disease over. %98.8 of nurses expressed that they know effects of drugs used and 99.1% of them stated they know the side effects of drugs used. The entire group of postgraduate education status stated that they have not received the drug recommended by others. The level of suggesting a drug to someone else fort he same disease is higher in 65.8% of the group 31 years and older and group working over 40 hours per week. It were determined that used in consultation with the physician 65.2% of nurses antibiotics, 87.5% of them weiht loss drug and 82.7% of them contraceptive . 99.5% of the nurses have expressed that they inform to patients about use of their medications. Among the issues that expressed informations took place the application form of drugs (51.0 %and information of need to consult one if deemed one unexpected effect (59.6% . Also has been identified that of nurses acquired inform about drugs from drug book (vademecum (87.5 % and they

  3. Penanganan Kasus Low Self-Esteem dalam Berinteraksi Sosial Melalui Konseling Rational Emotif Teknik Reframing

    Directory of Open Access Journals (Sweden)

    Aldila Fitri R.N. Maynawati

    2012-08-01

    Full Text Available Self-esteem is the most important thing for creating a good personality. Self-esteem is an individual evaluation from the differentiation between self-image and ideal-self. However, low self-esteem is often experienced by several individuals in sosial interaction which happened at SMP Negeri 2 Ungaran. The aim of this research is to know whether the case low self-esteem in social interaction of VIII grade students could be solved through rational emotive counseling by using reframing technique. This research used case handling approach. In addition, the method that used are interview and observation. In analising data, the researcher used comparative analysis, content analysis, and logic analysis. After giving treatment to three students, can be seen that students who had low self-esteem had changed with had rational beliefe, when meeting with his friends no longer beat the view, the intensity of the client alone in a classroom when recess was already reduced, it looks more confident when interact with his friends, and his was not ashamed and afraid when hanging out with friends. The research can be concluded that low self-esteem can be solved through rational emotive counseling by using reframing technique.

  4. Rationalization with ruled surfaces in architecture

    DEFF Research Database (Denmark)

    Steenstrup, Kasper Hornbak

    This thesis addresses the problems of rationalizing and segmenting large scale 3D models, and how to handle difficult production constraints in this area. The design choices when constructing large scale architecture are influenced by the budget. Therefore I strive to minimize the amount of time...... and material needed for production. This makes advanced free form architecture viable for low cost projects, allowing the architects to realize their designs. By pre-cutting building blocks using hot wire robots, the amount of milling necessary can be reduced drastically. I do this by rationalizing...

  5. Rational homotopy theory and differential forms

    CERN Document Server

    Griffiths, Phillip

    2013-01-01

    This completely revised and corrected version of the well-known Florence notes circulated by the authors together with E. Friedlander examines basic topology, emphasizing homotopy theory. Included is a discussion of Postnikov towers and rational homotopy theory. This is then followed by an in-depth look at differential forms and de Tham's theorem on simplicial complexes. In addition, Sullivan's results on computing the rational homotopy type from forms is presented.  New to the Second Edition: *Fully-revised appendices including an expanded discussion of the Hirsch lemma*Presentation of a natu

  6. Newborn hearing screening protocol in tuscany region.

    Science.gov (United States)

    Berrettini, Stefano; Ghirri, Paolo; Lazzerini, Francesco; Lenzi, Giovanni; Forli, Francesca

    2017-09-20

    Newborn hearing screening has to be considered the first step of a program for the identification, diagnosis, treatment and habilitation/rehabilitation of children with hearing impairment. In Tuscany Region of Italy, the universal newborn hearing screening is mandatory since november 2007. The first guidelines for the execution of the screening have been released in June 2008; then many other Italian regions partially or totally adopted these guidelines. On the basis of the experience from 2008 and according to the recent evidences in the scientific literature, a new screening protocol was released in Tuscany region. The new protocol is an evolution of the previous one. Some issues reported in the previous protocol and in the Joint Committee on Infant Hearing statement published in 2007 were revised, such as the risk factors for auditory neuropathy and for late onset, progressive or acquired hearing loss. The new updated guidelines were submitted to the Sanitary Regional Council and then they have been approved in August 2016. The updated screening protocol is mainly aimed to identify newborns with a congenital moderate-to-profound hearing loss, but it also provides indications for the audiological follow-up of children with risk's factor for progressive or late onset hearing loss; further it provides indications for the audiological surveillance of children at risk for acquired hearing impairment. Then, in the new guidelines the role of the family paediatrician in the newborn hearing screening and audiological follow-up and surveillance is underscored. Finally the new guidelines provide indications for the treatment with hearing aids and cochlear implant, in accordance with the recent Italian Health Technology Assessment (HTA) guidelines. In the paper we report the modality of execution of the universal newborn hearing screening in the Tuscany Region, according to the recently updated protocol. The main features of the protocol and the critical issues are

  7. Rational approximation of vertical segments

    Science.gov (United States)

    Salazar Celis, Oliver; Cuyt, Annie; Verdonk, Brigitte

    2007-08-01

    In many applications, observations are prone to imprecise measurements. When constructing a model based on such data, an approximation rather than an interpolation approach is needed. Very often a least squares approximation is used. Here we follow a different approach. A natural way for dealing with uncertainty in the data is by means of an uncertainty interval. We assume that the uncertainty in the independent variables is negligible and that for each observation an uncertainty interval can be given which contains the (unknown) exact value. To approximate such data we look for functions which intersect all uncertainty intervals. In the past this problem has been studied for polynomials, or more generally for functions which are linear in the unknown coefficients. Here we study the problem for a particular class of functions which are nonlinear in the unknown coefficients, namely rational functions. We show how to reduce the problem to a quadratic programming problem with a strictly convex objective function, yielding a unique rational function which intersects all uncertainty intervals and satisfies some additional properties. Compared to rational least squares approximation which reduces to a nonlinear optimization problem where the objective function may have many local minima, this makes the new approach attractive.

  8. Teaching Rational Decision-Making.

    Science.gov (United States)

    Woolever, Roberts

    1978-01-01

    Presented is an outline of a college course, "Education in American Society," that focused on teaching students rational decision-making skills while examining current issues in American Education. The outline is followed by student comments, reactions, and evaluations of the course. (JMD)

  9. Geometry of minimal rational curves on Fano manifolds

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, J -M [Korea Institute for Advanced Study, Seoul (Korea, Republic of)

    2001-12-15

    This lecture is an introduction to my joint project with N. Mok where we develop a geometric theory of Fano manifolds of Picard number 1 by studying the collection of tangent directions of minimal rational curves through a generic point. After a sketch of some historical background, the fundamental object of this project, the variety of minimal rational tangents, is defined and various examples are examined. Then some results on the variety of minimal rational tangents are discussed including an extension theorem for holomorphic maps preserving the geometric structure. Some applications of this theory to the stability of the tangent bundles and the rigidity of generically finite morphisms are given. (author)

  10. Evaluation of the Implementation of a Rapid Response Treatment Protocol for Patients with Acute Onset Stroke: Can We Increase the Number of Patients Treated and Shorten the Time Needed

    Directory of Open Access Journals (Sweden)

    Rajiv Advani

    2014-06-01

    Full Text Available Aims: This study aims to evaluate the implementation of a rapid response treatment protocol for patients presenting with acute onset ischemic stroke. Improvements of routines surrounding the admission and treatment of patients with intravenous thrombolysis (IVT, such as door-to-needle (DTN times, and increasing the numbers of patients treated are discussed. Methods: We conducted a retrospective analysis of all patients (n = 320 treated with IVT for acute onset ischemic stroke at the Stavanger University Hospital, Norway, between 2003 and 2012. In 2009, a succession of changes to pre- and intra-hospital routines were made as well as an improvement in the education of primary health care physicians, nurses and paramedics involved in the treatment of acute onset stroke patients (rapid response treatment protocol. Analyses of DTN times, onset-to-needle times and the number of patients treated per year were carried out to ascertain the effect of the changes made. The primary aim was to analyze DTN times to look for any changes, and the secondary aim was to analyze changes in the number of patients treated per year. Results: In the years after the implementation of the rapid treatment protocol, we saw an improvement in the median DTN time with a decrease from 73 to 50 min in the first year (p = 0.03, a decrease of 45 min in the second year (p = 0.01 and a decrease of 31 min in the third year (p Conclusions: The implementation of the rapid treatment protocol for acute onset ischemic stroke patients led to a significant decrease in the DTN time at our center. These improvements also produced an increase in the number of patients treated per year. The extension of the therapeutic window from 3 to 4.5 h for the use of intravenous recombinant tissue plasminogen activator also played a role in the increased treatment numbers.

  11. Antiretroviral therapy (ART) rationing and access mechanisms and their impact on youth ART utilization in Malawi.

    Science.gov (United States)

    Dixon, Jimmy-Gama; Gibson, Sarah; McPake, Barbara; Maleta, Ken

    2011-06-01

    The World Health Organization (WHO) staging is a commonly used rationing mechanism for highly active antiretroviral therapy (HAART) among various HIV infected populations including youths in most developing countries. Rationing is defined as any policy or practice that restricts consumption of or access to certain goods due to its limited supply. However, as HIV prevalence is rapidly increasing among youth, understanding the capacity of the staging approach to achieve HAART uptake in youth is of considerable importance. This study aimed to explore how HAART rationing and access mechanisms impact on youth's utilization of HAART in Malawi. The study used mixed methods with quantitative analysis of existing Ministry of Health Clinical HIV Unit data used to determine existing levels of youth HAART use. Qualitative methods employed in-depth interviews that interviewed nine ART providers, nine HIV positive youth on HAART and nine HIV positive youth not on HAART; and field observations to nine ART clinics were used to understand HAART rationing and access mechanisms and how such mechanisms impact youth uptake of HAART. The findings revealed that ART providers use both explicit rationing mechanisms like WHO clinical staging and implicit rationing mechanisms like use of waiting lists, queues and referral in ART provision. However, the WHO staging approach had some challenges in its implementation. It was also observed that factors like non-comprehensive approach to HAART provision, costs incurred to access HAART, negative beliefs and misconceptions about HAART and HIV were among the key factors that limit youth access to HAART. The study recommends that while WHO staging is successful as a rationing mechanism in Malawi, measures should be put in place to improve access to CD4 assessment for clients who may need it. ART providers also need to be made aware of the implicit rationing mechanisms that may affect HAART access. There is also need to improve monitoring of those HIV

  12. Working Memory Strategies during Rational Number Magnitude Processing

    Science.gov (United States)

    Hurst, Michelle; Cordes, Sara

    2017-01-01

    Rational number understanding is a critical building block for success in more advanced mathematics; however, how rational number magnitudes are conceptualized is not fully understood. In the current study, we used a dual-task working memory (WM) interference paradigm to investigate the dominant type of strategy (i.e., requiring verbal WM…

  13. Rational Emotive Behavior Therapy: Origins, Constructs, and Applications.

    Science.gov (United States)

    Watson, Joshua C.

    In 1956, Dr. Albert Ellis presented his seminal work on Rational Therapy, subsequently renamed Rational Emotive Behavior Therapy (REBT) in 1993. This paper explores the origins, theoretical foundations, applications, and implications of REBT and provides a look at the empirical research available in support of the approach's efficacy. REBT is…

  14. Rationality and Integration in a Family Childrearing Decision.

    Science.gov (United States)

    Diana, Mark S.

    This paper illuminates how concepts of rationality developed by Diesing in l962 are reflected in parents' childrearing decisions. After examining technical (TR), economic (ER), social (SR), legal (LR), and political (PR) rationalities or decision-making styles, consideration is given to integrative effects and the influence of parents' friends and…

  15. Heterogeneous Parking Market Subject to Parking Rationing

    Directory of Open Access Journals (Sweden)

    Saeed Asadi Bagloee

    2015-01-01

    Full Text Available Different types of drivers and parking spaces delineate a heterogeneous parking market for which the literature has yet to provide a model applicable to the real world. The main obstacle is computational complexities of considering various parking restrictions along with traffic congestion on the road network. In this study, the heterogeneity aspects are considered within a Logit parking choice model. A mathematical programming problem was introduced to explicitly consider parking capacities and parking rationing constraints. The parking rationing is defined as any arrangement to reserve parking space for some specific demand such as parking permit, private parking, VIP parking, and different parking durations. Introduction of parking rationing in the presence of other constraints is a unique factor in this study which makes the model more realistic. The algorithm was tested on a central business district case study. The results prove that the algorithm is able to converge rapidly. Among the algorithm’s output are shadow prices of the parking capacity and parking rationing constraints. The shadow prices contain important information which is key to addressing a variety of parking issues, such as the location of parking shortages, identification of fair parking charges, viability of parking permits, and the size of reserved parking.

  16. Developing and Testing Rational Models of Message Design.

    Science.gov (United States)

    O'Keefe, Barbara J.

    1992-01-01

    Responds to an article in the same issue regarding research methods for conversational cognition. Argues for a noncognitive view of rational models in communication research. Sets out an analysis of the kinds of claims made by rational models of message design. Discusses the implications of this analysis for studies of the cognitive processes…

  17. Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy [RSDH].

    Science.gov (United States)

    Boutin, G E; Tosi, D J

    1983-05-01

    Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis and vivid-emotive-imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at post-treatment or at follow-up.

  18. Transarterial chemoembolization of hepatocellular carcinoma in a rat model: the effect of additional injection of survivin siRNA to the treatment protocol

    International Nuclear Information System (INIS)

    Vogl, Thomas J.; Oppermann, Elsie; Qian, Jun; Imlau, Ulli; Tran, Andreas; Hamidavi, Yousef; Korkusuz, Huedayi; Bechstein, Wolf Otto; Nour-Eldin, Nour-Eldin Abdel-Rehim; Gruber-Rouh, Tatjana; Hammerstingl, Renate; Naguib, Nagy Naguib Naeem

    2016-01-01

    Transarterial chemoembolization is one of the most widely accepted interventional treatment options for treatment of hepatocellular carcinoma. Still there is a lack of a standard protocol regarding the injected chemotherapeutics. Survivin is an inhibitor of Apoptosis protein that functions to inhibit apoptosis, promote proliferation, and enhance invasion. Survivin is selectively up-regulated in many human tumors. Small interfering RNA (siRNA) can trigger an RNA interference response in mammalian cells and induce strong inhibition of specific gene expression including Survivin. The aim of the study is to assess the effectiveness of the additional injection of Survivin siRNA to the routine protocol of Transarterial Chemoembolization (TACE) for the treatment of hepatocellular carcinoma in a rat model. The study was performed on 20 male ACI rats. On day 0 a solid Morris Hepatoma 3924A was subcapsullary implanted in the liver. On day 12 MRI measurement of the initial tumor volume (V1) was performed. TACE was performed on day 13. The rats were divided into 2 groups; Group (A, n = 10) in which 0.1 mg mitomycin, 0.1 ml lipiodol and 5.0 mg degradable starch microspheres were injected in addition 2.5 nmol survivin siRNA were injected. The same agents were injected in Group (B,=10) without Survivin siRNA. MRI was repeated on day 25 to assess the tumor volume (V2). The tumor growth ratio (V2/V1) was calculated. Western blot and immunohistochemical analysis were performed. For group A the mean tumor growth ratio (V2/V1) was 1.1313 +/− 0.1381, and was 3.1911 +/− 0.1393 in group B. A statistically significant difference between both groups was observed regarding the inhibition of tumor growth (P < 0.0001) where Group A showed more inhibition compared to Group B. Similarly immunohistochemical analysis showed significantly lower (p < 0.002) VEGF staining in group A compared to group B. Western Blot analysis showed a similar difference in VEGF expression (P < 0.0001). The

  19. Autonomy, rationality and the wish to die.

    Science.gov (United States)

    Clarke, D M

    1999-12-01

    Although suicide has traditionally carried a negative sanction in Western societies, this is now being challenged, and while there remains substantial public concern surrounding youth and elder suicide, there is a paradoxical push to relax the prohibition under certain circumstances. Central to the arguments behind this are the principles of respect for autonomy and the importance of rationality. It is argued here that the concepts of rationality and autonomy, while valuable, are not strong enough to substantiate a categorical "right to suicide" and that the concepts of "understandability" and "respect" are more useful and able to provide the foundation for responding to a person expressing a wish to die. Roman suicide, sometimes held as an example of "rational suicide", illustrates the effects of culture, tradition and values on the attitudes to, and the practice of, suicide.

  20. Changing Conspiracy Beliefs through Rationality and Ridiculing.

    Science.gov (United States)

    Orosz, Gábor; Krekó, Péter; Paskuj, Benedek; Tóth-Király, István; Bőthe, Beáta; Roland-Lévy, Christine

    2016-01-01

    Conspiracy theory (CT) beliefs can be harmful. How is it possible to reduce them effectively? Three reduction strategies were tested in an online experiment using general and well-known CT beliefs on a comprehensive randomly assigned Hungarian sample ( N = 813): exposing rational counter CT arguments, ridiculing those who hold CT beliefs, and empathizing with the targets of CT beliefs. Several relevant individual differences were measured. Rational and ridiculing arguments were effective in reducing CT, whereas empathizing with the targets of CTs had no effect. Individual differences played no role in CT reduction, but the perceived intelligence and competence of the individual who conveyed the CT belief-reduction information contributed to the success of the CT belief reduction. Rational arguments targeting the link between the object of belief and its characteristics appear to be an effective tool in fighting conspiracy theory beliefs.

  1. Changing Conspiracy Beliefs through Rationality and Ridiculing

    OpenAIRE

    Orosz, Gábor; Krekó, Péter; Paskuj, Benedek; Tóth-Király, István; Bőthe, Beáta; Roland-Lévy, Christine

    2016-01-01

    Conspiracy theory (CT) beliefs can be harmful. How is it possible to reduce them effectively? Three reduction strategies were tested in an online experiment using general and well-known CT beliefs on a comprehensive randomly assigned Hungarian sample (N = 813): exposing rational counter CT arguments, ridiculing those who hold CT beliefs, and empathizing with the targets of CT beliefs. Several relevant individual differences were measured. Rational and ridiculing arguments were effective in re...

  2. A School Passport as Part of a Protocol to Assist Educational Reintegration After Medulloblastoma Treatment in Childhood.

    Science.gov (United States)

    Tresman, Rachel; Brown, Morven; Fraser, Faye; Skinner, Roderick; Bailey, Simon

    2016-09-01

    Medulloblastoma is the most common malignant brain tumour in children and is treated with a combination of surgery, radiotherapy and chemotherapy. These children frequently experience long-term cognitive, social and physical sequelae, which significantly affect school reintegration. This study aimed to explore school-return experiences to create a more structured school reintegration protocol for children postmedulloblastoma. A cohort of nine patients who had completed treatment and for whom full neuropsychometric data were available was included in the study (median time since diagnosis 8 years). Data were collected using qualitative parental questionnaires, semistructured interviews with teachers (n = 12) and healthcare professionals (HCPs) (n = 6) involved in their school reintegration. Thematic analysis was employed. A focus group with five HCPs was then used for data validation. This study uncovered the following four main subjects: (1) Information sharing; (2) education and empowerment (of educational professionals (EP) and parents); (3) communication between parents, HCPs and EPs; and (4) long-term difficulties. Implementation of a standardised protocol delivered within the structure of a school passport document would aid uniform follow-up. The proposed multistage protocol includes early communication and reintegration planning followed by meetings at school re-entry. Follow-up meetings are suggested to reduce information loss and reassess the child's needs. Hospital support at school transitions, inclusion of school data in long-term clinical follow-up and long-term rehabilitation are also recommended. Each stage would be supported by school passport documentation and would facilitate school and parental empowerment, paramount to the long-term sustainability of successful schooling. © 2016 Wiley Periodicals, Inc.

  3. Rational synthetic pathway refactoring of natural products biosynthesis in actinobacteria.

    Science.gov (United States)

    Tan, Gao-Yi; Liu, Tiangang

    2017-01-01

    Natural products (NPs) and their derivatives are widely used as frontline treatments for many diseases. Actinobacteria spp. are used to produce most of NP antibiotics and have also been intensively investigated for NP production, derivatization, and discovery. However, due to the complicated transcriptional and metabolic regulation of NP biosynthesis in Actinobacteria, especially in the cases of genome mining and heterologous expression, it is often difficult to rationally and systematically engineer synthetic pathways to maximize biosynthetic efficiency. With the emergence of new tools and methods in metabolic engineering, the synthetic pathways of many chemicals, such as fatty acids and biofuels, in model organisms (e.g. Escherichia coli ), have been refactored to realize precise and flexible control of production. These studies also offer a promising approach for synthetic pathway refactoring in Actinobacteria. In this review, the great potential of Actinobacteria as a microbial cell factory for biosynthesis of NPs is discussed. To this end, recent progress in metabolic engineering of NP synthetic pathways in Actinobacteria are summarized and strategies and perspectives to rationally and systematically refactor synthetic pathways in Actinobacteria are highlighted. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  4. A Rational, Successive G-Index Applied to Economics Departments in Ireland

    NARCIS (Netherlands)

    Tol, R.S.J.

    2008-01-01

    A rational, successive g-index is proposed, and applied to economics departments in Ireland. The successive g-index has greater discriminatory power than the successive h-index, and the rational index performs better still. The rational, successive g-index is also more robust to differences in

  5. Rational Behavior Skills: A Teaching Sequence for Students with Emotional Disabilities.

    Science.gov (United States)

    Patton, Patricia Lucey

    1995-01-01

    Rational behavior training is a proactive teaching model concerned with helping students with behavior disorders or serious emotional disturbances develop rational thinking and appropriate social skills. Describes a seven-session sequence for teaching rational behavior skills in a middle school setting. Pre- and posttest data revealed significant…

  6. Rationality, morality and Economic Coordination: The Contours of Interaction

    Directory of Open Access Journals (Sweden)

    Sushentsova Maria, S.

    2017-06-01

    Full Text Available The article represents an overview of general tendencies in interaction between the notions of rationality and morality, and their influence on the foundations of economic coordination. Firstly, two main directions of evolution of rationality model are considered: the theory of perspectives of D. Kahneman and A. Tverski (the empirical restriction and economic imperialism of G. Becker (the conceptual widening, the role of the modern institutionalism being emphasized. The theoretical evolution of economic rationality had mainly instrumental character and didn’t change its ethical core – the central idea of welfare in economic motivation. In this regard, the two main ways of integration of rationality and morality in modern discussion are considered: conceptions of “multiple preferences” (1 and “moral obligations” (2. The first conception assumes the existence of stable beliefs or “meta-preferences”, which range ordinal desires or preferences. According to the second approach, a distinction of a qualitative nature is drawn between rational behavior, motivated by personal benefit or “sympathy”, and exclusively moral behavior, underlain by “obligation”. An approach according to which a distinction between rational and moral arguments is drawn, directly determines the principles of economic coordination, including the foundations of social justice. Among the latter, there are two ethical grounds – mutual benefit, based on the “sympathy” principle, and impartiality, grounded on the “obligation of power”. These conceptions imply the corresponding types of economic coordination: market-evolutional (focused on effectiveness and constructivist (focused on redistribution.

  7. FUNCTIONAL SUBCLONE PROFILING FOR PREDICTION OF TREATMENT-INDUCED INTRA-TUMOR POPULATION SHIFTS AND DISCOVERY OF RATIONAL DRUG COMBINATIONS IN HUMAN GLIOBLASTOMA

    Science.gov (United States)

    Reinartz, Roman; Wang, Shanshan; Kebir, Sied; Silver, Daniel J.; Wieland, Anja; Zheng, Tong; Küpper, Marius; Rauschenbach, Laurèl; Fimmers, Rolf; Shepherd, Timothy M.; Trageser, Daniel; Till, Andreas; Schäfer, Niklas; Glas, Martin; Hillmer, Axel M.; Cichon, Sven; Smith, Amy A.; Pietsch, Torsten; Liu, Ying; Reynolds, Brent A.; Yachnis, Anthony; Pincus, David W.; Simon, Matthias; Brüstle, Oliver; Steindler, Dennis A.; Scheffler, Björn

    2016-01-01

    Purpose Investigation of clonal heterogeneity may be key to understanding mechanisms of therapeutic failure in human cancer. However, little is known on the consequences of therapeutic intervention on the clonal composition of solid tumors. Experimental Design Here, we used 33 single cell-derived subclones generated from five clinical glioblastoma specimens for exploring intra- and inter-individual spectra of drug resistance profiles in vitro. In a personalized setting, we explored whether differences in pharmacological sensitivity among subclones could be employed to predict drug-dependent changes to the clonal composition of tumors. Results Subclones from individual tumors exhibited a remarkable heterogeneity of drug resistance to a library of potential anti-glioblastoma compounds. A more comprehensive intra-tumoral analysis revealed that stable genetic and phenotypic characteristics of co-existing subclones could be correlated with distinct drug sensitivity profiles. The data obtained from differential drug response analysis could be employed to predict clonal population shifts within the naïve parental tumor in vitro and in orthotopic xenografts. Furthermore, the value of pharmacological profiles could be shown for establishing rational strategies for individualized secondary lines of treatment. Conclusions Our data provide a previously unrecognized strategy for revealing functional consequences of intra-tumor heterogeneity by enabling predictive modeling of treatment-related subclone dynamics in human glioblastoma. PMID:27521447

  8. Rational Solutions of the Painlevé-II Equation Revisited

    Science.gov (United States)

    Miller, Peter D.; Sheng, Yue

    2017-08-01

    The rational solutions of the Painlevé-II equation appear in several applications and are known to have many remarkable algebraic and analytic properties. They also have several different representations, useful in different ways for establishing these properties. In particular, Riemann-Hilbert representations have proven to be useful for extracting the asymptotic behavior of the rational solutions in the limit of large degree (equivalently the large-parameter limit). We review the elementary properties of the rational Painlevé-II functions, and then we describe three different Riemann-Hilbert representations of them that have appeared in the literature: a representation by means of the isomonodromy theory of the Flaschka-Newell Lax pair, a second representation by means of the isomonodromy theory of the Jimbo-Miwa Lax pair, and a third representation found by Bertola and Bothner related to pseudo-orthogonal polynomials. We prove that the Flaschka-Newell and Bertola-Bothner Riemann-Hilbert representations of the rational Painlevé-II functions are explicitly connected to each other. Finally, we review recent results describing the asymptotic behavior of the rational Painlevé-II functions obtained from these Riemann-Hilbert representations by means of the steepest descent method.

  9. Rational maps, monopoles and skyrmions

    International Nuclear Information System (INIS)

    Houghton, C.J.; Manton, N.S.

    1998-01-01

    We discuss the similarities between BPS monopoles and skyrmions, and point to an underlying connection in terms of rational maps between Riemann spheres. This involves the introduction of a new ansatz for Skyrme fields. We use this to construct good approximations to several known skyrmions, including all the minimal energy configurations up to baryon number nine, and some new solutions such as a baryon number seventeen Skyrme field with the truncated icosahedron structure of a buckyball. The new approach is also used to understand the low-lying vibrational modes of skyrmions, which are required for quantization. Along the way we discover an interesting Morse function on the space of rational maps which may be of use in understanding the Sen forms on the monopole moduli spaces. (orig.)

  10. Bounded Rationality in Transposition Processes

    DEFF Research Database (Denmark)

    Vollaard, Hans; Martinsen, Dorte Sindbjerg

    2014-01-01

    Studies explaining the timeliness and correctness of the transposition of EU directives into national legislation have provided rather inconclusive findings. They do not offer a clear-cut prediction concerning the transposition of the patients’ rights directive, which is one of the first that con......Studies explaining the timeliness and correctness of the transposition of EU directives into national legislation have provided rather inconclusive findings. They do not offer a clear-cut prediction concerning the transposition of the patients’ rights directive, which is one of the first...... that concerns the organisation and financing of national healthcare systems. This article applies the perspective of bounded rationality to explain (irregularities in) the timely and correct transposition of EU directives. The cognitive and organisational constraints long posited by the bounded rationality...

  11. Graded levels of sugar syrup in broiler rations and its effect on growth performance and blood biochemical parameters

    Directory of Open Access Journals (Sweden)

    Ahmed S. Hussein

    2016-09-01

    Full Text Available Dietary energy for chickens normally includes cereal grains and fat. This innovative study investigated the effect of replacing part of the corn and fat in broiler chicken rations with graded levels of sugar syrup on growth performance and biochemical parameters. Experimental treatments consisted of feeding a corn-soy basal diet alone, or with graded levels of sugar syrup in increments of 5%, 10% and 15%. All starter diets were isonitrogenous and isocaloric. Body weight gain and efficiency of feed utilization of chicks fed the control diet alone were not significantly (P < 0.05 different from chicks fed diets supplemented with either 5% or 15% sugar syrup. Supplementation of sugar syrup to broiler diets had no significant effect on blood glucose, creatinine, total protein, or liver enzymes. Adding 5% sugar syrup to broiler rations significantly decreased blood cholesterol and triglycerides in chickens fed the sugar syrup diet compared with birds fed the control diet. In conclusion, the results shows sugar syrup can be used in poultry ration to replace part of the corn as a source of energy. These results allowed the authors to recommend the safe usage of sugar syrup in broiler rations.

  12. Age-related macular degeneration: using morphological predictors to modify current treatment protocols.

    Science.gov (United States)

    Ashraf, Mohammed; Souka, Ahmed; Adelman, Ron A

    2018-03-01

    therapy and extended follow-up intervals (4 weekly) can be suggested for patients who show adequate visual response and have both SRF and PVD at baseline. In addition, patients with poor prognostic indicators such as IRC, VMA, large CNV size, older age and poor response at 12 weeks should be extended very cautiously with the possibility of fixed monthly/bimonthly (every 2 months) treatments if they fail to achieve dryness. Patients with PED at baseline should receive monthly/bimonthly injections of anti-VEGF therapy or can be extended very cautiously (two weekly intervals) using a TAE protocol. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  13. Emotional and rational disease acceptance in patients with depression and alcohol addiction

    OpenAIRE

    Matthiessen Peter F; Büssing Arndt; Mundle Götz

    2008-01-01

    Abstract Background The concept of a rational respectively emotional acceptance of disease is highly valued in the treatment of patients with depression or addiction. Due to the importance of this concept for the long-term course of disease, there is a strong interest to develop a tool to identify the levels and factors of acceptance. We thus intended to test an instrument designed to assess the level of positive psychological wellbeing and coping, particularly emotional disease acceptance an...

  14. Matrix factorisations for rational boundary conditions by defect fusion

    International Nuclear Information System (INIS)

    Behr, Nicolas; Fredenhagen, Stefan

    2015-01-01

    A large class of two-dimensional N=(2,2) superconformal field theories can be understood as IR fixed-points of Landau-Ginzburg models. In particular, there are rational conformal field theories that also have a Landau-Ginzburg description. To understand better the relation between the structures in the rational conformal field theory and in the Landau-Ginzburg theory, we investigate how rational B-type boundary conditions are realised as matrix factorisations in the SU(3)/U(2) Grassmannian Kazama-Suzuki model. As a tool to generate the matrix factorisations we make use of a particular interface between the Kazama-Suzuki model and products of minimal models, whose fusion can be realised as a simple functor on ring modules. This allows us to formulate a proposal for all matrix factorisations corresponding to rational boundary conditions in the SU(3)/U(2) model.

  15. Rasmussen's legacy and the long arm of rational choice.

    Science.gov (United States)

    Dekker, Sidney W A

    2017-03-01

    Rational choice theory says that operators and others make decisions by systematically and consciously weighing all possible outcomes along all relevant criteria. This paper first traces the long historical arm of rational choice thinking in the West to Judeo-Christian thinking, Calvin and Weber. It then presents a case study that illustrates the consequences of the ethic of rational choice and individual responsibility. It subsequently examines and contextualizes Rasmussen's legacy of pushing back against the long historical arm of rational choice, showing that bad outcomes are not the result of human immoral choice, but the product of normal interactions between people and systems. If we don't understand why people did what they did, Rasmussen suggested, it is not because people behaved inexplicably, but because we took the wrong perspective. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Matrix factorisations for rational boundary conditions by defect fusion

    Energy Technology Data Exchange (ETDEWEB)

    Behr, Nicolas [Department of Mathematics, Heriot-Watt University,Riccarton, Edinburgh, EH14 4AS (United Kingdom); Maxwell Institute for Mathematical Sciences,Edinburgh (United Kingdom); Fredenhagen, Stefan [Max-Planck-Institut für Gravitationsphysik, Albert-Einstein-Institut,D-14424 Golm (Germany)

    2015-05-11

    A large class of two-dimensional N=(2,2) superconformal field theories can be understood as IR fixed-points of Landau-Ginzburg models. In particular, there are rational conformal field theories that also have a Landau-Ginzburg description. To understand better the relation between the structures in the rational conformal field theory and in the Landau-Ginzburg theory, we investigate how rational B-type boundary conditions are realised as matrix factorisations in the SU(3)/U(2) Grassmannian Kazama-Suzuki model. As a tool to generate the matrix factorisations we make use of a particular interface between the Kazama-Suzuki model and products of minimal models, whose fusion can be realised as a simple functor on ring modules. This allows us to formulate a proposal for all matrix factorisations corresponding to rational boundary conditions in the SU(3)/U(2) model.

  17. [The impact of ethical and moral competence in decision making on rationalism and rationing nursing interventions].

    Science.gov (United States)

    Schwerdt, R

    2005-08-01

    The intraprofessional discourse about economical aspects in nursing from an ethical point of view has not taken place yet. To cope with the increasing restriction of resources, some preconditions have to be met: It is necessary to communicate issues in rationalizing and rationing in nursing openly. Person-oriented criteria in the nursing process indicate a high level of competence and user-oriented quality in nursing care. But nursing professionals do not decide in favor or against resources to perform this task on a high or poor quality level. Democratic decision-making on providing nursing services depends on a continuous societal discourse about allocation criteria.

  18. Structure-based, rational design of T cell receptors

    Directory of Open Access Journals (Sweden)

    Vincent eZoete

    2013-09-01

    Full Text Available Adoptive cell transfer using engineered T cells is emerging as a promising treatment for metastatic melanoma. Such an approach allows one to introduce TCR modifications that, while maintaining the specificity for the targeted antigen, can enhance the binding and kinetic parameters for the interaction pMHC. Using the well-characterized 2C TCR/SIYR/H-2K(b structure as a model system, we demonstrated that a binding free energy decomposition based on the MM-GBSA approach provides a detailed and reliable description of the TCR/pMHC interactions at the structural and thermodynamic levels. Starting from this result, we developed a new structure-based approach, to rationally design new TCR sequences, and applied it to the BC1 TCR targeting the HLA-A2 restricted NY-ESO-1157-165 cancer-testis epitope. 54% of the designed sequence replacements exhibited improved pMHC-binding as compared to the native TCR, with up to 150 fold increase in affinity, while preserving specificity. Genetically-engineered CD8+ T cells expressing these modified TCRs showed an improved functional activity compared to those expressing BC1 TCR. We measured maximum levels of activities for TCRs within the upper limit of natural affinity. Beyond the affinity threshold at KD < 1 μM we observed an attenuation in cellular function. We have also developed a homology modeling-based approach, TCRep 3D, to obtain accurate structural models of any TCR-pMHC complexes. We have complemented the approach with a simplified rigid method to predict the TCR orientation over pMHC. These methods potentially extend the use of our TCR engineering method to entire TCR repertoires for which no X-ray structure is available. We have also performed a steered molecular dynamics study of the unbinding of the TCR-pMHC complex to get a better understanding of how TCRs interact with pMHCs. This entire rational TCR design pipeline is now being used to produce rationally optimized TCRs for adoptive cell therapies of

  19. CIME-CIRM course Rationality Problems in Algebraic Geometry

    CERN Document Server

    Pirola, Gian

    2016-01-01

    Providing an overview of the state of the art on rationality questions in algebraic geometry, this volume gives an update on the most recent developments. It offers a comprehensive introduction to this fascinating topic, and will certainly become an essential reference for anybody working in the field. Rationality problems are of fundamental importance both in algebra and algebraic geometry. Historically, rationality problems motivated significant developments in the theory of abelian integrals, Riemann surfaces and the Abel–Jacobi map, among other areas, and they have strong links with modern notions such as moduli spaces, Hodge theory, algebraic cycles and derived categories. This text is aimed at researchers and graduate students in algebraic geometry.

  20. Diagnosis, Dogmatism, and Rationality.

    Science.gov (United States)

    Rabinowitz, Jonathan; Efron, Noah J.

    1997-01-01

    Presents findings suggesting that misdiagnoses frequently stem from flaws in human information processing, particularly in collecting and using information. Claims that improved diagnostic tools will not remedy the problem. Drawing on the work of Karl Popper and Robin Collingwood, proposes operational principles to ensure a rational diagnostic…