Toward a National Ocean Policy, 1976 and Beyond.

ERIC Educational Resources Information Center

Osgood, Robert E.; And Others

Each chapter in this publication takes up a specific issue, analyzes its importance to the United States, discusses its evolution in the international negotiating process, and considers the various policy options in the context of the treaty making exercise. The criteria for evaluating policy options are included. The eight chapters are: (1) The…

Life or Death of Severely Disabled Infants: A Counseling Issue.

ERIC Educational Resources Information Center

Head, David W.; And Others

1985-01-01

Presents dimensions that serve as a background for counselors to assist families in considering options related to disabled infants. Dimensions include the meaning of life, cost to benefit ratio, medical options, legal precedent, and a theological perspective. This issue is related to counseling practice through counselor ethics and values.…

Investment in hydrogen tri-generation for wastewater treatment plants under uncertainties

NASA Astrophysics Data System (ADS)

Gharieh, Kaveh; Jafari, Mohsen A.; Guo, Qizhong

2015-11-01

In this article, we present a compound real option model for investment in hydrogen tri-generation and onsite hydrogen dispensing systems for a wastewater treatment plant under price and market uncertainties. The ultimate objective is to determine optimal timing and investment thresholds to exercise initial and subsequent options such that the total savings are maximized. Initial option includes investment in a 1.4 (MW) Molten Carbonate Fuel Cell (MCFC) fed by mixture of waste biogas from anaerobic digestion and natural gas, along with auxiliary equipment. Produced hydrogen in MCFC via internal reforming, is recovered from the exhaust gas stream using Pressure Swing Adsorption (PSA) purification technology. Therefore the expansion option includes investment in hydrogen compression, storage and dispensing (CSD) systems which creates additional revenue by selling hydrogen onsite in retail price. This work extends current state of investment modeling within the context of hydrogen tri-generation by considering: (i) Modular investment plan for hydrogen tri-generation and dispensing systems, (ii) Multiple sources of uncertainties along with more realistic probability distributions, (iii) Optimal operation of hydrogen tri-generation is considered, which results in realistic saving estimation.

Mission and Design Sensitivities for Human Mars Landers Using Hypersonic Inflatable Aerodynamic Decelerators

NASA Technical Reports Server (NTRS)

Polsgrove, Tara P.; Thomas, Herbert D.; Collins, Tim; Dwyer Cianciolo, Alicia; Samareh, Jamshid

2017-01-01

Landing humans on Mars is one of NASA's long term goals. The Evolvable Mars Campaign (EMC) is focused on evaluating architectural trade options to define the capabilities and elements needed for a sustainable human presence on the surface of Mars. The EMC study teams have considered a variety of in-space propulsion options and surface mission options. As we seek to better understand how these choices affect the performance of the lander, this work informs and influences requirements for transportation systems to deliver the landers to Mars and enable these missions. This paper presents the effects of mission and vehicle design options on lander mass and performance. Beginning with Earth launch, options include fairing size assumptions, co-manifesting other elements with the lander, and Earth-Moon vicinity operations. Capturing into Mars orbit using either aerocapture or propulsive capture is assessed. For entry, descent, and landing both storable as well as oxygen and methane propellant combinations are considered, engine thrust level is assessed, and sensitivity to landed payload mass is presented. This paper focuses on lander designs using the Hypersonic Inflatable Aerodynamic Decelerators (HIAD), one of several entry system technologies currently considered for human missions.

Counseling and choosing between infant-feeding options: overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon).

PubMed

Desclaux, Alice; Alfieri, Chiara

2009-09-01

As part of prevention of HIV mother-to-child transmission (PMTCT) strategies, HIV-positive women are asked to choose between two options regarding infant feeding: replacement feeding or exclusive breastfeeding with early weaning. Health services must offer women counseling, guidance, and support to enable them to make an informed choice. This article aims to shed light on the content of counseling and its adaptation to local situations, including women's perceptions, in three resource-poor countries with different infant feeding patterns (Burkina Faso, Cambodia, and Cameroon). The qualitative study included observations in health facilities and interviews with HIV-positive mothers and health workers. The results show that counseling practices vary, including prescriptive counseling proposing only one option to all women, an option based on the mother's economic level assessed by health care providers, and the choice between options. While health workers consider economic aspects first, women mostly consider social aspects related to the risk of being stigmatized as a "bad mother'" or as HIV-positive. Overall trends identify some limits to counseling effectiveness when considering women's perceptions and needs, such as: the content of information provided by health care providers, duration and timing of counseling, discrepancies between information provided during counseling and from the health system, and ranking of preventive options by health workers. Women's agency for feeding choices is related to local practices and local authorities' abilities to provide more or less comprehensive counseling based on the organization of the health and aid system. Local practices also depend on institutions' interpretations of international recommendations based on public health considerations regarding standard of care and women's and the health system's respective responsibilities. Beyond structural constraints that hinder the adoption of preventive infant feeding patterns, addressing these issues may help improve counseling practices.

Satellite services system analysis study. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1981-01-01

Service requirements are considered. Topics include development of on-orbit operations scenarios, service equipment summary, crew interaction, and satellite features facilitating servicing. Service equipment concepts are considered. Topics include payload deployment, close proximity retrieval, on-orbit servicing, backup/contingency, delivery/retrieval of high energy payloads, Earth return, optional service, and advanced capabilities. Program requirements are assessed.

High temperature sensible heat storage options

NASA Astrophysics Data System (ADS)

Wang, K. Y.; Kreith, F.; West, R. E.; Lynn, P.

1984-11-01

Design options and operation criteria for sensible heat molten salt storage with internal insulation are presented. Raft thermocline, two-tank, and two-media thermocline systems are the concepts discussed. Regenerative cooling, bottom insulation, and thermocline stability are considered in the thermal analysis. A brief discussion of the technical risks of each tank system is included. Cost estimations are also provided.

New Information Technology Directions for American Education. Improving Science and Mathematics Education. Final Report.

ERIC Educational Resources Information Center

Melmed, Arthur S.; Burnham, Robert A.

This report is an analysis of the findings of four workshops exploring the ways interactive technology can be considered an option for improving American education after 25 years of research and development. Sections include: (1) "Manpower Needs and School Problems"; (2) "Science and Technology Option"; (3) "Barriers and Strategy"; and (4) "To…

76 FR 40798 - Antidrug and Alcohol Misuse Prevention Programs for Personnel Engaged in Specified Aviation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... includes contractors and subcontractors. Contracting companies have two testing options: Option one is for... case today and as such, there are no alternatives to the final rule that could have been considered and... stations would be classified as small business under NAICS 488180, the FAA reviewed a recent study...

Surgical options for lumbosacral fusion: biomechanical stability, advantage, disadvantage and affecting factors in selecting options.

PubMed

Yoshihara, Hiroyuki

2014-07-01

Numerous surgical procedures and instrumentation techniques for lumbosacral fusion (LSF) have been developed. This is probably because of its high mechanical demand and unique anatomy. Surgical options include anterior column support (ACS) and posterior stabilization procedures. Biomechanical studies have been performed to verify the stability of those options. The options have their own advantage but also disadvantage aspects. This review article reports the surgical options for lumbosacral fusion, their biomechanical stability, advantages/disadvantages, and affecting factors in option selection. Review of literature. LSF has lots of options both for ACS and posterior stabilization procedures. Combination of posterior stabilization procedures is an option. Furthermore, combinations of ACS and posterior stabilization procedures are other options. It is difficult to make a recommendation or treatment algorithm of LSF from the current literature. However, it is important to know all aspects of the options and decision-making of surgical options for LSF needs to be tailored for each patient, considering factors such as biomechanical stress and osteoporosis.

Photovoltaic solar array technology required for three wide scale generating systems for terrestrial applications: rooftop, solar farm, and satellite

NASA Technical Reports Server (NTRS)

Berman, P. A.

1972-01-01

Three major options for wide-scale generation of photovoltaic energy for terrestrial use are considered: (1) rooftop array, (2) solar farm, and (3) satellite station. The rooftop array would use solar cell arrays on the roofs of residential or commercial buildings; the solar farm would consist of large ground-based arrays, probably in arid areas with high insolation; and the satellite station would consist of an orbiting solar array, many square kilometers in area. The technology advancement requirements necessary for each option are discussed, including cost reduction of solar cells and arrays, weight reduction, resistance to environmental factors, reliability, and fabrication capability, including the availability of raw materials. The majority of the technology advancement requirements are applicable to all three options, making possible a flexible basic approach regardless of the options that may eventually be chosen. No conclusions are drawn as to which option is most advantageous, since the feasibility of each option depends on the success achieved in the technology advancement requirements specified.

Evaluation of Proposed Solutions to Global Warming, Air Pollution, and Energy Security

NASA Astrophysics Data System (ADS)

Jacobson, M. Z.

2008-12-01

This study reviews and ranks major proposed solutions to global warming, air pollution mortality, and energy security while considering other impacts of the proposed solutions, such as on water supply, land use, wildlife, resource availability, thermal pollution, water chemical pollution, nuclear proliferation, and undernutrition. Nine electric power sources and two liquid fuel options are considered. The electricity sources include solar-photovoltaics (PV), concentrated solar power (CSP), wind, geothermal, hydroelectric, wave, tidal, nuclear, and coal with carbon capture and storage (CCS) technology. The liquid fuel options include corn-E85 and cellulosic E85. To place the electric and liquid fuel sources on an equal footing, we examine their comparative abilities to address the problems mentioned by powering new-technology vehicles, including battery-electric vehicles (BEVs), hydrogen fuel cell vehicles (HFCVs), and flex-fuel vehicles run on E85. Twelve combinations of energy source-vehicle type are considered. Upon ranking and weighting each combination with respect to each of 11 impact categories, four clear divisions of ranking, or tiers, emerge. Tier 1 (highest-ranked) includes wind-BEVs and wind-HFCVs. Tier 2 includes CSP-BEVs, geothermal-BEVs, PV-BEVs, tidal-BEVs, and wave-BEVs. Tier 3 includes hydro-BEVs, nuclear-BEVs, and CCS-BEVs. Tier 4 includes corn- and cellulosic-E85. Wind-BEVs ranked first in six out of 11 categories, including the two most important, mortality and climate damage reduction. Although HFCVs are less efficient than BEVs, wind- HFCVs ranked second among all combinations. Tier 2 options provide significant benefits and are recommended. Tier 3 options are less desirable. However, hydroelectricity, which was ranked ahead of coal- CCS and nuclear with respect to climate and health, is an excellent load balancer, thus strongly recommended. The Tier-4 combinations (cellulosic- and corn-E85) were ranked lowest overall and with respect to climate, air pollution, land use, wildlife damage, and chemical waste. Cellulosic-E85 ranked lower than corn-E85 overall, primarily due to its potentially larger land footprint based on recent data and its higher upstream air pollution emissions than corn-E85. Whereas cellulosic-E85 may cause the greatest average human mortality, nuclear-BEVs cause the greatest upper-limit mortality risk due to the expansion of plutonium separation and uranium enrichment in nuclear energy facilities worldwide. Wind-BEVs and CSP-BEVs cause the least mortality. The footprint area of wind-BEVs is 2-6 orders of magnitude less than that of any other option. Because of their low footprint and pollution, wind-BEVs cause the least wildlife loss. The largest consumer of water is corn-E85. The smallest are wind-, tidal-, and wave-BEVs. In sum, use of wind, CSP, geothermal, tidal, PV, wave, and hydro to power electricity for BEVs and HFCVs and for general use in the residential, industrial, and commercial sectors will result in the most benefit among the options considered. The combination of these technologies should be advanced as a solution to global warming, air pollution, and energy security. Coal-CCS and nuclear offer less benefit, and the biofuel options provide little or no benefit and greater negative impacts.

Pollution Swapping in Agricultural Systems: deciding between mitigation measures with conflicting outcomes

NASA Astrophysics Data System (ADS)

Quinton, John; Stevens, Carly

2010-05-01

Pollution swapping occurs when a mitigation option introduced to reduce one pollutant results in an increase in a different pollutant. Although the concept of pollution swapping is widely understood it has received little attention in research and policy design. This study investigated diffuse pollution mitigation options applied in combinable crop systems. They are: cover crops, residue management, no-tillage, riparian buffer zones, contour grass strips and constructed wetlands. A wide range of water and atmospheric pollutants were considered, including nitrogen, phosphorus, carbon and sulphur. It is clear from this investigation that there is no single mitigation option that will reduce all pollutants and in this poster we consider how choices may be made between mitigation measures which may have a positive effect on one pollutant but a negative effect on another.

State Bioenergy Primer: Information and Resources for States on Issues, Opportunities, and Options for Advancing Bioenergy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Byrnett, D. S.; Mulholland, D.; Zinsmeister, E.

One renewable energy option that states frequently consider to meet their clean energy goals is the use of biomass resources to develop bioenergy. Bioenergy includes bioheat, biopower, biofuels, and bioproducts. This document provides an overview of biomass feedstocks, basic information about biomass conversion technologies, and a discussion of benefits and challenges of bioenergy options. The Primer includes a step-wise framework, resources, and tools for determining the availability of feedstocks, assessing potential markets for biomass, and identifying opportunities for action at the state level. Each chapter contains a list of selected resources and tools that states can use to explore topicsmore » in further detail.« less

5 CFR 581.105 - Exclusions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... insurance premiums, including, but not limited to, amounts deducted from civil service annuities for... life insurance premiums from salary or other remuneration for employment, not including amounts... Employees' Group Life Insurance premiums are considered to be normal life insurance premiums; all optional...

Indications and interventional options for non-resectable tracheal stenosis

PubMed Central

Bacon, Jenny Louise; Patterson, Caroline Marie

2014-01-01

Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management. PMID:24624290

40 CFR 93.105 - Consultation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... § 93.122. (6) A process for consulting on the design, schedule, and funding of research and data... highway travel), and which projects should be considered to have a significant change in design concept... locations, design concept and scope, or the no-build option are still being considered), including those by...

40 CFR 93.105 - Consultation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... § 93.122. (6) A process for consulting on the design, schedule, and funding of research and data... highway travel), and which projects should be considered to have a significant change in design concept... locations, design concept and scope, or the no-build option are still being considered), including those by...

40 CFR 93.105 - Consultation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... § 93.122. (6) A process for consulting on the design, schedule, and funding of research and data... highway travel), and which projects should be considered to have a significant change in design concept... locations, design concept and scope, or the no-build option are still being considered), including those by...

40 CFR 93.105 - Consultation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... § 93.122. (6) A process for consulting on the design, schedule, and funding of research and data... highway travel), and which projects should be considered to have a significant change in design concept... locations, design concept and scope, or the no-build option are still being considered), including those by...

40 CFR 93.105 - Consultation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... § 93.122. (6) A process for consulting on the design, schedule, and funding of research and data... highway travel), and which projects should be considered to have a significant change in design concept... locations, design concept and scope, or the no-build option are still being considered), including those by...

The afterlife for retiring deans and other senior medical administrators.

PubMed

Tannen, Richard L

2008-11-01

Career options for individuals leaving the administrative role as dean of a school of medicine or other senior administrative positions are considered. Options discussed include retirement and a variety of other positions both within schools of medicines and in other venues. Many opportunities exist for a challenging and fulfilling career path after leaving the role as a senior administrator in an academic medical center.

A Study of Phased Array Antennas for NASA's Deep Space Network

NASA Technical Reports Server (NTRS)

Jamnejad, Vahraz; Huang, John; Cesarone, Robert J.

2001-01-01

In this paper we briefly discuss various options but focus on the feasibility of the phased arrays as a viable option for this application. Of particular concern and consideration will be the cost, reliability, and performance compared to the present 70-meter antenna system, particularly the gain/noise temperature levels in the receive mode. Many alternative phased arrays including planar horizontal arrays, hybrid mechanically/electronically steered arrays, phased array of mechanically steered reflectors, multi-faceted planar arrays, phased array-fed lens antennas, and planar reflect-arrays are compared and their viability is assessed. Although they have many advantages including higher reliability, near-instantaneous beam switching or steering capability, the cost of such arrays is presently prohibitive and it is concluded that the only viable array options at the present are the arrays of a few or many small reflectors. The active planar phased arrays, however, may become feasible options in the next decade and can be considered for deployment in smaller configurations as supplementary options.

Puget Sound Area Electric Reliability Plan : Appendix E, Transmission Reinforcement Analysis.

DOE Office of Scientific and Technical Information (OSTI.GOV)

United States. Bonneville Power Administration.

1992-04-01

The purpose of this appendix to the draft environmental impact statement (EIS) report is to provide an update of the latest study work done on transmission system options for the Puget Sound Area Electric Reliability Plan. Also included in the attachments to the EIS are 2 reports analyzing the voltage stability of the Puget Sound transmission system and a review by Power Technologies, Inc. of the BPA voltage stability analysis and reactive options. Five transmission line options and several reactive options are presently being considered as possible solutions to the PSAFRP by the Transmission Team. The first two line optionsmore » would be built on new rights-of way adjacent (as much as possible) to existing corridors. The reactive options would optimize the existing transmission system capability by adding new stations for series capacitors and/or switchgear. The other three line options are rebuilds or upgrades of existing cross mountain transmission lines. These options are listed below and include a preliminary assessment of the additional transmission system reinforcement required to integrate the new facilities into the existing transmission system. Plans were designed to provide at least 500 MVAR reactive margin.« less

What Women Want from Their Health Care Providers about Pregnancy Options Counseling: A Qualitative Study.

PubMed

French, Valerie A; Steinauer, Jody E; Kimport, Katrina

Unintended pregnancy is common in the United States, yet scant research has evaluated women's preferences on pregnancy options counseling. This study explores pregnant women's preferences for pregnancy options counseling from health care providers. We conducted semistructured interviews with pregnant women at a prenatal clinic and an abortion clinic. We asked women about recent discussions-or lack thereof-about pregnancy options (parenting, adoption, and abortion) with a clinician, and what they would want their provider to discuss about pregnancy options. We analyzed transcripts using modified grounded theory. We interviewed 10 women in prenatal care and 18 women seeking abortion. In both settings, most said clinicians should discuss pregnancy options with pregnant women and 1) respect patient autonomy, 2) avoid assumptions about a woman's desired pregnancy outcome, and 3) consider the patient-including her health and fertility intentions-beyond her pregnancy. Participants wanted their doctors to assess a pregnancy's individual circumstances to determine the appropriateness of options counseling. A few participants, including women who did and did not receive options counseling, reported they personally preferred not to receive such counseling. Explaining this preference, they cited preservation of privacy, having already made a decision for the pregnancy, or just not wanting to discuss abortion. Regarding best practices for providing options counseling, participants said it should be done in a routine manner, with discretion, and early in pregnancy. Pregnant women seeking both prenatal and abortion care broadly support options counseling. Discussion of pregnancy options, including abortion, provides patient-centered care and supports women's preferences. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Pedestrian and bicycle accommodations on superstreets.

DOT National Transportation Integrated Search

2014-01-01

The objective of this research was to consider the unique challenges for pedestrians and bicyclists at superstreet intersections and : recommend crossing alternatives for both users. For pedestrians the options included the diagonal cross, median cro...

Electronic Reference Service: A Teen's Eye View.

ERIC Educational Resources Information Center

Farmer, Lesley S.

2003-01-01

Discusses electronic reference service from a teen's point of view and from the school library media specialist's view. Considers traits that attract teens, including anonymity, speed, and convenience; and explains concerns of media specialists, including quality of electronic resources, how to provide access, library instruction options, and…

The costs and benefits of Option B+ for the prevention of mother-to-child transmission of HIV.

PubMed

Gopalappa, Chaitra; Stover, John; Shaffer, Nathan; Mahy, Mary

2014-01-01

Most countries follow WHO 2010 guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV using either Option A or B for women not yet eligible for antiretroviral therapy (ART). Both of these approaches involve the use of antiretrovirals during pregnancy and breastfeeding. Some countries have adopted a new strategy, Option B+, in which HIV-positive pregnant women are started immediately on ART and continued for life. Option B+ is more costly than Options A or B, but provides additional health benefits. In this article, we estimate the additional costs and effectiveness of Option B+. We developed a deterministic model to simulate births, breastfeeding, and HIV infection in women in four countries, Kenya, Zambia, South Africa, and Vietnam that differ in fertility rate, birth interval, age at first birth, and breastfeeding patterns, but have similar age at HIV infection. We estimated the total PMTCT costs and new child infections under Options A, B, and B+, and measured cost-effectiveness as the incremental PMTCT-related costs per child infection averted. We included adult sexual transmissions averted from ART, the corresponding costs saved, and estimated the total incremental cost per transmission (child and adult) averted. When considering PMTCT-related costs and child infections, Option B+ was the most cost-effective strategy costing between $6000 and $23 000 per infection averted compared with Option A. Option B+ averted more child infections compared with Option B in all four countries and cost less than Option B in Kenya and Zambia. When including adult sexual transmissions averted, Option B+ cost less and averted more infections than Options A and B.

77 FR 53231 - Final Environmental Impact Statement for the Odessa Subarea Special Study-Columbia Basin Project...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-31

... scope of the action alternative which include acreage, water supply, and general site locations would... authorized boundary with a surface water supply as part of continued phased development of the CBP. The... alternative impacts considered in the Draft EIS. Two water supply options are being considered that would use...

Analysis and Evaluation of Processes and Equipment in Tasks 2 and 4 of the Low-cost Solar Array Project

NASA Technical Reports Server (NTRS)

Wolf, M.

1979-01-01

To facilitate the task of objectively comparing competing process options, a methodology was needed for the quantitative evaluation of their relative cost effectiveness. Such a methodology was developed and is described, together with three examples for its application. The criterion for the evaluation is the cost of the energy produced by the system. The method permits the evaluation of competing design options for subsystems, based on the differences in cost and efficiency of the subsystems, assuming comparable reliability and service life, or of competing manufacturing process options for such subsystems, which include solar cells or modules. This process option analysis is based on differences in cost, yield, and conversion efficiency contribution of the process steps considered.

Evaluating State Options for Reducing Medicaid Churning

PubMed Central

Swartz, Katherine; Short, Pamela Farley; Graefe, Deborah R.; Uberoi, Namrata

2015-01-01

Medicaid churning - the constant exit and re-entry of beneficiaries as their eligibility changes - has long been a problem for both Medicaid administrators and recipients. Churning will continue under the Affordable Care Act, because despite new federal rules, Medicaid eligibility will continue to be based on current monthly income. We developed a longitudinal simulation model to evaluate four policy options for modifying or extending Medicaid eligibility to reduce churning. The simulations suggest that two options, extending Medicaid eligibility either to the end of a calendar year or for twelve months after enrollment, would be far more effective in reducing churning than the other options of a three-month extension or eligibility based on projected annual income. States should consider implementation of the option that best balances costs, including both administration and services, with improved health of Medicaid enrollees. PMID:26153313

Engineering Options Assessment Report. Nitrate Salt Waste Stream Processing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anast, Kurt Roy

2015-11-13

This report examines and assesses the available systems and facilities considered for carrying out remediation activities on remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The assessment includes a review of the waste streams consisting of 60 RNS, 29 above-ground UNS, and 79 candidate below-ground UNS containers that may need remediation. The waste stream characteristics were examined along with the proposed treatment options identified in the Options Assessment Report . Two primary approaches were identified in the five candidate treatment options discussed in the Options Assessment Report: zeolite blending and cementation.more » Systems that could be used at LANL were examined for housing processing operations to remediate the RNS and UNS containers and for their viability to provide repackaging support for remaining LANL legacy waste.« less

Engineering Options Assessment Report: Nitrate Salt Waste Stream Processing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anast, Kurt Roy

2015-11-18

This report examines and assesses the available systems and facilities considered for carrying out remediation activities on remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The assessment includes a review of the waste streams consisting of 60 RNS, 29 aboveground UNS, and 79 candidate belowground UNS containers that may need remediation. The waste stream characteristics were examined along with the proposed treatment options identified in the Options Assessment Report . Two primary approaches were identified in the five candidate treatment options discussed in the Options Assessment Report: zeolite blending and cementation.more » Systems that could be used at LANL were examined for housing processing operations to remediate the RNS and UNS containers and for their viability to provide repackaging support for remaining LANL legacy waste.« less

Pricing and Fee Management.

ERIC Educational Resources Information Center

Fischer, Richard B.

1986-01-01

Defines key terms and discusses things to consider when setting fees for a continuing education program. These include (1) the organization's philosophy and mission, (2) certain key variables, (3) pricing strategy options, and (4) the test of reasonableness. (CH)

Transportation: Destination Mars

NASA Technical Reports Server (NTRS)

Eoff, Bill

1998-01-01

As the agency space transportation lead center, Marshall Space Flight Center has been conducting transportation assessments for future robotic and human Mars missions to identify critical technologies. Five human Mars options are currently under assessment with each option including all transportation requirements from Earth to Mars and return. The primary difference for each option is the propulsion source from Earth to Mars. In case any of the options require heavy launch capability that is not currently projected as available, an in-house study has been initiated to determine the most cost effective means of providing such launch capability. This assessment is only considering launch architectures that support the overall human Mars mission cost goal of $25B. The guidelines for the launch capability study included delivery of 80 metric ton (176 KLB) payloads, 25 feet diameter x 92 feet long, to 220 nmi orbits at 28.5 degrees. The launch vehicle concept of the study was designated "Magnum" to differentiate from prior heavy launch vehicle assessments. This assessment along with the assessment of options for all transportation phases of a Mars mission are on-going.

Potential benefits of a ceramic thermal barrier coating on large power generation gas turbine

NASA Technical Reports Server (NTRS)

Clark, J. S.; Nainiger, J. J.

1977-01-01

Thermal barrier coating design option offers benefit in terms of reduced electricity costs when used in utility gas turbines. Options considered include: increased firing temperature, increased component life, reduced cooling air requirements, and increased corrosion resistance (resulting in increased tolerance for dirty fuels). Performance and cost data were obtained. Simple, recuperated and combined cycle applications were considered, and distillate and residual fuels were assumed. The results indicate that thermal barrier coatings could produce large electricity cost savings if these coatings permit turbine operation with residual fuels at distillate-rated firing temperatures. The results also show that increased turbine inlet temperature can result in substantial savings in fuel and capital costs.

Birthplace choices: what are the information needs of women when choosing where to give birth in England? A qualitative study using online and face to face focus groups.

PubMed

Hinton, Lisa; Dumelow, Carol; Rowe, Rachel; Hollowell, Jennifer

2018-01-08

Current clinical guidelines and national policy in England support offering 'low risk' women a choice of birth setting. Options include: home, free-standing midwifery unit (FMU), alongside midwifery unit (AMU) or obstetric unit (OU). This study, which is part of a broader project designed to inform policy on 'choice' in relation to childbirth, aimed to provide evidence on UK women's experiences of choice and decision-making in the period since the publication of the Birthplace findings (2011) and new NICE guidelines (2014). This paper reports on findings relating to women's information needs when making decisions about where to give birth. A qualitative focus group study including 69 women in the last trimester of pregnancy in England in 2015-16. Seven focus groups were conducted online via a bespoke web portal, and one was face-to-face. To explore different aspects of women's experience, each group included women with specific characteristics or options; planning a home birth, living in areas with lots of choice, living in areas with limited choice, first time mothers, living close to a FMU, living in opt-out AMU areas, living in socioeconomically disadvantaged areas and planning to give birth in an OU. Focus group transcripts were analysed thematically. Women drew on multiple sources when making choices about where to give birth. Sources included; the Internet, friends' recommendations and experiences, antenatal classes and their own personal experiences. Their midwife was not the main source of information. Women wanted the option to discuss and consider their birth preferences throughout their pregnancy, not at a fixed point. Birthplace choice is informed by many factors. Women may encounter fewer overt obstacles to exercising choice than in the past, but women do not consistently receive information about birthplace options from their midwife at a time and in a manner that they find helpful. Introducing options early in pregnancy, but deferring decision-making about birthplace until a woman has had time to consider and explore options and discuss these with her midwife, might facilitate choice.

Treatment options for the management of exercise-induced asthma and bronchoconstriction.

PubMed

Millward, David T; Tanner, Lindsay G; Brown, Mark A

2010-12-01

Treatment for exercise-induced bronchospasm and exercise-induced asthma includes both pharmacologic and nonpharmacologic options. Pharmacologic agents that have been proven to be effective for treating these conditions include short- and long-acting β2-adrenoceptor agonists, mast cell-stabilizing agents, anticholinergics, leukotriene receptor antagonists, and inhaled corticosteroids (ICS). When selecting the most appropriate medication, factors to consider include the effectiveness of each, the duration of action, frequency of administration, potential side effects, and tolerance level. Long-acting β2-adrenoceptor agonists should not be used without ICS. Nonpharmacologic treatments include physical conditioning, incorporating a warm-up before and a cool-down period after exercise, performing nasal breathing, avoiding cold weather or environmental allergens, using a face mask or other aid to warm and humidify inhaled air, and modifying dietary intake. The data to support nonpharmacologic treatments are limited; however, they are routinely recommended because of the low risk associated with their use. This article highlights the advantages and limitations of each treatment option.

Scope Complexity Options Risks Excursions (SCORE) Version 3.0 Mathematical Description.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gearhart, Jared Lee; Samberson, Jonell Nicole; Shettigar, Subhasini

The purpose of the Scope, Complexity, Options, Risks, Excursions (SCORE) model is to estimate the relative complexity of design variants of future warhead options. The results of this model allow those considering these options to understand the complexity tradeoffs between proposed warhead options. The core idea of SCORE is to divide a warhead option into a well- defined set of scope elements and then estimate the complexity of each scope element against a well understood reference system. The uncertainty associated with estimates can also be captured. A weighted summation of the relative complexity of each scope element is used tomore » determine the total complexity of the proposed warhead option or portions of the warhead option (i.e., a National Work Breakdown Structure code). The SCORE analysis process is a growing multi-organizational Nuclear Security Enterprise (NSE) effort, under the management of the NA- 12 led Enterprise Modeling and Analysis Consortium (EMAC), that has provided the data elicitation, integration and computation needed to support the out-year Life Extension Program (LEP) cost estimates included in the Stockpile Stewardship Management Plan (SSMP).« less

'GRC1.5': Uptower Gearbox Testing to Investigate Bearing Axial Cracking

DOE Office of Scientific and Technical Information (OSTI.GOV)

Keller, Jonathan; Vaes, David; McNiff, Brian

2016-02-16

This presentation focuses on the investigation of bearing axial cracking using the GRC1.5 uptower gearbox. Topics covered include the testing options considered, the project goal, and current and near-term activities.

Causes and Recommendations for Unanticipated Ink Retention Following Tattoo Removal Treatment

PubMed Central

Chen, Cynthia L.; Desai, Alpesh; Desai, Tejas

2013-01-01

While placement of ink into the skin is a long-standing tradition, patients are now seeking tattoo removal on a more frequent basis. Once considered acceptable removal options, tattoo ink removal via physical destruction included dermabrasion, chemical destruction, salabrasion, thermal destruction, and cryotherapy. Now these options are used extremely infrequently. These modalities provided unpredictable results and often required prolonged healing times and left patients with skin discoloration, pain, scarring, and ink retention. Even the widely adopted use of lasers, now considered the gold standard method, offers some level of unpredictability surrounding the natural progression of ink resolution. Multiple factors need to be taken into consideration when successfully removing tattoo pigment including the modalities used, number and frequency of treatments, proper device technique, and physiological barriers to tattoo removal. This paper serves to elucidate the common causes of ink retention following tattoo removal treatment with recommendations on how best to address this relatively common occurrence. PMID:23882312

Benefits and work-schedule options in hospital pharmacy practice.

PubMed

Gaither, C A; Mason, N A; Diokno, D A; Hoffman, E J

1994-03-15

Hospital pharmacy directors were surveyed to determine whether their departments offered specific family-related benefits and work-schedule options and how their attitudes about these options compared with those of female hospital pharmacists. Questionnaires were mailed to 300 randomly selected hospital pharmacy directors to collect the following information: vacancy rates and male:female ratios in hospital pharmacy positions, which of 13 selected benefits and work-schedule options were offered, barriers that prevented the other options from being offered, and attitudes about the listed options. The options included in the survey were selected because they represent ways of balancing home and work (e.g., maternity leave, job sharing, day care). The pharmacy directors' responses were compared with those from a similar survey of female hospital pharmacists. The usable response rate was 50.3%. Position vacancy rates ranged from 5.5% for directors to 35.8% for clinical supervisors. All full-time positions had an even distribution of men and women except for director and assistant or associate director positions. Of 13 options, only maternity leave, part-time schedules, and flexible schedules were offered by more than half of the hospitals. These three were also the only listed options that the respondents considered important in recruiting and retaining pharmacists. Barriers to offering other options included the perception that current benefits and work-schedule options were adequate, lack of staff coverage, lack of funds, and the perception that some positions are not compatible with alternative schedules. Respondents' ratings of the importance of the listed benefits and work-schedule options were significantly lower than ratings given by female hospital pharmacists in a separate survey.(ABSTRACT TRUNCATED AT 250 WORDS)

In-situ Resource Utilization (ISRU) to Support the Lunar Outpost and the Rationale for Precursor Missions

NASA Technical Reports Server (NTRS)

Simon, Thomas M.

2008-01-01

One of the ways that the Constellation Program can differ from Apollo is to employ a live-off-the-land or In-Situ Resource Utilization (ISRU) supported architecture. The options considered over the past decades for using indigenous materials have varied considerably in terms of what resources to attempt to acquire, how much to acquire, and what the motivations are to acquiring these resources. The latest NASA concepts for supporting the lunar outpost have considered many of these plans and compared these options to customers requirements and desires. Depending on the architecture employed, ISRU technologies can make a significant contribution towards a sustainable and affordable lunar outpost. While extensive ground testing will reduce some mission risk, one or more flight demonstrations prior to the first crew's arrival will build confidence and increase the chance that outpost architects will include ISRU as part of the early outpost architecture. This presentation includes some of the options for using ISRU that are under consideration for the lunar outpost, the precursor missions that would support these applications, and a notional timeline to allow the lessons learned from the precursor missions to support outpost hardware designs.

Management of transgenderism.

PubMed

Spack, Norman P

2013-02-06

Gender identity disorder (transgenderism) is poorly understood from both mechanistic and clinical standpoints. Awareness of the condition appears to be increasing, probably because of greater societal acceptance and available hormonal treatment. Therapeutic options include hormone and surgical treatments but may be limited by insurance coverage because costs are high. For patients seeking male-to-female (MTF) change, hormone treatment includes estrogens, finasteride, spironolactone, and gonadotropin-releasing hormone (GnRH) analogs. Surgical options include feminizing genital and facial surgery, breast augmentation, and various fat transplantations. For patients seeking a female-to-male (FTM) gender change, medical therapy includes testosterone and GnRH analogs and surgical therapy includes mammoplasty and phalloplasty. Medical therapy for both FTM and MTF can be started in early puberty, although long-term effects are not known. All patients considering treatment need counseling and medical monitoring.

Options for Staging Orbits in Cis-Lunar Space

NASA Technical Reports Server (NTRS)

Whitley, Ryan; Martinez, Roland

2015-01-01

NASA has been studying options to conduct missions beyond Low Earth Orbit, but within the Earth-Moon system, in preparation for deep space exploration including human missions to Mars. Referred to as the Proving Ground, this arena of exploration activities will enable the development of human spaceflight systems and operations to satisfy future exploration objectives beyond the cis-lunar environment. One option being considered includes the deployment of a habitable element or elements, which could be used as a central location for aggregation of supplies and resources for human missions in cis-lunar space and beyond. Characterizing candidate orbit locations for this asset and the impacts on system design and mission operations is important in the overall assessment of the options being considered. The orbits described in this paper were initially selected by taking advantage of previous studies conducted by NASA and the work of other authors. In this paper orbits are assessed for their relative attractiveness based on various factors. First, a set of constraints related to the capability of the combined Orion and SLS system to deliver humans and cargo to and from the orbit are evaluated. Second, the ability to support potential lunar surface activities is considered. Finally, deployed assets intended to spend multiple years in the Proving Ground would ideally require minimal station keeping costs to reduce the mass budget allocated to this function. Additional mission design drivers include potential for uninterrupted communication with deployed assets, thermal, communications, and other operational implications. The results of the characterization and evaluation of the selected orbits indicate a Near Rectilinear Orbit (NRO) is an attractive candidate as an aggregation point or staging location for operations. In this paper, the NRO is further described in terms which balance a number of key attributes that favor a variety of mission classes to meet multiple, sometimes competing, constraints.

Options for Staging Orbits in Cis-Lunar Space

NASA Technical Reports Server (NTRS)

Martinez, Roland; Whitley, Ryan

2016-01-01

NASA has been studying options to conduct missions beyond Low Earth Orbit, but within the Earth-Moon system, in preparation for deep space exploration including human missions to Mars. Referred to as the Proving Ground, this arena of exploration activities will enable the development of human spaceflight systems and operations to satisfy future exploration objectives beyond the cis-lunar environment. One option being considered includes the deployment of a habitable element or elements, which could be used as a central location for aggregation of supplies and resources for human missions in cis-lunar space and beyond. Characterizing candidate orbit locations for this asset and the impacts on system design and mission operations is important in the overall assessment of the options being considered. The orbits described in this paper were initially selected by taking advantage of previous studies conducted by NASA and the work of other authors. In this paper orbits are assessed for their relative attractiveness based on various factors. A set of constraints related to the capability of the combined Orion and SLS system to deliver humans and cargo to and from the orbit are evaluated. Deployed assets intended to spend multiple years in the Proving Ground would ideally require minimal station keeping costs to reduce the mass budget allocated to this function. Additional mission design drivers include eclipse frequency, potential for uninterrupted communication with deployed assets, thermal, attitude control, communications, and other operational implications. Also the ability to support potential lunar surface activities and excursion missions beyond Earth-Moon space is considered. The results of the characterization and evaluation of the selected orbits indicate a Near Rectilinear Orbit (NRO) is an attractive candidate as an aggregation point or staging location for operations. In this paper, the NRO is further described in terms which balance a number of key attributes that favor a variety of mission classes to meet multiple, sometimes competing, constraints.

Managing Vacant and Abandoned Property in the Green Zone of Saginaw, Michigan

EPA Pesticide Factsheets

Report from a technical assistance project with Saginaw, MI, gives the city options to consider to stabilize neighborhoods through sustainable reuse of abandoned properties, including redeveloping them as green infrastructure, and to create opportunities.

Prader-Willi Syndrome: Quality of Life Issues in Home, School and Community.

ERIC Educational Resources Information Center

James, Terrance N.; Brown, Roy I.

1993-01-01

Management of psychosocial aspects of Prader-Willi syndrome is considered for several quality of life issues, including social change, increased life expectancy, parent stress, child stress, independence, residential options, and access to services. (JDD)

Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study.

PubMed

Kleynen, Melanie; Moser, Albine; Haarsma, Frederike A; Beurskens, Anna J; Braun, Susy M

2017-08-01

The goal of this study was to examine which motor learning options are applied by experienced physiotherapists in neurological rehabilitation, and how they choose between the different options. A descriptive qualitative approach was used. A purposive sample of five expert physiotherapists from the neurological ward of a rehabilitation center participated. Data were collected using nine videotaped therapy situations. During retrospective think-aloud interviews, the physiotherapists were instructed to constantly "think aloud" while they were watching their own videos. Five "operators" were identified: "act", "know", "observe", "assess" and "argue". The "act" operator consisted of 34 motor learning options, which were clustered into "instruction", "feedback" and "organization". The "know", "observe", "assess" and "argue" operators explained how therapists chose one of these options. The four operators seem to be interrelated and together lead to a decision to apply a particular motor learning option. Results show that the participating physiotherapists used a great variety of motor learning options in their treatment sessions. Further, the decision-making process with regard to these motor learning options was identified. Results may support future intervention studies that match the content and process of therapy in daily practice. The study should be repeated with other physiotherapists. Implications for Rehabilitation The study provided insight into the way experienced therapist handle the great variety of possible motor learning options, including concrete ideas on how to operationalize these options in specific situations. Despite differences in patients' abilities, it seems that therapists use the same underlying clinical reasoning process when choosing a particular motor learning option. Participating physiotherapists used more than the in guidelines suggested motor learning options and considered more than the suggested factors, hence adding practice based options of motor learning to the recommended ones in the guidelines. A think-aloud approach can be considered for peer-to-peer and student coaching to enhance discussion on the motor learning options applied and the underlying choices and to encourage research by practicing clinicians.

Space disposal of nuclear wastes

NASA Technical Reports Server (NTRS)

Priest, C. C.; Nixon, R. F.; Rice, E. E.

1980-01-01

The DOE has been studying several options for nuclear waste disposal, among them space disposal, which NASA has been assessing. Attention is given to space disposal destinations noting that a circular heliocentric orbit about halfway between Earth and Venus is the reference option in space disposal studies. Discussion also covers the waste form, showing that parameters to be considered include high waste loading, high thermal conductivity, thermochemical stability, resistance to leaching, fabrication, resistance to oxidation and to thermal shock. Finally, the Space Shuttle nuclear waste disposal mission profile is presented.

Technical Options for Energy Conservation in Buildings. National Conference of States on Building Codes and Standards and National Bureau of Standards Joint Emergency Workshop on Energy Conservation in Buildings. (Washington, D.C., June 19, 1973) NBS Technical Note 789.

ERIC Educational Resources Information Center

National Bureau of Standards (DOC), Washington, DC. Inst. for Applied Technology.

The purpose of this report is to provide reference material on the technical options for energy conservation in buildings. Actions pertinent to existing buildings and new buildings are considered separately. Regarding existing buildings, principal topics include summer cooling, winter heating, and other energy-related features such as insulation,…

Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana.

PubMed

VanDeusen, Adam; Paintsil, Elijah; Agyarko-Poku, Thomas; Long, Elisa F

2015-03-18

Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana. A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios. HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses. Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.

Current treatment for vitreous floaters.

PubMed

Sendrowski, David P; Bronstein, Mark A

2010-03-01

Vitreous floaters are a common complaint in the ophthalmic care setting. Patients seek explanation and advice regarding possible treatment options. Because the condition is considered benign, ophthalmic care practitioners have little to offer regarding treatment options. The majority of cases encountered are managed with patient education and reassurance. Although almost all patients accept the conservative management option, there is a small subset of patients who may desire a more aggressive treatment intervention for resolution of their visual symptoms. Information with regard to treatment options is readily available to patients through Internet searches and non-peer reviewed educational Web sites. The risks and benefits for these treatment options are not fully covered. Management of floaters should include education regarding "off-label" procedures as well as discussion about benefits and risks associated with such treatment options. It is vital that eye care practitioners advise and counsel patients with symptomatic floaters for optimum ocular health care. This article reviews the current conventional and "off-label" treatment options for symptomatic patients with vitreous floaters. Copyright (c) 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness analysis of therapeutic options for chronic hepatitis C genotype 3 infected patients.

PubMed

Gimeno-Ballester, Vicente; Mar, Javier; O'Leary, Aisling; Adams, Róisín; San Miguel, Ramón

2017-01-01

This study provides a cost-effectiveness analysis of therapeutic strategies for chronic hepatitis C genotype 3 infected patients in Spain. A Markov model was designed to simulate the progression in a cohort of patients aged 50 years over a lifetime horizon. Sofosbuvir (SOF) plus peginterferon and ribavirin for 12 weeks was a cost-effective option when compared to standard of care (SoC) in the treatment of both 'moderate fibrosis' and 'cirrhotic' patients. Incremental cost-effectiveness ratios were €35,276/QALY and €18,374/QALY respectively. ICERs for SOF plus daclatasvir (DCV) regimens versus SoC were over the threshold limit considered, at €56,178/QALY and €77,378/QALY for 'moderate fibrosis' and 'cirrhotic' patients respectively. Addition of SOF to IFN-based regimens for genotype 3 was cost-effective for both 'moderate fibrosis' and 'cirrhotic' patients. IFN-free options including SOF and DCV association required price reductions lower than the list prices to be considered cost-effective.

Ebola virus convalescent blood products: where we are now and where we may need to go.

PubMed

Burnouf, Thierry; Seghatchian, Jerard

2014-10-01

The world is regularly exposed to emerging infections with the potential to burst into a pandemic. One possible way to treat patients, when no other treatment is yet developed,is passive immunization performed by transfusing blood, plasma or plasma immunoglobul infractions obtained from convalescent donors who have recovered from the disease and have developed protective antibodies. The most recent on-going epidemic is caused by the Ebola virus, a filovirus responsible for Ebola virus disease, a severe, often lethal, hemorrhagic fever. Recently, the use of convalescent blood products was proposed by the WHO as one early option for treating patients with Ebola virus disease. This publication provides an overview of the various convalescent blood products and technological options that could theoretically be considered when there is a need to rely on this therapeutic approach.In countries without access to advanced blood-processing technologies, the choice may initially be restricted to convalescent whole blood or plasma. In technologically advanced countries, additional options for convalescent blood products are available, including virally inactivated plasma and fractionated immunoglobulins. The preparation of minipool immunoglobulins is also a realistic option to consider.

Chemical Mixtures and Epidemiologic Fundamentals for Risk Assessment Applications

EPA Science Inventory

Risk management options are increasingly being considered early in the risk assessment process to help scope the considerations and bound the inherent complexities related to potential exposures, risk and future clean-up decisions (including acceptable pollutant levels) related t...

Childhood Nasopharyngeal Cancer Treatment (PDQ®)—Health Professional Version

Cancer.gov

Treatment options for children with nasopharyngeal cancer include combined-modality therapy with chemotherapy and radiation. Surgery has a limited role because the disease is usually considered unresectable due to extensive local spread. Get detailed treatment information in this clinician summary.

Micros for the 1990's: An Update.

ERIC Educational Resources Information Center

Grosch, Audrey N.

1991-01-01

Discusses new hardware and software developments for microcomputers and considers strategies for future library microcomputing. Topics discussed include developments with Macintosh computers; the importance of local area networks (LANs); upgrading options for hardware; operating system upgrades; dynamic data exchange (DDE); microcomputer…

Updated CDC Recommendations for Using Artemether-Lumefantrine for the Treatment of Uncomplicated Malaria in Pregnant Women in the United States.

PubMed

Ballard, Sarah-Blythe; Salinger, Allison; Arguin, Paul M; Desai, Meghna; Tan, Kathrine R

2018-04-13

Malaria infection during pregnancy is associated with an increased risk for maternal and fetal complications. In the United States, treatment options for uncomplicated, chloroquine-resistant Plasmodium falciparum and P. vivax malaria in pregnant women are limited to mefloquine or quinine plus clindamycin (1). However, limited availability of quinine and increasing resistance to mefloquine restrict these options. Strong evidence now demonstrates that artemether-lumefantrine (AL) (Coartem) is effective and safe in the treatment of malaria in pregnancy. The World Health Organization (WHO) has endorsed artemisinin-based combination therapies (ACTs), such as AL, for treatment of uncomplicated malaria during the second and third trimesters of pregnancy and is currently considering whether to add ACTs, including AL, as an option for malaria treatment during the first trimester (2,3). This policy note reviews the evidence and updates CDC recommendations to include AL as a treatment option for uncomplicated malaria during the second and third trimesters of pregnancy and during the first trimester of pregnancy when other treatment options are unavailable. These updated recommendations reflect current evidence and are consistent with WHO treatment guidelines.

Mercury orbiter transport study

NASA Technical Reports Server (NTRS)

Friedlander, A. L.; Feingold, H.

1977-01-01

A data base and comparative performance analyses of alternative flight mode options for delivering a range of payload masses to Mercury orbit are provided. Launch opportunities over the period 1980-2000 are considered. Extensive data trades are developed for the ballistic flight mode option utilizing one or more swingbys of Venus. Advanced transport options studied include solar electric propulsion and solar sailing. Results show the significant performance tradeoffs among such key parameters as trip time, payload mass, propulsion system mass, orbit size, launch year sensitivity and relative cost-effectiveness. Handbook-type presentation formats, particularly in the case of ballistic mode data, provide planetary program planners with an easily used source of reference information essential in the preliminary steps of mission selection and planning.

Assessing CO2 Mitigation Options Utilizing Detailed Electricity Characteristics and Including Renewable Generation

NASA Astrophysics Data System (ADS)

Bensaida, K.; Alie, Colin; Elkamel, A.; Almansoori, A.

2017-08-01

This paper presents a novel techno-economic optimization model for assessing the effectiveness of CO2 mitigation options for the electricity generation sub-sector that includes renewable energy generation. The optimization problem was formulated as a MINLP model using the GAMS modeling system. The model seeks the minimization of the power generation costs under CO2 emission constraints by dispatching power from low CO2 emission-intensity units. The model considers the detailed operation of the electricity system to effectively assess the performance of GHG mitigation strategies and integrates load balancing, carbon capture and carbon taxes as methods for reducing CO2 emissions. Two case studies are discussed to analyze the benefits and challenges of the CO2 reduction methods in the electricity system. The proposed mitigations options would not only benefit the environment, but they will as well improve the marginal cost of producing energy which represents an advantage for stakeholders.

Realistic Specific Power Expectations for Advanced Radioisotope Power Systems

NASA Technical Reports Server (NTRS)

Mason, Lee S.

2006-01-01

Radioisotope Power Systems (RPS) are being considered for a wide range of future NASA space science and exploration missions. Generally, RPS offer the advantages of high reliability, long life, and predictable power production regardless of operating environment. Previous RPS, in the form of Radioisotope Thermoelectric Generators (RTG), have been used successfully on many NASA missions including Apollo, Viking, Voyager, and Galileo. NASA is currently evaluating design options for the next generation of RPS. Of particular interest is the use of advanced, higher efficiency power conversion to replace the previous thermoelectric devices. Higher efficiency reduces the quantity of radioisotope fuel and potentially improves the RPS specific power (watts per kilogram). Power conversion options include Segmented Thermoelectric (STE), Stirling, Brayton, and Thermophotovoltaic (TPV). This paper offers an analysis of the advanced 100 watt-class RPS options and provides credible projections for specific power. Based on the analysis presented, RPS specific power values greater than 10 W/kg appear unlikely.

Implementation of power barrier option valuation

NASA Astrophysics Data System (ADS)

Cahyani, Agatha C. P.; Sumarti, Novriana

2015-09-01

Options are financial instruments that can be utilized to reduce risk in stock investment. Barrier options are one of the major types of options actively used in financial markets where its life period depends on the path of the underlying stock prices. The features of the barrier option can be used to modify other types of options. In this research, the barrier option will be implemented into power option, so it is called power barrier option. This option is an extension of the vanilla barrier options where the Call payoff being considered is defined as P C =max (STβ-Kβ,0 ) , and the Put payoff being considered is defined as P P =max (Kβ-STβ,0 ) . Here β > 0 and β ≠ 1, K is the strike price of the option, and ST is the price of the underlying stock at time maturity T. In this paper, we generate the prices of stock using binomial method which is adjusted to the power option. In the conclusion, the price of American power barrier option is more expensive than the price of European power barrier option.

Repurposing Used Electric Car Batteries: A Review of Options

NASA Astrophysics Data System (ADS)

DeRousseau, Mikaela; Gully, Benjamin; Taylor, Christopher; Apelian, Diran; Wang, Yan

2017-09-01

In the United States, millions of electric and hybrid vehicles have cumulatively been sold. Although the batteries in these vehicles are expected to last at least 8 years, end-of-life options must still be considered. There are several possible options for battery packs from electric vehicles when they reach end-of-life, including remanufacturing, repurposing for a different application, and recycling. Remanufacturing is the most desirable end-of-life scenario but is the most stringent in terms of battery quality. Recycling is less desirable because there are larger material and energy losses that occur in the process. Repurposing batteries for a different use lies between these two scenarios in terms of desirability. This review paper focuses on non-automotive reuse and explores several options for using electric car battery packs in grid energy storage applications.

Supplementing Conservation Practices with Alternative Energy Sources.

ERIC Educational Resources Information Center

Kraetsch, Gayla A.

1981-01-01

Universities and colleges have two major roles: to reduce their own energy consumption and costs, and to develop and test new energy options. Alternative energy sources considered include solar energy, wind power, biomass, hydropower, ocean energy, geothermal heat, coal, and nuclear energy. (MLW)

When Hospice Fails: The Limits of Palliative Care.

ERIC Educational Resources Information Center

Logue, Barbara J.

1994-01-01

Examines feasibility of palliative approach for all patients, showing reasonable people may refuse even the most exemplary care for themselves or an incompetent relative. Medical realities and alleviation of pointless suffering necessitate that policymakers consider other options, including "active" euthanasia, consistent with patient…

Information Technology for Economic and Social Benefit--Options for Bangladesh.

ERIC Educational Resources Information Center

Bhuiyan, Farhad Ali

2002-01-01

Considers how information technology (IT) can help socioeconomic growth of developing countries based on experiences in Bangladesh. Topics include Bangladesh's development plans; future economic growth trends triggered by IT; emerging technologies; intellectual and societal development; industrial revolutions; telematics; regional and world…

45 CFR 1306.31 - Choosing a Head Start program option.

Code of Federal Regulations, 2010 CFR

2010-10-01

... option must consider such factors as the child's age, developmental level, disabilities, health or learning problems, previous preschool experiences and family situation. Grantees must also consider parents...

45 CFR 1306.31 - Choosing a Head Start program option.

Code of Federal Regulations, 2011 CFR

2011-10-01

... option must consider such factors as the child's age, developmental level, disabilities, health or learning problems, previous preschool experiences and family situation. Grantees must also consider parents...

An Analysis of Fuel Cell Options for an All-electric Unmanned Aerial Vehicle

NASA Technical Reports Server (NTRS)

Kohout, Lisa L.; Schmitz, Paul C.

2007-01-01

A study was conducted to assess the performance characteristics of both PEM and SOFC-based fuel cell systems for an all-electric high altitude, long endurance Unmanned Aerial Vehicle (UAV). Primary and hybrid systems were considered. Fuel options include methane, hydrogen, and jet fuel. Excel-based models were used to calculate component mass as a function of power level and mission duration. Total system mass and stored volume as a function of mission duration for an aircraft operating at 65 kft altitude were determined and compared.

Application of selection techniques to electric-propulsion options on an advanced synchronous satellite

NASA Technical Reports Server (NTRS)

Holcomb, L. B.; Degrey, S. P.

1973-01-01

This paper addresses the comparison of several candidate auxiliary-propulsion systems and system combinations for an advanced synchronous satellite. Economic selection techniques, evolved at the Jet Propulsion Laboratory, are used as a basis for system option comparisons. Electric auxiliary-propulsion types considered include pulsed plasma and ion bombardment, with hydrazine systems used as a state-of-the-art reference. Current as well as projected electric-propulsion system performance data are used, as well as projected hydrazine system costs resulting from NASA standardization program projections.

Treatment planning of implants in posterior quadrants.

PubMed

Jivraj, S; Chee, W

2006-07-08

Differences in anatomy and biomechanics make treatment of posterior quadrants with dental implants substantially different to that of anterior areas. Without implants, when posterior teeth were lost, treatment options included a long span fixed partial denture or a removable prosthesis, especially when no terminal abutment was available. Today, with the use of implants, options are available that allow preservation of unrestored teeth.(1) When teeth are missing, implant supported restorations can be considered the treatment of choice from the perspective of occlusal support, preservation of adjacent teeth and avoidance of a removable partial denture.

ENVIRONMENTAL LIFE CYCLE ASSESSMENT OF GASOLINE ALTERNATIVES: MTBE AND ETHANOL ADDITIVES

EPA Science Inventory

Currently, the U.S. is considering options for additives to reformulated gasoline. To inform this debate the U.S. EPA's Office of Research and Development is conducting a screening life cycle assessment (LCA) of three gasoline alternatives. These alternatives include gasoline w...

Integrating algaculture into small wastewater treatment plants: process flow options and life cycle impacts.

PubMed

Steele, Muriel M; Anctil, Annick; Ladner, David A

2014-05-01

Algaculture has the potential to be a sustainable option for nutrient removal at wastewater treatment plants. The purpose of this study was to compare the environmental impacts of three likely algaculture integration strategies to a conventional nutrient removal strategy. Process modeling was used to determine life cycle inventory data and a comparative life cycle assessment was used to determine environmental impacts. Treatment scenarios included a base case treatment plant without nutrient removal, a plant with conventional nutrient removal, and three other cases with algal unit processes placed at the head of the plant, in a side stream, and at the end of the plant, respectively. Impact categories included eutrophication, global warming, ecotoxicity, and primary energy demand. Integrating algaculture prior to activated sludge proved to be most beneficial of the scenarios considered for all impact categories; however, this scenario would also require primary sedimentation and impacts of that unit process should be considered for implementation of such a system.

76 FR 23904 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Reef Fish Fishery of the Gulf of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-29

... restaurants will be hurt by this closure. People will start limiting their trips to the Gulf coast because of... shops, hotels, and restaurants. The Council considered several closure options, including spring and... owned and operated, is not dominant in its field of operation (including its affiliates), and has...

Environmental and economic analyses of waste disposal options for traditional markets in Indonesia.

PubMed

Aye, Lu; Widjaya, E R

2006-01-01

Waste from traditional markets in Indonesia is the second largest stream of municipal solid waste after household waste. It has a higher organic fraction and may have greater potential to be managed on a business scale compared to household wastes. The attributed reason is that in general the wastes generated from traditional markets are more uniform, more concentrated and less hazardous than waste from other sources. This paper presents the results of environmental and economic assessments to compare the options available for traditional market waste disposal in Indonesia. The options compared were composting in labour intensive plants, composting in a centralised plant that utilised a simple wheel loader, centralised biogas production and landfill for electricity production. The current open dumping practice was included as the baseline case. A life cycle assessment (LCA) was used for environmental analysis. All options compared have lower environmental impacts than the current practice of open dumping. The biogas production option has the lowest environmental impacts. A cost-benefit analysis, which considered greenhouse gas savings, was used for the economic assessment. It was found that composting at a centralised plant is the most economically feasible option under the present Indonesian conditions. The approach reported in this study could be applied for 'a pre-feasibility first cut comparison' that includes environmental aspects in a decision-making framework for developing countries even though European emission factors were used.

Contribution of Sudanese medical diaspora to the healthcare delivery system in Sudan: exploring options and barriers.

PubMed

Abdalla, Fayrouz Mohammed; Omar, Maye Abu; Badr, Elsheikh Elsiddig

2016-06-30

Medical diaspora options, including the engagement of expatriate physicians in development efforts within their home country, are being called for to reverse the effects of brain drain from developing countries. This paper presents the results of a study exploring the potential contributions for the Sudanese Medial Diaspora Options to the healthcare delivery system (HCDS) in Sudan, focusing on the options of temporal and permanent returns and the likely obstacles faced in their implementation. This was a cross-sectional study using a mixed methods design including quantitative and qualitative approaches. For the quantitative approach, the study, which focused on the possible contribution of the diaspora to healthcare delivery in Sudan, was based on an online survey using random purposive and snowballing sampling techniques involving 153 Sudanese physicians working in Saudi Arabia and other Gulf States, the United Kingdom, the Republic of Ireland, and the United States of America. The qualitative approach involved in-depth interviews with returnee physicians and key informants in Sudan, focusing on the return experiences, the barriers for return, and the options to improve future contributions. Despite contributions of the Sudanese medical diaspora being of a small scale considering the size of the phenomenon, as well as infrequent and not appropriately organized, their inputs to academia and the links built with overseas institutions and specialist clinical services were nevertheless remarkable. The main barrier to temporal return was inappropriate organization by the local counterparts, while those for permanent return of physicians were poor work environment, insufficient financial payment, unsecured accommodation, and offspring education. The study identified short-term return as a feasible option considering the country's current conditions. Proper coordination mechanisms for short-term returns and facilitation of permanent return through stakeholders' collaboration were proposed to improve diaspora contributions. The potentials of Sudanese medial diaspora contributions to the HCDS in Sudan are promising. Short-term contributions were observed as the best option for the current country situation. Creation of a coordinating body from within the healthcare sector in Sudan to effectively coordinate diaspora contributions is recommended.

Lunar Cube Transfer Trajectory Options

NASA Technical Reports Server (NTRS)

Folta, David; Dichmann, Donald James; Clark, Pamela E.; Haapala, Amanda; Howell, Kathleen

2015-01-01

Numerous Earth-Moon trajectory and lunar orbit options are available for Cubesat missions. Given the limited Cubesat injection infrastructure, transfer trajectories are contingent upon the modification of an initial condition of the injected or deployed orbit. Additionally, these transfers can be restricted by the selection or designs of Cubesat subsystems such as propulsion or communication. Nonetheless, many trajectory options can b e considered which have a wide range of transfer duration, fuel requirements, and final destinations. Our investigation of potential trajectories highlights several options including deployment from low Earth orbit (LEO) geostationary transfer orbits (GTO) and higher energy direct lunar transfer and the use of longer duration Earth-Moon dynamical systems. For missions with an intended lunar orbit, much of the design process is spent optimizing a ballistic capture while other science locations such as Sun-Earth libration or heliocentric orbits may simply require a reduced Delta-V imparted at a convenient location along the trajectory.

Lunar Cube Transfer Trajectory Options

NASA Technical Reports Server (NTRS)

Folta, David; Dichmann, Donald J.; Clark, Pamela; Haapala, Amanda; Howell, Kathleen

2015-01-01

Numerous Earth-Moon trajectory and lunar orbit options are available for Cubesat missions. Given the limited Cubesat injection infrastructure, transfer trajectories are contingent upon the modification of an initial condition of the injected or deployed orbit. Additionally, these transfers can be restricted by the selection or designs of Cubesat subsystems such as propulsion or communication. Nonetheless, many trajectory options can be considered which have a wide range of transfer durations, fuel requirements, and final destinations. Our investigation of potential trajectories highlights several options including deployment from low Earth orbit (LEO), geostationary transfer orbits (GTO), and higher energy direct lunar transfers and the use of longer duration Earth-Moon dynamical systems. For missions with an intended lunar orbit, much of the design process is spent optimizing a ballistic capture while other science locations such as Sun-Earth libration or heliocentric orbits may simply require a reduced Delta-V imparted at a convenient location along the trajectory.

Some unconventional approaches to the exploration of Mars

NASA Astrophysics Data System (ADS)

French, J. R.

1991-02-01

The topics of space transport to Mars, and surface transport and surface operations on Mars are discussed in detail and new options for accomplishing these activities are presented. The question of maximizing the return on the investment in a Mars mission is addressed. One way to accomplish this is through reduction of propellant requirements by increasing the performance of the rocket engine, while another option is to make use of nuclear fuel. A technique discussed in detail would provide a means to manufacture fuel from Martian resources for both the return trip and for Mars surface exploration. Options for Mars surface transport include battery and nuclear powered rovers, solar powered automobiles, and either battery, nuclear or Mars-generated-propellant-powered aircraft specially designed to explore the Martian surface. The advantages and disadvantages of each of these options are considered, and the usefulness of a manned aircraft for both exploration and surface operational functions is discussed.

DNA vaccines in veterinary use

PubMed Central

Redding, Laurel; Werner, David B

2015-01-01

DNA vaccines represent a new frontier in vaccine technology. One important application of this technology is in the veterinary arena. DNA vaccines have already gained a foothold in certain fields of veterinary medicine. However, several important questions must be addressed when developing DNA vaccines for animals, including whether or not the vaccine is efficacious and cost effective compared with currently available options. Another important question to consider is how to apply this developing technology in a wide range of different situations, from the domestic pet to individual fish in fisheries with several thousand animals, to wildlife programs for disease control. In some cases, DNA vaccines represent an interesting option for vaccination, while in others, currently available options are sufficient. This review will examine a number of diseases of veterinary importance and the progress being made in DNA vaccine technology relevant to these diseases, and we compare these with the conventional treatment options available. PMID:19722897

Technology-aided leisure and communication: Opportunities for persons with advanced Parkinson's disease.

PubMed

Lancioni, Giulio; Singh, Nirbhay; O'Reilly, Mark; Sigafoos, Jeff; D'Amico, Fiora; Sasanelli, Giovanni; Denitto, Floriana; Lang, Russell

2016-12-01

This study investigated whether simple technology-aided programs could be used to promote leisure and communication engagement in three persons with advanced Parkinson's disease. The programs included music and video options, which were combined with (a) text messaging and telephone calls for the first participant, (b) verbal statements/requests, text messaging, and reading for the second participant, and (c) verbal statements/requests and prayers for the third participant. The participants could activate those options via hand movement or vocal emission and specific microswitches. All three participants were successful in activating the options available. The mean cumulative frequencies of option activations were about five per 15-min session for the first two participants and about four per 10-min session for the third participant. The results were considered encouraging and relevant given the limited amount of evidence available on helping persons with advanced Parkinson's disease with leisure and communication.

Renewable Energy Feasibility Study Leading to Development of the Native Spirit Solar Energy Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Carolyn Stewart; Tracey LeBeau

2008-01-31

DOE-funded renewable energy feasibility study conducted by Red Mountain Tribal Energy on behalf of the Southwest Tribal Energy Consortium (SWTEC). During the course of the study, SWTEC members considered multiple options for the organization structure, selected a proposed organization structure, and drafted a Memorandum of Understanding for the SWTEC organization. High-level resource assessments for SWTEC members were completed; surveys were developed and completed to determine each member’s interest in multiple participation options, including on-reservation projects. With the survey inputs in mind, multiple energy project options were identified and evaluated on a high-level basis. That process led to a narrowing ofmore » the field of technology options to solar generation, specifically, utility-scale Concentrating Solar-Powered Generation projects, with a specific, tentative project location identified at the Fort Mojave Indian Reservation -- the Native Spirit Solar Energy Facility.« less

Solar Heating Considerations for Green Schools

ERIC Educational Resources Information Center

Kelley, Brian; Fiedler, Lon

2012-01-01

As energy costs continue to rise, many schools and universities are considering energy-saving solutions, including solar heating options, to lower costs and to attract students and staff that support environmentally friendly practices. However, administrators and facility engineers should take several issues into account before pursuing a solar…

Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults.

PubMed

Aurora, R Nisha; Casey, Kenneth R; Kristo, David; Auerbach, Sanford; Bista, Sabin R; Chowdhuri, Susmita; Karippot, Anoop; Lamm, Carin; Ramar, Kannan; Zak, Rochelle; Morgenthaler, Timothy I

2010-10-01

Practice parameters for the treatment of obstructive sleep apnea syndrome (OSAS) in adults by surgical modification of the upper airway were first published in 1996 by the American Academy of Sleep Medicine (formerly ASDA). The following practice parameters update the previous practice parameters. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. A systematic review of the literature was performed, and the GRADE system was used to assess the quality of evidence. The findings from this evaluation are provided in the accompanying review paper, and the subsequent recommendations have been developed from this review. The following procedures have been included: tracheostomy, maxillo-mandibular advancement (MMA), laser assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), radiofrequency ablation (RFA), and palatal implants. The presence and severity of obstructive sleep apnea must be determined before initiating surgical therapy (Standard). The patient should be advised about potential surgical success rates and complications, the availability of alternative treatment options such as nasal positive airway pressure and oral appliances, and the levels of effectiveness and success rates of these alternative treatments (Standard). The desired outcomes of treatment include resolution of the clinical signs and symptoms of obstructive sleep apnea and the normalization of sleep quality, the apnea-hypopnea index, and oxyhemoglobin saturation levels (Standard). Tracheostomy has been shown to be an effective single intervention to treat obstructive sleep apnea. This operation should be considered only when other options do not exist, have failed, are refused, or when this operation is deemed necessary by clinical urgency (Option). MMA is indicated for surgical treatment of severe OSA in patients who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances, which are more often appropriate in mild and moderate OSA patients, have been considered and found ineffective or undesirable (Option). UPPP as a sole procedure, with or without tonsillectomy, does not reliably normalize the AHI when treating moderate to severe obstructive sleep apnea syndrome. Therefore, patients with severe OSA should initially be offered positive airway pressure therapy, while those with moderate OSA should initially be offered either PAP therapy or oral appliances (Option). Use of multi-level or stepwise surgery (MLS), as a combined procedure or as stepwise multiple operations, is acceptable in patients with narrowing of multiple sites in the upper airway, particularly if they have failed UPPP as a sole treatment (Option). LAUP is not routinely recommended as a treatment for obstructive sleep apnea syndrome (Standard). RFA can be considered as a treatment in patients with mild to moderate obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Palatal implants may be effective in some patients with mild obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Postoperatively, after an appropriate period of healing, patients should undergo follow-up evaluation including an objective measure of the presence and severity of sleep-disordered breathing and oxygen saturation, as well as clinical assessment for residual symptoms. Additionally, patients should be followed over time to detect the recurrence of disease (Standard). While there has been significant progress made in surgical techniques for the treatment of OSA, there is a lack of rigorous data evaluating surgical modifications of the upper airway. Systematic and methodical investigations are needed to improve the quality of evidence, assess additional outcome measures, determine which populations are most likely to benefit from a particular procedure or procedures, and optimize perioperative care.

Pharmacological management of narcolepsy with and without cataplexy.

PubMed

Kallweit, Ulf; Bassetti, Claudio L

2017-06-01

Narcolepsy is an orphan neurological disease and presents with sleep-wake, motoric, neuropsychiatric and metabolic symptoms. Narcolepsy with cataplexy is most commonly caused by an immune-mediated process including genetic and environmental factors, resulting in the selective loss of hypocretin-producing neurons. Narcolepsy has a major impact on workableness and quality of life. Areas covered: This review provides an overview of the temporal available treatment options for narcolepsy (type 1 and 2) in adults, including authorization status by regulatory agencies. First- and second-line options are discussed as well as combination therapies. In addition, treatment options for frequent coexisting co-morbidities and different phenotypes of narcolepsy are presented. Finally, this review considers potential future management strategies. Non-pharmacological approaches are important in the management of narcolepsy but will not be covered in this review. Expert opinion: Concise evaluation of symptoms and type of narcolepsy, coexisting co-morbidities and patients´ distinct needs is mandatory in order to identify a suitable, individual pharmacological treatment. First-line options include Modafinil/Armodafinil (for excessive daytime sleepiness, EDS), Sodium Oxybate (for EDS and/with cataplexy), Pitolisant (for EDS and cataplexy) and Venlafaxine (for cataplexy (off-label) and co-morbid depression). New symptomatic and causal treatment most probably will be completed by hypocretin-replacement and immune-modifying strategies.

Cost and risk assessment for spacecraft operation decisions caused by the space debris environment

NASA Astrophysics Data System (ADS)

Schaub, Hanspeter; Jasper, Lee E. Z.; Anderson, Paul V.; McKnight, Darren S.

2015-08-01

Space debris is a topic of concern among many in the space community. Most forecasting analyses look centuries into the future to attempt to predict how severe debris densities and fluxes will become in orbit regimes of interest. Conversely, space operators currently do not treat space debris as a major mission hazard. This survey paper outlines the range of cost and risk evaluations a space operator must consider when determining a debris-related response. Beyond the typical direct costs of performing an avoidance maneuver, the total cost including indirect costs, political costs and space environmental costs are discussed. The weights on these costs can vary drastically across mission types and orbit regimes flown. The operator response options during a mission are grouped into four categories: no action, perform debris dodging, follow stricter mitigation, and employ ADR. Current space operations are only considering the no action and debris dodging options, but increasing debris risk will eventually force the stricter mitigation and ADR options. Debris response equilibria where debris-related risks and costs settle on a steady-state solution are hypothesized.

An overview of pharmacotherapy in premature ejaculation.

PubMed

Porst, Hartmut

2011-10-01

With increasing interest and clinical research in male sexual disorders, it has become clear that not only psychological but also organic, neurobiological, and genetic factors may play an important role in premature ejaculation (PE). This article provides an overview of the different treatment options both for lifelong (primary, "congenital") and acquired (secondary) PE. Review of the literature. Currently used treatment options for PE. Treatments reviewed include psychological/behavioral/sexual counseling therapy, topical anesthetics, dapoxetine, and other selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and phosphodiesterase-5 (PDE-5) inhibitors. Before starting any therapy for PE, correct diagnosis has to be made considering the patient's reported intravaginal ejaculatory latency time (IELT) and the duration and type of PE. Concomitant erectile dysfunction (ED) should be either ruled out or proven by appropriate means. In uncomplicated cases of PE with stable partnerships, medical treatment represents the first-choice option with a high likelihood of success. Dapoxetine, where available, or other SSRIs provide suitable therapeutic options with a good risk/benefit profile for patients. In complicated ("difficult-to-treat") PE patients, a combination of medication and sexual counseling should be considered the first treatment option. Combination therapies of PDE-5 inhibitors and PE-related medications should be offered to patients suffering from comorbid PE and ED, with ED treatment starting first. In those patients with severe PE-IELTs of <30-60 seconds or anteportal ejaculation-combination therapy of topical and oral medications can be offered and may considerably increase IELT, compared with either monotherapy. 2011 International Society for Sexual Medicine.

How to Get Greener Books

ERIC Educational Resources Information Center

Malone, Cynthia N.

2008-01-01

Professors select readings for their students in different forms: printed matter, including books and journals; print-on-demand texts; and online material. Before long, enough books and articles will be available for downloading onto devices like the Sony Reader and Amazon.com's new Kindle to make that format another option. They consider a wide…

Special Educators' Roles as Virtual Teachers

ERIC Educational Resources Information Center

Coy, Kimberly

2014-01-01

Students with disabilities are included in the nearly two million students who attend school online (Queen & Lewis, 2011). Like many families, parents of children with disabilities are increasingly considering online schools as an option for their child's education. Online schools may be more attractive to parents of students with disabilities…

Aquaculture: A Component of Low Cost Sanitation Technology

NASA Technical Reports Server (NTRS)

Edwards, P.

1985-01-01

The paper discusses all phases of aquaculture, including commercial viability, sanitary and biological considerations, public health, financial/economic and sociological aspects. Current studies are detailed and options are discussed for their potential applicability to developing countries, considering requirements for capital and labor skills as well as physical needs such as land.

Rational Suicide and the Crisis of Terminal Illness.

ERIC Educational Resources Information Center

Lokhandwala, Tasneem M.; Westefeld, John S.

1998-01-01

Whether or not suicide may be considered a rational choice for clients with terminal illness is controversial. Rational suicide and the literature and statistics pertaining to suicide and terminal illness are reviewed. Implications of accepting rational suicide as a treatment option, including moral and ethical issues, are addressed. (Author/EMK)

The Right to a Better Life: Using an After-School Work Camp to Create Customized Employment Opportunities for Rural High School Students with Severe Disabilities

ERIC Educational Resources Information Center

Molina, Leslie; Demchak, MaryAnn

2016-01-01

If people with intellectual disability are to become truly self-determined, they must be allowed to express choice throughout their lives, including employment. Expectations for competitive employment tend to be low for this population, if considered at all (Citron et al., 2008). Theoretically, integrated employment options, including customized…

41 CFR 102-73.130 - When may Federal agencies consider acquiring leases with purchase options?

Code of Federal Regulations, 2010 CFR

2010-07-01

... consider leasing with a purchase option at or below fair market value, consistent with the lease-purchase... and other advantages to the Government and is consistent with the Government's goals. (b) The...

Policy considerations for improving influenza vaccination rates among pregnant women.

PubMed

Mollard, Elizabeth K; Guenzel, Nicholas; Brown, Peggy A; Keeler, Heidi J; Cramer, Mary E

2014-01-01

Influenza exposure during pregnancy can cause severe health problems for both the mother and her offspring, including an increased risk of mortality. Influenza vaccination during all trimesters of pregnancy is safe and effective, and recommended by professional organizations such as the American College of Obstetrics and Gynecology. Despite these recommendations, the U.S. vaccination rates remain low in this high-risk population. A policy analysis based on the five-part method identified by Teitelbaum and Wilensky () addresses factors to consider in identifying the best voluntary policy options to improve the vaccination rates. The authors provide discussion of the background, landscape, and stakeholder interests and the pros and cons of two voluntary policy options to increase vaccination. The policy options include: (a) financial incentives for providers and (b) an education emphasis for providers and staff. The authors conclude that based on considerations of cost, provider preference, and practicality of implementation, a continuing educational intervention is the preferred policy venue to increase vaccination rates. © 2014 Wiley Periodicals, Inc.

Antiretroviral treatment sequencing strategies to overcome HIV type 1 drug resistance in adolescents and adults in low-middle-income countries.

PubMed

De Luca, Andrea; Hamers, Raphael L; Schapiro, Jonathan M

2013-06-15

Antiretroviral treatment (ART) is expanding to human immunodeficiency virus type 1 (HIV-1)-infected persons in low-middle income countries, thanks to a public health approach. With 3 available drug classes, 2 ART sequencing lines are programmatically foreseen. The emergence and transmission of viral drug resistance represents a challenge to the efficacy of ART. Knowledge of HIV-1 drug resistance selection associated with specific drugs and regimens and the consequent activity of residual drug options are essential in programming ART sequencing options aimed at preserving ART efficacy for as long as possible. This article determines optimal ART sequencing options for overcoming HIV-1 drug resistance in resource-limited settings, using currently available drugs and treatment monitoring opportunities. From the perspective of drug resistance and on the basis of limited virologic monitoring data, optimal sequencing seems to involve use of a tenofovir-containing nonnucleoside reverse-transcriptase inhibitor-based first-line regimen, followed by a zidovudine-containing, protease inhibitor (PI)-based second-line regimen. Other options and their consequences are explored by considering within-class and between-class sequencing opportunities, including boosted PI monotherapies and future options with integrase inhibitors. Nucleoside reverse-transcriptase inhibitor resistance pathways in HIV-1 subtype C suggest an additional reason for accelerating stavudine phase out. Viral load monitoring avoids the accumulation of resistance mutations that significantly reduce the activity of next-line options. Rational use of resources, including broader access to viral load monitoring, will help ensure 3 lines of fully active treatment options, thereby increasing the duration of ART success.

Systematic Evaluation of Industrial, Commercial, and Institutional Food Waste Management Strategies in the United States.

PubMed

Hodge, Keith L; Levis, James W; DeCarolis, Joseph F; Barlaz, Morton A

2016-08-16

New regulations and targets limiting the disposal of food waste have been recently enacted in numerous jurisdictions. This analysis evaluated selected environmental implications of food waste management policies using life-cycle assessment. Scenarios were developed to evaluate management alternatives applicable to the waste discarded at facilities where food waste is a large component of the waste (e.g., restaurants, grocery stores, and food processors). Options considered include anaerobic digestion (AD), aerobic composting, waste-to-energy combustion (WTE), and landfilling, and multiple performance levels were considered for each option. The global warming impact ranged from approximately -350 to -45 kg CO2e Mg(-1) of waste for scenarios using AD, -190 to 62 kg CO2e Mg(-1) for those using composting, -350 to -28 kg CO2e Mg(-1) when all waste was managed by WTE, and -260 to 260 kg CO2e Mg(-1) when all waste was landfilled. Landfill diversion was found to reduce emissions, and diverting food waste from WTE generally increased emissions. The analysis further found that when a 20 year GWP was used instead of a 100 year GWP, every scenario including WTE was preferable to every scenario including landfill. Jurisdictions seeking to enact food waste disposal regulations should consider regional factors and material properties before duplicating existing statutes.

26 CFR 1.544-4 - Options.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Options. 1.544-4 Section 1.544-4 Internal Revenue... (CONTINUED) Personal Holding Companies § 1.544-4 Options. The shares of stock which may be acquired by reason of an option shall be considered to be constructively owned by the individual having the option to...

Energy and Climate Change Report Provides Options for the White House

NASA Astrophysics Data System (ADS)

Showstack, Randy

2013-03-01

A newly approved energy and climate change report prepared by the President's Council of Advisors on Science and Technology (PCAST) provides a menu of options for President Barack Obama to consider in dealing with climate change and includes components for a national climate preparedness strategy. The report was approved at a 15 March PCAST meeting in Washington, D. C., and is subject to final edits. It is the first report by the advisory council that focuses exclusively on climate, according to PCAST member Daniel Schrag, who provided a presentation about the document at the meeting.

Functional Interface Considerations within an Exploration Life Support System Architecture

NASA Technical Reports Server (NTRS)

Perry, Jay L.; Sargusingh, Miriam J.; Toomarian, Nikzad

2016-01-01

As notional life support system (LSS) architectures are developed and evaluated, myriad options must be considered pertaining to process technologies, components, and equipment assemblies. Each option must be evaluated relative to its impact on key functional interfaces within the LSS architecture. A leading notional architecture has been developed to guide the path toward realizing future crewed space exploration goals. This architecture includes atmosphere revitalization, water recovery and management, and environmental monitoring subsystems. Guiding requirements for developing this architecture are summarized and important interfaces within the architecture are discussed. The role of environmental monitoring within the architecture is described.

Photovoltaic and thermal energy conversion for solar powered satellites

NASA Technical Reports Server (NTRS)

Von Tiesenhausen, G. F.

1976-01-01

A summary is provided concerning the most important aspects of present investigations related to a use of solar power satellites (SPS) as a future source of terrestrial energy. General SPS characteristics are briefly considered, early work is reviewed, and a description of current investigations is presented. System options presently under study include a photovoltaic array, a thermionic system, and a closed Brayton cycle. Attention is given to system reference options, basic building blocks, questions of system analysis and engineering, photovoltaic conversion, and the utility interface. It is concluded that an SPS may be cost effective compared to terrestrial systems by 1995.

Atmospheric studies in complex terrain: a planning guide for future studies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Orgill, M.M.

The objective of this study is to assist the US Department of Energy in Conducting its atmospheric studies in complex terrain (ASCOT0 by defining various complex terrain research systems and relating these options to specific landforms sites. This includes: (1) reviewing past meteorological and diffusion research on complex terrain; (2) relating specific terrain-induced airflow phenomena to specific landforms and time and space scales; (3) evaluating the technical difficulty of modeling and measuring terrain-induced airflow phenomena; and (4) avolving severdal research options and proposing candidate sites for continuing and expanding field and modeling work. To evolve research options using variable candidatemore » sites, four areas were considered: site selection, terrain uniqueness and quantification, definition of research problems and research plans. 36 references, 111 figures, 20 tables.« less

Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care?

PubMed Central

Ramirez, Pedro T.; Pareja, Rene; Rendón, Gabriel J.; Millan, Carlos; Frumovitz, Michael; Schmeler, Kathleen M.

2014-01-01

The standard treatment for women with early-stage cervical cancer (IA2-IB1) remains radical hysterectomy with pelvic lymphadenectomy. In select patients interested in future fertility, the option of radical trachelectomy with pelvic lymphadenectomy is also considered a viable option. The possibility of less radical surgery may be appropriate not only for patients desiring to preserve fertility but also for all patients with low-risk early-stage cervical cancer. Recently, a number of studies have explored less radical surgical options for early-stage cervical cancer, including simple hysterectomy, simple trachelectomy, and cervical conization with or without sentinel lymph node biopsy and pelvic lymph node dissection. Such options may be available for patients with low-risk early-stage cervical cancer. Criteria that define this low-risk group include: squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma, tumor size <2 cm, stromal invasion <10mm, and no lymph-vascular space invasion. In this report, we provide a review of the existing literature on the conservative management of cervical cancer and describe ongoing multi-institutional trials evaluating the role of conservative surgery in selected patients with early-stage cervical cancer. PMID:24041877

75 FR 17412 - Cancer Therapy Evaluation Program Intellectual Property Option to Collaborator

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-06

... Program Intellectual Property Option to Collaborator AGENCY: National Cancer Institute (NCI), National... Evaluation Program (CTEP) INTELLECTUAL PROPERTY OPTION. The proposed policy, if finalized, would establish... recommended Intellectual Property Option and Institution Notification if they wish to be considered for...

Environmental and economic analyses of waste disposal options for traditional markets in Indonesia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aye, Lu; Widjaya, E.R.

2006-07-01

Waste from traditional markets in Indonesia is the second largest stream of municipal solid waste after household waste. It has a higher organic fraction and may have greater potential to be managed on a business scale compared to household wastes. The attributed reason is that in general the wastes generated from traditional markets are more uniform, more concentrated and less hazardous than waste from other sources. This paper presents the results of environmental and economic assessments to compare the options available for traditional market waste disposal in Indonesia. The options compared were composting in labour intensive plants, composting in amore » centralised plant that utilised a simple wheel loader, centralised biogas production and landfill for electricity production. The current open dumping practice was included as the baseline case. A life cycle assessment (LCA) was used for environmental analysis. All options compared have lower environmental impacts than the current practice of open dumping. The biogas production option has the lowest environmental impacts. A cost-benefit analysis, which considered greenhouse gas savings, was used for the economic assessment. It was found that composting at a centralised plant is the most economically feasible option under the present Indonesian conditions. The approach reported in this study could be applied for 'a pre-feasibility first cut comparison' that includes environmental aspects in a decision-making framework for developing countries even though European emission factors were used.« less

Effect of allelopathic rice varieties combined with cultural management options on paddy field weeds.

PubMed

Kong, Chui-Hua; Hu, Fei; Wang, Peng; Wu, Jing-Lun

2008-03-01

A number of techniques, including cultural management, allelopathy and bioherbicide, have been considered as alternatives for synthetic herbicides, but successful weed control will require the careful integration of these multiple techniques. This study was conducted to assess the use of allelopathic rice varieties in combination with cultural management options on paddy weeds, in order to develop an allelopathy-based technique to reduce herbicide use in paddies. The weed-suppressive effects of the rice varieties tested varied highly with allelopathic trait, planting pattern and cultural management including planting density, flooding depth and duration and supply of nitrogen. Allelopathic rice varieties PI312777 and Huagan-1 demonstrated much stronger weed suppression than the non-allelopathic variety Huajianxian under the same planting pattern and cultural management. Their weed-suppressive effect was increased with cultural management options. In particular, if integrated cultural management options of allelopathic rice varieties included a low-dose (bensulfuron-methyl, 25 g AI ha(-1), a third of the recommended dose) herbicide application, the emergence and growth of most weeds found in paddy fields was completely controlled. No grain yield reduction for allelopathic varieties occurred under integrated cultural management options, whereas with the non-allelopathic variety a reduction of up to 45-60% was measurable even with the low-dose herbicide application. The allelopathic potential of rice varieties will likely have a great impact on paddy weed control if integrated with cultural management options and application of low doses of herbicides. Therefore, it is feasible to reduce herbicide input in paddies if allelopathic rice is grown under integrated cultural management practices. (c) 2008 Society of Chemical Industry.

Project HELP: a study protocol to pilot test a shared decision-making tool about treatment options for patients with hepatitis C and chronic kidney disease.

PubMed

Politi, M C; George, N; Li, T; Korenblat, K M; Fowler, K J; Ho, C; Liapakis, A; Roth, D; Yee, J

2018-01-01

Recent advances in treatment have given patients with chronic kidney disease (CKD) access to safer and more effective medications to treat comorbid hepatitis C virus (HCV) infection. Given the variety and complexity of treatment options that depend on patients' clinical characteristics and personal preferences, education and decision support are needed to prepare patients better to discuss treatment options with their clinicians. Drawing on International Patient Decision Aids Standards guidelines, literature reviews, and guidance from a diverse expert advisory group of nephrologists, hepatologists, and patients, we will develop and test a HCV and CKD decision support tool. Named Project HELP ( Helping Empower Liver and kidney Patients ), this tool will support patients with HCV and CKD during decisions about whether, when, and how to treat each illness. The tool will (1) explain information using plain language and graphics; (2) provide a step-by-step process for thinking about treating HCV and CKD; (3) tailor relevant information to each user by asking about the individual's stage of CKD, stage of fibrosis, prior treatment, and comorbidities; (4) assess user knowledge and values for treatment choices; and (5) help individuals use and consider information appropriate to their values and needs to discuss with a clinician. A pilot study including 70 individuals will evaluate the tool's efficacy, usability, and likelihood of using it in clinical practice. Eligibility criteria will include individuals who understand and read English, who are at least 18 years old, have a diagnosis of HCV (any genotype) and CKD (any stage), and are considering treatment options. This study can identify particular characteristics of individuals or groups that might experience challenges initiating treatment for HCV in the CKD population. This tool could provide a resource to facilitate patient-clinician discussions regarding HCV and CKD treatment options.

13 CFR 124.514 - Exercise of 8(a) options and modifications.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false Exercise of 8(a) options and... Contractual Assistance § 124.514 Exercise of 8(a) options and modifications. (a) Unpriced options. The exercise of an unpriced option is considered to be a new contracting action. (1) If a concern has graduated...

13 CFR 124.514 - Exercise of 8(a) options and modifications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Exercise of 8(a) options and... Contractual Assistance § 124.514 Exercise of 8(a) options and modifications. (a) Unpriced options. The exercise of an unpriced option is considered to be a new contracting action. (1) If a concern has graduated...

13 CFR 124.514 - Exercise of 8(a) options and modifications.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Exercise of 8(a) options and... Contractual Assistance § 124.514 Exercise of 8(a) options and modifications. (a) Unpriced options. The exercise of an unpriced option is considered to be a new contracting action. (1) If a concern has graduated...

13 CFR 124.514 - Exercise of 8(a) options and modifications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false Exercise of 8(a) options and... Contractual Assistance § 124.514 Exercise of 8(a) options and modifications. (a) Unpriced options. The exercise of an unpriced option is considered to be a new contracting action. (1) If a concern has graduated...

13 CFR 124.514 - Exercise of 8(a) options and modifications.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Exercise of 8(a) options and... Contractual Assistance § 124.514 Exercise of 8(a) options and modifications. (a) Unpriced options. The exercise of an unpriced option is considered to be a new contracting action. (1) If a concern has graduated...

76 FR 39221 - HUD Debt Collection: Revisions and Update to the Procedures for the Collection of Claims

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

...' Group Life Insurance and ``Basic Life'' Federal Employees' Group Life Insurance premiums are considered to be normal life insurance premiums; all optional Federal Employees' Group Life Insurance premiums... Other Actions, would include the procedures that apply when HUD seeks satisfaction of debts owed to HUD...

75 FR 73140 - Self-Regulatory Organizations; NASDAQ OMX PHLX, Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-29

... categories of participants: Customers, broker-dealers, market makers (including specialists, Registered... respect to all-or-none orders, which will be treated like customer orders), 1033(e), 1064.02 (except professional orders will be considered customer orders subject to facilitation), and 1080.08 as well as Options...

Introducing Big Data Concepts in an Introductory Technology Course

ERIC Educational Resources Information Center

Frydenberg, Mark

2015-01-01

From their presence on social media sites to in-house application data files, the amount of data that companies, governments, individuals, and sensors generate is overwhelming. The growth of Big Data in both consumer and enterprise activities has caused educators to consider options for including Big Data in the Information Systems curriculum.…

Security Implications of Electronic Commerce: A Survey of Consumers and Businesses.

ERIC Educational Resources Information Center

Furnell, S. M.; Karweni, T.

1999-01-01

Examines general requirement for security technologies that provide a basis for trust in the electronic commerce environment. Discusses the results of two surveys that included general Internet users who are potential customers as well as commercial businesses, that considered attitudes to electronic commerce in general and options relating to…

Individual Educational Programs: Issues and Options for Change. Final Report.

ERIC Educational Resources Information Center

McLaughlin, Margaret J.; And Others

Major issues concerning the Individualized Education Program (IEP) are reviewed and modifications are proposed. The history of the IEP and current legal requirements for developing IEPs are considered. Current issues with the IEP include the cost of development, the lack of parent involvement in IEP development, and the use of the IEP for…

75 FR 69148 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated: Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-10

...-customer relationship would be considered a Sponsoring Participant/Sponsored User relationship subject to... filing indicated that TPHs may also make the workstation available to their customers, including...' customers. STS would also have the ability, if it determines to do so, to permit TPHs to make the...

Nursing Education and Training: Alternative Federal Approaches. Budget Issue Paper for Fiscal Year 1979.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Congressional Budget Office.

Key issues pertinent to federal support of nursing education and training are considered. Policy options for nurse training include: support for programs to increase aggregate supply, support for programs to improve geographic distribution of nurses, support for programs to increase the availability of nurses with advanced training, and support…

Distributed problem solving by pilots and dispatchers

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Wich, Mike; Fischer, Ute; Jobe, Kim; Mccoy, Elaine; Beatty, Roger; Smith, Phil

1993-01-01

The study addressed the following question: Are flight planning problems solved differently by PILOTS and DISPATCHERS when they work alone versus when they work together? Aspect of their performance that were of interest include the following: Problem perception and definition; Problem solving strategies and information use; Options considered; Solution and rational; and errors.

Space Station needs, attributes and architectural options study. Volume 7-4A: Data book, architecture, technology and programmatics, part A

NASA Technical Reports Server (NTRS)

1983-01-01

Various parameters of the orbital space station are discussed. The space station environment, data management system, communication and tracking, environmental control, and life support system are considered. Specific topics reviewed include crew work stations, restraint systems, stowage, computer hardware, and expert systems.

Identifying and Addressing Stakeholder Interests in Design Science Research: An Analysis Using Critical Systems Heuristics

NASA Astrophysics Data System (ADS)

Venable, John R.

This paper utilises the Critical Systems Heuristics (CSH) framework developed by Werner Ulrich to critically consider the stakeholders and design goals that should be considered as relevant by researchers conducing Design Science Research (DSR). CSH provides a philosophically and theoretically grounded framework and means for critical consideration of the choices of stakeholders considered to be relevant to any system under design consideration. The paper recommends that legitimately undertaken DSR should include witnesses to represent the interests of the future consumers of the outcomes of DSR, i.e., the future clients, decision makers, professionals, and other non-included stakeholders in the future use of the solution technologies to be invented in DSR. The paper further discusses options for how witnesses might be included, who should be witnessed for and obstacles to implementing the recommendations.

Reconstruction of the midface and maxilla.

PubMed

Dalgorf, Dustin; Higgins, Kevin

2008-08-01

To review the current classification systems and reconstructive options available for restoration of maxillectomy defects. Defects involving the midface can have a great functional and aesthetic impact on the patient. Adequate restoration of the complex three-dimensional maxillary structure is required to replace form and function of the native tissue. An in-depth discussion of appropriate recipient vessel selection and reconstructive options are included in this article. The superficial temporal vessel system is presented as a reliable anastomosis site for restoration of midfacial defects. In addition, the complications of vein grafting, arteriovenous fistula loops and alternative recipient vessels sites are addressed to manage the challenge of the vessel-depleted neck. The current indications, advantages and disadvantages of local, regional and free-flap reconstructive options available for maxillectomy defects are highlighted in order to aid the surgeon in appropriate flap selection. A myriad of reconstructive options are available to restore maxillectomy defects. The surgeon must consider each defect and the needs of the individual patient when choosing the best suited reconstructive technique.

Potential new regulatory options for e-cigarettes in New Zealand.

PubMed

Wilson, Nick; Edwards, Richard; Hoek, Janet; Thomson, George; Blakely, Tony; van der Deen, Frederieke Sanne; Crane, Julian

2015-11-20

While e-cigarette usage has grown rapidly in New Zealand and around the world, the scientific evidence base regarding the net benefits and risks of these types of products at the population level remains uncertain. The health-based policy experience is also minimal. Here, we analyse plausible future regulatory options for e-cigarettes that the New Zealand Government could explore, and that further research could help clarify. These options include: (1) a full free market (an option we doubt is desirable for multiple reasons); (2) controlled increased access through: (a) pharmacy only, (b) pharmacy only plus sales by prescription/ to licensed vapers; (c) additional controls through non-profit supply/distribution (eg, public hospital pharmacies); (3) increased restrictions compared with current (eg, adopting a complete ban on self-imports and use). In addition, we consider mechanisms to improve product quality and safety, and argue that policy makers should take great care when regulating e-cigarettes, given the scientific uncertainty and the role of commercial vested interests.

Percutaneous Radiofrequency Ablation for Treatment of Recurrent Retroperitoneal Liposarcoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Keil, Sebastian, E-mail: keil@rad.rwth-aachen.de; Bruners, Philipp; Brehmer, Bernhard

2008-07-15

Percutaneous CT-guided radiofrequency ablation (RFA) is becoming more and more established in the treatment of various neoplasms, including retroperitoneal tumors of the kidneys and the adrenal glands. We report the case of RFA in a patient suffering from the third relapse of a retroperitoneal liposarcoma in the left psoas muscle. After repeated surgical resection and supportive radiation therapy of a primary retroperitoneal liposarcoma and two surgically treated recurrences, including replacement of the ureter by a fraction of the ileum, there was no option for further surgery. Thus, we considered RFA as the most suitable treatment option. Monopolar RFA was performedmore » in a single session with a 2-cm umbrella-shaped LeVeen probe. During a 27-month follow-up period the patient remained free of tumor.« less

Meta Search Engines.

ERIC Educational Resources Information Center

Garman, Nancy

1999-01-01

Describes common options and features to consider in evaluating which meta search engine will best meet a searcher's needs. Discusses number and names of engines searched; other sources and specialty engines; search queries; other search options; and results options. (AEF)

Evaluation of alternatives for best available technology treatment and retreatment of uranium-contaminated solutions at the Paducah Gaseous Diffusion Plant C-400 Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Del Cul, G.D.

1991-02-01

The Paducah Gaseous Diffusion Plant C-400 Decontamination Facility generators aqueous solutions that originate in drum washing, machine parts and equipment cleaning, and other decontamination processes. In general, the waste contains uranyl, fluoride, carbonate, and nitrate ions, in addition to soaps, detergents, secondary contaminants, and particulate matter. The main contaminants are fluoride, technetium, uranium, and other heavy metals. In accordance with Department of Energy (DOE) Order 5400.5, the releases of radioactive materials must be as low as reasonably achievable and be below the derived concentration guide limits. To comply with the DOE order, an action plan was formulated. The action planmore » included a literature search to support best available technology evaluation of treatment alternatives, a quality assurance/quality control plan, suggestion of alternative treatment options, bench-scale test studies of the proposed treatment alternatives, and establishment of the final recommendation. Five major technologies were considered: precipitation/coprecipitation, reverse osmosis, ultrafiltration, supported liquid membranes, and ion exchange. Biosorption was also briefly considered. Based on C-400's requirements and facilities, the precipitation/coprecipitation process appears to be the best suited for use at the plant. Four different treatment options using the precipitation/coprecipitation technology were proposed. Bench-scale studies of all four options were suggested. Options 1 and 2 represent a combination of lime-softening and iron coprecipitation. Laboratory test evaluations were initiated and the results involving Options 1 and 2 reported here. 29 refs., 1 fig., 2 tabs.« less

Altair Lander Life Support: Design Analysis Cycles 1, 2, and 3

NASA Technical Reports Server (NTRS)

Anderson, Molly; Rotter, Hank; Stambaugh, Imelda; Curley, Su

2009-01-01

NASA is working to develop a new lunar lander to support lunar exploration. The development process that the Altair project is using for this vehicle is unlike most others. In Lander Design Analysis Cycle 1 (LDAC-1), a single-string, minimum functionality design concept was developed, including life support systems for different vehicle configuration concepts, first for a combination of an ascent vehicle and a habitat with integral airlocks, and then for a combined ascent vehicle-habitat with a detachable airlock. In LDAC-2, the Altair team took the ascent vehicle-habitat with detachable airlock and analyzed the design for the components that were the largest contributors to the risk of loss of crew (LOC). For life support, the largest drivers were related to oxygen supply and carbon dioxide control. Integrated abort options were developed at the vehicle level. Many life support failures were not considered to result in LOC because they had a long enough time to effect that abort was considered a feasible option to safely end the mission before the situation became life threatening. These failures were then classified as loss of mission (LOM) failures. Many options to reduce LOC risk were considered, and mass efficient solutions to the LOC problems were added to the vehicle design at the end of LDAC-2. In LDAC-3, the new design was analyzed for large contributors to the risk of LOM. To avoid ending the mission early or being unable to accomplish goals like performing all planned extravehicular activities (EVAs), various options were assessed for their combination of risk reduction and mass cost. This paper outlines the major assumptions, design features, and decisions related to the development of the life support system for the Altair project through LDAC-3.

Investing in deliberation: a definition and classification of decision support interventions for people facing difficult health decisions.

PubMed

Elwyn, Glyn; Frosch, Dominick; Volandes, Angelo E; Edwards, Adrian; Montori, Victor M

2010-01-01

This article provides an analysis of 'decision aids', interventions to support patients facing tough decisions. Interest has increased since the concept of shared decision making has become widely considered to be a means of achieving desirable clinical outcomes. We consider the aims of these interventions and examine assumptions about their use. We propose three categories, interventions that are used in face-to-face encounters, those designed for use outside clinical encounters and those which are mediated, using telephone or other communication media. We propose the following definition: decision support interventions help people think about choices they face; they describe where and why choice exists; they provide information about options, including, where reasonable, the option of taking no action. These interventions help people to deliberate, independently or in collaboration with others, about options, by considering relevantattributes; they support people to forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, in ways which help the process of constructing preferences and eventual decision making, appropriate to their individual situation. Although quality standards have been published for these interventions, we are also cautious about premature closure and consider that the need for short versions for use inside clinical encounters and long versions for external use requires further research. More work is also needed on the use of narrative formats and the translation of theory into practical designs. The interest in decision support interventions for patients heralds a transformation in clinical practice although many important areas remain unresolved.

Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy.

PubMed

Ager, B; Jansen, J; Porter, D; Phillips, K A; Glassey, R; Butow, P

2018-05-22

Describe the development, acceptability and feasibility of a Decision Aid (DA) for women with early-stage breast cancer (BC) at average contralateral breast cancer (CBC) risk considering contralateral prophylactic mastectomy (CPM). The DA was developed using the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. It provides evidence-based information about CPM in a booklet format combining text, graphs and images of surgical options. Twenty-three women with a history of early-stage breast cancer were interviewed in person or over the phone using a 'think aloud approach'. Framework analysis was used to code and analyse data. Twenty-three women participated in the study. Mean age of participants was 58.6 years and time since diagnosis ranged from 14 months to 21 years. Five women had CPM and eighteen had not. Women strongly endorsed the DA. Many felt validated by a section on appearance and found information on average risk of recurrence and metastases helpful, however, noted the importance of discussing personal risk with their surgeon. Many requested more information on surgery details (time taken, recovery) and costs of the different options. The DA was acceptable to women, including the format, content and proposed implementation strategies. Practical and financial issues are important to women in considering treatment options. Women appreciate information about CPM at diagnosis and emphasised the importance of discussing potential downsides of the procedure in addition to benefits. The DA was considered acceptable to facilitate such discussions. Copyright © 2018 Elsevier Ltd. All rights reserved.

Should Title 24 Ventilation Requirements Be Amended to include an Indoor Air Quality Procedure?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dutton, Spencer M.; Mendell, Mark J.; Chan, Wanyu R.

Minimum outdoor air ventilation rates (VRs) for buildings are specified in standards, including California?s Title 24 standards. The ASHRAE ventilation standard includes two options for mechanically-ventilated buildings ? a prescriptive ventilation rate procedure (VRP) that specifies minimum VRs that vary among occupancy classes, and a performance-based indoor air quality procedure (IAQP) that may result in lower VRs than the VRP, with associated energy savings, if IAQ meeting specified criteria can be demonstrated. The California Energy Commission has been considering the addition of an IAQP to the Title 24 standards. This paper, based on a review of prior data and newmore » analyses of the IAQP, evaluates four future options for Title 24: no IAQP; adding an alternate VRP, adding an equivalent indoor air quality procedure (EIAQP), and adding an improved ASHRAE-like IAQP. Criteria were established for selecting among options, and feedback was obtained in a workshop of stakeholders. Based on this review, the addition of an alternate VRP is recommended. This procedure would allow lower minimum VRs if a specified set of actions were taken to maintain acceptable IAQ. An alternate VRP could also be a valuable supplement to ASHRAE?s ventilation standard.« less

Policy options for increasing the supply of transplantable kidneys in Singapore

PubMed Central

Chong, Jia Loon

2016-01-01

Kidney transplantation is the preferred treatment for eligible end-stage renal disease patients. However, the supply of donated kidneys has been consistently insufficient to meet the transplantation requirements of the population. In this paper, I discuss the feasibility of several policy options that engage potential donors or key individuals in a Singapore context, including financial and non-financial incentives for deceased/living organ donors and their families, improving actualisation rates of both donation after brain death, donation after cardiac death through quality improvement programmes and remuneration schemes, and a media platform for directed organ donation. I conclude by highlighting the most feasible policies to be considered. PMID:27779281

Space Operations Center system analysis study extension. Volume 2: Programmatics and cost

NASA Technical Reports Server (NTRS)

1982-01-01

A summary of Space Operations Center (SOC) orbital space station costs, program options and program recommendations is presented. Program structure, hardware commonality, schedules and program phasing are considered. Program options are analyzed with respect to mission needs, design and technology options, and anticipated funding constraints. Design and system options are discussed.

Patient knowledge on stroke risk factors, symptoms and treatment options.

PubMed

Faiz, Kashif Waqar; Sundseth, Antje; Thommessen, Bente; Rønning, Ole Morten

2018-01-01

Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients. This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: "Do you believe that stroke is a serious disorder?" and "Do you believe that time is of importance for stroke treatment?". In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could. A total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger ( p <0.001) and had higher educational level ( p <0.001), but had a nonsignificant shorter prehospital delay time ( p =0.292). The level of stroke treatment knowledge in stroke patients seems to be poor. Public campaigns should probably also focus on information on treatment options, which may contribute to reduce prehospital delay and onset-to-treatment-time.

Queering Chapter Books with LGBT Characters for Young Readers: Recognizing and Complicating Representations of Homonormativity

ERIC Educational Resources Information Center

Hermann-Wilmarth, Jill M.; Ryan, Caitlin L.

2016-01-01

In this paper, we consider the limited chapter book options with lesbian, gay, bisexual, and transgender (LGBT) characters available for upper elementary readers. While these texts all include one or more LGBT character(s), the overall representations of LGBT people and issues highlight particular normative identities and silence others. We are…

Attitudes towards Industrial Training in the BEng. Course in Building Services Engineering at Hong Kong Polytechnic.

ERIC Educational Resources Information Center

Yeung, Y. N. Au; And Others

1993-01-01

A survey of staff, industrial sector members, and current and past students in a Hong Kong Polytechnic cooperative education program investigated perceptions of the academic and nonacademic values of the system and the needs of local industries. Program design options are considered, including part-time and full-time study. (MSE)

Dynamic overset grid communication on distributed memory parallel processors

NASA Technical Reports Server (NTRS)

Barszcz, Eric; Weeratunga, Sisira K.; Meakin, Robert L.

1993-01-01

A parallel distributed memory implementation of intergrid communication for dynamic overset grids is presented. Included are discussions of various options considered during development. Results are presented comparing an Intel iPSC/860 to a single processor Cray Y-MP. Results for grids in relative motion show the iPSC/860 implementation to be faster than the Cray implementation.

The Hidden Costs of Owning a Microcomputer.

ERIC Educational Resources Information Center

McDole, Thomas L.

Before purchasing computer hardware, individuals must consider the costs associated with the setup and operation of a microcomputer system. Included among the initial costs of purchasing a computer are the costs of the computer, one or more disk drives, a monitor, and a printer as well as the costs of such optional peripheral devices as a plotter…

13 CFR 125.9 - Who does SBA consider to own an SDVO SBC?

Code of Federal Regulations, 2010 CFR

2010-01-01

.... Ownership by a trust, such as a living trust, may be treated as the functional equivalent of ownership by... unexercised stock options or similar agreements (including rights to convert non-voting stock or debentures into voting stock) held by non-service-disabled veterans sill be treated as exercised, except for any...

13 CFR 125.9 - Who does SBA consider to own an SDVO SBC?

Code of Federal Regulations, 2012 CFR

2012-01-01

.... Ownership by a trust, such as a living trust, may be treated as the functional equivalent of ownership by... unexercised stock options or similar agreements (including rights to convert non-voting stock or debentures into voting stock) held by non-service-disabled veterans sill be treated as exercised, except for any...

Greenhouse gas mitigation options in the Forest sector of Russia: National and project level assessments

NASA Astrophysics Data System (ADS)

Vinson, Ted S.; Kolchugina, Tatyana P.; Andrasko, Kenneth A.

1996-01-01

Greenhouse gas (GHG) mitigation options in the Russian forest sector include: afforestation and reforestation of unforested/degraded land area; enhanced forest productivity; incorporation of nondestructive methods of wood harvesting in the forest industry; establishment of land protective forest stands; increase in stand age of final harvest in the European part of Russia; increased fire control; increased disease and pest control; and preservation of old growth forests in the Russian Far-East, which are presently threatened. Considering the implementation of all of the options presented, the GHG mitigation potential within the forest and agroforestry sectors of Russia is approximately 0.6 0.7 Pg C/yr or one half of the industrial carbon emissions of the United States. The difference between the GHG mitigation potential and the actual level of GHGs mitigated in the Russian forest sector will depend to a great degree on external financing that may be available. One possibility for external financing is through joint implementation (JI). However, under the JI process, each project will be evaluated by considering a number of criteria including also the difference between the carbon emissions or sequestration for the baseline (or reference) and the project case, the permanence of the project, and leakage. Consequently, a project level assessment must appreciate the near-term constraints that will face practitioners who attempt to realize the GHG mitigation potential in the forest and agroforestry sectors of their countries.

Cost-effectiveness of the management of rh-negative pregnant women.

PubMed

Duplantie, Julie; Gonzales, Odilon Martinez; Bois, Antoine; Nshimyumukiza, Léon; Gekas, Jean; Bujold, Emmanuel; Morin, Valérie; Vallée, Maud; Giguère, Yves; Gagné, Christian; Rousseau, François; Reinharz, Daniel

2013-08-01

The purpose of this study was to determine the most cost-effective option to prevent alloimmunization against the Rh factor. A virtual population of Rh-negative pregnant women in Quebec was built to simulate the cost-effectiveness of preventing alloimmunization. The model considered four options: (1) systematic use of anti-D immunoglobulin; (2) fetal Rh(D) genotyping; (3) immunological determination of the father's Rh type; (4) mixed screening: immunological determination of the father's Rh type, followed if positive by fetal Rh(D) genotyping. Two outcomes were considered, in addition to the estimated costs: (1) the number of babies without hemolytic disease, and (2) the number of surviving infants. In a first pregnancy, two options emerged as the most cost-effective options: systematic prophylaxis and immunological Rh typing of the father, with overlapping confidence intervals between them. In a second pregnancy, the results were similar. In all cases (first or second pregnancy or a combination of the two) fetal genotyping was not found to be a cost-effective option. Routine prophylaxis and immunological Rh typing of the father are the most cost-effective options for the prevention of Rh alloimmunization. Considering that immunological typing of the father would probably not be carried out by the majority of clinicians, routine prophylaxis remains the preferred option. However, this could change if the cost of Rh(D) fetal genotyping fell below $140 per sample.

26 CFR 1.1563-3 - Rules for determining stock ownership.

Code of Federal Regulations, 2010 CFR

2010-04-01

... acquire such stock. For example, assume Smith owns an option to purchase 100 shares of the outstanding stock of M Corporation. Under this subparagraph, Smith is considered to own such 100 shares. The result would be the same if Smith owned an option to acquire the option (or one of a series of options) to...

Identify potential lock treatment options to prevent movement of aquatic invasive species through the Chicago Area Waterways System (CAWS)

USGS Publications Warehouse

Hubert, Terrance D.; Boogaard, Michael A.; Fredricks, Kim T.

2016-01-14

Compatibility of the various options was also evaluated to assess the possibility that options could be combined to enhance efficacy. Engineering requirements were not considered as part of this evaluation. The available information suggests that hot water at 43 °C and ozone are the most feasible options.

Options for management of municipal solid waste in New York City: A preliminary comparison of health risks and policy implications

PubMed Central

Moy, Pearl; Krishnan, Nikhil; Ulloa, Priscilla; Cohen, Steven; Brandt-Rauf, Paul W.

2008-01-01

Landfill disposal and waste-to-energy (WTE) incineration remain the two principal options for managing municipal solid waste (MSW). One critical determinant of the acceptability of these options is the different health risks associated with each. In this analysis relying on published data and exposure modeling, we have performed health risk assessments for landfill disposal versus WTE treatment options for the management of New York City’s MSW. These are based on the realistic scenario of using a waste transfer station (WTS) in Brooklyn and then transporting the untreated MSW by truck to a landfill in Pennsylvania or using a WTE facility in Brooklyn and then transporting the resultant ash by truck to a landfill in Pennsylvania. The overall results indicate that the individual cancer risks for both options would be considered generally acceptable, although the risk from landfilling is approximately 5 times greater than from WTE treatment; the individual non-cancer health risks for both options would be considered generally unacceptable, although once again the risk from landfilling is approximately 5 times greater than from WTE treatment. If one considers only the population in Brooklyn that would be directly affected by the siting of either a WTS or a WTE facility in their immediate neighborhood, individual cancer and non-cancer health risks for both options would be considered generally acceptable, but risks for the former remain considerably higher than for the latter. These results should be considered preliminary due to several limitations of this study such as: consideration of risks only from inhalation exposures; assumption that only volume and not composition of the waste stream is altered by WTE treatment; reliance on data from the literature rather than actual measurements of the sites considered, assuming comparability of the sites. However, the results of studies such as this, in conjunction with ecological, socioeconomic and equity considerations, should prove useful to environmental managers, regulators, policy makers, community representatives and other stakeholders in making sound and acceptable decisions regarding the optimal handling of MSW. PMID:17379391

Practice Parameters for the Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults

PubMed Central

Aurora, R. Nisha; Casey, Kenneth R.; Kristo, David; Auerbach, Sanford; Bista, Sabin R.; Chowdhuri, Susmita; Karippot, Anoop; Lamm, Carin; Ramar, Kannan; Zak, Rochelle; Morgenthaler, Timothy I.

2010-01-01

Background: Practice parameters for the treatment of obstructive sleep apnea syndrome (OSAS) in adults by surgical modification of the upper airway were first published in 1996 by the American Academy of Sleep Medicine (formerly ASDA). The following practice parameters update the previous practice parameters. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Methods: A systematic review of the literature was performed, and the GRADE system was used to assess the quality of evidence. The findings from this evaluation are provided in the accompanying review paper, and the subsequent recommendations have been developed from this review. The following procedures have been included: tracheostomy, maxillo-mandibular advancement (MMA), laser assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP),radiofrequency ablation (RFA), and palatal implants. Recommendations: The presence and severity of obstructive sleep apnea must be determined before initiating surgical therapy (Standard). The patient should be advised about potential surgical success rates and complications, the availability of alternative treatment options such as nasal positive airway pressure and oral appliances, and the levels of effectiveness and success rates of these alternative treatments (Standard). The desired outcomes of treatment include resolution of the clinical signs and symptoms of obstructive sleep apnea and the normalization of sleep quality, the apnea-hypopnea index, and oxyhemoglobin saturation levels (Standard). Tracheostomy has been shown to be an effective single intervention to treat obstructive sleep apnea. This operation should be considered only when other options do not exist, have failed, are refused, or when this operation is deemed necessary by clinical urgency (Option). MMA is indicated for surgical treatment of severe OSA in patients who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances, which are more often appropriate in mild and moderate OSA patients, have been considered and found ineffective or undesirable (Option). UPPP as a sole procedure, with or without tonsillectomy, does not reliably normalize the AHI when treating moderate to severe obstructive sleep apnea syndrome. Therefore, patients with severe OSA should initially be offered positive airway pressure therapy, while those with moderate OSA should initially be offered either PAP therapy or oral appliances (Option). Use of multi-level or stepwise surgery (MLS), as a combined procedure or as stepwise multiple operations, is acceptable in patients with narrowing of multiple sites in the upper airway, particularly if they have failed UPPP as a sole treatment (Option). LAUP is not routinely recommended as a treatment for obstructive sleep apnea syndrome (Standard). RFA can be considered as a treatment in patients with mild to moderate obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Palatal implants may be effective in some patients with mild obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Postoperatively, after an appropriate period of healing, patients should undergo follow-up evaluation including an objective measure of the presence and severity of sleep-disordered breathing and oxygen saturation, as well as clinical assessment for residual symptoms. Additionally, patients should be followed over time to detect the recurrence of disease (Standard). Conclusions: While there has been significant progress made in surgical techniques for the treatment of OSA, there is a lack of rigorous data evaluating surgical modifications of the upper airway. Systematic and methodical investigations are needed to improve the quality of evidence, assess additional outcome measures, determine which populations are most likely to benefit from a particular procedure or procedures, and optimize perioperative care. Citation: Aurora RN; Casey KR; Kristo D; Auerbach S; Bista SR; Chowdhuri S; Karippot A; Lamm C; Ramar K; Zak R; Morgenthaler TI. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. SLEEP 2010;33(10):1408-1413. PMID:21061864

Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report.

PubMed

Morgenthaler, Timothy I; Lee-Chiong, Teofilo; Alessi, Cathy; Friedman, Leah; Aurora, R Nisha; Boehlecke, Brian; Brown, Terry; Chesson, Andrew L; Kapur, Vishesh; Maganti, Rama; Owens, Judith; Pancer, Jeffrey; Swick, Todd J; Zak, Rochelle

2007-11-01

The expanding science of circadian rhythm biology and a growing literature in human clinical research on circadian rhythm sleep disorders (CRSDs) prompted the American Academy of Sleep Medicine (AASM) to convene a task force of experts to write a review of this important topic. Due to the extensive nature of the disorders covered, the review was written in two sections. The first review paper, in addition to providing a general introduction to circadian biology, addresses "exogenous" circadian rhythm sleep disorders, including shift work disorder (SWD) and jet lag disorder (JLD). The second review paper addresses the "endogenous" circadian rhythm sleep disorders, including advanced sleep phase disorder (ASPD), delayed sleep phase disorder (DSPD), irregular sleep-wake rhythm (ISWR), and the non-24-hour sleep-wake syndrome (nonentrained type) or free-running disorder (FRD). These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the AASM to present recommendations for the assessment and treatment of CRSDs based on the two accompanying comprehensive reviews. The main diagnostic tools considered include sleep logs, actigraphy, the Morningness-Eveningness Questionnaire (MEQ), circadian phase markers, and polysomnography. Use of a sleep log or diary is indicated in the assessment of patients with a suspected circadian rhythm sleep disorder (Guideline). Actigraphy is indicated to assist in evaluation of patients suspected of circadian rhythm disorders (strength of recommendation varies from "Option" to "Guideline," depending on the suspected CRSD). Polysomnography is not routinely indicated for the diagnosis of CRSDs, but may be indicated to rule out another primary sleep disorder (Standard). There is insufficient evidence to justify the use of MEQ for the routine clinical evaluation of CRSDs (Option). Circadian phase markers are useful to determine circadian phase and confirm the diagnosis of FRD in sighted and unsighted patients but there is insufficient evidence to recommend their routine use in the diagnosis of SWD, JLD, ASPD, DSPD, or ISWR (Option). Additionally, actigraphy is useful as an outcome measure in evaluating the response to treatment for CRSDs (Guideline). A range of therapeutic interventions were considered including planned sleep schedules, timed light exposure, timed melatonin doses, hypnotics, stimulants, and alerting agents. Planned or prescribed sleep schedules are indicated in SWD (Standard) and in JLD, DSPD, ASPD, ISWR (excluding elderly-demented/nursing home residents), and FRD (Option). Specifically dosed and timed light exposure is indicated for each of the circadian disorders with variable success (Option). Timed melatonin administration is indicated for JLD (Standard); SWD, DSPD, and FRD in unsighted persons (Guideline); and for ASPD, FRD in sighted individuals, and for ISWR in children with moderate to severe psychomotor retardation (Option). Hypnotic medications may be indicated to promote or improve daytime sleep among night shift workers (Guideline) and to treat jet lag-induced insomnia (Option). Stimulants may be indicated to improve alertness in JLD and SWD (Option) but may have risks that must be weighed prior to use. Modafinil may be indicated to improve alertness during the night shift for patients with SWD (Guideline).

Gastroparesis: a review of current and emerging treatment options

PubMed Central

Enweluzo, Chijioke; Aziz, Fahad

2013-01-01

Gastroparesis is a motility disorder of the stomach causing delay in food emptying from the stomach without any evidence of mechanical obstruction. The majority of cases are idiopathic. Patients need to be diagnosed properly by formal testing, and the evaluation of the severity of the gastroparesis may assist in guiding therapy. Initially, dietary modifications are encouraged, which include frequent and small semisolid-based meals. Promotility medications, like erythromycin, and antiemetics, like prochlorperazine, are offered for symptom relief. In patients who are refractory to pharmacologic treatment, more invasive options, such as intrapyloric botulinum toxin injections, placement of a jejunostomy tube, or implantation of a gastric stimulator, can be considered. Hemin therapy and gastric electric stimulation are emerging treatment options that are still at different stages of research. Regenerative medicine and stem cell-based therapies also hold promise for gastroparesis in the near future. PMID:24039443

How Should Clinicians Counsel a Woman with a Strong Family History of Early-Onset Alzheimer's Disease about Her Pregnancy?

PubMed

Mapes, Marianna V; O'Brien, Barbara M; King, Louise P

2017-07-01

Counseling patients regarding the benefits, harms, and dilemmas of genetic testing is one of the greatest ethical challenges facing reproductive medicine today. With or without test results, clinicians grapple with how to communicate potential genetic risks as patients weigh their reproductive options. Here, we consider a case of a woman with a strong family history of early-onset Alzheimer's disease (EOAD). She is early in her pregnancy and unsure about learning her own genetic status. We address the ethical ramifications of each of her options, which include genetic testing, genetic counseling, and termination versus continuation of the pregnancy. Our analysis foregrounds clinicians' role in helping to ensure autonomous decision making as the patient reflects on these clinical options in light of her goals and values. © 2017 American Medical Association. All Rights Reserved.

75 FR 26738 - Sunshine Act Meeting Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-12

... Considered: Agenda: (1) Consideration of the trading of futures and binary options based on motion picture... revenues collared futures and binary option contracts, and the Cantor Exchange (``Cantor'') The Expendables... related to MDEX's Takers opening weekend motion picture revenues collared futures and binary option...

Methodological considerations for economic modelling of latent tuberculous infection screening in migrants.

PubMed

Shedrawy, J; Siroka, A; Oxlade, O; Matteelli, A; Lönnroth, K

2017-09-01

Tuberculosis (TB) in migrants from endemic to low-incidence countries results mainly from the reactivation of latent tuberculous infection (LTBI). LTBI screening policies for migrants vary greatly between countries, and the evidence on the cost-effectiveness of the different approaches is weak and heterogeneous. The aim of this review was to assess the methodology used in published economic evaluations of LTBI screening among migrants to identify critical methodological options that must be considered when using modelling to determine value for money from different economic perspectives. Three electronic databases were searched and 10 articles were included. There was considerable variation across this small number of studies with regard to economic perspective, main outcomes, modelling technique, screening options and target populations considered, as well as in parameterisation of the epidemiological situation, test accuracy, efficacy, safety and programme performance. Only one study adopted a societal perspective; others adopted a health care or wider government perspective. Parameters representing the cascade of screening and treating LTBI varied widely, with some studies using highly aspirational scenarios. This review emphasises the need for a more harmonised approach for economic analysis, and better transparency in how policy options and economic perspectives influence methodological choices. Variability is justifiable for some parameters. However, sufficient data are available to standardise others. A societal perspective is ideal, but can be challenging due to limited data. Assumptions about programme performance should be based on empirical data or at least realistic assumptions. Results should be interpreted within specific contexts and policy options, with cautious generalisations.

Optimization of European call options considering physical delivery network and reservoir operation rules

NASA Astrophysics Data System (ADS)

Cheng, Wei-Chen; Hsu, Nien-Sheng; Cheng, Wen-Ming; Yeh, William W.-G.

2011-10-01

This paper develops alternative strategies for European call options for water purchase under hydrological uncertainties that can be used by water resources managers for decision making. Each alternative strategy maximizes its own objective over a selected sequence of future hydrology that is characterized by exceedance probability. Water trade provides flexibility and enhances water distribution system reliability. However, water trade between two parties in a regional water distribution system involves many issues, such as delivery network, reservoir operation rules, storage space, demand, water availability, uncertainty, and any existing contracts. An option is a security giving the right to buy or sell an asset; in our case, the asset is water. We extend a flow path-based water distribution model to include reservoir operation rules. The model simultaneously considers both the physical distribution network as well as the relationships between water sellers and buyers. We first test the model extension. Then we apply the proposed optimization model for European call options to the Tainan water distribution system in southern Taiwan. The formulation lends itself to a mixed integer linear programming model. We use the weighing method to formulate a composite function for a multiobjective problem. The proposed methodology provides water resources managers with an overall picture of water trade strategies and the consequence of each strategy. The results from the case study indicate that the strategy associated with a streamflow exceedence probability of 50% or smaller should be adopted as the reference strategy for the Tainan water distribution system.

Accounting for Irish Catholic ill health in Scotland: a qualitative exploration of some links between 'religion', class and health.

PubMed

Walls, Patricia; Williams, Rory

2004-07-01

This paper considers the ways in which accounts from Glasgow Catholics diverge from those of Protestants and explores the reasons why people leave jobs, including health grounds. Accounts reveal experiences distinctive to Catholics, of health-threatening stress, obstacles to career progression within (mainly) private-sector organisations, and interactional difficulties which create particular problems for (mainly) middle class men. This narrows the employment options for upwardly mobile Catholics, who may then resort to self-employment or other similarly stressful options. The paper considers whether the competence of Catholics or Catholic cultural factors are implicated in thwarting social mobility among Catholics or, alternatively, whether institutional sectarianism is involved. We conclude that, of these options, theories of institutional sectarianism provide the hypothesis which currently best fits these data. In Glasgow, people of indigenous Irish descent are recognisable from their names and Catholic background and are identified as Catholic by others. Overt historical exclusion of Catholics from middle class employment options now seems to take unrecognised forms in routine assumptions and practices which restrict Catholic employment opportunities. It is argued that younger Catholics use education to overcome the obstacles to mobility faced by older people and circumvent exclusions by recourse to middle class public-sector employment. This paper aims to link historical, structural and sectarian patterns of employment experience to accounts of health and work, and in so doing to contribute to an explanation for the relatively poor health of Catholic Glaswegians with Irish roots.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rigali, Mark J.; Pye, Steven; Hardin, Ernest

This study considers the feasibility of large diameter deep boreholes for waste disposal. The conceptual approach considers examples of deep large diameter boreholes that have been successfully drilled, and also other deep borehole designs proposed in the literature. The objective for large diameter boreholes would be disposal of waste packages with diameters of 22 to 29 inches, which could enable disposal of waste forms such as existing vitrified high level waste. A large-diameter deep borehole design option would also be amenable to other waste forms including calcine waste, treated Na-bonded and Na-bearing waste, and Cs and Sr capsules.

Accidental spills at sea--risk, impact, mitigation and the need for co-ordinated post-incident monitoring.

PubMed

Kirby, Mark F; Law, Robin J

2010-06-01

A fully integrated and effective response to an oil or chemical spill at sea must include a well planned and executed post-incident assessment of environmental contamination and damage. While salvage, rescue and clean-up operations are generally well considered, including reviews and exercises, the expertise, resources, networks and logistical planning required to achieve prompt and effective post-spill impact assessment and monitoring are not generally well established. The arrangement and co-ordination of post-incident monitoring and impact assessment need to consider sampling design, biological effects, chemical analysis and collection/interpretation of expert local knowledge. This paper discusses the risks, impacts and mitigation options associated with accidental spills and considers the importance of pre-considered impact assessment and monitoring programmes in the wider response cycle. The PREMIAM (Pollution Response in Emergencies: Marine Impact Assessment and Monitoring; www.premiam.org) project is considered as an example of an improved approach to the planning, co-ordination and conduct of post-incident monitoring.

Modular space station phase B extension period executive summary

NASA Technical Reports Server (NTRS)

Tischler, A. A.; Could, C. L.

1972-01-01

A narrative summary is presented of technical, programmatic, and planning information developed during the space station definition study extension period. The modular space station is emphasized, but tasks pertaining to shuttle sorties missions and information management advanced development are included. A series of program options considering technical, schedule, and programmatic alternatives to the baseline program are defined and evaluated.

Modeling Firing Range Best Management Practices with TREECS (trademark)

DTIC Science & Technology

2013-06-01

is reduced. Phytoremediation can also be considered a source treatment BMP when plants uptake and transform the MC into other chemical forms that are...the amendment, and the local soil conditions. Phytoremediation includes phytoextraction, phytostabilization, and phytotransformation...model can then be run as usual while taking into account the phytoremediation of the MC. Phytotransformation is being implemented as an option in

How to Organize a Community Assembly Based on a New England Town Meeting Format: A Technique for Determining Community Priorities.

ERIC Educational Resources Information Center

Bolton Inst., Inc., Wellesley, MA.

This model, developed and tested in Vermont, involved a two-day assembly using a technique concentrating on small-group dynamics to encourage productive community assessment and decision-making. Included are exhaustive documentation of an example assembly to consider options for integrating human and environmental requirements in Vermont as a…

Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents

PubMed Central

Gaidos, Jill KJ; Draganov, Peter V

2009-01-01

Malignant gastroduodenal obstruction can occur in up to 20% of patients with primary pancreatic, gastric or duodenal carcinomas. Presenting symptoms include nausea, vomiting, abdominal distention, pain and decreased oral intake which can lead to dehydration, malnutrition, and poor quality of life. Endoscopic stent placement has become the primary therapeutic modality because it is safe, minimally invasive, and a cost-effective option for palliation. Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement, shorter time to resumption of an oral diet, and shorter hospital stays as compared with surgical options. Recurrence of the obstructive symptoms resulting from stent occlusion, due to tumor ingrowth or overgrowth, can be successfully treated with repeat endoscopic stent placement in the majority of the cases. Both endoscopic stenting and surgical bypass are considered palliative treatments and, to date, no improvement in survival with either modality has been demonstrated. A tailored therapeutic approach, taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist, surgeon, medical oncologist, radiation therapist, and interventional radiologist, should be considered in all cases. PMID:19764086

75 FR 49475 - Petroleum Wax Candles From the People's Republic of China: Preliminary Results of Request for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-13

... prior scope rulings, refers to candles that are in the shapes of identifiable objects, or are holiday... 30686 (August 28, 1996) (``Order''). Option A: The Department would consider all candle shapes...-related art. All other candle shapes would be considered outside of the scope of the Order. Option B: The...

Study to define an approach for developing a computer-based system capable of automatic, unattended assembly/disassembly of spacecraft, phase 1

NASA Technical Reports Server (NTRS)

Nevins, J. L.; Defazio, T. L.; Seltzer, D. S.; Whitney, D. E.

1981-01-01

The initial set of requirements for additional studies necessary to implement a space-borne, computer-based work system capable of achieving assembly, disassembly, repair, or maintenance in space were developed. The specific functions required of a work system to perform repair and maintenance were discussed. Tasks and relevant technologies were identified and delineated. The interaction of spacecraft design and technology options, including a consideration of the strategic issues of repair versus retrieval-replacement or destruction by removal were considered along with the design tradeoffs for accomplishing each of the options. A concept system design and its accompanying experiment or test plan were discussed.

S3 Guideline for the treatment of psoriasis vulgaris, update - Short version part 1 - Systemic treatment.

PubMed

Nast, Alexander; Amelunxen, Lasse; Augustin, Matthias; Boehncke, Wolf-Henning; Dressler, Corinna; Gaskins, Matthew; Härle, Peter; Hoffstadt, Bernd; Klaus, Joachim; Koza, Joachim; Mrowietz, Ulrich; Ockenfels, Hans-Michael; Philipp, Sandra; Reich, Kristian; Rosenbach, Thomas; Rzany, Berthold; Schlaeger, Martin; Schmid-Ott, Gerhard; Sebastian, Michael; von Kiedrowski, Ralph; Weberschock, Tobias

2018-05-01

The German guideline for the treatment of psoriasis vulgaris was updated using GRADE methodology. The guideline is based on a systematic literature review completed on December 1, 2016, and on a formal consensus and approval process. The first section of this short version of the guideline covers systemic treatment options considered relevant by the expert panel and approved in Germany at the time of the consensus conference (acitretin, adalimumab, apremilast, cyclosporine, etanercept, fumaric acid esters, infliximab, methotrexate, secukinumab and ustekinumab). Detailed information is provided on the management and monitoring of the included treatment options. © 2018 The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

Policy options for increasing the supply of transplantable kidneys in Singapore.

PubMed

Chong, Jia Loon

2016-10-01

Kidney transplantation is the preferred treatment for eligible end-stage renal disease patients. However, the supply of donated kidneys has been consistently insufficient to meet the transplantation requirements of the population. In this paper, I discuss the feasibility of several policy options that engage potential donors or key individuals in a Singapore context, including financial and non-financial incentives for deceased/living organ donors and their families, improving actualisation rates of both donation after brain death, donation after cardiac death through quality improvement programmes and remuneration schemes, and a media platform for directed organ donation. I conclude by highlighting the most feasible policies to be considered. Copyright: © Singapore Medical Association.

Pharmacoeconomic evaluations of antifungal therapies.

PubMed

Hennen, Cynthia R

2009-07-01

Invasive fungal infections are a growing source of morbidity and mortality in the United States and are associated with excess hospital stay and costs. Although clinicians now have more effective and safe treatment options for invasive candidiasis, evidence confirming the pharmacoeconomic benefits of newer treatment options such as the echinocandins is scarce as few rigorous pharmacoeconomic studies have been completed in the arena of invasive fungal infections. Beyond the cost of drug acquisition, costs associated with ineffective treatment and significant drug-related side-effects must be factored into pharmacoeconomic analysis. Additional administrative costs may need to be considered when a formulary medication switch is undertaken, including those involved with re-education of clinicians unfamiliar with the newer product.

Pharmacologic Treatments for Binge-Eating Disorder.

PubMed

McElroy, Susan L

2017-01-01

Binge-eating disorder (BED) is the most common eating disorder and is associated with poor physical and mental health outcomes. Psychological and behavioral interventions have been a mainstay of treatment for BED, but as understanding of this disorder has grown, pharmacologic agents have become promising treatment options for some patients. At this time, only one drug-the stimulant prodrug lisdexamfetamine-is approved for the treatment of BED. Numerous classes of medications including antidepressants, anticonvulsants, and antiobesity drugs have been explored as off-label treatments for BED with variable success. Although not all patients with BED may be suitable candidates for pharmacotherapy, all patients should be considered for and educated about pharmacologic treatment options. © Copyright 2017 Physicians Postgraduate Press, Inc.

Preconditions for market solution to urban water scarcity: Empirical results from Hyderabad City, India

NASA Astrophysics Data System (ADS)

Saleth, R. Maria; Dinar, Ariel

2001-01-01

Utilizing both primary and secondary information pertaining to the water sector of Hyderabad City, India, this paper (1) evaluates the economics of various technically feasible supply augmentations options; (2) estimates the group-specific water demand and consumption response functions under alternative pricing behaviors; (3) calculates the net willingness to pay (NWTP, considered to be the value of raw water at source) of different user groups as derived from their respective price elasticities; (4) shows how inadequate the NWTP is to justify most supply augmentation options including intersectoral water transfers under the existing water rate structure; (5) argues that the economic and institutional conditions internal to urban water sector cannot justify an externally imposed water transfers, whether market-based or otherwise, as long as the water rate structure is inefficient and regressive; and (6) concludes by underlining the central role that the pricing option, both the level and structure, plays not only in activating a number of nonprice options but also in generating incentives for the emergence of new and the consolidation of existing institutional conditions needed to support economically rooted water transfers and conservation initiatives.

Nuclear risk assessment for the Mars 2020 mission environmental impact statement.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clayton, Daniel James; Bignell, John L.; Jones, Christopher Andrew

In the summer of 2020, the National Aeronautics and Space Administration (NASA) plans to launch a spacecraft as part of the Mars 2020 mission. One option for the rover on the proposed spacecraft uses a Multi-Mission Radioisotope Thermoelectric Generator (MMRTG) to provide continuous electrical and thermal power for the mission. An alternative option being considered is a set of solar panels for electrical power with up to 80 Light-Weight Radioisotope Heater Units (LWRHUs) for local component heating. Both the MMRTG and the LWRHUs use radioactive plutonium dioxide. NASA is preparing an Environmental Impact Statement (EIS) in accordance with the Nationalmore » Environmental Policy Act. The EIS will include information on the risks of mission accidents to the general public and on-site workers at the launch complex. This Nuclear Risk Assessment (NRA) addresses the responses of the MMRTG or LWRHU options to potential accident and abort conditions during the launch opportunity for the Mars 2020 mission and the associated consequences. This information provides the technical basis for the radiological risks of both options for the EIS.« less

Recurrent pericarditis: new and emerging therapeutic options.

PubMed

Imazio, Massimo; Lazaros, George; Brucato, Antonio; Gaita, Fiorenzo

2016-02-01

Recurrent pericarditis is one of the most common and troublesome complications after an episode of pericarditis, and affects 20-50% of patients treated for pericarditis. In most of these patients, the pericarditis remains idiopathic, although an immune-mediated (either autoimmune or autoinflammatory) pathogenesis is often presumed. The mainstay of therapy for recurrences is aspirin or NSAIDs, with the adjunct of colchicine. Corticosteroids are a second-line option to be considered for specific indications, such as connective tissue disease or pregnancy; contraindications or intolerance to aspirin, NSAIDs, and/or colchicine; or insufficient response to these medications. Furthermore, corticosteroids can be added to NSAIDs and colchicine in patients with persistent symptoms. In patients who do not respond adequately to any of these conventional therapies, alternative treatment options include azathioprine, intravenous human immunoglobulins, and anakinra. An improved understanding of how recurrent pericarditis develops after an initiating event is critical to prevent this complication, and further research is needed into the pathogenesis of recurrences. We discuss the aetiology and diagnosis of recurrent pericarditis, and extensively review the treatment options for this condition.

Multi-criteria analysis for municipal solid waste management in a Brazilian metropolitan area.

PubMed

Santos, Simone Machado; Silva, Maisa Mendonça; Melo, Renata Maciel; Gavazza, Savia; Florencio, Lourdinha; Kato, Mario T

2017-10-15

The decision-making process involved in municipal solid waste management (MSWM) must consider more than just financial aspects, which makes it a difficult task in developing countries. The Recife Metropolitan Region (RMR) in the Northeast of Brazil faces a MSWM problem that has been ongoing since the 1970s, with no common solution. In order to direct short-term solutions, three MSWM alternatives were outlined for the RMR, considering the current and future situations, the time and cost involved and social/environmental criteria. A multi-criteria approach, based on the Preference Ranking Organization Method for Enrichment Evaluations (PROMETHEE), was proposed to rank these alternatives. The alternative that included two private landfill sites and seven transfer, sorting and composting stations was confirmed as the most suitable and stable option for short-term MSWM, considering the two scenarios for the criteria weights. Sensitivity analysis was also performed to support the robustness of the results. The implementation of separate collections would minimize the amount of waste buried, while maximizing the useful life of landfill sites and increasing the timeframe of the alternative. Overall, the multi-criteria analysis was helpful and accurate during the alternative selection process, considering the similarities and restrictions of each option, which can lead to difficulties during the decision-making process.

Estimating Alarm Thresholds for Process Monitoring Data under Different Assumptions about the Data Generating Mechanism

DOE PAGES

Burr, Tom; Hamada, Michael S.; Howell, John; ...

2013-01-01

Process monitoring (PM) for nuclear safeguards sometimes requires estimation of thresholds corresponding to small false alarm rates. Threshold estimation dates to the 1920s with the Shewhart control chart; however, because possible new roles for PM are being evaluated in nuclear safeguards, it is timely to consider modern model selection options in the context of threshold estimation. One of the possible new PM roles involves PM residuals, where a residual is defined as residual = data − prediction. This paper reviews alarm threshold estimation, introduces model selection options, and considers a range of assumptions regarding the data-generating mechanism for PM residuals.more » Two PM examples from nuclear safeguards are included to motivate the need for alarm threshold estimation. The first example involves mixtures of probability distributions that arise in solution monitoring, which is a common type of PM. The second example involves periodic partial cleanout of in-process inventory, leading to challenging structure in the time series of PM residuals.« less

Student attraction to engineering through flexibility and breadth in the curriculum

NASA Astrophysics Data System (ADS)

Alpay, E.

2013-03-01

Several European universities provide entry to general engineering studies prior to degree specialisation. The potential advantages of such entry include the provision of a broader foundation in engineering fundamentals, the option for students to defer specialisation until a greater awareness of the different engineering disciplines and the preparation of students for a more versatile career. In this paper, the attractiveness of general engineering (specifically in the first year of study) is explored through a national (UK) survey on pre-university students. Attention is given to gauging student enthusiasm for flexibility in engineering specialisation, combined degree options and exposure to other non-technical courses. The findings indicate that a general engineering programme is highly attractive to students who are currently considering an engineering degree. The programme is also attractive to some students who had previously not considered engineering. For both sets of students, the desire for education on broader topics is indicated, specifically in areas of leadership, teamwork and business skills, and more generally self-awareness and personal development.

Social cost considerations and legal constraints in implementing modular integrated utility systems

NASA Technical Reports Server (NTRS)

Lede, N. W.; Dixon, H. W.; King, O.; Hill, D. K.

1974-01-01

Social costs associated with the design, demonstration, and implementation of the Modular Integrated Utility System are considered including the social climate of communities, leadership patterns, conflicts and cleavages, specific developmental values, MIUS utility goal assessment, and the suitability of certian alternative options for use in a program of implementation. General considerations are discussed in the field of socio-technological planning. These include guidelines for understanding the conflict and diversity; some relevant goal choices and ideas useful to planners of the MIUS facility.

Age correction in monitoring audiometry: method to update OSHA age-correction tables to include older workers

PubMed Central

Dobie, Robert A; Wojcik, Nancy C

2015-01-01

Objectives The US Occupational Safety and Health Administration (OSHA) Noise Standard provides the option for employers to apply age corrections to employee audiograms to consider the contribution of ageing when determining whether a standard threshold shift has occurred. Current OSHA age-correction tables are based on 40-year-old data, with small samples and an upper age limit of 60 years. By comparison, recent data (1999–2006) show that hearing thresholds in the US population have improved. Because hearing thresholds have improved, and because older people are increasingly represented in noisy occupations, the OSHA tables no longer represent the current US workforce. This paper presents 2 options for updating the age-correction tables and extending values to age 75 years using recent population-based hearing survey data from the US National Health and Nutrition Examination Survey (NHANES). Both options provide scientifically derived age-correction values that can be easily adopted by OSHA to expand their regulatory guidance to include older workers. Methods Regression analysis was used to derive new age-correction values using audiometric data from the 1999–2006 US NHANES. Using the NHANES median, better-ear thresholds fit to simple polynomial equations, new age-correction values were generated for both men and women for ages 20–75 years. Results The new age-correction values are presented as 2 options. The preferred option is to replace the current OSHA tables with the values derived from the NHANES median better-ear thresholds for ages 20–75 years. The alternative option is to retain the current OSHA age-correction values up to age 60 years and use the NHANES-based values for ages 61–75 years. Conclusions Recent NHANES data offer a simple solution to the need for updated, population-based, age-correction tables for OSHA. The options presented here provide scientifically valid and relevant age-correction values which can be easily adopted by OSHA to expand their regulatory guidance to include older workers. PMID:26169804

Age correction in monitoring audiometry: method to update OSHA age-correction tables to include older workers.

PubMed

Dobie, Robert A; Wojcik, Nancy C

2015-07-13

The US Occupational Safety and Health Administration (OSHA) Noise Standard provides the option for employers to apply age corrections to employee audiograms to consider the contribution of ageing when determining whether a standard threshold shift has occurred. Current OSHA age-correction tables are based on 40-year-old data, with small samples and an upper age limit of 60 years. By comparison, recent data (1999-2006) show that hearing thresholds in the US population have improved. Because hearing thresholds have improved, and because older people are increasingly represented in noisy occupations, the OSHA tables no longer represent the current US workforce. This paper presents 2 options for updating the age-correction tables and extending values to age 75 years using recent population-based hearing survey data from the US National Health and Nutrition Examination Survey (NHANES). Both options provide scientifically derived age-correction values that can be easily adopted by OSHA to expand their regulatory guidance to include older workers. Regression analysis was used to derive new age-correction values using audiometric data from the 1999-2006 US NHANES. Using the NHANES median, better-ear thresholds fit to simple polynomial equations, new age-correction values were generated for both men and women for ages 20-75 years. The new age-correction values are presented as 2 options. The preferred option is to replace the current OSHA tables with the values derived from the NHANES median better-ear thresholds for ages 20-75 years. The alternative option is to retain the current OSHA age-correction values up to age 60 years and use the NHANES-based values for ages 61-75 years. Recent NHANES data offer a simple solution to the need for updated, population-based, age-correction tables for OSHA. The options presented here provide scientifically valid and relevant age-correction values which can be easily adopted by OSHA to expand their regulatory guidance to include older workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Study design options in evaluating gene-environment interactions: practical considerations for a planned case-control study of pediatric leukemia.

PubMed

Goodman, Michael; Dana Flanders, W

2007-04-01

We compare methodological approaches for evaluating gene-environment interaction using a planned study of pediatric leukemia as a practical example. We considered three design options: a full case-control study (Option I), a case-only study (Option II), and a partial case-control study (Option III), in which information on controls is limited to environmental exposure only. For each design option we determined its ability to measure the main effects of environmental factor E and genetic factor G, and the interaction between E and G. Using the leukemia study example, we calculated sample sizes required to detect and odds ratio (OR) of 2.0 for E alone, an OR of 10 for G alone and an interaction G x E of 3. Option I allows measuring both main effects and interaction, but requires a total sample size of 1,500 cases and 1,500 controls. Option II allows measuring only interaction, but requires just 121 cases. Option III allows calculating the main effect of E, and interaction, but not the main effect of G, and requires a total of 156 cases and 133 controls. In this case, the partial case-control study (Option III) appears to be more efficient with respect to its ability to answer the research questions for the amount of resources required. The design options considered in this example are not limited to observational epidemiology and may be applicable in studies of pharmacogenomics, survivorship, and other areas of pediatric ALL research.

Adaptation of the Electra Radio to Support Multiple Receive Channels

NASA Technical Reports Server (NTRS)

Satorius, Edgar H.; Shah, Biren N.; Bruvold, Kristoffer N.; Bell, David J.

2011-01-01

Proposed future Mars missions plan communication between multiple assets (rovers). This paper presents the results of a study carried out to assess the potential adaptation of the Electra radio to a multi-channel transceiver. The basic concept is a Frequency Division multiplexing (FDM) communications scheme wherein different receiver architectures are examined. Options considered include: (1) multiple IF slices, A/D and FPGAs each programmed with an Electra baseband modem; (2) common IF but multiple A/Ds and FPGAs and (3) common IF, single A/D and single or multiple FPGAs programmed to accommodate the FDM signals. These options represent the usual tradeoff between analog and digital complexity. Given the space application, a common IF is preferable; however, multiple users present dynamic range challenges (e.g., near-far constraints) that would favor multiple IF slices (Option 1). Vice versa, with a common IF and multiple A/Ds (Option 2), individual AGC control of the A/Ds would be an important consideration. Option 3 would require a common AGC control strategy and would entail multiple digital down conversion paths within the FPGA. In this paper, both FDM parameters as well as the different Electra design options will be examined. In particular, signal channel spacing as a function of user data rates and transmit powers will be evaluated. In addition, tradeoffs between the different Electra design options will be presented with the ultimate goal of defining an augmented Electra radio architecture for potential future missions.

The 1980 V-TECS Marketing Study.

ERIC Educational Resources Information Center

Hattwick, Richard E.; And Others

The Vocational-Technical Education Consortium of States (V-TECS) conducted a marketing study that considered the implications of six options for the organization's future. The first option is continuation of the status quo, which is dangerous because existing members may leave the consortium. The second option is the status quo combined with an…

Optional thinking ability among hospital-treated deliberate self-harm patients: a 1-year follow-up study.

PubMed

McAuliffe, Carmel; Corcoran, Paul; Hickey, Portia; McLeavey, Breda C

2008-03-01

To investigate the association between optional thinking (the ability to generate alternative solutions to interpersonal problems) in deliberate self-harm (DSH) patients and repeated self-harm. A prospective study of the association between optional thinking in interpersonal problem solving and repeated DSH within 12 months. A non-consecutive sample (N=152) of DSH patients presenting to the Accident and Emergency department of an acute hospital in Cork city, Ireland, was assessed using a structured interview schedule including the Suicide Intent Scale, the Hopelessness Scale, and the Optional Thinking Test. Repetition within 1 year was established by checking Accident and Emergency records at all three city hospitals. Participants were categorized as repeaters if they engaged in at least one further hospital-treated DSH episode, or non-repeaters. Approximately two-thirds (63.1%) of the sample had engaged in at least one act of DSH prior to their index episode. During follow-up 31 individuals (20.4%) repeated. History of self-harm was significantly associated with prospective repetition when considered alongside all the other predictor variables. Among first evers, low scores on the optional thinking test were significantly associated with the increased risk of repetition within 12 months. Among those with previous DSH, there was no evidence of an association between optional thinking and repetition within 12 months. Poor optional thinking is associated with increased risk of repeated deliberate self-harm in those who present with a first self-harm episode. Interventions to improve optional thinking skills, delivered soon after a first DSH presentation, may be useful in preventing repetition.

Other Remedy Options Evaluated

EPA Pesticide Factsheets

EPA considered several remedy options for reducing emissions from electric generating units (EGUs) that contribute significantly to nonattainment or interfere with maintenance of the air quality standards by downwind states.

Evaluation of low wind modeling approaches for two tall-stack databases.

PubMed

Paine, Robert; Samani, Olga; Kaplan, Mary; Knipping, Eladio; Kumar, Naresh

2015-11-01

The performance of the AERMOD air dispersion model under low wind speed conditions, especially for applications with only one level of meteorological data and no direct turbulence measurements or vertical temperature gradient observations, is the focus of this study. The analysis documented in this paper addresses evaluations for low wind conditions involving tall stack releases for which multiple years of concurrent emissions, meteorological data, and monitoring data are available. AERMOD was tested on two field-study databases involving several SO2 monitors and hourly emissions data that had sub-hourly meteorological data (e.g., 10-min averages) available using several technical options: default mode, with various low wind speed beta options, and using the available sub-hourly meteorological data. These field study databases included (1) Mercer County, a North Dakota database featuring five SO2 monitors within 10 km of the Dakota Gasification Company's plant and the Antelope Valley Station power plant in an area of both flat and elevated terrain, and (2) a flat-terrain setting database with four SO2 monitors within 6 km of the Gibson Generating Station in southwest Indiana. Both sites featured regionally representative 10-m meteorological databases, with no significant terrain obstacles between the meteorological site and the emission sources. The low wind beta options show improvement in model performance helping to reduce some of the over-prediction biases currently present in AERMOD when run with regulatory default options. The overall findings with the low wind speed testing on these tall stack field-study databases indicate that AERMOD low wind speed options have a minor effect for flat terrain locations, but can have a significant effect for elevated terrain locations. The performance of AERMOD using low wind speed options leads to improved consistency of meteorological conditions associated with the highest observed and predicted concentration events. The available sub-hourly modeling results using the Sub-Hourly AERMOD Run Procedure (SHARP) are relatively unbiased and show that this alternative approach should be seriously considered to address situations dominated by low-wind meander conditions. AERMOD was evaluated with two tall stack databases (in North Dakota and Indiana) in areas of both flat and elevated terrain. AERMOD cases included the regulatory default mode, low wind speed beta options, and use of the Sub-Hourly AERMOD Run Procedure (SHARP). The low wind beta options show improvement in model performance (especially in higher terrain areas), helping to reduce some of the over-prediction biases currently present in regulatory default AERMOD. The SHARP results are relatively unbiased and show that this approach should be seriously considered to address situations dominated by low-wind meander conditions.

Evaluation of Policy Options for Increasing the Availability of Primary Care Services in Rural Washington State.

PubMed

Friedberg, Mark W; Martsolf, Grant R; White, Chapin; Auerbach, David I; Kandrack, Ryan; Reid, Rachel O; Butcher, Emily; Yu, Hao; Hollands, Simon; Nie, Xiaoyu

2017-01-01

The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. These policy options include opening the new Elson S. Floyd College of Medicine at Washington State University in 2017; increasing the number of primary care residency positions in the state; expanding educational loan-repayment incentives to encourage primary care physicians to practice in rural Washington; increasing Medicaid payment rates for primary care physicians in rural Washington; and encouraging the adoption of alternative models of primary care, such as medical homes and nurse-managed health centers, that reallocate work from physicians to nurse practitioners (NPs) and physician assistants (PAs). RAND Corporation researchers projected the effects that these and other policy options could have on the state's rural primary care workforce through 2025. They project a 7-percent decrease in the number of rural primary care physicians and a 5-percent decrease in the number of urban ones. None of the policy options modeled in this study, on its own, will offset this expected decrease by relying on physicians alone. However, combinations of these strategies or partial reallocation of rural primary care services to NPs and PAs via such new practice models as medical homes and nurse-managed health centers are plausible options for preserving the overall availability of primary care services in rural Washington through 2025.

Real options analysis for land use management: Methods, application, and implications for policy.

PubMed

Regan, Courtney M; Bryan, Brett A; Connor, Jeffery D; Meyer, Wayne S; Ostendorf, Bertram; Zhu, Zili; Bao, Chenming

2015-09-15

Discounted cash flow analysis, including net present value is an established way to value land use and management investments which accounts for the time-value of money. However, it provides a static view and assumes passive commitment to an investment strategy when real world land use and management investment decisions are characterised by uncertainty, irreversibility, change, and adaptation. Real options analysis has been proposed as a better valuation method under uncertainty and where the opportunity exists to delay investment decisions, pending more information. We briefly review the use of discounted cash flow methods in land use and management and discuss their benefits and limitations. We then provide an overview of real options analysis, describe the main analytical methods, and summarize its application to land use investment decisions. Real options analysis is largely underutilized in evaluating land use decisions, despite uncertainty in policy and economic drivers, the irreversibility and sunk costs involved. New simulation methods offer the potential for overcoming current technical challenges to implementation as demonstrated with a real options simulation model used to evaluate an agricultural land use decision in South Australia. We conclude that considering option values in future policy design will provide a more realistic assessment of landholder investment decision making and provide insights for improved policy performance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Selection of antibiotics for meticillin-resistant Staphylococcus pseudintermedius: time to revisit some old drugs?

PubMed

Papich, Mark G

2012-08-01

The aim of this review is to consider systemic therapy options for meticillin-resistant Staphylococcus pseudintermedius (MRSP). Infections caused by MRSP in small animals--particularly dogs--have been frustrating veterinarians in recent years. After a susceptibility test is performed, veterinarians are left to select from drugs that have not been frequently encountered on a susceptibility report. Some of these are old drugs that have not been used regularly by veterinary dermatologists. As MRSP is, by definition, resistant to all β-lactam antibiotics, including cephalosporins, penicillins and amoxicillin-clavulanate combinations, the β-lactam drugs are not an option for systemic treatment. As most MRSPs are multidrug resistant, familiar drugs, such as trimethoprim-sulfonamides, fluoroquinolones, macrolides and lincosamides (clindamycin), are also not usually an option for treatment. Therefore, veterinarians are left with drugs such as rifampicin, chloramphenicol, tetracyclines, aminoglycosides and vancomycin to choose from on the basis of an in vitro susceptibility test. Some of these drugs were originally approved over 50 years ago and may not be familiar to some veterinarians. Each of these drugs possesses unique properties and has particular advantages and disadvantages. Veterinarians should be particularly aware of the adverse effects, limitations and precautions when using these drugs. New drugs also have been developed for meticillin-resistant Staphylococcus aureus in humans. These include linezolid, ceftaroline, daptomycin and tigecycline. Although these drugs are very infrequently--if ever--considered for veterinary use, the properties of these drugs should also be known to veterinary dermatologists. © 2012 The Author. Veterinary Dermatology. © 2012 ESVD and ACVD.

Economics of Utility Scale Photovoltaics at Purdue University

NASA Astrophysics Data System (ADS)

Arnett, William

The research for this case study shows that utility scale solar photovoltaics has become a competitive energy investment option, even when a campus operates a power plant at low electricity rates. To evaluate this an economic model called SEEMS (Solar Economic Evaluation Modelling Spreadsheets) was developed to evaluate a number of financial scenarios in Real Time Pricing for universities. The three main financing structures considered are 1) land leasing, 2) university direct purchase, and 3) third party purchase. Unlike other commercially available models SEEMS specifically accounts for real time pricing, where the local utility provides electricity at an hourly rate that changes with the expected demand. In addition, SEEMS also includes a random simulation that allows the model to predict the likelihood of success for a given solar installation strategy. The research showed that there are several options for utility scale solar that are financially attractive. The most practical financing structure is with a third party partnership because of the opportunity to take advantage of tax incentives. Other options could become more attractive if non-financial benefits are considered. The case study for this research, Purdue University, has a unique opportunity to integrate utility-scale solar electricity into its strategic planning. Currently Purdue is updating its master plan which will define how land is developed. Purdue is also developing a sustainability plan that will define long term environmental goals. In addition, the university is developing over 500 acres of land west of campus as part of its Aerospace Innovation District. This research helps make the case for including utility-scale solar electricity as part of the university's strategic planning.

Endophytic Phytoaugmentation: Treating Wastewater and Runoff Through Augmented Phytoremediation

PubMed Central

Redfern, Lauren K.

2016-01-01

Abstract Limited options exist for efficiently and effectively treating water runoff from agricultural fields and landfills. Traditional treatments include excavation, transport to landfills, incineration, stabilization, and vitrification. In general, treatment options relying on biological methods such as bioremediation have the ability to be applied in situ and offer a sustainable remedial option with a lower environmental impact and reduced long-term operating expenses. These methods are generally considered ecologically friendly, particularly when compared to traditional physicochemical cleanup options. Phytoremediation, which relies on plants to take up and/or transform the contaminant of interest, is another alternative treatment method which has been developed. However, phytoremediation is not widely used, largely due to its low treatment efficiency. Endophytic phytoaugmentation is a variation on phytoremediation that relies on augmenting the phytoremediating plants with exogenous strains to stimulate associated plant-microbe interactions to facilitate and improve remediation efficiency. In this review, we offer a summary of the current knowledge as well as developments in endophytic phytoaugmentation and present some potential future applications for this technology. There has been a limited number of published endophytic phytoaugmentation case studies and much remains to be done to transition lab-scale results to field applications. Future research needs include large-scale endophytic phytoaugmentation experiments as well as the development of more exhaustive tools for monitoring plant-microbe-pollutant interactions. PMID:27158249

Medial Patella Subluxation: Diagnosis and Treatment

PubMed Central

McCarthy, Mark A.; Bollier, Mathew J.

2015-01-01

Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity. PMID:26361441

Surgical margins in head and neck squamous cell carcinoma: what is 'close'?

PubMed

Alicandri-Ciufelli, Matteo; Bonali, Marco; Piccinini, Alessia; Marra, Laura; Ghidini, Angelo; Cunsolo, Elio Maria; Maiorana, Antonino; Presutti, Livio; Conte, Pier Franco

2013-09-01

The aim of this systematic review is to evaluate the definition of close margin in head and neck squamous cell carcinoma (HNSCC), and its possible prognostic significance. An appropriate string was run on PubMed to retrieve articles discussing the 'close' surgical margin issue in HNSCC. A double cross-check was performed on citations and full-text articles retrieved. In total, 348 articles were identified. Further references were included by using the option "Titles in your search terms" option in PubMed. 15 papers were finally included for qualitative synthesis. In vocal cord surgery of HNSCC, a close margin could be considered to be ≤1 mm, in the larynx ≤5 mm, in the oral cavity ≤4 mm, and in the oropharynx ≤5 mm. In each patient, the choice of extent of close margin should be balanced against general condition, tumor stage, and functional issues to indicate appropriate adjuvant therapy.

Factors influencing postnatal Option B+ participation and breastfeeding duration among HIV-positive women in Lilongwe District, Malawi: A qualitative study.

PubMed

Flax, Valerie L; Hamela, Gloria; Mofolo, Innocent; Hosseinipour, Mina C; Hoffman, Irving F; Maman, Suzanne

2017-01-01

To ensure the health of mothers and children, prevention of mother-to-child HIV transmission (PMTCT) programs test women for HIV, engage HIV-positive women in care, and promote recommended breastfeeding practices. Under Malawi's Option B+ PMTCT program, ~20% of women are lost-to-follow-up (LTFU) and little is known about their breastfeeding practices. The purpose of this study is to describe facilitators and barriers to Option B+ participation and how participation influences breastfeeding duration. We conducted in-depth interviews with HIV-positive women in Option B+ (n = 32) or LTFU from Option B+ (n = 32). They were recruited from four government clinics in Lilongwe District and had a child aged 0-23 months. Women in Option B+ had better disclosure experiences and more social support than LTFU women. The most common reasons for LTFU were fear of HIV disclosure, anticipated or experienced stigma, and insufficient social support. Other reasons included: non-acceptance of HIV status, antiretroviral therapy (ART) side effects, lack of funds for transport, and negative experiences with clinic staff. Worries about possible transmission, even while on ART, influenced timing of weaning for some women in Option B+. Despite their knowledge of the risk of HIV transmission to the child, most LTFU women continued to breastfeed after stopping ART because they considered breastmilk to be an important source of nutrients for the child. Given that HIV-positive Malawian women LTFU from Option B+ breastfeed in the absence of ART, efforts are needed to use evidence-based strategies to address the barriers to Option B+ participation and avert preventable transmission through breastmilk.

Real options and asset valuation in competitive energy markets

NASA Astrophysics Data System (ADS)

Oduntan, Adekunle Richard

The focus of this work is to develop a robust valuation framework for physical power assets operating in competitive markets such as peaking or mid-merit thermal power plants and baseload power plants. The goal is to develop a modeling framework that can be adapted to different energy assets with different types of operating flexibilities and technical constraints and which can be employed for various purposes such as capital budgeting, business planning, risk management and strategic bidding planning among others. The valuation framework must also be able to capture the reality of power market rules and opportunities, as well as technical constraints of different assets. The modeling framework developed conceptualizes operating flexibilities of power assets as "switching options' whereby the asset operator decides at every decision point whether to switch from one operating mode to another mutually exclusive mode, within the limits of the equipment constraints of the asset. As a current decision to switch operating modes may affect future operating flexibilities of the asset and hence cash flows, a dynamic optimization framework is employed. The developed framework accounts for the uncertain nature of key value drivers by representing them with appropriate stochastic processes. Specifically, the framework developed conceptualizes the operation of a power asset as a multi-stage decision making problem where the operator has to make a decision at every stage to alter operating mode given currently available information about key value drivers. The problem is then solved dynamically by decomposing it into a series of two-stage sub-problems according to Bellman's optimality principle. The solution algorithm employed is the Least Squares Monte Carlo (LSM) method. The developed valuation framework was adapted for a gas-fired thermal power plant, a peaking hydroelectric power plant and a baseload power plant. This work built on previously published real options valuation methodologies for gas-fired thermal power plants by factoring in uncertainty from gas supply/consumption imbalance which is usually faced by gas-fired power generators. This source of uncertainty arises because of mismatch between natural gas and electricity wholesale markets. Natural gas markets in North America operate on a day-ahead basis while power plants are dispatched in real time. Inability of a power generator to match its gas supply and consumption in real time, leading to unauthorized gas over-run or under-run, attracts penalty charges from the gas supplier to the extent that the generator can not manage the imbalance through other means. By considering an illustrative power plant operating in Ontario, we show effects of gas-imbalance on dispatch strategies on a daily cycling operation basis and the resulting impact on net revenue. Similarly, we employ the developed valuation framework to value a peaking hydroelectric power plant. This application also builds on previous real options valuation work for peaking hydroelectric power plants by considering their operations in a joint energy and ancillary services market. Specifically, the valuation model is developed to capture the value of a peaking power plant whose owner has the flexibility to participate in a joint operating reserve market and an energy market, which is currently the case in the Ontario wholesale power market. The model factors in water inflow uncertainty into the reservoir forebay of a hydroelectric facility and also considers uncertain energy and operating reserve prices. The switching options considered include (i) a joint energy and operating reserve bid (ii) an energy only bid and (iii) a do nothing (idle) strategy. Being an energy limited power plant, by doing nothing at a decision interval, the power asset operator is able to timeshift scarce water for use at a future period when market situations are expected to be better. Finally, the developed valuation framework was employed to optimize life-cycle management decisions of a baseload power plant, such as a nuclear power plant. Given uncertainty of long-term value drivers, including power prices, equipment performance and the relationship between current life cycle spending and future equipment degradation, optimization is carried out with the objective of minimizing overall life-cycle related costs. These life-cycle costs include (i) lost revenue during planned and unplanned outages, (ii) potential costs of future equipment degradation due to inadequate preventative maintenance, and (iii) the direct costs of implementing the life-cycle projects. The switching options in this context include the option to shutdown the power plant in order to execute a given preventative maintenance and inspection project and the option to keep the option "alive" by choosing to delay a planned life-cycle activity.

A guide to taxable debt financing alternatives.

PubMed

Aderholdt, J M; Pardue, C R

1989-07-01

The 1986 Tax Reform Act placed new restrictions on the use of tax-exempt financing for certain healthcare projects, and policymakers are considering further restrictions. In light of these developments, financial managers should become familiar with the available taxable debt financing options. These include commercial paper, taxable variable rate demand notes, floating rate notes, medium-term notes, long-term domestic public offerings, and domestic private placements.

Exploring Opportunities for Efficiency and Joint Provision of Services Using Nonappropriated Funds

DTIC Science & Technology

2016-01-01

analyzed two of them: accounting and employee benefits. RAND assessed the rec- ommendations’ costs , detailed the potential challenges, and identified...Consolidated Service Center: This option would standardize all accounting , including the SGL, cost - center structures, and core feeder and financial...ings of about $100 million would go toward replacing its out- dated accounting system. The analysis considered the costs of developing, deploying

The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities.

PubMed

Chou, Roger; Côté, Pierre; Randhawa, Kristi; Torres, Paola; Yu, Hainan; Nordin, Margareta; Hurwitz, Eric L; Haldeman, Scott; Cedraschi, Christine

2018-02-19

The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain. We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries. Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs). For patients with chronic low back and neck pain without serious pathology, primary treatment options are exercise, yoga, cognitive behavioral therapies, acupuncture, biofeedback, progressive relaxation, massage, manual therapy, interdisciplinary rehabilitation, NSAIDs, acetaminophen, and antidepressants. For patients with spinal pain with radiculopathy, clinicians may consider exercise, spinal manipulation, or NSAIDs; use of other interventions requires extrapolation from evidence regarding effectiveness for non-radicular spinal pain. Clinicians should not offer treatments that are not effective, including benzodiazepines, botulinum toxin injection, systemic corticosteroids, cervical collar, electrical muscle stimulation, short-wave diathermy, transcutaneous electrical nerve stimulation, and traction. Guidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of recommended conservative treatments must be finalized through discussion with the involved community and based on a biopsychosocial approach. Decision determinants for selecting recommended treatments include costs, availability of interventions, and cultural and patient preferences. These slides can be retrieved under Electronic Supplementary Material.

Screening regional management options for their impact on climate resilience: an approach and case study in the Venen-Vechtstreek wetlands in the Netherlands.

PubMed

Wardekker, J A; Wildschut, D; Stemberger, S; van der Sluijs, J P

2016-01-01

Freshwater systems provide various resources and services. These are often vulnerable to climate change and other pressures. Therefore, enhancing resilience to climate change is important for their long term viability. This paper explores how management options can be evaluated on their resilience implications. The approach included five steps: (1) characterizing the system, (2) characterizing the impacts of climate change and other disturbances, (3) inventorying management options, (4) assessing the impacts of these on climate resilience, and (5) follow-up analysis. For the resilience assessment, we used a set of 'resilience principles': homeostasis, omnivory, high flux, flatness, buffering, and redundancy. We applied the approach in a case study in a Dutch wetlands region. Many options in the region's management plan contribute to resilience, however, the plan underutilised several principles, particularly flatness, but also redundancy and omnivory for agriculture, and high flux for nature. Co-benefits was identified as an important additional criterion to obtain support for adaptation from local stakeholders, such as farmers. The approach provided a relatively quick and participatory way to screen options. It allowed us to consider multiple impacts and sectors, multiple dimensions of resilience, and stakeholder perspectives. The results can be used to identify gaps or pitfalls, and set priorities for follow-up analyses.

Fungating wounds: management and treatment options.

PubMed

Tandler, Suzanne; Stephen-Haynes, Jackie

2017-06-22

This article defines fungating wounds and considers the underlying cause, location and presentation. The clinical challenges presented by fungating wounds are discussed, with reference to evidence-based care delivery. This includes wound assessment, cleansing, debridement and management of malodour, infection, bleeding and exudate. Guidance on the use of wound management dressings is considered in relation to symptom management. The importance of clinical decision-making and educational preparation in the delivery of evidenced-based care for those with fungating wounds is emphasised. A conclusion is made that the clinician can support the patient with a fungating wound by the delivery of evidenced-based care.

A Policy Alternative Analysis and Simplified Scoring Method to Assess Policy Options for Marine Conservation Areas

NASA Astrophysics Data System (ADS)

Sharuga, S. M.; Reams, M.

2016-02-01

Traditional approaches to marine conservation and management are increasingly being found as inadequate; and, consequently, more complex ecosystem-based approaches to protecting marine ecosystems are growing in popularity. Ecosystem-based approaches, however, can be particularly challenging at a local level where resources and knowledge of specific marine conservation components may be limited. Marine conservation areas are known by a variety of names globally, but can be divided into four general types: Marine Protected Areas (MPAs), Marine Reserves, Fishery Reserves, and Ecological Reserves (i.e. "no take zones"). Each type of conservation area involves specific objectives, program elements and likely socioeconomic consequences. As an aid to community stakeholders and decision makers considering establishment of a marine conservation area, a simple method to compare and score the objectives and attributes of these four approaches is presented. A range of evaluation criteria are considered, including conservation of biodiversity and habitat, effective fishery management, overall cost-effectiveness, fairness to current users, enhancement of recreational activities, fairness to taxpayers, and conservation of genetic diversity. Environmental and socioeconomic costs and benefits of each type of conservation area are also considered. When exploring options for managing the marine environment, particular resource conservation needs must be evaluated individually on a case-by-case basis and the type of conservation area established must be tailored accordingly. However, MPAs are often more successful than other conservation areas because they offer a compromise between the needs of society and the environment, and therefore represent a viable option for ecosystem-based management.

A Policy Alternative Analysis and Simplified Scoring Method to Assess Policy Options for Marine Conservation Areas

NASA Astrophysics Data System (ADS)

Sharuga, S. M.; Reams, M.

2016-12-01

Traditional approaches to marine conservation and management are increasingly being found as inadequate; and, consequently, more complex ecosystem-based approaches to protecting marine ecosystems are growing in popularity. Ecosystem-based approaches, however, can be particularly challenging at a local level where resources and knowledge of specific marine conservation components may be limited. Marine conservation areas are known by a variety of names globally, but can be divided into four general types: Marine Protected Areas (MPAs), Marine Reserves, Fishery Reserves, and Ecological Reserves (i.e. "no take zones"). Each type of conservation area involves specific objectives, program elements and likely socioeconomic consequences. As an aid to community stakeholders and decision makers considering establishment of a marine conservation area, a simple method to compare and score the objectives and attributes of these four approaches is presented. A range of evaluation criteria are considered, including conservation of biodiversity and habitat, effective fishery management, overall cost-effectiveness, fairness to current users, enhancement of recreational activities, fairness to taxpayers, and conservation of genetic diversity. Environmental and socioeconomic costs and benefits of each type of conservation area are also considered. When exploring options for managing the marine environment, particular resource conservation needs must be evaluated individually on a case-by-case basis and the type of conservation area established must be tailored accordingly. However, MPAs are often more successful than other conservation areas because they offer a compromise between the needs of society and the environment, and therefore represent a viable option for ecosystem-based management.

Evidence-based drug treatment practice and the child welfare system: the example of methadone.

PubMed

Lundgren, Lena M; Schilling, Robert F; Peloquin, Susan D

2005-01-01

This article examined the extent to which methadone maintenance (MM) is considered a treatment alternative for drug-dependent parents, as reflected in the social work and child welfare literature and in child welfare policies. Findings were derived from a review of 15 social work journals published from 1996 through 2002 and from a review of child welfare policies in 27 states in regard to treatment recommendations for substance-abusing parents. These reviews found that 23 articles focused on child welfare-substance abuse issues; no article specifically discussed MM as a treatment option for heroin-using parents; and of the 27 states, only three included methadone as a treatment option in their child welfare policy recommendations. Practice and policy recommendations are discussed.

Restoration of Elbow Flexion.

PubMed

Loeffler, Bryan J; Lewis, Daniel R

2016-08-01

Active elbow flexion is required to position the hand in space, and loss of this function is debilitating. Nerve transfers or nerve grafts to restore elbow flexion may be options when the target muscle is viable, but in delayed reconstruction when the biceps and brachialis are atrophied or damaged, muscle transfer options should be considered. Muscle transfer options are discussed with attention to the advantages and disadvantages of each transfer option. Copyright © 2016 Elsevier Inc. All rights reserved.

Sustainability assessment of electrokinetic bioremediation compared with alternative remediation options for a petroleum release site.

PubMed

Gill, R T; Thornton, S F; Harbottle, M J; Smith, J W N

2016-12-15

Sustainable management practices can be applied to the remediation of contaminated land to maximise the economic, environmental and social benefits of the process. The Sustainable Remediation Forum UK (SuRF-UK) have developed a framework to support the implementation of sustainable practices within contaminated land management and decision making. This study applies the framework, including qualitative (Tier 1) and semi-quantitative (Tier 2) sustainability assessments, to a complex site where the principal contaminant source is unleaded gasoline, giving rise to a dissolved phase BTEX and MTBE plume. The pathway is groundwater migration through a chalk aquifer and the receptor is a water supply borehole. A hydraulic containment system (HCS) has been installed to manage the MTBE plume migration. The options considered to remediate the MTBE source include monitored natural attenuation (MNA), air sparging/soil vapour extraction (AS/SVE), pump and treat (PT) and electrokinetic-enhanced bioremediation (EK-BIO). A sustainability indictor set from the SuRF-UK framework, including priority indicator categories selected during a stakeholder engagement workshop, was used to frame the assessments. At Tier 1 the options are ranked based on qualitative supporting information, whereas in Tier 2 a multi-criteria analysis is applied. Furthermore, the multi-criteria analysis was refined for scenarios where photovoltaics (PVs) are included and amendments are excluded from the EK-BIO option. Overall, the analysis identified AS/SVE and EK-BIO as more sustainable remediation options at this site than either PT or MNA. The wider implications of this study include: (1) an appraisal of the management decision from each Tier of the assessment with the aim to highlight areas for time and cost savings for similar assessments in the future; (2) the observation that EK-BIO performed well against key indicator categories compared to the other intensive treatments; and (3) introducing methods to improve the sustainability of the EK-BIO treatment design (such as PVs) did not have a significant effect in this instance. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Food System Trade Study for a Near-Term Mars Mission

NASA Technical Reports Server (NTRS)

Levri, Julie; Luna, Bernadette (Technical Monitor)

2000-01-01

This paper evaluates several food system options for a near-term Mars mission, based on plans for the 120-day BIO-Plex test. Food systems considered in the study are based on the International Space Station (ISS) Assembly Phase and Assembly Complete food systems. The four systems considered are: 1) ISS assembly phase food system (US portion) with individual packaging without salad production; 2) ISS assembly phase food system (US portion) with individual packaging, with salad production; 3) ISS assembly phase food system (US portion) with bulk packaging, with salad production; 4) ISS assembly complete food system (US portion) with bulk packaging with salad and refrigeration/freezing. The food system options are assessed using equivalent system mass (ESM), which evaluates each option based upon the mass, volume, power, cooling and crewtime requirements that are associated with each food system option. However, since ESM is unable to elucidate the differences in psychological benefits between the food systems, a qualitative evaluation of each option is also presented.

Unlocking Solar for Low- and Moderate-Income Residents: A Matrix of Financing Options by Resident, Provider, and Housing Type

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cook, Jeffrey J.; Bird, Lori A.

Historically the low and moderate income (LMI) market has been underserved by solar photovoltaics (PV), in part due to the unique barriers LMI residents face to participation in the PV market. The intent of this report is to identify the most promising strategies state policymakers might consider to finance PV for LMI customers across three housing types: single family, multi-family, and manufactured housing. The result is a financing matrix that documents the first and second tier financing options states may consider for each housing type. The first tier options were selected based upon their potential impact on LMI PV deployment.more » Second tier financing approaches could also be used to achieve state policy goals, but may not have as much effect on the relevant LMI market segment. Nevertheless, each financing option comes with tradeoffs that state policymakers may wish to consider when they make decisions about which financing approaches are best suited to achieve their LMI PV deployment goals.« less

Mixed waste management options

DOE Office of Scientific and Technical Information (OSTI.GOV)

Owens, C.B.; Kirner, N.P.

1991-12-31

Disposal fees for mixed waste at proposed commercial disposal sites have been estimated to be $15,000 to $40,000 per cubit foot. If such high disposal fees are imposed, generators may be willing to apply extraordinary treatment or regulatory approaches to properly dispose of their mixed waste. This paper explores the feasibility of several waste management scenarios and attempts to answer the question: Can mixed waste be managed out of existence? Existing data on commercially generated mixed waste streams are used to identify the realm of mixed waste known to be generated. Each waste stream is evaluated from both a regulatorymore » and technical perspective in order to convert the waste into a strictly low-level radioactive or a hazardous waste. Alternative regulatory approaches evaluated in this paper include a delisting petition, no migration petition, and a treatability variance. For each waste stream, potentially available treatment options are identified that could lead to these variances. Waste minimization methodology and storage for decay are also considered. Economic feasibility of each option is discussed broadly.« less

Space Tug systems study (storable). Volume 3: Executive summary

NASA Technical Reports Server (NTRS)

1974-01-01

Space tug program options that consider key issues and mission requirements are assessed, component and subsystem candidates are evaluated, and tug configurations synthesized. Three tug program options are defined and evaluated.

77 FR 62303 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-12

... attendant therewith, may dissuade investors from using SPY options when they can instead use an SPX option... own account or for the account of a customer, must report information, in a manner and form prescribed... surrounding the use of options. The Exchange understands that the Commission, when considering the appropriate...

5 CFR 870.402 - Withholdings for Optional insurance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... individual is considered to reach the next age band the 1st day of the pay period following the pay period in... Withholdings for Optional insurance. (a)(1) The insured individual pays the full cost of all Optional insurance..., it will issue a public notice in the Federal Register. (b) During each pay period in any part of...

26 CFR 1.318-3 - Estates, trusts, and options.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 4 2010-04-01 2010-04-01 false Estates, trusts, and options. 1.318-3 Section 1... (CONTINUED) INCOME TAXES Definitions; Constructive Ownership of Stock § 1.318-3 Estates, trusts, and options... of section 318(a)(2)(B) stock owned by a trust will be considered as being owned by its beneficiaries...

Mapping regulatory models for medicinal cannabis: a matrix of options.

PubMed

Belackova, Vendula; Shanahan, Marian; Ritter, Alison

2017-05-30

Objective The aim of the present study was to develop a framework for assessing regulatory options for medicinal cannabis in Australia. Methods International regulatory regimes for medicinal cannabis were reviewed with a qualitative policy analysis approach and key policy features were synthesised, leading to a conceptual framework that facilitates decision making across multiple dimensions. Results Two central organising dimensions of medicinal cannabis regulation were identified: cannabis supply and patient authorisation (including patient access). A number of the different supply options can be matched with a number of different patient authorisation options, leading to a matrix of possible regulatory regimes. Conclusions The regulatory options, as used internationally, involve different forms of cannabis (synthetic and plant-based pharmaceutical preparations or herbal cannabis) and the varying extent to which patient authorisation policies and procedures are stringently or more loosely defined. The optimal combination of supply and patient authorisation options in any jurisdiction that chooses to make medicinal cannabis accessible will depend on policy goals. What is known about the topic? Internationally, regulation of medicinal cannabis has developed idiosyncratically, depending on formulations that were made available and local context. There has been no attempt to date in the scientific literature to systematically document the variety of regulatory possibilities for medicinal cannabis. What does this paper add? This paper presents a new conceptual schema for considering options for the regulation of medicinal cannabis, across both supply and patient authorisation aspects. What are the implications for practitioners? The design of regulatory systems in Australia, whether for pharmaceutical or herbal products, is a vital issue for policy makers right now as federal and state and territory governments grapple with the complexities of medicinal cannabis regulation. The conceptual schema presented herein provides a tool for more systematic thinking about the options.

The potential role of taxes and subsidies on food in the prevention of obesity in Europe.

PubMed

González-Zapata, Laura Inés; Alvarez-Dardet, Carlos; Millstone, Erik; Clemente-Gómez, Vicente; Holdsworth, Michelle; Ortiz-Moncada, Rocio; Lobstein, Tim; Sarri, Katerina; De Marchi, Bruna; Horvath, Katalin Z

2010-08-01

Obesity implies costs not only for the individual but also for society. The authors explore the opinions of stakeholders on the potential of taxes or subsidies, as measures for tackling obesity in Europe. Structured interviews were conducted using Multicriteria Mapping, a computer-based, decision-support tool, with 189 interviewees drawn from 21 different stakeholder categories across nine members of the EU interviews, to appraise 20 predefined policy options aimed at reducing obesity, including 'taxing obesity-promoting foods' and 'subsidising healthy foods.' A four-step approach involved selecting options, defining criteria, scoring options quantitatively and weighting criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data. Compared with other policy options appraised, taxation and subsidies were not favourably received, mainly because they were considered difficult to implement. Overall, trade unions rated both options more favourably than all other stakeholder groups. As anticipated, both options received their lowest scores from representatives of the farming, food processing and advertising industries. Nutritional/obesity advisory experts and public sector caterers gave the most positive ratings to subsidies overall. Along with public health professionals, large commercial retailers were most in favour of taxation. Taxation and subsidies were poorly appraised compared with other policy measures, with stakeholders expressing reservations mainly focussed on the practicalities and cost of introducing such measures. Although applying taxes/subsidies could be useful to combat obesity, the study suggests that most stakeholders still need to be convinced of their viability and acceptability when compared with other measures.

48 CFR 536.213-371 - Bids that include options.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Bids that include options... Contracting for Construction 536.213-371 Bids that include options. (a) Subject to the limitations in paragraph (c) of this section, you may include options in contracts if it is in the Government's interest...

Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder

PubMed Central

Anley, Cameron M; Chan, Samuel KL; Snow, Martyn

2014-01-01

The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients. PMID:25405083

Operational approaches to managing forests of the future in Mediterranean regions within a context of changing climates

NASA Astrophysics Data System (ADS)

Stephens, Scott L.; Millar, Constance I.; Collins, Brandon M.

2010-04-01

Many US forest managers have used historical ecology information to assist in the development of desired conditions. While there are many important lessons to learn from the past, we believe that we cannot rely on past forest conditions to provide us with blueprints for future management. To respond to this uncertainty, managers will be challenged to integrate adaptation strategies into plans in response to changing climates. Adaptive strategies include resistance options, resilience options, response options, and realignment options. Our objectives are to present ideas that could be useful in developing plans under changing climates that could be applicable to forests with Mediterranean climates. We believe that managing for species persistence at the broad ecoregion scale is the most appropriate goal when considering the effects of changing climates. Such a goal relaxes expectations that current species ranges will remain constant, or that population abundances, distribution, species compositions and dominances should remain stable. Allowing fundamental ecosystem processes to operate within forested landscapes will be critical. Management and political institutions will have to acknowledge and embrace uncertainty in the future since we are moving into a time period with few analogs and inevitably, there will be surprises.

Dental practice websites: creating a Web presence.

PubMed

Miller, Syrene A; Forrest, Jane L

2002-07-01

Web technology provides an opportunity for dentists to showcase their practice philosophy, quality of care, office setting, and staff in a creative manner. Having a Website provides a practice with innovative and cost-effective communications and marketing tools for current and potential patients who use the Internet. The main benefits of using a Website to promote one's practice are: Making office time more productive, tasks more timely, follow-up less necessary Engaging patients in an interactive and visual learning process Providing online forms and procedure examples for patients Projecting a competent and current image Tracking the usage of Web pages. Several options are available when considering the development of a Website. These options range in cost based on customization of the site and ongoing support services, such as site updates, technical assistance, and Web usage statistics. In most cases, Websites are less expensive than advertising in the phone book. Options in creating a Website include building one's own, employing a company that offers Website templates, and employing a company that offers customized sites. These development options and benefits will continue to grow as individuals access the Web and more information and sites become available.

TOPEX satellite concept. TOPEX option study report

NASA Technical Reports Server (NTRS)

Meyer, D. P.; Case, C. M.

1982-01-01

Candidate bus equipment from the Viking, Applications Explorer Mission, and Small Scientific Satellite programs for application to the TOPEX mission options is assessed. Propulsion module equipment and subsystem candidates from the Applications Explorer Mission satellites and the Small Scientific Satellite spacecraft are evaluated for those TOPEX options. Several subsystem concepts appropriate to the TOPEX options are described. These descriptions consider performance characteristics of the subsystems. Cost and availability information on the candidate equipment and subsystems are also provided.

Factors influencing infant-feeding choices selected by HIV-infected mothers: perspectives from Zimbabwe.

PubMed

Marembo, Joan; Zvinavashe, Mathilda; Nyamakura, Rudo; Shaibu, Sheila; Mogobe, Keitshokile Dintle

2014-10-01

To assess factors influencing infant-feeding methods selected by HIV-infected mothers. A descriptive quantitative study was conducted among 80 mothers with babies aged 0-6 months who were randomly selected and interviewed. Descriptive statistics were used to summarize the findings. Factors considered by women in choosing the infant-feeding methods included sociocultural acceptability (58.8%), feasibility and support from significant others (35%), knowledge of the selected method (55%), affordability (61.2%), implementation of the infant-feeding method without interference (62.5%), and safety (47.5%). Exclusive breast-feeding was the most preferred method of infant feeding. Disclosure of HIV status by a woman to her partner is a major condition for successful replacement feeding method, especially within the African cultural context. However, disclosure of HIV status to the partner was feared by most women as only 16.2% of the women disclosed their HIV status to partners. The factors considered by women in choosing the infant-feeding option were ability to implement the options without interference from significant others, affordability, and sociocultural acceptability. Knowledge of the selected option, its advantages and disadvantages, safety, and feasibility were also important factors. Nurses and midwives have to educate clients and support them in their choice of infant-feeding methods. © 2013 The Authors. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.

Affordable Development and Demonstration of a Small NTR Engine and Stage: How Small is Big Enough?

NASA Technical Reports Server (NTRS)

Borowski, Stanley K.; Sefcik, Robert J.; Fittje, James E.; McCurdy, David R.; Qualls, Arthur L.; Schnitzler, Bruce G.; Werner, James E.; Weitzberg (Abraham); Joyner, Claude R.

2015-01-01

The Nuclear Thermal Rocket (NTR) derives its energy from fission of uranium-235 atoms contained within fuel elements that comprise the engine's reactor core. It generates high thrust and has a specific impulse potential of approximately 900 seconds - a 100% increase over today's best chemical rockets. The Nuclear Thermal Propulsion (NTP) project, funded by NASA's AES program, includes five key task activities: (1) Recapture, demonstration, and validation of heritage graphite composite (GC) fuel (selected as the "Lead Fuel" option); (2) Engine Conceptual Design; (3) Operating Requirements Definition; (4) Identification of Affordable Options for Ground Testing; and (5) Formulation of an Affordable Development Strategy. During FY'14, a preliminary DDT&E plan and schedule for NTP development was outlined by GRC, DOE and industry that involved significant system-level demonstration projects that included GTD tests at the NNSS, followed by a FTD mission. To reduce cost for the GTD tests and FTD mission, small NTR engines, in either the 7.5 or 16.5 klbf thrust class, were considered. Both engine options used GC fuel and a "common" fuel element (FE) design. The small approximately 7.5 klbf "criticality-limited" engine produces approximately 157 megawatts of thermal power (MWt) and its core is configured with parallel rows of hexagonal-shaped FEs and tie tubes (TTs) with a FE to TT ratio of approximately 1:1. The larger approximately 16.5 klbf Small Nuclear Rocket Engine (SNRE), developed by LANL at the end of the Rover program, produces approximately 367 MWt and has a FE to TT ratio of approximately 2:1. Although both engines use a common 35 inch (approximately 89 cm) long FE, the SNRE's larger diameter core contains approximately 300 more FEs needed to produce an additional 210 MWt of power. To reduce the cost of the FTD mission, a simple "1-burn" lunar flyby mission was considered to reduce the LH2 propellant loading, the stage size and complexity. Use of existing and flight proven liquid rocket and stage hardware (e.g., from the RL10B-2 engine and Delta Cryogenic Second Stage) was also maximized to further aid affordability. This paper examines the pros and cons of using these two small engine options, including their potential to support future human exploration missions to the Moon, near Earth asteroids, and Mars, and recommends a preferred size. It also provides a preliminary assessment of the key activities, development options, and schedule required to affordably build, ground test and fly a small NTR engine and stage within a 10-year timeframe.

Power Systems Life Cycle Analysis Tool (Power L-CAT).

DOE Office of Scientific and Technical Information (OSTI.GOV)

Andruski, Joel; Drennen, Thomas E.

2011-01-01

The Power Systems L-CAT is a high-level dynamic model that calculates levelized production costs and tracks environmental performance for a range of electricity generation technologies: natural gas combined cycle (using either imported (LNGCC) or domestic natural gas (NGCC)), integrated gasification combined cycle (IGCC), supercritical pulverized coal (SCPC), existing pulverized coal (EXPC), nuclear, and wind. All of the fossil fuel technologies also include an option for including carbon capture and sequestration technologies (CCS). The model allows for quick sensitivity analysis on key technical and financial assumptions, such as: capital, O&M, and fuel costs; interest rates; construction time; heat rates; taxes; depreciation;more » and capacity factors. The fossil fuel options are based on detailed life cycle analysis reports conducted by the National Energy Technology Laboratory (NETL). For each of these technologies, NETL's detailed LCAs include consideration of five stages associated with energy production: raw material acquisition (RMA), raw material transport (RMT), energy conversion facility (ECF), product transportation and distribution (PT&D), and end user electricity consumption. The goal of the NETL studies is to compare existing and future fossil fuel technology options using a cradle-to-grave analysis. The NETL reports consider constant dollar levelized cost of delivered electricity, total plant costs, greenhouse gas emissions, criteria air pollutants, mercury (Hg) and ammonia (NH3) emissions, water withdrawal and consumption, and land use (acreage).« less

Allergies in orthopaedic and trauma surgery.

PubMed

Lohmann, C H; Hameister, R; Singh, G

2017-02-01

Hypersensitivity reactions to implants in orthopaedic and trauma surgery are a rare but devastating complication. They are considered as a delayed-type of hypersensitivity reaction (type IV), characterized by an antigen activation of sensitized T-lymphocytes releasing various cytokines and may result in osteoclast activation and bone resorption. Potential haptens are originated from metal alloys or bone-cement. A meta-analysis has confirmed a higher probability of developing a metal hypersensitivity postoperatively and noted a greater risk of failed replacements compared to stable implants. Hypersensitivity to implants may present with a variety of symptoms such as pain, joint effusion, delayed wound/bone healing, persistent secretion, allergic dermatitis (localized or systemic), clicking noises, loss of joint function, instability and failure of the implant. Various diagnostic options have been offered, including patch testing, metal alloy patch testing, histology, lymphocyte transformation test (LTT), memory lymphocyte immunostimulation assay (MELISA), leukocyte migration inhibition test (LIF) and lymphocyte activation test (LAT). No significant differences between in vivo and in vitro methods have been found. Due to unconvincing evidence for screening methods, predictive tests are not recommended for routine performance. Infectious aetiology always needs to be excluded. As there is a lack of evidence on large-scale studies with regards to the optimal treatment option, management currently relies on individual case-by-case decisions. Several options for patients with (suspected) metal-related hypersensitivity exist and may include materials based on ceramic, titanium or oxinium or modified surfaces. Promising results have been reported, but long-term experience is lacking. More large-scaled studies are needed in this context. In patients with bone-cement hypersensitivity, the component suspected for hypersensitivity should be avoided. The development of (predictive) biomarkers is considered as a major contribution for the future. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Risk Balance: A Key Tool for Mission Operations Assurance

NASA Technical Reports Server (NTRS)

Bryant, Larry W.; Faris, Grant B.

2011-01-01

The Mission Operations Assurance (MOA) discipline actively participates as a project member to achieve their common objective of full mission success while also providing an independent risk assessment to the Project Manager and Office of Safety and Mission Success staff. The cornerstone element of MOA is the independent assessment of the risks the project faces in executing its mission. Especially as the project approaches critical mission events, it becomes imperative to clearly identify and assess the risks the project faces. Quite often there are competing options for the project to select from in deciding how to execute the event. An example includes choices between proven but aging hardware components and unused but unproven components. Timing of the event with respect to visual or telecommunications visibility can be a consideration in the case of Earth reentry or hazardous maneuver events. It is in such situations that MOA is called upon for a risk balance assessment or risk trade study to support their recommendation to the Project Manager for a specific option to select. In the following paragraphs we consider two such assessments, one for the Stardust capsule Earth return and the other for the choice of telecommunications system configuration for the EPOXI flyby of the comet Hartley 2. We discuss the development of the trade space for each project's scenario and characterize the risks of each possible option. The risk characterization we consider includes a determination of the severity or consequence of each risk if realized and the likelihood of its occurrence. We then examine the assessment process to arrive at a MOA recommendation. Finally we review each flight project's decision process and the outcome of their decisions.

New techniques for modeling the reliability of reactor pressure vessels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, K.I.; Simonen, F.A.; Liebetrau, A.M.

1985-12-01

In recent years several probabilistic fracture mechanics codes, including the VISA code, have been developed to predict the reliability of reactor pressure vessels. This paper describes new modeling techniques used in a second generation of the VISA code entitled VISA-II. Results are presented that show the sensitivity of vessel reliability predictions to such factors as inservice inspection to detect flaws, random positioning of flaws within the vessel walls thickness, and fluence distributions that vary through-out the vessel. The algorithms used to implement these modeling techniques are also described. Other new options in VISA-II are also described in this paper. Themore » effect of vessel cladding has been included in the heat transfer, stress, and fracture mechanics solutions in VISA-II. The algorithm for simulating flaws has been changed to consider an entire vessel rather than a single flaw in a single weld. The flaw distribution was changed to include the distribution of both flaw depth and length. A menu of several alternate equations has been included to predict the shift in RTNDT. For flaws that arrest and later re-initiate, an option was also included to allow correlating the current arrest thoughness with subsequent initiation toughnesses. 21 refs.« less

The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses

PubMed Central

Aurora, R. Nisha; Chowdhuri, Susmita; Ramar, Kannan; Bista, Sabin R.; Casey, Kenneth R.; Lamm, Carin I.; Kristo, David A.; Mallea, Jorge M.; Rowley, James A.; Zak, Rochelle S.; Tracy, Sharon L.

2012-01-01

The International Classification of Sleep Disorders, Second Edition (ICSD-2) distinguishes 5 subtypes of central sleep apnea syndromes (CSAS) in adults. Review of the literature suggests that there are two basic mechanisms that trigger central respiratory events: (1) post-hyperventilation central apnea, which may be triggered by a variety of clinical conditions, and (2) central apnea secondary to hypoventilation, which has been described with opioid use. The preponderance of evidence on the treatment of CSAS supports the use of continuous positive airway pressure (CPAP). Much of the evidence comes from investigations on CSAS related to congestive heart failure (CHF), but other subtypes of CSAS appear to respond to CPAP as well. Limited evidence is available to support alternative therapies in CSAS subtypes. The recommendations for treatment of CSAS are summarized as follows: CPAP therapy targeted to normalize the apnea-hypopnea index (AHI) is indicated for the initial treatment of CSAS related to CHF. (STANDARD)Nocturnal oxygen therapy is indicated for the treatment of CSAS related to CHF. (STANDARD)Adaptive Servo-Ventilation (ASV) targeted to normalize the apnea-hypopnea index (AHI) is indicated for the treatment of CSAS related to CHF. (STANDARD)BPAP therapy in a spontaneous timed (ST) mode targeted to normalize the apnea-hypopnea index (AHI) may be considered for the treatment of CSAS related to CHF only if there is no response to adequate trials of CPAP, ASV, and oxygen therapies. (OPTION)The following therapies have limited supporting evidence but may be considered for the treatment of CSAS related to CHF after optimization of standard medical therapy, if PAP therapy is not tolerated, and if accompanied by close clinical follow-up: acetazolamide and theophylline. (OPTION)Positive airway pressure therapy may be considered for the treatment of primary CSAS. (OPTION)Acetazolamide has limited supporting evidence but may be considered for the treatment of primary CSAS. (OPTION)The use of zolpidem and triazolam may be considered for the treatment of primary CSAS only if the patient does not have underlying risk factors for respiratory depression. (OPTION)The following possible treatment options for CSAS related to end-stage renal disease may be considered: CPAP, supplemental oxygen, bicarbonate buffer use during dialysis, and nocturnal dialysis. (OPTION) Citation: Aurora RN; Chowdhuri S; Ramar K; Bista SR; Casey KR; Lamm CI; Kristo DA; Mallea JM; Rowley JA; Zak RS; Tracy SL. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. SLEEP 2012;35(1):17-40. PMID:22215916

Single Event Effects Test Facility Options at the Oak Ridge National Laboratory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Riemer, Bernie; Gallmeier, Franz X; Dominik, Laura J

2015-01-01

Increasing use of microelectronics of ever diminishing feature size in avionics systems has led to a growing Single Event Effects (SEE) susceptibility arising from the highly ionizing interactions of cosmic rays and solar particles. Single event effects caused by atmospheric radiation have been recognized in recent years as a design issue for avionics equipment and systems. To ensure a system meets all its safety and reliability requirements, SEE induced upsets and potential system failures need to be considered, including testing of the components and systems in a neutron beam. Testing of integrated circuits (ICs) and systems for use in radiationmore » environments requires the utilization of highly advanced laboratory facilities that can run evaluations on microcircuits for the effects of radiation. This paper provides a background of the atmospheric radiation phenomenon and the resulting single event effects, including single event upset (SEU) and latch up conditions. A study investigating requirements for future single event effect irradiation test facilities and developing options at the Spallation Neutron Source (SNS) is summarized. The relatively new SNS with its 1.0 GeV proton beam, typical operation of 5000 h per year, expertise in spallation neutron sources, user program infrastructure, and decades of useful life ahead is well suited for hosting a world-class SEE test facility in North America. Emphasis was put on testing of large avionics systems while still providing tunable high flux irradiation conditions for component tests. Makers of ground-based systems would also be served well by these facilities. Three options are described; the most capable, flexible, and highest-test-capacity option is a new stand-alone target station using about one kW of proton beam power on a gas-cooled tungsten target, with dual test enclosures. Less expensive options are also described.« less

Sustainability of UK shale gas in comparison with other electricity options: Current situation and future scenarios.

PubMed

Cooper, Jasmin; Stamford, Laurence; Azapagic, Adisa

2018-04-01

Many countries are considering exploitation of shale gas but its overall sustainability is currently unclear. Previous studies focused mainly on environmental aspects of shale gas, largely in the US, with scant information on socio-economic aspects. To address this knowledge gap, this paper integrates for the first time environmental, economic and social aspects of shale gas to evaluate its overall sustainability. The focus is on the UK which is on the cusp of developing a shale gas industry. Shale gas is compared to other electricity options for the current situation and future scenarios up to the year 2030 to investigate whether it can contribute towards a more sustainable electricity mix in the UK. The results obtained through multi-criteria decision analysis suggest that, when equal importance is assumed for each of the three sustainability aspects shale gas ranks seventh out of nine electricity options, with wind and solar PV being the best and coal the worst options. However, it outranks biomass and hydropower. Changing the importance of the sustainability aspects widely, the ranking of shale gas ranges between fourth and eighth. For shale gas to become the most sustainable option of those assessed, large improvements would be needed, including a 329-fold reduction in environmental impacts and 16 times higher employment, along with simultaneous large changes (up to 10,000 times) in the importance assigned to each criterion. Similar changes would be needed if it were to be comparable to conventional or liquefied natural gas, biomass, nuclear or hydropower. The results also suggest that a future electricity mix (2030) would be more sustainable with a lower rather than a higher share of shale gas. These results serve to inform UK policy makers, industry and non-governmental organisations. They will also be of interest to other countries considering exploitation of shale gas. Copyright © 2017 Elsevier B.V. All rights reserved.

Real-life decision making in college students. I: Consistency across specific decisions.

PubMed

Galotti, Kathleen M; Wiener, Hillary J D; Tandler, Jane M

2014-01-01

First-year undergraduates participated in a short-term longitudinal study of real-life decision making over their first 14 months of college. They were surveyed about 7 different decisions: choosing courses for an upcoming term (3 different terms), choosing an academic major (twice), planning for the upcoming summer, and planning for sophomore-year housing. Participants showed moderate levels of consistency in the options they considered and in the criteria they used to decide between options, with about half of the options or criteria being used at 2 different points on the decision repeatedly studied. Participants varied somewhat in structural consistency, the tendency to consider the same number of options or criteria across decisions. They also varied in the way they integrated information across decision-making tasks. We suggest that people attempt to keep the information demands of the task within workable limits, sometimes sacrificing consistency as a result.

42 CFR 436.201 - Individuals included in optional groups.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Individuals included in optional groups. 436.201... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS Options for Coverage as Categorically Needy § 436.201 Individuals included in optional groups. (a) The...

Wireless Power Transmission Options for Space Solar Power

NASA Technical Reports Server (NTRS)

Potter, Seth; Davis, Dean; Born, Martin; Bayer, Martin; Howell, Joe; Mankins, John

2008-01-01

Space Solar Power (SSP), combined with Wireless Power Transmission (WPT), offers the far-term potential to solve major energy problems on Earth. In the long term, we aspire to beam energy to Earth from geostationary Earth orbit (GEO), or even further distances in space. In the near term, we can beam power over more moderate distances, but still stretch the limits of today s technology. In recent studies, a 100 kWe-class "Power Plug" Satellite and a 10 kWe-class Lunar Polar Solar Power outpost have been considered as the first steps in using these WPT options for SSP. Our current assessments include consideration of orbits, wavelengths, and structural designs to meet commercial, civilian government, and military needs. Notional transmitter and receiver sizes are considered for use in supplying 5 to 40 MW of power. In the longer term, lunar or asteroidal material can be used. By using SSP and WPT technology for near-term missions, we gain experience needed for sound decisions in designing and developing larger systems to send power from space to Earth.

Wireless Power Transmission Options for Space Solar Power

NASA Technical Reports Server (NTRS)

Potter, Seth; Henley, Mark; Davis, Dean; Born, Andrew; Howell, Joe; Mankins, John

2008-01-01

Space Solar Power (SSP), combined with Wireless Power Transmission (WPT), offers the far-term potential to solve major energy problems on Earth. In the long-term, we aspire to beam energy to Earth from geostationary Earth orbit (GEO), or even further distances in space. In the near-term, we can beam power over more moderate distances, but still stretch the limits of today s technology. In recent studies, a 100 kWe-class "Power Plug" Satellite and a 10 kWe-class Lunar Polar Solar Power outpost have been considered as the first steps in using these WPT options for SSP. Our current assessments include consideration of orbits, wavelengths, and structural designs to meet commercial, civilian government, and military needs. Notional transmitter and receiver sizes are considered for use in supplying 5 to 15 MW of power. In the longer term, lunar or asteroidal material can be used. By using SSP and WPT technology for near-term missions, we gain experience needed for sound decisions in designing and developing larger systems to send power from space to Earth.

The omni-relevance of surgery: how medical specialization shapes orthopedic surgeons' treatment recommendations.

PubMed

Hudak, Pamela L; Clark, Shannon J; Raymond, Geoffrey

2013-01-01

This article examines treatment recommendations in orthopedic surgery consultations and shows how surgery is treated as "omni-relevant" within this activity, providing a context within which the broad range of treatment recommendations proposed by surgeons is offered. Using conversation analysis to analyse audiotaped encounters between orthopedic surgeons and patients, we highlight how surgeons treat surgery as having a special, privileged status relative to other treatment options by (1) invoking surgery (whether or not it is actually being recommended) and (2) presenting surgery as the "last best resort" (in relation to which other treatment options are calibrated, described and considered). This privileged status surfaces in the design and delivery of recommendations as a clear asymmetry: Recommendations for surgery are proposed early, in relatively simple and unmitigated form. In contrast, recommendations not for surgery tend to be delayed and involve significantly more interactional work in their delivery. Possible implications of these findings, including how surgeons' structuring of recommendations may shape patient expectations (whether for surgery or some alternative), and potentially influence the distribution of orthopedic surgery procedures arising from these consultations, are considered.

A conceptual framework for the sustainable management of wastewater in Harare, Zimbabwe.

PubMed

Nhapi, I; Gijzen, H J; Siebel, M A

2003-01-01

The aim of this study was to formulate an integrated wastewater management model for Harare, Zimbabwe, based on current thinking. This implies that wastewater is treated/disposed of as close to the source of generation as possible. Resource recovery and reuse in a local thriving urban agriculture are integrated into this model. Intervention strategies were considered for controlling water, nitrogen and phosphorus flows to the lake. In the formulation of strategies, Harare was divided into five major operational areas of high-, medium-, and low-density residential areas, and also commercial and industrial areas. Specific options were then considered to suit landuse, development constraints and socio-economic status for each area, within the overall criteria of limiting nutrient inflows into the downstream Lake Chivero. Flexible and differential solutions were developed in relation to built environment, population density, composition of users, ownership, future environmental demands, and technical, environmental, hygienic, social and organisational factors. Options considered include source control by the users (residents, industries, etc.), using various strategies like implementation of toilets with source separation, and natural methods of wastewater treatment. Other possible strategies are invoking better behaviour through fees and information, incentives for cleaner production, and user responsibility through education, legislative changes and stricter controls over industry.

Maximizing value in opioid utilization: Is oxycodone immediate release a good option for pain management?

PubMed

Pergolizzi, Joseph V; Köknel Talu, Gül; Zmponga, Gianpetrio; Erdine, Serdar; Taylor, Robert; Ayan, Burak; Raffa, Robert B

2015-01-01

The modern approach to the management of pain involves optimizing all aspects of the process. This includes utilization of pharmacologic and non-pharmacologic modalities, consideration of patient characteristics, proper matching of the physiology of the pain with the analgesic's mechanism of action (pharmacodynamics, PD), and the onset and duration of action (pharmacokinetics, PK). No single agent or formulation satisfies all of the requirements for all patients. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are effective options for inflammatory pain and, as is acetaminophen, for mild pain. Specialized agents are helpful for particular pains, such as for migraine headache. Opioids remain the standard option for severe pain. Although they are generally a safe and effective option, opioids can produce dose-limiting adverse effects and have abuse potential. The goal of pain therapy is thus to achieve the maximum pain relief with the least amount of opioid exposure. Against this background of measured approach to the use of analgesics, an immediate release (IR) oral formulation of the established opioid oxycodone has been developed to provide rapid onset of action and rate of titration, both of which could maximize temporal matching of dose with pain level and reduce total exposure to drug. This article considers the option of an immediate release (IR) oral formulation for the management of pain.

ELICITED EXPERT PERCEPTIONS FOR CLIMATE CHANGE RISKS AND ADAPTATION IN AGRICULTURE AND FOOD PRODUCTION THROUGH MENTAL MODELS APPROACH

NASA Astrophysics Data System (ADS)

Suda, Eiko; Kubota, Hiromi; Baba, Kenshi; Hijioka, Yasuaki; Takahashi, Kiyoshi; Hanasaki, Naota

Impacts of climate change have become obvious in agriculture and food production in Japan these days, and researches to adapt to their risks have been conducted as a key effort to cope with the climate change. Numerous scientific findings on climate change impacts have been presented so far; however, prospective risks to be adapted to and their management in the context of individual on-site situations have not been investigated in detail. The structure of climate change risks and their management vary depending on geographical and social features in the regions where the adaptation options should be applied; therefore, a practical adaptation strategy should consider actual on-site situations. This study intended to clarify climate change risks to be adapted to in the Japanese agricultural sector, and factors to be considered in adaptation options, for encouragement of decision-making on adaptation implementation in the field. Semi-structured individual interviews have been conducted with 9 multidisciplinary experts engaging in climate change impacts research in agricultural production, economics, engineering, policy, and so on. Based on the results of the interviews, and the latest literatures available for risk assessment and adaptation, an expert mental model including their perceptions which cover the process from climate change impacts assessment to adaptation has been developed. The prospective risks, adaptation options, and issues to be examined to progress the development of practical and effective adaptation options and to support individual or social decision-making, have been shown on the developed expert mental model. It is the basic information for developing social communication and stakeholders cooperations in climate change adaptation strategies in agriculture and food production in Japan.

Sizing and Lifecycle Cost Analysis of an Ares V Composite Interstage

NASA Technical Reports Server (NTRS)

Mann, Troy; Smeltzer, Stan; Grenoble, Ray; Mason, Brian; Rosario, Sev; Fairbairn, Bob

2012-01-01

The Interstage Element of the Ares V launch vehicle was sized using a commercially available structural sizing software tool. Two different concepts were considered, a metallic design and a composite design. Both concepts were sized using similar levels of analysis fidelity and included the influence of design details on each concept. Additionally, the impact of the different manufacturing techniques and failure mechanisms for composite and metallic construction were considered. Significant details were included in analysis models of each concept, including penetrations for human access, joint connections, as well as secondary loading effects. The designs and results of the analysis were used to determine lifecycle cost estimates for the two Interstage designs. Lifecycle cost estimates were based on industry provided cost data for similar launch vehicle components. The results indicated that significant mass as well as cost savings are attainable for the chosen composite concept as compared with a metallic option.

Prospects for development of heat supply systems in high-rise districts

NASA Astrophysics Data System (ADS)

Zhila, Viktor; Solovyeva, Elena

2018-03-01

The article analyzes the main advantages and disadvantages of centralized and decentralized heat supply systems in high-rise districts. The main schemes of centralized heat supply systems are considered. They include centralized heat supply from boiler houses, centralized heat supply from autonomous heat sources, heat supply from roof boiler houses and door-to-door heating supply. For each of these variant, the gas distribution systems are considered and analyzed. These systems vary depending on the heat source location. For each of these systems, technical and economic indicators are taken into account, the analysis of which allows choosing the best option for districts where high-rise buildings predominate.

Severe disease exacerbations in patients with multiple sclerosis after discontinuing fingolimod.

PubMed

Członkowska, Anna; Smoliński, Łukasz; Litwin, Tomasz

Discontinuation of fingolimod in patients with multiple sclerosis (MS) can lead to disease reactivation. In this review, we describe cases of severe exacerbations in patients with MS following discontinuation of fingolimod, including three cases from our center. We consider potential mechanisms of disease reactivation after cessation of fingolimod, and the evidence supporting this rebound effect. We conclude that discontinuation of fingolimod results in the return of disease activity, which then leads to severe exacerbations (i.e., rebounds) in a clinically significant proportion of patients. Lastly, we consider disease-modifying treatment options for patients who discontinue fingolimod. Copyright © 2017. Published by Elsevier Urban & Partner Sp. z o.o.

A study of industrial hydrogen and syngas supply systems

NASA Technical Reports Server (NTRS)

Amos, W. J.; Solomon, J.; Eliezer, K. F.

1979-01-01

The potential and incentives required for supplying hydrogen and syngas feedstocks to the U.S. chemical industry from coal gasification systems were evaluated. Future hydrogen and syngas demand for chemical manufacture was estimated by geographic area and projected economics for hydrogen and syngas manufacture was estimated with geographic area of manufacture and plant size as parameters. Natural gas, oil and coal feedstocks were considered. Problem areas presently affecting the commercial feasibility of coal gasification discussed include the impact of potential process improvements, factors involved in financing coal gasification plants, regulatory barriers affecting coal gasification, coal mining/transportation, air quality regulations, and competitive feedstock pricing barriers. The potential for making coal gasification the least costly H2 and syngas supply option. Options to stimulate coal gasification system development are discussed.

Service contract with periodic preventive maintenance for a dump truck sold with a two-dimensional warranty

NASA Astrophysics Data System (ADS)

Nasrum, A.; Pasaribu, U. S.; Husniah, H.

2016-02-01

This paper deals with maintenance service contract for a dump truck sold with a two-dimensional warranties. We consider a situation where an agent offers two maintenance contract options and the owner of the equipment has to select the optimal option either the OEM carried out all repairs and preventive maintenance activities (option one) or the OEM only carries out failure while the costumer undertakes preventive maintenance action in-house (option two). As the number of preventive maintenance and corrective maintenance that occurs in the area of servicing contracts is very influential in determining the value of the contract, we have to determine the optimal time between preventive maintenance that can minimize the cost of repair in the contract area. Moreover, we also study the maintenance service contract considering reduction of the intensity function after preventive maintenance from both the owner and OEM point of views. In this paper, we use a Weibull intensity function to consider a product with increasing failure intensity. We use a non-cooperative game formulation to determine the optimal price structure (i.e., the contract price and repair cost) for the OEM and the owner. A numerical example derived from the model has shown that if the owner choose option one then the owner obtain a higher profit compared with the profit resulted from option two. The result agree with earlier work which uses the accelerated failure time (AFT) for the failure modeling, while here we model the failure of the dump truck without the use of the AFT.

Preeradication vaccine policy options for poliovirus infection and disease control.

PubMed

Thompson, Kimberly M; Pallansch, Mark A; Duintjer Tebbens, Radboud J; Wassilak, Steve G; Kim, Jong-Hoon; Cochi, Stephen L

2013-04-01

With the circulation of wild poliovirus (WPV) types 1 and 3 continuing more than a decade after the original goal of eradicating all three types of WPVs by 2000, policymakers consider many immunization options as they strive to stop transmission in the remaining endemic and outbreak areas and prevent reintroductions of live polioviruses into nonendemic areas. While polio vaccination choices may appear simple, our analysis of current options shows remarkable complexity. We offer important context for current and future polio vaccine decisions and policy analyses by developing decision trees that clearly identify potential options currently used by countries as they evaluate national polio vaccine choices. Based on a comprehensive review of the literature we (1) identify the current vaccination options that national health leaders consider for polio vaccination, (2) characterize current practices and factors that appear to influence national and international choices, and (3) assess the evidence of vaccine effectiveness considering sources of variability between countries and uncertainties associated with limitations of the data. With low numbers of cases occurring globally, the management of polio risks might seem like a relatively low priority, but stopping live poliovirus circulation requires making proactive and intentional choices to manage population immunity in the remaining endemic areas and to prevent reestablishment in nonendemic areas. Our analysis shows remarkable variability in the current national polio vaccine product choices and schedules, with combination vaccine options containing inactivated poliovirus vaccine and different formulations of oral poliovirus vaccine making choices increasingly difficult for national health leaders. © 2013 Society for Risk Analysis.

Satellite services system analysis study. Volume 4: Service equipment concepts

NASA Technical Reports Server (NTRS)

1981-01-01

Payload deployment equipment is discussed, including payload separation, retention structures, the remote manipulator system, tilt tables, the payload installation and deployment aid, the handling and positioning aid, and spin tables. Close proximity retrieval, and on-orbit servicing equipment is discussed. Backup and contingency equipment is also discussed. Delivery and retrieval of high-energy payloads are considered. Earth return equipment, the aft flight deck, optional, and advanced equipment are also discussed.

Space Station Systems Analysis Study. Volume 2: Program review report

NASA Technical Reports Server (NTRS)

1977-01-01

Major growth options for tended and manned space stations in LEO and GEO are examined including increased orbiter augmentation and habitation requirements. Approaches for providing power supplies, construction aids needed to assemble support platforms, transportation system constraints, and the hardware required for various missions categories are defined. Subsystem requirements are analyzed for structure; flight control; power generation and storage; avionic; life support systems; personnel provisions; and environmental control. Tradeoffs are considered.

Physiotherapy assessment of patients with rotator cuff pathology

PubMed Central

2014-01-01

Pathology of the rotator cuff and sub-acromial bursa are considered to be the main cause of shoulder pain and dysfunction. In the absence of trauma, conservative care, including physiotherapy is the primary treatment. This paper aims to present the key features of a physiotherapy assessment, excluding diagnostic tests for rotator cuff pathology. It describes and explores how assessment can be used to direct management options and develop a treatment plan. PMID:27582940

Paratransit Integration Symposium Proceedings, October 14, 1977

DOT National Transportation Integrated Search

1978-06-01

Paratransit innovation is considered by DOT/UMTA to be an essential part of the provision of public transportation. A variety of service options, ranging from many-to-many dial-a-ride to subscription ridership, offer cost effective options to convent...

42 CFR 435.201 - Individuals included in optional groups.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Individuals included in optional groups. 435.201... Individuals included in optional groups. (a) The agency may choose to cover as optional categorically needy any group or groups of the following individuals who are not receiving cash assistance and who meet...

Precision medicine in colorectal cancer: the molecular profile alters treatment strategies.

PubMed

Tran, Nguyen H; Cavalcante, Ludmila L; Lubner, Sam J; Mulkerin, Daniel L; LoConte, Noelle K; Clipson, Linda; Matkowskyj, Kristina A; Deming, Dustin A

2015-09-01

When considering treatment options for patients with metastatic colorectal cancer (mCRC), molecular profiling has become a pivotal component in guiding clinical decisions. FOLFOX and FOLFIRI (fluorouracuil, leucovorin plus oxaliplatin or ininotecan, respectively) are the standard base regimens used for the treatment of mCRC. Biologic agents, such as the epidermal growth factor receptor (EGFR) targeted therapies, cetuximab and panitumumab and the vascular endothelial growth factor monoclonal antibody, bevacizumab, are safe and effective in the first-line setting. The most efficacious use of these agents in terms of timing and selection of the right patient population continues to be debated. Here we review multiple investigations into the effectiveness of treatment options as a function of the mutations present in colon cancers. Early studies have reported that KRAS mutations at exon 2 predict resistance to EGFR targeted therapies. More recently the data have expanded to include KRAS mutations at exons 3 and 4 and NRAS mutations at exons 2, 3 and 4 as well as other biomarkers including BRAF and PIK3CA, leading to the evolution of the treatment of mCRC to a more precision-based approach. As our understanding of relevant biomarkers increases, and data from both molecular profiling and treatment response become more readily available, treatment options will become more precise and their outcomes more effective.

Decision-making in healthy children, adolescents and adults explained by the use of increasingly complex proportional reasoning rules.

PubMed

Huizenga, Hilde M; Crone, Eveline A; Jansen, Brenda J

2007-11-01

In the standard Iowa Gambling Task (IGT), participants have to choose repeatedly from four options. Each option is characterized by a constant gain, and by the frequency and amount of a probabilistic loss. Crone and van der Molen (2004) reported that school-aged children and even adolescents show marked deficits in IGT performance. In this study, we have re-analyzed the data with a multivariate normal mixture analysis to show that these developmental changes can be explained by a shift from unidimensional to multidimensional proportional reasoning (Siegler, 1981; Jansen & van der Maas, 2002). More specifically, the results show a gradual shift with increasing age from (a) guessing with a slight tendency to consider frequency of loss to (b) focusing on frequency of loss, to (c) considering both frequency and amount of probabilistic loss. In the latter case, participants only considered options with low-frequency loss and then chose the option with the lowest amount of loss. Performance improved in a reversed task, in which punishment was placed up front and gain was delivered unexpectedly. In this reversed task, young children are guessing with already a slight tendency to consider both the frequency and amount of gain; this strategy becomes more pronounced with age. We argue that these findings have important implications for the interpretation of IGT performance, as well as for methods to analyze this performance.

Methadone for the treatment of Prescription Opioids Dependence. A retrospective chart review.

PubMed

Barrio, Pablo; Ezzeldin, Mohamed; Bruguera, Pol; Pérez, Ana; Mansilla, Sara; Fàbrega, Marina; Lligoña, Anna; Mondón, Sílvia; Balcells, Mercè

2016-06-14

Prescription opioids (PO) addiction is increasing to an epidemic level. Few studies exist regarding its treatment. Although buprenorphine has been the mainstay so far, other treatment options might be considered, such as methadone. We conducted a retrospective assessment of all patients admitted to a psychiatry ward for PO detoxification using methadone between 2010 and 2013. The assessment and description was carried out during a 3-month follow-up period after their discharge. Although this is a retrospective chart review, our exploration included sociodemographic and treatment variables in addition to the abstinence rates for the whole sample. Eleven patients were included, mostly women (81.8%), with a median age of 50 years. The median duration of dependence was 8 years. Dependence on other substances and psychiatric comorbidities were high. Eight patients were monitored during three months. Of these, 7 (87.5%) were abstinent after that period. The results suggest that methadone deserves further exploration as a potentially efficacious treatment option for PO dependence.

The Human Frontal Lobes and Frontal Network Systems: An Evolutionary, Clinical, and Treatment Perspective

PubMed Central

Hoffmann, Michael

2013-01-01

Frontal lobe syndromes, better termed as frontal network systems, are relatively unique in that they may manifest from almost any brain region, due to their widespread connectivity. The understandings of the manifold expressions seen clinically are helped by considering evolutionary origins, the contribution of the state-dependent ascending monoaminergic neurotransmitter systems, and cerebral connectivity. Hence, the so-called networktopathies may be a better term for the syndromes encountered clinically. An increasing array of metric tests are becoming available that complement that long standing history of qualitative bedside assessments pioneered by Alexander Luria, for example. An understanding of the vast panoply of frontal systems' syndromes has been pivotal in understanding and diagnosing the most common dementia syndrome under the age of 60, for example, frontotemporal lobe degeneration. New treatment options are also progressively becoming available, with recent evidence of dopaminergic augmentation, for example, being helpful in traumatic brain injury. The latter include not only psychopharmacological options but also device-based therapies including mirror visual feedback therapy. PMID:23577266

Basic science and surgical treatment options for articular cartilage injuries of the knee.

PubMed

Tetteh, Elizabeth S; Bajaj, Sarvottam; Ghodadra, Neil S

2012-03-01

The complex structure of articular cartilage allows for diverse knee function throughout range of motion and weight bearing. However, disruption to the structural integrity of the articular surface can cause significant morbidity. Due to an inherently poor regenerative capacity, articular cartilage defects present a treatment challenge for physicians and therapists. For many patients, a trial of nonsurgical treatment options is paramount prior to surgical intervention. In instances of failed conservative treatment, patients can undergo an array of palliative, restorative, or reparative surgical procedures to treat these lesions. Palliative methods include debridement and lavage, while restorative techniques include marrow stimulation. For larger lesions involving subchondral bone, reparative procedures such as osteochondral grafting or autologous chondrocyte implantation are considered. Clinical success not only depends on the surgical techniques but also requires strict adherence to rehabilitation guidelines. The purpose of this article is to review the basic science of articular cartilage and to provide an overview of the procedures currently performed at our institution for patients presenting with symptomatic cartilage lesions.

Using info-Gap Decision Theory for Water Resources Planning Under Severe Uncertainty

NASA Astrophysics Data System (ADS)

Korteling, B.; Brazier, R.; Kapelan, Z.; Dessai, S.

2012-12-01

Water resource managers are required to develop comprehensive water resource plans based on severely uncertain information of the effects of climate change on local hydrology and future socio-economic changes on localised demand. In England and Wales, current water resource planning methodologies include a headroom estimation process that quantifies uncertainty based on only one point of an assumed range of deviations from the expected climate and projected demand 25 years into the future. There are many situations where there is not enough knowledge to be able to estimate a representative probability of occurrence, or to be confident that the tails of an assumed probability distribution will not exhibit unexpected skewness, or that the kurtosis of a distribution differs from the norm. These situations can be considered severely uncertain. Information-Gap decision theory offers a method to sample a wider range of uncertainty than with traditional methods, and as a result, compare the robustness of various water resource management options under conditions of severe uncertainty. A more robust management option is one that delivers the same level of performance as other options at higher levels of uncertainty. A case study is based on a Water Supply Area that encompasses the county of Cornwall in southwest England containing 17 reservoirs and 19 demand nodes. The performance success of management options are evaluated primarily by measures of water availability including a reservoir risk measure that tests the probability and magnitude that strategic reservoir storage levels fall below the drought management curve under adverse conditions and also a safety margin deficit that tests how quickly reservoir levels can return to optimum operating levels in favourable conditions. Multi-Criteria Decision Analysis (MCDA) is used to test the effectiveness of different management options with different weightings for metrics other than water availability including; capital and operating costs, costs to customers, carbon emissions, environmental impact and social acceptability. Findings show that beyond the uncertainty range explored with the traditional headroom method, preference reversals can occur, i.e. some management options that underperform at lower uncertainties, outperform at higher levels of uncertainty. This study also shows that when 50% or more of the population adopts demand side management, efficiency related measures and innovative options such as rainwater collection can perform equally well or better than some supply side options. The additional use of MCDA shifts the focus away from reservoir expansion options that perform best with respect to water availability, to combined strategies that include innovative demand side management actions of rainwater collection and greywater reuse as well as efficiency measures and additional regional transfers. This research illustrates how an Info-Gap based approach can offer a comprehensive picture of potential supply/demand futures and a rich variety of information to support adaptive management of water systems under severe uncertainty.

Age, Loss Minimization, and the Role of Probability for Decision-Making.

PubMed

Best, Ryan; Freund, Alexandra M

2018-04-05

Older adults are stereotypically considered to be risk averse compared to younger age groups, although meta-analyses on age and the influence of gain/loss framing on risky choices have not found empirical evidence for age differences in risk-taking. The current study extends the investigation of age differences in risk preference by including analyses on the effect of the probability of a risky option on choices in gain versus loss situations. Participants (n = 130 adults aged 19-80 years) chose between a certain option and a risky option of varying probability in gain- and loss-framed gambles with actual monetary outcomes. Only younger adults displayed an overall framing effect. Younger and older adults responded differently to probability fluctuations depending on the framing condition. Older adults were more likely to choose the risky option as the likelihood of avoiding a larger loss increased and as the likelihood of a larger gain decreased. Younger adults responded with the opposite pattern: they were more likely to choose the risky option as the likelihood of a larger gain increased and as the likelihood of avoiding a (slightly) larger loss decreased. Results suggest that older adults are more willing to select a risky option when it increases the likelihood that larger losses be avoided, whereas younger adults are more willing to select a risky option when it allows for slightly larger gains. This finding supports expectations based on theoretical accounts of goal orientation shifting away from securing gains in younger adulthood towards maintenance and avoiding losses in older adulthood. Findings are also discussed in respect to the affective enhancement perspective and socioemotional selectivity theory. © 2018 S. Karger AG, Basel.

Parental Preference Assessment for Vesicoureteral Reflux Management in Children.

PubMed

Tran, Geraldine N; Bodapati, Anand V; Routh, Jonathan C; Saigal, Christopher S; Copp, Hillary L

2017-03-01

Parents of children with vesicoureteral reflux are presented with a variety of management options, which in many cases offer a similar risk-benefit ratio. To facilitate shared decision making, parental preferences regarding vesicoureteral reflux treatment options need to be acknowledged. We aimed to characterize the clinical experience of parents and elicit core themes affecting decision making in regard to managing vesicoureteral reflux in their child. A semistructured, qualitative interview script was developed and vetted by 25 pediatric urologists to discuss treatment options for vesicoureteral reflux. Additional patient interviews were conducted until new themes failed to arise. Content analysis was performed to extract all statements that described treatment options. Similar statements were combined until a final list of unique themes emerged. A total of 26 interviews were performed, yielding 689 statements about overall parent experiences with managing vesicoureteral reflux in the child and 450 statements (65%) pertaining to treatment options. Of the 13 themes that emerged, those most commonly considered were the prevention of future urinary tract infections by 85% of parents, the efficacy rate of treatment options by 85%, the burden of daily maintenance or compliance by 77%, antibiotic resistance by 69%, chronic kidney damage by 62% and invasiveness by 58%. Our study emphasizes that when choosing a treatment option for vesicoureteral reflux in their child, parent preferences regarding risks and benefits are variable. However, their chief concerns include whether a method decreases the risk of urinary tract infections, has an acceptable efficacy rate and aligns itself with the capabilities of the family. These themes help frame discussions between families and clinicians regarding vesicoureteral reflux management, and they can facilitate shared decision making. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The Importance of Measuring Strength-of-Preference Scores for Health Care Options in Preference-Sensitive Care

PubMed Central

Crump, R. Trafford; Llewellyn-Thomas, Hilary A.

2012-01-01

Objective The objective was to determine whether a paired-comparison/leaning scale method: a) could feasibly be used to elicit strength-of-preference scores for elective health care options in large community-based survey settings; and b) could reveal preferential sub-groups that would have been overlooked if only a categorical-response format had been used. Study Design Medicare beneficiaries in four different regions of the United States were interviewed in person. Participants considered 8 clinical scenarios, each with 2 to 3 different health care options. For each scenario, participants categorically selected their favored option, then indicated how strongly they favored that option relative to the alternative on a paired-comparison bi-directional Leaning Scale. Results Two hundred and two participants were interviewed. For 7 of the 8 scenarios, a clear majority (> 50%) indicated that, overall, they categorically favored one option over the alternative(s). However, the bi-directional strength-of-preference Leaning Scale scores revealed that, in 4 scenarios, for half of those participants, their preference for the favored option was actually “weak” or “neutral”. Conclusion Investigators aiming to assess population-wide preferential attitudes towards different elective health care scenarios should consider gathering ordinal-level strength-of-preference scores and could feasibly use the paired-comparison/bi-directional Leaning Scale to do so. PMID:22494579

Planning water supply under uncertainty - benefits and limitations of RDM, Info-Gap, economic optimization and many-objective optimization

NASA Astrophysics Data System (ADS)

Matrosov, E.; Padula, S.; Huskova, I.; Harou, J. J.

2012-12-01

Population growth and the threat of drier or changed climates are likely to increase water scarcity world-wide. A combination of demand management (water conservation) and new supply infrastructure is often needed to meet future projected demands. In this case system planners must decide what to implement, when and at what capacity. Choices can range from infrastructure to policies or a mix of the two, culminating in a complex planning problem. Decision making under uncertainty frameworks can be used to help planners with this planning problem. This presentation introduces, applies and compares four decision making under uncertainty frameworks. The application is to the Thames basin water resource system which includes the city of London. The approaches covered here include least-economic cost capacity expansion optimization (EO), Robust Decision Making (RDM), Info-Gap Decision Theory (Info-gap) and many-objective evolutionary optimization (MOEO). EO searches for the least-economic cost program, i.e. the timing, sizing, and choice of supply-demand management actions/upgrades which meet projected water demands. Instead of striving for optimality, the RDM and Info-gap approaches help build plans that are robust to 'deep' uncertainty in future conditions. The MOEO framework considers multiple performance criteria and uses water systems simulators as a function evaluator for the evolutionary algorithm. Visualizations show Pareto approximate tradeoffs between multiple objectives. In this presentation we detail the application of each framework to the Thames basin (including London) water resource planning problem. Supply and demand options are proposed by the major water companies in the basin. We apply the EO method using a 29 year time horizon and an annual time step considering capital, operating (fixed and variable), social and environmental costs. The method considers all plausible combinations of supply and conservation schemes and capacities proposed by water companies and generates the least-economic cost annual plan. The RDM application uses stochastic simulation under a weekly time-step and regret analysis to choose a candidate strategy. We then use a statistical cluster algorithm to identify future states of the world under which the strategy is vulnerable. The method explicitly considers the effects of uncertainty in supply, demands and energy price on multiple performance criteria. The Info-gap approach produces robustness and opportuneness plots that show the performance of different plans under the most dire and favorable sets of future conditions. The same simulator, supply and demand options and uncertainties are considered as in the RDM application. The MOEO application considers many more combinations of supply and demand options while still employing a simulator that enables a more realistic representation of the physical system and operating rules. A computer cluster is employed to ease the computational burden. Visualization software allows decision makers to interactively view tradeoffs in many dimensions. Benefits and limitations of each framework are discussed and recommendations for future planning in the basin are provided.

A Review of the Tawny Crazy Ant, Nylanderia fulva, an Emergent Ant Invader in the Southern United States: Is Biological Control a Feasible Management Option?

PubMed

Wang, Zinan; Moshman, Lori; Kraus, Emily C; Wilson, Blake E; Acharya, Namoona; Diaz, Rodrigo

2016-12-15

The tawny crazy ant, Nylanderia fulva (Mayr) (Hymenoptera: Formicidae), has invaded states of the U.S. including Texas, Louisiana, Mississippi, Alabama, Florida, and Georgia. Native to South America, N. fulva is considered a pest in the U.S. capable of annoying homeowners and farmers, as well as displacing native ant species. As it continues to expand its range, there is a growing need to develop novel management techniques to control the pest and prevent further spread. Current management efforts rely heavily on chemical control, but these methods have not been successful. A review of the biology, taxonomy, ecology, and distribution of N. fulva , including discussion of ecological and economic consequences of this invasive species, is presented. Options for future management are suggested focusing on biological control, including parasitoid flies in the genus Pseudacteon , the microsporidian parasite Myrmecomorba nylanderiae , and a novel polynucleotide virus as potential biological control agents. We suggest further investigation of natural enemies present in the adventive range, as well as foreign exploration undertaken in the native range including Paraguay, Brazil, and Argentina. We conclude that N. fulva may be a suitable candidate for biological control.

A Review of the Tawny Crazy Ant, Nylanderia fulva, an Emergent Ant Invader in the Southern United States: Is Biological Control a Feasible Management Option?

PubMed Central

Wang, Zinan; Moshman, Lori; Kraus, Emily C.; Wilson, Blake E.; Acharya, Namoona; Diaz, Rodrigo

2016-01-01

The tawny crazy ant, Nylanderia fulva (Mayr) (Hymenoptera: Formicidae), has invaded states of the U.S. including Texas, Louisiana, Mississippi, Alabama, Florida, and Georgia. Native to South America, N. fulva is considered a pest in the U.S. capable of annoying homeowners and farmers, as well as displacing native ant species. As it continues to expand its range, there is a growing need to develop novel management techniques to control the pest and prevent further spread. Current management efforts rely heavily on chemical control, but these methods have not been successful. A review of the biology, taxonomy, ecology, and distribution of N. fulva, including discussion of ecological and economic consequences of this invasive species, is presented. Options for future management are suggested focusing on biological control, including parasitoid flies in the genus Pseudacteon, the microsporidian parasite Myrmecomorba nylanderiae, and a novel polynucleotide virus as potential biological control agents. We suggest further investigation of natural enemies present in the adventive range, as well as foreign exploration undertaken in the native range including Paraguay, Brazil, and Argentina. We conclude that N. fulva may be a suitable candidate for biological control. PMID:27983690

A planning comparison of 7 irradiation options allowed in RTOG 1005 for early-stage breast cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Guang-Pei, E-mail: gpchen@mcw.edu; Liu, Feng; White, Julia

2015-04-01

This study compared the 7 treatment plan options in achieving the dose-volume criteria required by the Radiation Therapy Oncology Group (RTOG) 1005 protocol. Dosimetry plans were generated for 15 representative patients with early-stage breast cancer (ESBC) based on the protocol-required dose-volume criteria for each of the following 7 treatment options: 3D conformal radiotherapy (3DCRT), whole-breast irradiation (WBI) plus 3DCRT lumpectomy boost, 3DCRT WBI plus electron boost, 3DCRT WBI plus intensity-modulated radiation therapy (IMRT) boost, IMRT WBI plus 3DCRT boost, IMRT WBI plus electron boost, IMRT WBI plus IMRT boost, and simultaneous integrated boost (SIB) with IMRT. A variety of dose-volumemore » parameters, including target dose conformity and uniformity and normal tissue sparing, were compared for these plans. For the patients studied, all plans met the required acceptable dose-volume criteria, with most of them meeting the ideal criteria. When averaged over patients, most dose-volume goals for all plan options can be achieved with a positive gap of at least a few tenths of standard deviations. The plans for all 7 options are generally comparable. The dose-volume goals required by the protocol can in general be easily achieved. IMRT WBI provides better whole-breast dose uniformity than 3DCRT WBI does, but it causes no significant difference for the dose conformity. All plan options are comparable for lumpectomy dose uniformity and conformity. Patient anatomy is always an important factor when whole-breast dose uniformity and conformity and lumpectomy dose conformity are considered.« less

A multi-criteria decision analysis assessment of waste paper management options.

PubMed

Hanan, Deirdre; Burnley, Stephen; Cooke, David

2013-03-01

The use of Multi-criteria Decision Analysis (MCDA) was investigated in an exercise using a panel of local residents and stakeholders to assess the options for managing waste paper on the Isle of Wight. Seven recycling, recovery and disposal options were considered by the panel who evaluated each option against seven environmental, financial and social criteria. The panel preferred options where the waste was managed on the island with gasification and recycling achieving the highest scores. Exporting the waste to the English mainland for incineration or landfill proved to be the least preferred options. This research has demonstrated that MCDA is an effective way of involving community groups in waste management decision making. Copyright © 2012 Elsevier Ltd. All rights reserved.

77 FR 25319 - Commodity Options

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-27

... marketing loan program would not be considered swaps.\\25\\ \\25\\ After CFTC staff reviewed the ``options to redeem'' with both USDA staff members responsible for managing the cotton marketing loan program and industry representatives from Amcot (an association of US cotton marketing cooperatives), the Commission...

48 CFR 552.217-71 - Notice Regarding Option(s).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Notice Regarding Option(s... Notice Regarding Option(s). As prescribed in 517.208(b), insert the following provision: Notice Regarding Option(s) (NOV 1992) The General Services Administration (GSA) has included an option to [Insert...

Space Station crew safety alternatives study. Volume 2: Threat development

NASA Technical Reports Server (NTRS)

Raasch, R. F.; Peercy, R. L., Jr.; Rockoff, L. A.

1985-01-01

The first 15 years of accumulated space station concepts for initial operational capability (IOC) during the early 1990's were considered. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration, and debris.

Space station crew safety alternatives study, volume 1

NASA Technical Reports Server (NTRS)

Peercy, R. L., Jr.; Raasch, R. F.; Rockoff, L. A.

1985-01-01

The first 15 years of accumulated space station concepts for initial operational capability (IOC) during the early 1990's were considered. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration and debris.

The Future of U.S. Trade Policy: An Analysis of Issues and Options for the 111th Congress

DTIC Science & Technology

2010-03-24

Bush Administration and the Democratic leadership in the 110th Congress over the FTAs led to a stalemate. The Bush...the proposed U.S.-Colombia FTA to Congress over the objections of the House Democratic leadership . However, the latter cited what it considered to be...included as negotiating objectives in recent TPA. The debate over the inclusion of these provisions heightened with the change to Democratic

Cardiac toxoplasmosis after heart transplantation diagnosed by endomyocardial biopsy.

PubMed

Petty, L A; Qamar, S; Ananthanarayanan, V; Husain, A N; Murks, C; Potter, L; Kim, G; Pursell, K; Fedson, S

2015-10-01

We describe a case of cardiac toxoplasmosis diagnosed by routine endomyocardial biopsy in a patient with trimethoprim-sulfamethoxazole (TMP-SMX) intolerance on atovaquone prophylaxis. Data are not available on the efficacy of atovaquone as Toxoplasma gondii prophylaxis after heart transplantation. In heart transplant patients in whom TMP-SMX is not an option, other strategies may be considered, including the addition of pyrimethamine to atovaquone. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Alternatives to neonicotinoid insecticides for pest control: case studies in agriculture and forestry.

PubMed

Furlan, Lorenzo; Kreutzweiser, David

2015-01-01

Neonicotinoid insecticides are widely used for control of insect pests around the world and are especially pervasive in agricultural pest management. There is a growing body of evidence indicating that the broad-scale and prophylactic uses of neonicotinoids pose serious risks of harm to beneficial organisms and their ecological function. This provides the impetus for exploring alternatives to neonicotinoid insecticides for controlling insect pests. We draw from examples of alternative pest control options in Italian maize production and Canadian forestry to illustrate the principles of applying alternatives to neonicotinoids under an integrated pest management (IPM) strategy. An IPM approach considers all relevant and available information to make informed management decisions, providing pest control options based on actual need. We explore the benefits and challenges of several options for management of three insect pests in maize crops and an invasive insect pest in forests, including diversifying crop rotations, altering the timing of planting, tillage and irrigation, using less sensitive crops in infested areas, applying biological control agents, and turning to alternative reduced risk insecticides. Continued research into alternatives is warranted, but equally pressing is the need for information transfer and training for farmers and pest managers and the need for policies and regulations to encourage the adoption of IPM strategies and their alternative pest control options.

Default neglect in attempts at social influence.

PubMed

Zlatev, Julian J; Daniels, David P; Kim, Hajin; Neale, Margaret A

2017-12-26

Current theories suggest that people understand how to exploit common biases to influence others. However, these predictions have received little empirical attention. We consider a widely studied bias with special policy relevance: the default effect, which is the tendency to choose whichever option is the status quo. We asked participants (including managers, law/business/medical students, and US adults) to nudge others toward selecting a target option by choosing whether to present that target option as the default. In contrast to theoretical predictions, we find that people often fail to understand and/or use defaults to influence others, i.e., they show "default neglect." First, in one-shot default-setting games, we find that only 50.8% of participants set the target option as the default across 11 samples ( n = 2,844), consistent with people not systematically using defaults at all. Second, when participants have multiple opportunities for experience and feedback, they still do not systematically use defaults. Third, we investigate beliefs related to the default effect. People seem to anticipate some mechanisms that drive default effects, yet most people do not believe in the default effect on average, even in cases where they do use defaults. We discuss implications of default neglect for decision making, social influence, and evidence-based policy.

Childhood Arthritis and Rheumatology Research Alliance consensus clinical treatment plans for juvenile dermatomyositis with skin predominant disease.

PubMed

Kim, Susan; Kahn, Philip; Robinson, Angela B; Lang, Bianca; Shulman, Andrew; Oberle, Edward J; Schikler, Kenneth; Curran, Megan Lea; Barillas-Arias, Lilliana; Spencer, Charles H; Rider, Lisa G; Huber, Adam M

2017-01-11

Juvenile dermatomyositis (JDM) is the most common form of the idiopathic inflammatory myopathies in children. A subset of children have the rash of JDM without significant weakness, and the optimal treatments for these children are unknown. The goal of this study was to describe the development of consensus clinical treatment plans (CTPs) for children with JDM who have active skin rashes, without significant muscle involvement, referred to as skin predominant JDM in this manuscript. The Children's Arthritis and Rheumatology Research Alliance (CARRA) is a North American consortium of pediatric rheumatology health care providers. CARRA members collaborated to determine consensus on typical treatments for JDM patients with skin findings without significant weakness, to develop CTPs for this subgroup of patients. We used a combination of Delphi surveys and nominal group consensus meetings to develop these CTPs. Consensus was reached on patient characteristics and outcome assessment, and CTPs were developed and finalized for patients with skin predominant JDM. Treatment option A included hydroxychloroquine alone, Treatment option B included hydroxychloroquine and methotrexate, and Treatment option C included hydroxychloroquine, methotrexate and corticosteroids. Three CTPs were developed for use in children with skin predominant JDM, which reflect typical treatment approaches. These are not considered to be specific recommendations or standard of care. Using the CARRA network and prospective data collection, we will be able to apply statistical methods in the future to allow comparisons of JDM patients following these consensus treatment plans.

Incorporating Green Infrastructure into Water Resources Management Plans to Address Water Quality Impairments

NASA Astrophysics Data System (ADS)

Piscopo, A. N.; Detenbeck, N. E.

2017-12-01

Managers of urban watersheds with excessive nutrient loads are more frequently turning to green infrastructure (GI) to manage their water quality impairments. The effectiveness of GI is dependent on a number of factors, including (1) the type and placement of GI within the watershed, (2) the specific nutrients to be treated, and (3) the uncertainty in future climates. Although many studies have investigated the effectiveness of individual GI units for different types of nutrients, relatively few have considered the effectiveness of GI on a watershed scale, the scale most relevant to management plans. At the watershed scale, endless combinations of GI type and location are possible, each with different effectiveness in reducing nutrient loads, minimizing costs, and maximizing co-benefits such as reducing runoff. To efficiently generate management plan options that balance the tradeoffs between these objectives, we simulate candidate options using EPA's Stormwater Management Model for multiple future climates and determine the Pareto optimal set of solution options using a multi-objective evolutionary algorithm. Our approach is demonstrated for an urban watershed in Rockville, Maryland.

Technical and economic assessment of different options for minor actinide transmutation: the French case

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chabert, C.; Coquelet-Pascal, C.; Saturnin, A.

Studies have been performed to assess the industrial perspectives of partitioning and transmutation of long-lived elements. These studies were carried out in tight connection with GEN-IV systems development. The results include the technical and economic evaluation of fuel cycle scenarios along with different options for optimizing the processes between the minor actinide transmutation in fast neutron reactors, their interim storage and geological disposal of ultimate waste. The results are analysed through several criteria (impacts on waste, on waste repository, on fuel cycle plants, on radiological exposure of workers, on costs and on industrial risks). These scenario evaluations take place inmore » the French context which considers the deployment of the first Sodium-cooled Fast Reactor (SFR) in 2040. 3 management options of minor actinides have been studied: no transmutation, transmutation in SFR and transmutation in an accelerator-driven system (ADS). Concerning economics the study shows that the cost overrun related to the transmutation process could vary between 5 to 9% in SFR and 26 % in the case of ADS.« less

Active surveillance for nonmuscle invasive bladder cancer.

PubMed

Miyake, Makito; Fujimoto, Kiyohide; Hirao, Yoshihiko

2016-06-01

Nonmuscle invasive bladder cancer (NMIBC) is known to be a heterogeneous malignancy that requires varying treatment modalities and follow-up schedules. Low-grade Ta papillary tumors are categorized as low-risk NMIBC because of their favorable prognosis. There is an expanding movement that overdiagnosis and overtreatment should be avoided considering the economic impact and the patients' quality of life. It has been over 10 years since the initial assessment of active surveillance for low-risk NMIBC suggested its feasibility and safety. However, urologists are still unfamiliar with this treatment option, which can be ideal in appropriately selected patients. In this review article, we focus on active surveillance for low-risk NMIBC and discuss the evidence and rationale for this treatment option. There are several issues to resolve in order to advocate active surveillance as a standard option in selected patients. A specific follow-up protocol including intervals of cystoscopy, urine cytology, urine markers, and other radiographic examinations need to be optimized and validated. Finally, we integrate the available data into the follow-up strategy and propose a new surveillance protocol for active surveillance of recurrent low-risk bladder cancer.

Experiences with the in vivo and in vitro comet assay in regulatory testing.

PubMed

Frötschl, Roland

2015-01-01

The in vivo comet assay has recently been implemented into regulatory genotoxicity testing of pharmaceuticals with inclusion into the ICH S2R1 guidance. Regulatory genotoxicity testing aims to detect DNA alterations in form of gene mutations, larger scale chromosomal damage and recombination and aneuploidy. The ICH S2R1 guideline offers two options of standard batteries of tests for the detection of these endpoints. Both options start with an AMES assay and option 1 includes an in vitro mammalian cell assay and an in vivo micronucleus assay in rodent, whereas option 2 includes an in vivo micronucleus assay in bone marrow in rodent and a second in vivo assay in a second tissue with a second endpoint. The test recommended as second in vivo test is the comet assay in rat liver. The in vivo comet assay is considered as mature enough to ensure reliable detection of relevant in vivo genotoxicants in combination with the micronucleus test in bone marrow and the AMES assay. Although lots of research papers have been published using the in vitro comet assay, the in vitro version has not been implemented into official regulatory testing guidelines. A survey of the years 1999-2014 revealed 27 in vivo comet assays submitted to BfArM with market authorisation procedures, European and national advice procedures and clinical trial applications. In three procedures, in vitro comet assays had been submitted within the genetic toxicology packages. © The Author 2014. Published by Oxford University Press on behalf of the Mutagenesis Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Evaluating holistic environmental consequences of brownfield management options using consequential life cycle assessment for different perspectives.

PubMed

Lesage, Pascal; Deschênes, Louise; Samson, Réjean

2007-08-01

Brownfields are abandoned, idled, or underused sites whose reuse necessitates some sort of intervention. These sites are largely urban and are frequently contaminated. Brownfield management options can be associated with three types of environmental consequences: those resulting from changes in the site's environmental quality (primary impacts); those resulting from the actual intervention stage (secondary impacts); and, if the vocation of the site changes, those resulting from effects on regional land use (tertiary impacts). Different stakeholders and decision-making contexts will place a different importance on each of these types of impacts. This article proposes a framework for comparing brownfield management options in regard to these three types of environmental impacts and for interpreting these results from different perspectives. The assessment framework is based on consequential life cycle assessment (LCA), which is shown to provide environmental information on the three types of impacts. The results for a case study are presented, where a "rehabilitation" option allowing residential redevelopment is compared to an "exposure minimization" option not resulting in the site being reused. Calculated primary and tertiary impacts are favorable to the rehabilitation option, whereas secondary impacts are favorable to the exposure minimization option. A ternary diagram presents the favorable option for different stereotypical perspectives. Tertiary impacts are much greater than secondary impacts, and consequently all perspectives that consider tertiary impacts favor rehabilitation. The perspective that considers primary and secondary impacts receives conflicting information. The ternary diagram, showing results for all perspectives, could possibly be useful for consensus-building among stakeholders.

Evaluating Holistic Environmental Consequences of Brownfield Management Options Using Consequential Life Cycle Assessment for Different Perspectives

NASA Astrophysics Data System (ADS)

Lesage, Pascal; Deschênes, Louise; Samson, Réjean

2007-08-01

Brownfields are abandoned, idled, or underused sites whose reuse necessitates some sort of intervention. These sites are largely urban and are frequently contaminated. Brownfield management options can be associated with three types of environmental consequences: those resulting from changes in the site’s environmental quality (primary impacts); those resulting from the actual intervention stage (secondary impacts); and, if the vocation of the site changes, those resulting from effects on regional land use (tertiary impacts). Different stakeholders and decision-making contexts will place a different importance on each of these types of impacts. This article proposes a framework for comparing brownfield management options in regard to these three types of environmental impacts and for interpreting these results from different perspectives. The assessment framework is based on consequential life cycle assessment (LCA), which is shown to provide environmental information on the three types of impacts. The results for a case study are presented, where a “rehabilitation” option allowing residential redevelopment is compared to an “exposure minimization” option not resulting in the site being reused. Calculated primary and tertiary impacts are favorable to the rehabilitation option, whereas secondary impacts are favorable to the exposure minimization option. A ternary diagram presents the favorable option for different stereotypical perspectives. Tertiary impacts are much greater than secondary impacts, and consequently all perspectives that consider tertiary impacts favor rehabilitation. The perspective that considers primary and secondary impacts receives conflicting information. The ternary diagram, showing results for all perspectives, could possibly be useful for consensus-building among stakeholders.

Fertility Preservation for Pediatric Patients: Current State and Future Possibilities.

PubMed

Johnson, Emilie K; Finlayson, Courtney; Rowell, Erin E; Gosiengfiao, Yasmin; Pavone, Mary Ellen; Lockart, Barbara; Orwig, Kyle E; Brannigan, Robert E; Woodruff, Teresa K

2017-07-01

This review provides an overview of pediatric fertility preservation. Topics covered include the patient populations who could benefit, the current state of fertility preservation options and research, and considerations related to ethics and program development. A broad Embase® and PubMed® search was performed to identify publications discussing investigational, clinical, ethical and health care delivery issues related to pediatric fertility preservation. Relevant publications were reviewed and summarized. Populations who could benefit from fertility preservation in childhood/adolescence include oncology patients, patients with nononcologic conditions requiring gonadotoxic chemotherapy, patients with differences/disorders of sex development and transgender individuals. Peripubertal and postpubertal fertility preservation options are well established and include cryopreservation of oocytes, embryos or sperm. Prepubertal fertility preservation is experimental. Multiple lines of active research aim to develop technologies that will enable immature eggs and sperm to be matured and used to produce a biological child in the future. Ethical challenges include the need for parental proxy decision making and the fact that fertility preservation procedures can be considered not medically necessary. Successful multidisciplinary fertility preservation care teams emphasize partnerships with adult colleagues, prioritize timely consultations and use standardized referral processes. Some aspects of fertility preservation are not covered by insurance and out-of-pocket costs can be prohibitive. Pediatric fertility preservation is an emerging, evolving field. Fertility preservation options for prepubertal patients with fertility altering conditions such as cancer and differences/disorders of sex development are currently limited. However, multiple lines of active research hold promise for the future. Key considerations include establishing a multidisciplinary team to provide pediatric fertility preservation services, an appreciation for relevant ethical issues and cost. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Analysis of digester design concepts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ashare, E.; Wilson, E. H.

1979-01-29

Engineering economic analyses were performed on various digester design concepts to determine the relative performance for various biomass feedstocks. A comprehensive literature survey describing the state-of-the-art of the various digestion designs is included. The digester designs included in the analyses are CSTR, plug flow, batch, CSTR in series, multi-stage digestion and biomethanation. Other process options investigated included pretreatment processes such as shredding, degritting, and chemical pretreatment, and post-digestion processes, such as dewatering and gas purification. The biomass sources considered include feedlot manure, rice straw, and bagasse. The results of the analysis indicate that the most economical (on a unit gasmore » cost basis) digester design concept is the plug flow reactor. This conclusion results from this system providing a high gas production rate combined with a low capital hole-in-the-ground digester design concept. The costs determined in this analysis do not include any credits or penalties for feedstock or by-products, but present the costs only for conversion of biomass to methane. The batch land-fill type digester design was shown to have a unit gas cost comparable to that for a conventional stirred tank digester, with the potential of reducing the cost if a land-fill site were available for a lower cost per unit volume. The use of chemical pretreatment resulted in a higher unit gas cost, primarily due to the cost of pretreatment chemical. A sensitivity analysis indicated that the use of chemical pretreatment could improve the economics provided a process could be developed which utilized either less pretreatment chemical or a less costly chemical. The use of other process options resulted in higher unit gas costs. These options should only be used when necessary for proper process performance, or to result in production of a valuable by-product.« less

Understanding Participatory Action Research: A Qualitative Research Methodology Option

ERIC Educational Resources Information Center

MacDonald, Cathy

2012-01-01

Participatory Action Research (PAR) is a qualitative research methodology option that requires further understanding and consideration. PAR is considered democratic, equitable, liberating, and life-enhancing qualitative inquiry that remains distinct from other qualitative methodologies (Kach & Kralik, 2006). Using PAR, qualitative features of an…

Diesel plant retrofitting options to enhance decentralized electricity supply in Indonesia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baring-Gould, E I; Barley, C D; Drouilhet, S

1997-09-01

Over the last 20 years, the government of Indonesia has undertaken an extensive program to provide electricity to the population of that country. The electrification of rural areas has been partially achieved through the use of isolated diesel systems, which account for about 20% of the country`s generated electricity. Due to many factors related to inefficient power production with diesels, the National Renewable Energy Laboratory, in conjunction with PLN, the Indonesian national utility, Community Power Corporation, and Idaho Power Company, analyzed options for retrofitting existing diesel power systems. This study considered the use of different combinations of advanced diesel control,more » the addition of wind generators, photovoltaics and batteries to reduce the systems of overall cost and fuel consumption. This analysis resulted in a general methodology for retrofitting diesel power systems. This paper discusses five different retrofitting options to improve the performance of diesel power systems. The systems considered in the Indonesian analysis are cited as examples for the options discussed.« less

Stolen twin: fascination and curiosity/twin research reports: evolution of sleep length; dental treatment of craniopagus twins; cryopreserved double embryo transfer; gender options in multiple pregnancy/current events: appendectomy in one twin; autistic twin marathon runners; 3D facial recognition; twin biathletes.

PubMed

Segal, Nancy L

2014-02-01

The story of her allegedly stolen twin brother in Armenia is recounted by a 'singleton twin' living in the United States. The behavioral consequences and societal implications of this loss are considered. This case is followed by twin research reports on the evolution of sleep length, dental treatment of craniopagus conjoined twins, cryopreserved double embryo transfer (DET), and gender options in multiple pregnancy. Current events include the diagnosis of appendectomy in one identical twin, the accomplishments of autistic twin marathon runners, the power of three-dimensional (3D) facial recognition, and the goals of twin biathletes heading to the 2014 Sochi Olympics in Russia.

Women in war: operational issues of menstruation and unintended pregnancy.

PubMed

Christopher, Leslie A; Miller, Leslie

2007-01-01

With rapid and frequent deployments around the world, the current high level of military operations demands combat readiness of every military member. In the U.S. Armed Forces, women represent 15% of active duty troops and 17% of reserve and Guard troops and are a critical component for mission accomplishment. The operational issues of menstruation and unintended pregnancy, unique to this population, can decrease a female member's military readiness and affect her ability to deploy. Strategies to mitigate and even eliminate these concerns include the optional use of hormonal medications to induce reversible menstrual cycle suppression. These medications, traditionally indicated for contraception, should be considered essential for female troops during training and deployment. This article, tailored specifically for military women, provides valuable information regarding the risks and benefits, as well as the various options available for menstrual cycle suppression.

Policy coherence, integration, and proportionality in tobacco control: Should tobacco sales be limited to government outlets?

PubMed

Smith, Elizabeth A; McDaniel, Patricia A; Hiilamo, Heikki; Malone, Ruth E

2017-08-01

Multiple factors, including marijuana decriminalization/legalization, tobacco endgame discourse, and alcohol industry pressures, suggest that the retail regulatory environment for psychoactive or addictive substances is a dynamic one in which new options may be considered. In most countries, the regulation of tobacco, marijuana, and alcohol is neither coherent, nor integrated, nor proportional to the potential harms caused by these substances. We review the possible consequences of restricting tobacco sales to outlets run by government-operated alcohol retail monopolies, as well as the likely obstacles to such a policy. Such a move would allow governments more options for regulating tobacco sales, and increase coherence, integration, and proportionality of substance regulation. It might also serve as an incremental step toward an endgame goal of eliminating sales of commercial combustible tobacco.

Assessing the environmental burdens of anaerobic digestion in comparison to alternative options for managing the biodegradable fraction of municipal solid wastes.

PubMed

Haight, M

2005-01-01

Biological treatment processes including anaerobic digestion (biogasification) and composting are increasingly being considered by waste management officials and planners as alternatives for managing the mainly organic residues of municipal solid wastes (MSW). The integrated waste management model which is based upon the application of life-cycle analysis was employed to compare the environmental burdens of landfilling, composting and anaerobic digestion of MSW at a mid-sized Canadian community. Energy consumption (or recovery), residue recoveries and emissions to air and water were quantified. Scenario comparisons were analyzed to demonstrate that the environmental burdens associated with anaerobic digestion are reduced in comparison with the alternative options. The major benefit occurs as a result of the electricity produced from burning the biogas and then supplying the 'green power' to the local electrical grid.

Emergy Analysis and Sustainability Efficiency Analysis of Different Crop-Based Biodiesel in Life Cycle Perspective

PubMed Central

Ren, Jingzheng; Manzardo, Alessandro; Mazzi, Anna; Fedele, Andrea; Scipioni, Antonio

2013-01-01

Biodiesel as a promising alternative energy resource has been a hot spot in chemical engineering nowadays, but there is also an argument about the sustainability of biodiesel. In order to analyze the sustainability of biodiesel production systems and select the most sustainable scenario, various kinds of crop-based biodiesel including soybean-, rapeseed-, sunflower-, jatropha- and palm-based biodiesel production options are studied by emergy analysis; soybean-based scenario is recognized as the most sustainable scenario that should be chosen for further study in China. DEA method is used to evaluate the sustainability efficiencies of these options, and the biodiesel production systems based on soybean, sunflower, and palm are considered as DEA efficient, whereas rapeseed-based and jatropha-based scenarios are needed to be improved, and the improved methods have also been specified. PMID:23766723

Web Applications for Patient Communication.

PubMed

Lewis, Kristopher; Reicher, Murray A

2016-12-01

Communication between imaging professionals and patients can help achieve many goals, including improved patient understanding of imaging-related diagnostic and treatment options, better compliance with appropriate imaging screening procedures, and improved efficiency of service. The explosive growth of out-of-pocket consumer spending on health care has heightened health care shopping, thus making patient communication an important goal of any imaging practice or health care organization. Furthermore, the Merit-Based Incentive Payment System introduced by CMS will publicly disclose physicians' quality ratings, which are in part dependent on patient engagement. The authors summarize the rationale for web communication with patients, the range of content that should be considered, and the technology options. The aim is to help imaging providers develop organized patient communication strategic and implementation plans. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Energy efficiency business options for industrial end users in Latin American competitive energy markets: The case of Colombia

NASA Astrophysics Data System (ADS)

Botero, Sergio

2002-01-01

Energy markets today in Latin America and worldwide are being restructured from monopolies, either state-owned or privately-owned, to be more openly competitive and incorporate more participation from the private sector. Thus, the schemes that were formerly developed to foster end use energy efficiency are no longer applicable because they were based on mandatory regulations made with political decisions, without sufficiently considering economic feasibility. A consensus exists that the only way energy efficiency could survive in this new paradigm is by being market oriented, giving better services, and additional options to users. However; there is very little information on what end users prefer, and which options would most satisfy customers. Using Colombia as a case study, this research determines and categorizes the energy efficiency business options for large energy end users that can freely participate in the competitive energy market. The energy efficiency market is understood as a market of services aiming to increase efficiency in energy use. These services can be grouped into seven business options. A survey, following the descriptive method, was sent to energy end users in order to determine their preferences for specific energy efficiency business options, as well as the decision-making criteria taken into account for such options. This data was categorized in ten industry groups. As a conclusion, energy efficiency providers should adapt not only to the economic activity or processes of each customer, but also to the potential business options. It was also found that not all industries consider performance contracting as their most preferred option, as a matter of fact, some industries show much higher preference for conventional business options. Among end users, the divergence in option preferences contrasted with the convergence in decision-making criteria. The decision-making criteria "cost-benefit ratio" overwhelmed all other criterion. End users appear to chose a specific energy efficiency option based mostly on obtaining better economic returns, giving low consideration to other criterion that feature differences among the energy efficiency options.

Comparative effectiveness of venous thromboembolism prophylaxis options for the patient undergoing total hip and knee replacement: a network meta-analysis.

PubMed

Kapoor, A; Ellis, A; Shaffer, N; Gurwitz, J; Chandramohan, A; Saulino, J; Ishak, A; Okubanjo, T; Michota, F; Hylek, E; Trikalinos, T A

2017-02-01

Essentials Despite trial data, guidelines have not endorsed direct oral Xa inhibitors above other options. We provide profiles of venous thromboembolism and hemorrhage risk for 12 options. Direct oral Xa inhibitors had a favorable profile compared with low-molecular-weight heparin. Other options did not have favorable profiles compared with low-molecular-weight heparin. Background There are numerous trials and several meta-analyses comparing venous thromboembolism (VTE) prophylaxis options after total hip and knee replacement (THR and TKR). None have included simultaneous comparison of new with older options. Objective To measure simultaneously the relative risk of VTE and hemorrhage for 12 prophylaxis options. Methods We abstracted VTE and hemorrhage information from randomized controlled trials published between January 1990 and June 2016 comparing 12 prophylaxis options. We then constructed networks to compute the relative risk for each option, relative to once-daily dosing with low-molecular-weight heparin (LMWH) Low. Results Main: Relative to LMWH Low, direct oral Xa inhibitors had the lowest risk of total deep vein thrombosis (DVT)-asymptomatic and symptomatic- (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.35-0.57), translating to 53-139 fewer DVTs per 1000 patients. Vitamin K antagonists (VKAs) titrated to International Normalized Ratio [INR] 2-3 predicted 56% more DVT events (OR, 1.56; 95% CI, 1.14-2.14). Aspirin performed similarly (OR, 0.80; 95% CI, 0.34-1.86), although small numbers prohibit firm conclusions. Direct oral Xa inhibitors did not lead to significantly more bleeding (OR, 1.21; 95% CI, 0.79-1.90). Secondary: Relative to LMWH Low, direct oral Xa inhibitors prevented 4-fold more symptomatic DVTs (OR, 0.25; 95% CI, 0.13-0.47). Conclusions Relative to LMWH Low, direct oral Xa inhibitors had a more favorable profile of VTE and hemorrhage risk, whereas VKAs had a less favorable profile. The profile of other agents was not more or less favorable. Clinicians should consider these profiles when selecting prophylaxis options. © 2016 International Society on Thrombosis and Haemostasis.

New techniques for modeling the reliability of reactor pressure vessels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, K.I.; Simonen, F.A.; Liebetrau, A.M.

1986-01-01

In recent years several probabilistic fracture mechanics codes, including the VISA code, have been developed to predict the reliability of reactor pressure vessels. This paper describes several new modeling techniques used in a second generation of the VISA code entitled VISA-II. Results are presented that show the sensitivity of vessel reliability predictions to such factors as inservice inspection to detect flaws, random positioning of flaws within the vessel wall thickness, and fluence distributions that vary throughout the vessel. The algorithms used to implement these modeling techniques are also described. Other new options in VISA-II are also described in this paper.more » The effect of vessel cladding has been included in the heat transfer, stress, and fracture mechanics solutions in VISA-II. The algorithms for simulating flaws has been changed to consider an entire vessel rather than a single flaw in a single weld. The flaw distribution was changed to include the distribution of both flaw depth and length. A menu of several alternate equations has been included to predict the shift in RT/sub NDT/. For flaws that arrest and later re-initiate, an option was also included to allow correlating the current arrest toughness with subsequent initiation toughnesses.« less

Vending Assessment and Program Implementation in Four Iowa Worksites.

PubMed

Lillehoj, Catherine J; Nothwehr, Faryle; Shipley, Kala; Voss, Carol

2015-11-01

The worksite food environment, including vending options, has been explored as an important contributor to dietary decisions made every day. The current study describes the vending environment, and efforts to change it, in four Iowa worksites using a series of case studies. Data were gathered by local coordinators as part of the Iowa Community Transformation Grant project. Data were collected from three sources. First, the Nutrition Environment Measures Survey-Vending was used to assess healthy vending options in worksite machines before and after the intervention. Second, employee vending behavior was evaluated with a pre-, post-intervention survey. Items assessed attitudes and behaviors regarding vending, plus awareness and reaction to intervention activities. Third, program coordinators documented vending machine intervention strategies used, such as social marketing materials and product labels. The Nutrition Environment Measures Survey-Vending documented that the majority of vending options did not meet criteria for healthfulness. The vending survey found that employees were generally satisfied with the healthier items offered. Some differences were noted over time at the four worksites related to employee behavior and attitudes concerning healthy options. There were also differences in intervention implementation and the extent of changes made by vending companies. Overall, findings demonstrate that a large percentage of employees are constrained in their ability to access healthy foods due to limited worksite vending options. There also remain challenges to making changes in this environment. Findings have implications for public health practitioners to consider when designing healthy vending interventions in worksites. © 2015 Society for Public Health Education.

Current Opinion and Knowledge on Peritoneal Carcinomatosis: A Survey among a Swiss Oncology Network.

PubMed

Grass, Fabian; Martin, David; Montemurro, Michael; Mathevet, Patrice; Wolfer, Anita; Coukos, George; Demartines, Nicolas; Hübner, Martin

2018-06-13

The present survey aimed to evaluate current opinion and practice regarding peritoneal metastasis (PM), satisfaction with available treatment options, and need for new therapeutic approaches. This was a qualitative study conducted between October 2016 and October 2017 in the Réseau Suisse Romand d'Oncologie including 101 members of various oncological specialties. Participants' demographics, current practice, knowledge, and satisfaction regarding available treatment options and need for new treatment options were assessed by semantic differential scales through 33 closed questions with automatic reminders at 4-, 8-, 12-, and 16-week intervals. Twenty-seven participants (27%) completed the survey. Participants were gastrointestinal or gynecologic oncologists and surgeons. Most participants (67%) evaluated their knowledge on PM as moderate, while 22% considered themselves as experts. Clinical usefulness of systemic chemotherapy and hyperthermic intraperitoneal chemotherapy was judged to be moderate to high for PM of ovarian and colorectal origin and moderate to poor for gastric origin. Satisfaction with available treatment options was 6/10 (interquartile range [IQR] 4-7) for ovarian, 5/10 (IQR 3-7) for colorectal, and 3/10 (IQR 1-3) for gastric PM. Treatment strategies varied widely for typical case vignettes. The need for new treatment modalities was rated as 8/10 (IQR 6-10). Usefulness of and satisfaction with available treatment options for PM were rated as moderate at best by oncological experts, and treatment strategies differed importantly among participants. There appears to be a clear need for standardization and new treatment modalities. © 2018 S. Karger AG, Basel.

75 FR 71773 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-24

... securities index options, index futures, and options on index futures to be included along with the ETF in an... hedged not only with SPY shares, but with S&P 500 options, S&P 500 futures, options on S&P 500 futures or... on a delta basis. \\9\\ ``Other units of trade'' would include, for example, options or futures...

U.S. Space Station Freedom waste fluid disposal system with consideration of hydrazine waste gas injection thrusters

NASA Technical Reports Server (NTRS)

Winters, Brian A.

1990-01-01

The results are reported of a study of various methods for propulsively disposing of waste gases. The options considered include hydrazine waste gas injection, resistojets, and eutectic salt phase change heat beds. An overview is given of the waste gas disposal system and how hydrozine waste gas injector thruster is implemented within it. Thruster performance for various gases are given and comparisons with currently available thruster models are made. The impact of disposal on station propellant requirements and electrical power usage are addressed. Contamination effects, reliability and maintainability assessments, safety issues, and operational scenarios of the waste gas thruster and disposal system are considered.

An inverse finance problem for estimation of the volatility

NASA Astrophysics Data System (ADS)

Neisy, A.; Salmani, K.

2013-01-01

Black-Scholes model, as a base model for pricing in derivatives markets has some deficiencies, such as ignoring market jumps, and considering market volatility as a constant factor. In this article, we introduce a pricing model for European-Options under jump-diffusion underlying asset. Then, using some appropriate numerical methods we try to solve this model with integral term, and terms including derivative. Finally, considering volatility as an unknown parameter, we try to estimate it by using our proposed model. For the purpose of estimating volatility, in this article, we utilize inverse problem, in which inverse problem model is first defined, and then volatility is estimated using minimization function with Tikhonov regularization.

Scleral Lenses in the Management of Corneal Irregularity and Ocular Surface Disease.

PubMed

Shorter, Ellen; Harthan, Jennifer; Nau, Cherie B; Nau, Amy; Barr, Joseph T; Hodge, David O; Schornack, Muriel M

2017-09-29

To describe current practice patterns regarding the use of scleral lens therapy in the management of corneal irregularity and ocular surface disease among eye care providers who fit scleral lenses. The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group conducted an electronic survey of eye care providers from January 15 to March 31, 2015. Respondents ranked management options for corneal irregularity in the order in which they would generally consider their use. Respondents also ranked options for the management of ocular surface disease in the order in which they would use each of the treatments. Results for each option were analyzed as percentage first-place ranking; percentage first-, second-, or third-place ranking; and mean rank score. Survey responses were obtained from 723 providers who had fit 5 or more scleral lenses. Of these respondents, 629 ranked options for management of corneal irregularity and 612 ranked options for management of ocular surface disease. Corneal rigid gas-permeable lenses were the first option for management of corneal irregularity for 44% of respondents, and scleral lenses were the first option for 34% of respondents. Lubricant drops were the first therapeutic recommendation for ocular surface disease for 84% of respondents, and scleral lenses were ranked first by 6% of respondents. Scleral lenses rank second only to corneal rigid gas-permeable lenses for management of corneal irregularity. Scleral lenses are generally considered after other medical intervention and before surgery for the management of ocular surface disease.

A Basic Study on Optimal Investment of Power Sources Considering Environmental Measures

NASA Astrophysics Data System (ADS)

Kato, Moritoshi; Zhou, Yicheng

This paper focuses on economic evaluations of a coal-fired thermal power station with a carbon dioxide capture and storage unit (CCS) by which an existing coal-fired thermal power station (COAL) is replaced. Decision makers decide to construct CCS considering both of contrary elements; one is waiting more favorable conditions such as a higher value of carbon credits which CCS has, another is reducing opportunity costs due to delay of construction of CCS. New methods using a real option approach are proposed. Firstly we calculate an economic value of CCS as an American coal option with dividend considering carbon emission costs of COAL as opportunity costs. Secondly we evaluate construction time of CCS using binominal decision tree taking into account the options. Numerical examples show that a real option value of CCS is from 28% to 44% of sales revenue, which are higher than net present values due to a value on waiting for more favorable conditions. And they also show that an earlier construction is exercised and the value becomes lower, the more challenging the benchmark of carbon emissions is or the higher the change rate of maintenance cost of COAL becomes. An effect of a lifetime of power stations is also analyzed.

Fertility preservation options in breast cancer patients.

PubMed

Kasum, Miro; von Wolff, Michael; Franulić, Daniela; Čehić, Ermin; Klepac-Pulanić, Tajana; Orešković, Slavko; Juras, Josip

2015-01-01

The purpose of this review is to analyse current options for fertility preservation in young women with breast cancer (BC). Considering an increasing number of BC survivors, owing to improvements in cancer treatment and delaying of childbearing, fertility preservation appears to be an important issue. Current fertility preservation options in BC survivors range from well-established standard techniques to experimental or investigational interventions. Among the standard options, random-start ovarian stimulation protocol represents a new technique, which significantly decreases the total time of the in vitro fertilisation cycle. However, in patients with oestrogen-sensitive tumours, stimulation protocols using aromatase inhibitors are currently preferred over tamoxifen regimens. Cryopreservation of embryos and oocytes are nowadays deemed the most successful techniques for fertility preservation in BC patients. GnRH agonists during chemotherapy represent an experimental method for fertility preservation due to conflicting long-term outcome results regarding its safety and efficacy. Cryopreservation of ovarian tissue, in vitro maturation of immature oocytes and other strategies are considered experimental and should only be offered within the context of a clinical trial. An early pretreatment referral to reproductive endocrinologists and oncologists should be suggested to young BC women at risk of infertility, concerning the risks and benefits of fertility preservation options.

Pressurization, Pneumatic, and Vent Subsystems of the X-34 Main Propulsion System

NASA Technical Reports Server (NTRS)

Hedayat, A.; Steadman, T. E.; Brown, T. M.; Knight, K. C.; White, C. E., Jr.; Champion, R. H., Jr.

1998-01-01

In pressurization systems, regulators and orifices are use to control the flow of the pressurant. For the X-34 Main Propulsion System, three pressurization subsystem design configuration options were considered. In the first option, regulators were used while in the other options, orifices were considered. In each design option, the vent/relief system must be capable of relieving the pressurant flow without allowing the tank pressure to rise above proof, therefore, impacts on the propellant tank vent system were investigated and a trade study of the pressurization system was conducted. The analysis indicated that design option using regulators poses least risk. Then, a detailed transient thermal/fluid analysis of the recommended pressurization system was performed. Helium usage, thermodynamic conditions, and overpressurization of each propellant tank were evaluated. The pneumatic and purge subsystem is used for pneumatic valve actuation, Inter-Propellant Seal purges, Engine Spin Start, and engine purges at the required interface pressures, A transient analysis of the pneumatic and purge subsystem provided helium usage and flow rates to Inter-Propellant Seal and engine interfaces. Fill analysis of the helium bottles of pressurization and pneumatic subsystems during ground operation was performed. The required fill time and the stored

Bariatric surgery options.

PubMed

Woodward, Bryan G

2003-01-01

There are multiple surgical procedures used for weight loss. The concept of achieving malabsorption through manipulation of the gastrointestinal contract is briefly discussed. Various surgical options are considered with their advantages and disadvantages, namely vertical banded gastroplasty, gastric banding, Roux-en-y gastric bypass, distal gastric bypass billiopancreatic diversion, and duodental switch.

Hemorrhoids and anal fissures in inflammatory bowel disease.

PubMed

D'Ugo, S; Stasi, E; Gaspari, A L; Sileri, P

2015-12-01

Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis.

The Opinions of GP's Patients About Suicide, Assisted Suicide, Euthanasia, and Suicide Prevention: An Italian Survey.

PubMed

Poma, Stefano Zanone; Vicentini, Silvia; Siviero, Francesca; Grossi, Antonello; Toniolo, Emanuele; Baldo, Vincenzo; De Leo, Diego

2015-08-01

A survey about opinions on end-of-life issues of a population represented by 1,171 people in the waiting room of general practitioners' surgeries was conducted in a province of northern Italy. Most subjects did not consider suicide as a reasonable option even in cases of a serious and incurable disease. Moreover, subjects did not consider euthanasia as a possible option either; however, they did express an opposite attitude when considering euthanasia in a third-person perspective. People with a personal history of suicidal behavior appear to present as a different population, overall expressing more open attitudes. © 2014 The American Association of Suicidology.

Grid-independent residential power systems

NASA Astrophysics Data System (ADS)

Nelson, Robert E.

1996-02-01

A self-powered, gas-fired, warm air furnace is evaluated as a candidate for the autonomous generation of electrical power. A popular, commercial residential furnace is analyzed for electrical power requirements. Available energy conversion concepts are considered for this application, and the thermophotovoltaic (TPV) option is selected due to reliability and cost. The design and the internal components peculiar to the TPV converter will be covered. Operating results, including NOx emission, will be summarized. This work was sponsored by the Basic Research Group, Gas Research Institute, Chicago, IL.

Choroidal neovascular membrane.

PubMed

Bhatt, N S; Diamond, J G; Jalali, S; Das, T

1998-06-01

Choroidal neovascular membrane in the macular area is one of the leading causes of severe visual loss. Usually a manifestation in elderly population, it is often associated with age-related macular degeneration. The current mainstay of management is early diagnosis, usually by fundus examination, aided by angiography and photocoagulation in selected cases. Various other modalities of treatment including surgery are being considered as alternate options, but with limited success. The purpose of this review is to briefly outline the current concepts and the management strategy from a clinician's viewpoint.

Space Station crew safety alternatives study. Volume 4: Appendices

NASA Technical Reports Server (NTRS)

Peercy, R. L., Jr.; Raasch, R. F.; Rockoff, L. A.

1985-01-01

The scope of this study considered the first 15 years of accumulated space station concepts for Initial Operational Capability (10C) during the early 1990's. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration and debris.

Near-term hybrid vehicle program, phase 1

NASA Technical Reports Server (NTRS)

1979-01-01

The preliminary design of a hybrid vehicle which fully meets or exceeds the requirements set forth in the Near Term Hybrid Vehicle Program is documented. Topics addressed include the general layout and styling, the power train specifications with discussion of each major component, vehicle weight and weight breakdown, vehicle performance, measures of energy consumption, and initial cost and ownership cost. Alternative design options considered and their relationship to the design adopted, computer simulation used, and maintenance and reliability considerations are also discussed.

Case for Deploying Complex Systems Utilizing Commodity Components

NASA Technical Reports Server (NTRS)

Bryant, Barry S.; Pitts, R. Lee; Ritter, George

2003-01-01

This viewgraph representation presents a study of the transition of computer networks and software engineering at the Huntsville Operations Support Center (HOSC) from a client/server UNIX based system to a client/server system based on commodity priced and open system components. Topics covered include: an overview of HOSC ground support systems, an analysis for changes to the existing ground support system, an analysis of options considered for the transition to a new system, and a consideration of goals for a new system.

Earth Observatory Satellite system definition study. Report no. 3: Design/cost tradeoff studies

NASA Technical Reports Server (NTRS)

1974-01-01

The key issues in the Earth Observatory Satellite (EOS) program which are subject to configuration study and tradeoff are identified. The issue of a combined operational and research and development program is considered. It is stated that cost and spacecraft weight are the key design variables and design options are proposed in terms of these parameters. A cost analysis of the EOS program is provided. Diagrams of the satellite configuration and subsystem components are included.

Labour circulation and the urban labour process.

PubMed

Standing, G

1986-01-01

The author investigates aspects of labor circulation, which he defines as "temporary movement between geographical areas for work or in search of work....[He attempts to determine] what roles have been played by labour circulation in the development of urban-industrial labour forces in the transition to industrial capitalism." Factors considered include the exploitation and oppression of labor migrants; the industrial-urban labor reserve; urban socioeconomic stratification and discrimination by age, sex, or race; the division of labor; and policy options. excerpt

Optimisation of the Management of Higher Activity Waste in the UK - 13537

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walsh, Ciara; Buckley, Matthew

2013-07-01

The Upstream Optioneering project was created in the Nuclear Decommissioning Authority (UK) to support the development and implementation of significant opportunities to optimise activities across all the phases of the Higher Activity Waste management life cycle (i.e. retrieval, characterisation, conditioning, packaging, storage, transport and disposal). The objective of the Upstream Optioneering project is to work in conjunction with other functions within NDA and the waste producers to identify and deliver solutions to optimise the management of higher activity waste. Historically, optimisation may have occurred on aspects of the waste life cycle (considered here to include retrieval, conditioning, treatment, packaging, interimmore » storage, transport to final end state, which may be geological disposal). By considering the waste life cycle as a whole, critical analysis of assumed constraints may lead to cost savings for the UK Tax Payer. For example, it may be possible to challenge the requirements for packaging wastes for disposal to deliver an optimised waste life cycle. It is likely that the challenges faced in the UK are shared in other countries. It is therefore likely that the opportunities identified may also apply elsewhere, with the potential for sharing information to enable value to be shared. (authors)« less

Failing to meet the goals of periodontal recall programs. What next?

PubMed

McCracken, Giles; Asuni, Abisola; Ritchie, Mark; Vernazza, Christopher; Heasman, Peter

2017-10-01

Supportive periodontal care is a crucial aspect of the management of chronic periodontitis and peri-implantitis and is inevitably a long-term commitment for both the clinician and the patient. The principal goals of supportive care are to achieve a high standard of plaque control, minimize bleeding and maintain pockets at less than 6 mm. Gain of attachment around natural teeth during supportive periodontal care has been reported, although gain of attachment and of bone during supportive care may be a more pragmatic and aspirational aim in the longer term. Furthermore, we occasionally see patients for whom, despite excellent home and professional care (surgical or nonsurgical), including the management of risk factors, supportive periodontal care appears to be failing and therefore for such patients the clinician needs to consider further management options. This review considers, in particular, the options of using local or systemically delivered antimicrobials to eradicate periodontal and peri-implant disease progression and discusses the extent to which culture and sensitivity testing before the prescription of systemically delivered antimicrobials may be a cost-effective alternative to prescribing 'blind'. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Long term orbital storage of cryogenic propellants for advanced space transportation missions

NASA Technical Reports Server (NTRS)

Schuster, John R.; Brown, Norman S.

1987-01-01

A comprehensive study has developed the major features of a large capacity orbital propellant depot for the space-based, cryogenic OTV. The study has treated both the Dual-Keel Space Station and co-orbiting platforms as the accommodations base for the propellant storage facilities, and trades have examined both tethered and hard-docked options. Five tank set concepts were developed for storing the propellants, and along with layout options for the station and platform, were evaluated from the standpoints of servicing, propellant delivery, boiloff, micrometeoroid/debris shielding, development requirements, and cost. These trades led to the recommendation that an all-passive storage concept be considered for the platform and an actively refrigerated concept providing for reliquefaction of all boiloff be considered for the Space Station. The tank sets are modular, each storing up to 45,400 kg of LO2/LH2, and employ many advanced features to provide for microgravity fluid management and to limit boiloff. The features include such technologies as zero-gravity mass gauging, total communication capillary liquid acquisition devices, autogenous pressurization, thermodynamic vent systems, thick multilayer insulation, vapor-cooled shields, solar-selective coatings, advanced micrometeoroid/debris protection systems, and long-lived cryogenic refrigeration systems.

42 CFR 435.201 - Individuals included in optional groups.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Individuals included in optional groups. 435.201... optional groups. (a) The agency may choose to cover as optional categorically needy any group or groups of... eligibility criteria for groups specified in the separate sections of this subpart: (1) Aged individuals (65...

78 FR 75642 - Self-Regulatory Organizations; NYSE MKT LLC; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-12

... Amending the NYSE Amex Options Fee Schedule To Include FLEX Option Transactions in the Strategy Execution...'') to include FLEX Option transactions in the strategy execution fee cap. The Exchange proposes to... Option transactions in the strategy execution fee cap. The Exchange proposes to implement the fee change...

Joint-ventures as strategic choice--a literature review.

PubMed

Lyons, M P

1991-08-01

The concept of 'strategic options' has become firmly established in recent years--this regards choices such as 'organic growth', acquisition, merger, and so on. This paper explores one such route forward, the option of joint-ventures. The examination is undertaken within a framework that considers market structures and the pressures for change. Initial sections introduce a form of analysis based upon the work of Michael Porter. This is used to suggest how and why joint-ventures and other alliances are attractive. Later discussion considers some of the practical considerations when setting-up a joint-venture.

Strategic biopharmaceutical portfolio development: an analysis of constraint-induced implications.

PubMed

George, Edmund D; Farid, Suzanne S

2008-01-01

Optimizing the structure and development pathway of biopharmaceutical drug portfolios are core concerns to the developer that come with several attached complexities. These include strategic decisions for the choice of drugs, the scheduling of critical activities, and the possible involvement of third parties for development and manufacturing at various stages for each drug. Additional complexities that must be considered include the impact of making such decisions in an uncertain environment. Presented here is the development of a stochastic multi-objective optimization framework designed to address these issues. The framework harnesses the ability of Bayesian networks to characterize the probabilistic structure of superior decisions via machine learning and evolve them to multi-objective optimality. Case studies that entailed three- and five-drug portfolios alongside a range of cash flow constraints were constructed to derive insight from the framework where results demonstrate that a variety of options exist for formulating nondominated strategies in the objective space considered, giving the manufacturer a range of pursuable options. In all cases limitations on cash flow reduce the potential for generating profits for a given probability of success. For the sizes of portfolio considered, results suggest that naïvely applying strategies optimal for a particular size of portfolio to a portfolio of another size is inappropriate. For the five-drug portfolio the most preferred means for development across the set of optimized strategies is to fully integrate development and commercial activities in-house. For the three-drug portfolio, the preferred means of development involves a mixture of in-house, outsourced, and partnered activities. Also, the size of the portfolio appears to have a larger impact on strategy and the quality of objectives than the magnitude of cash flow constraint.

Diabetes management and hypoglycemia in safety sensitive jobs.

PubMed

Lee, See-Muah; Koh, David; Chui, Winnie Kl; Sum, Chee-Fang

2011-03-01

The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, self-monitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs.

Diabetes Management and Hypoglycemia in Safety Sensitive Jobs

PubMed Central

Koh, David; Chui, Winnie KL; Sum, Chee-Fang

2011-01-01

The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, self-monitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs. PMID:22953182

Land Ecology Essay I: The siren song of the finish line

USDA-ARS?s Scientific Manuscript database

As the National Cooperative Soils Survey nears the completion of initial mapping and description activities, the options for next steps are being considered. One option is to deploy new and emerging mapping technologies for existing and refined concepts of soil behavior to create more precise maps ...

7 CFR 3555.304 - Special servicing options.

Code of Federal Regulations, 2014 CFR

2014-01-01

... consider a mortgage recovery advance under this section in addition to the extended-term loan modification... required for taxes and insurance. (6) The following terms apply to the repayment of mortgage recovery... does not change the terms of the loan note guarantee. (4) Special servicing options shall be used in...

76 FR 76783 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-08

... Exchange may considering revising the fee schedule to assess transaction fees rates for non-Trading Permit... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-65875; File No. SR-CBOE-2011-112] Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and Immediate...

12 CFR 350.4 - Contents of annual disclosure statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for each such year. The annual disclosure statement may, at the option of bank management, consist of... Reserve System: (i) Schedule RC (Balance Sheet); (ii) Schedule RC-N (Past Due and Nonaccrual, Loans... option, provide additional information that bank management considers important to an evaluation of the...

Assessing Governance Alternatives for University-Owned Public Teaching Hospitals.

ERIC Educational Resources Information Center

Whitley, Evangeline L.

The governance options matrix is provided to offer a way for state and university policymakers to examine the functioning environments of specific university-owned public teaching hospitals. With it, they can consider the benefits and problems involved with different options for governance. The issues related to the environmental factors affecting…

Techno-ecological synergy as a path toward sustainability of a North American residential system.

PubMed

Urban, Robert A; Bakshi, Bhavik R

2013-02-19

For any human-designed system to be sustainable, ecosystem services that support it must be readily available. This work explicitly accounts for this dependence by designing synergies between technological and ecological systems. The resulting techno-ecological network mimics nature at the systems level, can stay within ecological constraints, and can identify novel designs that are economically and environmentally attractive that may not be found by the traditional design focus on technological options. This approach is showcased by designing synergies for a typical American suburban home at local and life cycle scales. The objectives considered are carbon emissions, water withdrawal, and cost savings. Systems included in the design optimization include typical ecosystems in suburban yards: lawn, trees, water reservoirs, and a vegetable garden; technological systems: heating, air conditioning, faucets, solar panels, etc.; and behavioral variables: heating and cooling set points. The ecological and behavioral design variables are found to have a significant effect on the three objectives, in some cases rivaling and exceeding the effect of traditional technological options. These results indicate the importance and benefits of explicitly including ecosystems in the design of sustainable systems, something that is rarely done in existing methods.

A planning comparison of 7 irradiation options allowed in RTOG 1005 for early-stage breast cancer.

PubMed

Chen, Guang-Pei; Liu, Feng; White, Julia; Vicini, Frank A; Freedman, Gary M; Arthur, Douglas W; Li, X Allen

2015-01-01

This study compared the 7 treatment plan options in achieving the dose-volume criteria required by the Radiation Therapy Oncology Group (RTOG) 1005 protocol. Dosimetry plans were generated for 15 representative patients with early-stage breast cancer (ESBC) based on the protocol-required dose-volume criteria for each of the following 7 treatment options: 3D conformal radiotherapy (3DCRT), whole-breast irradiation (WBI) plus 3DCRT lumpectomy boost, 3DCRT WBI plus electron boost, 3DCRT WBI plus intensity-modulated radiation therapy (IMRT) boost, IMRT WBI plus 3DCRT boost, IMRT WBI plus electron boost, IMRT WBI plus IMRT boost, and simultaneous integrated boost (SIB) with IMRT. A variety of dose-volume parameters, including target dose conformity and uniformity and normal tissue sparing, were compared for these plans. For the patients studied, all plans met the required acceptable dose-volume criteria, with most of them meeting the ideal criteria. When averaged over patients, most dose-volume goals for all plan options can be achieved with a positive gap of at least a few tenths of standard deviations. The plans for all 7 options are generally comparable. The dose-volume goals required by the protocol can in general be easily achieved. IMRT WBI provides better whole-breast dose uniformity than 3DCRT WBI does, but it causes no significant difference for the dose conformity. All plan options are comparable for lumpectomy dose uniformity and conformity. Patient anatomy is always an important factor when whole-breast dose uniformity and conformity and lumpectomy dose conformity are considered. Copyright © 2015 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

SUPPORT Tools for evidence-informed health Policymaking (STP) 7: Finding systematic reviews

PubMed Central

2009-01-01

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Systematic reviews are increasingly seen as a key source of information in policymaking, particularly in terms of assisting with descriptions of the impacts of options. Relative to single studies they offer a number of advantages related to understanding impacts and are also seen as a key source of information for clarifying problems and providing complementary perspectives on options. Systematic reviews can be undertaken to place problems in comparative perspective and to describe the likely harms of an option. They also assist with understanding the meanings that individuals or groups attach to a problem, how and why options work, and stakeholder views and experiences related to particular options. A number of constraints have hindered the wider use of systematic reviews in policymaking. These include a lack of awareness of their value and a mismatch between the terms employed by policymakers, when attempting to retrieve systematic reviews, and the terms used by the original authors of those reviews. Mismatches between the types of information that policymakers are seeking, and the way in which authors fail to highlight (or make obvious) such information within systematic reviews have also proved problematic. In this article, we suggest three questions that can be used to guide those searching for systematic reviews, particularly reviews about the impacts of options being considered. These are: 1. Is a systematic review really what is needed? 2. What databases and search strategies can be used to find relevant systematic reviews? 3. What alternatives are available when no relevant review can be found? PMID:20018114

Conservative care as a treatment option for patients aged 75 years and older with CKD stage V: a National survey in the Netherlands.

PubMed

Susanto, Christopher; Kooman, J; Courtens, A M; Konings, C J A M

2018-01-01

Conservative care for patients aged 75 years and older with CKD stage 5 as a treatment option besides dialysis was proposed officially in the Netherlands in October 2016. This national survey showed the current implementation of this option in Netherlands nephrology departments. A web-based survey was sent to medical managers of 60 nephrology departments in the Netherlands in August 2016. Twenty-one medical managers (35%) completed the survey. The term "conservative care" is frequently used and well known. The estimated number of patients in whom the decision for maximal conservative care was made in 2015 was 310 of 2249 patients with CKD stage 5 age 75 years and older (range 5-50 patients per department). 164 patients became symptomatic and received no dialysis. There is no official registration for this treatment option and patient category. The practice patterns vary widely. Only one of 21 respondents reported a conservative care outpatient clinic. Formal training or education regarding conservative care is not available in most of departments. 95% of respondents discussed this treatment option with their patients. General practitioners are always being informed about their patient's decision. Their main role is providing or organizing palliative care support at the end of life and discussing advance care planning. Most respondents (86%) considered to include their patients in a prospective multicentre observational study, conservative care versus dialysis. Conservative care as a treatment option for patients with CKD stage 5 aged 75 years and older is well established. The practice patterns are varied in the Netherlands. Follow-up studies are needed to see whether the new multidisciplinary guideline facilitates harmonization of practice pattern. Funding is needed to optimize the implementation of conservative care.

Thyroid Cancer Treatment Choice: A pilot study of a tool to facilitate conversations with patients with papillary microcarcinomas considering treatment options.

PubMed

Brito, Juan P; Moon, Jae Hoon; Zeuren, Rebecca; Kong, Sung Hye; Kim, Yeo Koon; Iñiguez-Ariza, Nicole M; Choi, June Young; Lee, Kyu Eun; Kim, Ji-Hoon; Hargraves, Ian; Bernet, Victor; Montori, Victor; Park, Young Joo; Tuttle, R Michael

2018-06-15

The 2015 American Thyroid Association guidelines recognize active surveillance as an alternative to immediate surgery in patients with papillary microcarcinomas (PMCs). As a way to incorporate active surveillance as one of the management options for patients with PMCs, we describe the development and initial testing of a tool to support conversations between clinicians and patients with PMCs considering treatment options. Thyroid Cancer Treatment Choice was developed using an iterative process based on the principles of interaction, design and participatory action research. To evaluate the impact of the tool on treatment choice, a prospective study was conducted in two thyroid cancer clinics in Seongnam-si and Seoul, South Korea: both clinics had the expertise to offer active surveillance as well as immediate surgery. One clinic was trained in the use of the conversation aid, while the other clinic continued to care for patients without access to the conversation aid. Between May 2016 and April 2017, 278 patients mostly women (n=220, 79%) were included in the study; 152 (53%) received care at the clinic using the conversation aid. Age, gender, and mean tumor size [6.6 mm (SD 1.6) and 6.5 mm (SD 1.9)] distributions were similar across clinics. Overall, 233 (84%) patients opted for active surveillance and 53 (16%) for thyroid surgery. Patients in the conversation aid group were more likely to choose active surveillance than the patients seen in the usual care clinic [relative risk (RR) = 1.16; 95% confidence interval (CI), 1.04 - 1.29]. Of all patients opting for active surveillance, more patients in the conversation aid group had thyroid cancer nodules > 5 mm than in the usual care group (81% vs. 67% P = 0.013). Thyroid Cancer Treatment Choice is an evidence-based tool that supports the presentation of treatment options for PMCs. Pilot testing suggests that this conversation tool increases acceptance of active surveillance, suggesting that this option is an acceptable and preferable alternative for informed patients. Further studies are warranted to confirm this finding.

Lunar base agriculture: Soils for plant growth

NASA Technical Reports Server (NTRS)

Ming, Douglas W. (Editor); Henninger, Donald L. (Editor)

1989-01-01

This work provides information on research and experimentation concerning various aspects of food production in space and particularly on the moon. Options for human settlement of the moon and Mars and strategies for a lunar base are discussed. The lunar environment, including the mineralogical and chemical properties of lunar regolith are investigated and chemical and physical considerations for a lunar-derived soil are considered. It is noted that biological considerations for such a soil include controlled-environment crop production, both hydroponic and lunar regolith-based; microorganisms and the growth of higher plants in lunar-derived soils; and the role of microbes to condition lunar regolith for plant cultivation. Current research in the controlled ecological life support system (CELSS) project is presented in detail and future research areas, such as the growth of higher research plants in CELSS are considered. Optimum plant and microbiological considerations for lunar derived soils are examined.

Review: Malaria Chemoprophylaxis for Travelers to Latin America

PubMed Central

Steinhardt, Laura C.; Magill, Alan J.; Arguin, Paul M.

2011-01-01

Because of recent declining malaria transmission in Latin America, some authorities have recommended against chemoprophylaxis for most travelers to this region. However, the predominant parasite species in Latin America, Plasmodium vivax, can form hypnozoites sequestered in the liver, causing malaria relapses. Additionally, new evidence shows the potential severity of vivax infections, warranting continued consideration of prophylaxis for travel to Latin America. Individualized travel risk assessments are recommended and should consider travel locations, type, length, and season, as well as probability of itinerary changes. Travel recommendations might include no precautions, mosquito avoidance only, or mosquito avoidance and chemoprophylaxis. There are a range of good options for chemoprophylaxis in Latin America, including atovaquone-proguanil, doxycycline, mefloquine, and—in selected areas—chloroquine. Primaquine should be strongly considered for nonpregnant, G6PD-nondeficient patients traveling to vivax-endemic areas of Latin America, and it has the added benefit of being the only drug to protect against malaria relapses. PMID:22144437

A decision analysis approach to climate adaptation: comparing multiple pathways for multi-decadal decision making

NASA Astrophysics Data System (ADS)

Lin, B. B.; Little, L.

2013-12-01

Policy planners around the world are required to consider the implications of adapting to climatic change across spatial contexts and decadal timeframes. However, local level information for planning is often poorly defined, even though climate adaptation decision-making is made at this scale. This is especially true when considering sea level rise and coastal impacts of climate change. We present a simple approach using sea level rise simulations paired with adaptation scenarios to assess a range of adaptation options available to local councils dealing with issues of beach recession under present and future sea level rise and storm surge. Erosion and beach recession pose a large socioeconomic risk to coastal communities because of the loss of key coastal infrastructure. We examine the well-known adaptation technique of beach nourishment and assess various timings and amounts of beach nourishment at decadal time spans in relation to beach recession impacts. The objective was to identify an adaptation strategy that would allow for a low frequency of management interventions, the maintenance of beach width, and the ability to minimize variation in beach width over the 2010 to 2100 simulation period. 1000 replications of each adaptation option were produced against the 90 year simulation in order to model the ability each adaptation option to achieve the three key objectives. Three sets of adaptation scenarios were identified. Within each scenario, a number of adaptation options were tested. The three scenarios were: 1) Fixed periodic beach replenishment of specific amounts at 20 and 50 year intervals, 2) Beach replenishment to the initial beach width based on trigger levels of recession (5m, 10m, 20m), and 3) Fixed period beach replenishment of a variable amount at decadal intervals (every 10, 20, 30, 40, 50 years). For each adaptation option, we show the effectiveness of each beach replenishment scenario to maintain beach width and consider the implications of more frequent replenishment with that of implementation cost. We determine that a business as usual scenario, where no adaptation is implemented, would lead to an average beach recession of 12.02 meters and a maximum beach recession of 33.23 meters during the period of 2010-2100. The best adaptation option modeled was a fixed replenishment of 5 meters every 20 years leading to 4 replenishment events with an average beach recession of 2.99 meters and a maximum beach recession of 15.02 meters during the period of 2010-2100. The presented simulations explicitly address the uncertainty of future impacts due to sea level rise and storm surge and show a range of options that could be considered by a local council to meet their policy objectives. The simulation runs provide managers the ability to consider the utility of various adaptation options and the timing and costs of implementation. Such information provides an evidence-based practice to decision-making and allows policy makers to transparently make decisions based on best estimates of modeled climate change.

Optimization of the treatment with immunosuppressants and biologics in inflammatory bowel disease

PubMed Central

Renna, Sara; Cottone, Mario; Orlando, Ambrogio

2014-01-01

Many placebo controlled trials and meta-analyses evaluated the efficacy of different drugs for the treatment of inflammatory bowel disease (IBD), including immunosuppressants and biologics. Their use is indicated in moderate to severe disease in non responders to corticosteroids and in steroid-dependent patients, as induction and maintainance treatment. Infliximab, as well as cyclosporine, is considered a second line therapy in the case of severe ulcerative colitis, or non-responders to intravenous corticosteroids. An adequate dosage and duration of therapy with thiopurines should be reached before evaluating their efficacy. Methotrexate is a valid option in patients with Crohn’s disease but its use is confined to patients who are intolerant or non-responders to thiopurines. Evidence for the use of methotrexate in ulcerative colitis is insufficient. The use of thalidomide and mycophenolate mofetil is not recommended in patients with inflammatory bowel disease, these treatments could be considered in case of failure of all other therapeutic options. In patients with moderately active ulcerative colitis, refractory to thiopurines, the use of tacrolimus is considered an alternative to biologics. An increase of the dose or a decrease in the interval of administration of biological treatment could be useful in the presence of an incomplete clinical response. In the case of primary failure of an anti-tumor necrosis factor alpha a switch to another one should be considered. Data on the efficacy of combination therapy are up to now insufficient to consider this strategy in all IBD patients. The final outcome of the treatment should be considered the clinical remission, with mucosa healing, and not the clinical response. The evaluation of serum concentration of thiopurine methyl transferase activity, thiopurine metabolites, biologic serum levels and antibiologic antibodies could be useful for the management of the treatment but it has not been routinely applied in clinical practice. The evidence of high risk development of lymphoma and cutaneous malignancies should be considered in patients treated with immunosuppressants and biologics for a long period. PMID:25110407

Providing Guidance for Patients With Moderate-to-Severe Psoriasis Who Are Candidates for Biologic Therapy: Role of the Nurse Practitioner and Physician Assistant.

PubMed

Aldredge, Lakshi M; Young, Melodie S

2016-01-01

Psoriasis is a chronic, immune-mediated disease characterized by itchy, scaly, and often painful plaques in the skin. Psoriasis can have significant psychosocial burdens and increased risks for numerous comorbidities, including diabetes, hypertension, and cardiovascular disease, particularly in patients with moderate-to-severe disease. Dermatology nurse practitioners and physician assistants are an important part of the healthcare team, contributing to all aspects of psoriasis management. This review reinforces the unique aspects of care that nurse practitioners and physician assistants provide to patients with psoriasis, such as facilitating conversations about managing disease, setting appropriate expectations, and considering treatment options, including when treatment response or tolerability is suboptimal. The importance of relationship building is stressed. Patient management topics discussed include helpful tips about assessing treatment options, initiating biologic therapy, optimizing patient adherence, and managing comorbidities. Also reviewed are how to deal with common barriers including lack of knowledge about psoriasis or making healthy lifestyle changes, fear of injections or side effect risks, lack of health insurance, and concerns about treatment costs. Overall, by forming meaningful relationships and engaging patients in their psoriasis care, nurse practitioners and physician assistants can help to optimize clinical efficacy outcomes and consistently manage moderate-to-severe psoriasis and its comorbidities over the patient's life course.

Automating the Analytical Laboratories Section, Lewis Research Center, National Aeronautics and Space Administration: A feasibility study

NASA Technical Reports Server (NTRS)

Boyle, W. G.; Barton, G. W.

1979-01-01

The feasibility of computerized automation of the Analytical Laboratories Section at NASA's Lewis Research Center was considered. Since that laboratory's duties are not routine, the automation goals were set with that in mind. Four instruments were selected as the most likely automation candidates: an atomic absorption spectrophotometer, an emission spectrometer, an X-ray fluorescence spectrometer, and an X-ray diffraction unit. Two options for computer automation were described: a time-shared central computer and a system with microcomputers for each instrument connected to a central computer. A third option, presented for future planning, expands the microcomputer version. Costs and benefits for each option were considered. It was concluded that the microcomputer version best fits the goals and duties of the laboratory and that such an automted system is needed to meet the laboratory's future requirements.

Net energy analysis: Powerful tool for selecting electric power options

NASA Astrophysics Data System (ADS)

Baron, S.

A number of net energy analysis studies have been conducted in recent years for electric power production from coal, oil and uranium fuels; synthetic fuels from coal and oil shale; and heat and electric power from solar energy. This technique is an excellent indicator of investment costs, environmental impact and potential economic competitiveness of alternative electric power systems for energy planners from the Eastern European countries considering future options. Energy conservation is also important to energy planners and the net energy analysis technique is an excellent accounting system on the extent of energy resource conservation. The author proposes to discuss the technique and to present the results of his studies and others in the field. The information supplied to the attendees will serve as a powerful tool to the energy planners considering their electric power options in the future.

Benefit, risk and cost of new oral anticoagulants and warfarin in atrial fibrillation; A multicriteria decision analysis.

PubMed

Mendoza-Sanchez, Jose; Silva, Federico; Rangel, Lady; Jaramillo, Linda; Mendoza, Leidy; Garzon, Jenny; Quiroga, Andrea

2018-01-01

Warfarin and new oral anticoagulants are effective in reducing stroke in atrial fibrillation; however, the benefits and risks rates in clinical trials show heterogeneity for each anticoagulant, and is unknown the cost influence on a model considering most of the treatment consequences. We designed a benefit-risk and cost assessment of oral anticoagulants. We followed the roadmap proposed by IMI-PROTECT and the considerations of emerged good practice to perform Multi-Criteria Decision Analysis (MCDA). The roadmap defines the following steps: (1) planning, (2) evidence gathering and data preparation, (3) analyses, (4) explorations, and (5) conclusions. We defined two reference points (0-100) to allocate numerical values for scores and weights, and used an analogue numeric scale to assess physicians' preferences. As benefits of the anticoagulant therapy, we included reductions in stroke and all-cause mortality; intracranial haemorrhage, gastrointestinal haemorrhage, minor bleeding and myocardial infarction were considered risks. We also made an estimation of the annual drug cost per person. The scores were: Apixaban 33, Dabigatrán 25, warfarin 18 and Rivaroxaban 14 this score reveals the most preferred up to the less preferred option, considering the benefit-risk ratio and drug costs altogether. The relative model weights were: 51.1% for risks, 40.4% for benefits and 8.5% for cost. The sensitivity analysis confirms the model robustness. From this analysis, apixaban should be considered as the preferred anticoagulant option -due to a better benefit-risk balance and a minor cost influence- followed by dabigatran, warfarin and rivaroxaban.

Coordinating Demand-Side Efficiency Evaluation, Measurement and Verification Among Western States: Options for Documenting Energy and Non-Energy Impacts for the Power Sector

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schiller, Steven R.; Schwartz, Lisa C.

Demand-side energy efficiency (efficiency) represents a low-cost opportunity to reduce electricity consumption and demand and provide a wide range of non-energy benefits, including avoiding air pollution. Efficiency-related energy and non-energy impacts are determined and documented by implementing evaluation, measurement and verification (EM&V) systems. This technical brief describes efficiency EM&V coordination strategies that Western states can consider taking on together, outlines EM&V-related products that might be appropriate for multistate coordination, and identifies some implications of coordination. Coordinating efficiency EM&V activities can save both time and costs for state agencies and stakeholders engaged in efficiency activities and can be particularly beneficial formore » multiple states served by the same utility. First, the brief summarizes basic information on efficiency, its myriad potential benefits and EM&V for assessing those benefits. Second, the brief introduces the concept of multistate EM&V coordination in the context of assessing such benefits, including achievement of state and federal goals to reduce air pollutants.1 Next, the brief presents three coordination strategy options for efficiency EM&V: information clearinghouse/exchange, EM&V product development, and a regional energy efficiency tracking system platform. The brief then describes five regional EM&V products that could be developed on a multistate basis: EM&V reporting formats, database of consistent deemed electricity savings values, glossary of definitions and concepts, efficiency EM&V methodologies, and EM&V professional standards or accreditation processes. Finally, the brief discusses options for next steps that Western states can take to consider multistate coordination on efficiency EM&V. Appendices provide background information on efficiency and EM&V, as well as definitions and suggested resources on the covered topics. This brief is intended to inform state public utility commissions, boards for public and consumer-owned utilities, state energy offices and air agencies, and other organizations involved in discussions about the use of efficiency EM&V.« less

Scenario-Based Case Study Analysis of Asteroid Mitigation in the Short Response Time Regime

NASA Astrophysics Data System (ADS)

Seery, B.; Greenaugh, K. C.

2017-12-01

Asteroid impact on Earth is a rare but inevitable occurrence, with potentially cataclysmic consequences. If a pending impact is discovered, mitigation options include civil-defense preparations as well as missions to deflect the asteroid and/or robustly disrupt and disperse it to an extent that only a negligible fraction remains on a threatening path (National Research Council's "Defending the Planet," 2010). If discovered with sufficient warning time, a kinetic impactor can deflect smaller objects, but response delays can rule out the option. If a body is too large to deflect by kinetic impactor, or the time for response is insufficient, deflection or disruption can be achieved with a nuclear device. The use of nuclear ablation is considered within the context of current capabilities, requiring no need for nuclear testing. Existing, well-understood devices are sufficient for the largest known Potentially Hazardous Objects (PHOs). The National Aeronautics and Space Administration/Goddard Space Flight Center and the Department of Energy/National Nuclear Security Administration are collaborating to determine the critical characterization issues that define the boundaries for the asteroid-deflection options. Drawing from such work, we examine the timeline for a deflection mission, and how to provide the best opportunity for an impactor to suffice by minimizing the response time. This integrated problem considers the physical process of the deflection method (impact or ablation), along with the spacecraft, launch capability, risk analysis, and the available intercept flight trajectories. Our joint DOE/NASA team has conducted case study analysis of three distinctly different PHOs, on a hypothetical earth impacting trajectory. The size of the design reference bodies ranges from 100 - 500 meters in diameter, with varying physical parameters such as composition, spin state, and metallicity, to name a few. We assemble the design reference of the small body in question using known values for key parameters and expert elicitation to make educated guesses on the unknown parameters, including an estimate of the overall uncertainties in those values. Our scenario-based systems approach includes 2-D and 3-D physics-based modeling and simulations.

Urinary incontinence in women

PubMed Central

Aoki, Yoshitaka; Brown, Heidi W.; Brubaker, Linda; Cornu, Jean Nicolas; Daly, J. Oliver; Cartwright, Rufus

2018-01-01

Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence. PMID:28681849

[Gastroesophageal reflux and obstructive sleep apnea syndrome].

PubMed

Esteller, E; Modolell, I; Segarra, F; Matiño, E; Enrique, A; Ademà, J M; Estivill, E

2005-11-01

Patients with mild or moderate Sleep Apnea Syndrome (SAS) need wider therapeutic scope options according to their disease severity. To consider including proton pump inhibitors (PPI) to the therapeutical alternatives of these patients. A prospective study was designed, among patients with SAS. Nocturnal polysomnography and double channel pHmetry were performed simultaneously. From the 18 patients included in this preliminary phase, in three (16.7%) nocturnal proximal ph monitoring was positive. These 3 patients were treated with PPI during at least 3 months with a very satisfactory outcome in two of them. Treatment with PPI may be a useful therapeutical alternative in patients with mild to moderate SAS.

Cost-effectiveness of medical, endovascular and surgical management of peripheral vascular disease☆

PubMed Central

Fanari, Zaher; Weintraub, William S.

2015-01-01

Peripheral arterial disease (PAD) is responsible for 20% of all US hospital admissions. Management of PAD has evolved over time to include many medical and transcatheter interventions in addition to the traditional surgical approach. Non-invasive interventions including supervised exercise programs and antiplatelets use are economically attractive therapies that should be considered in all patients at risk. While surgery offers so far a clinically and economically appropriate option, the improvement of percutaneous transluminal angioplasty (PTA) technique with the addition of drug-coated balloons offers a reasonably clinically and economically attractive alternative that will continue to evolve in the future. PMID:26238266

MARTA: a suite of Java-based tools for assigning taxonomic status to DNA sequences.

PubMed

Horton, Matthew; Bodenhausen, Natacha; Bergelson, Joy

2010-02-15

We have created a suite of Java-based software to better provide taxonomic assignments to DNA sequences. We anticipate that the program will be useful for protistologists, virologists, mycologists and other microbial ecologists. The program relies on NCBI utilities including the BLAST software and Taxonomy database and is easily manipulated at the command-line to specify a BLAST candidate's query-coverage or percent identity requirements; other options include the ability to set minimal consensus requirements (%) for each of the eight major taxonomic ranks (Domain, Kingdom, Phylum, ...) and whether to consider lower scoring candidates when the top-hit lacks taxonomic classification.

Trade study: Liquid hydrogen transportation - Kennedy Space Center. [cost and operational effectivenss of shipping methods.

NASA Technical Reports Server (NTRS)

Gray, D. J.

1978-01-01

Cryogenic transportation methods for providing liquid hydrogen requirements are examined in support of shuttle transportation system launch operations at Kennedy Space Center, Florida, during the time frames 1982-1991 in terms of cost and operational effectiveness. Transportation methods considered included sixteen different options employing mobile semi-trailer tankers, railcars, barges and combinations of each method. The study concludes that the most effective method of delivering liquid hydrogen from the vendor production facility in New Orleans to Kennedy Space Center includes maximum utilization of existing mobile tankers and railcars supplemented by maximum capacity mobile tankers procured incrementally in accordance with shuttle launch rates actually achieved.

Ovulation induction in polycystic ovary syndrome.

PubMed

Tanbo, Tom; Mellembakken, Jan; Bjercke, Sverre; Ring, Eva; Åbyholm, Thomas; Fedorcsak, Peter

2018-06-11

The objective of this narrative review is to suggest a rational order of treatment choices in anovulatory women with polycystic ovary syndrome (PCOS), for whom a multitude of treatment options exist. In obese/overweight PCOS patients the importance of weight reduction should be stressed. Inositol, a dietary supplement with a documented effect on ovulation and without side effects in the doses recommended, may be suggested. Additional first line medical alternatives include insulin sensitizers, selective estrogen receptor modulators and aromatase inhibitors. Of these, the aromatase inhibitor letrozole and the combination of clomiphene citrate and metformin have the highest rates of ovulation and live birth. Second line treatments are ovarian electrocautery and low-dose follicle stimulating hormone stimulation. Controlled ovarian stimulation with in vitro fertilization, should be considered the last option since it carries a significant risk of ovarian hyperstimulation syndrome in patients with PCOS. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The Proton Pump Inhibitor Nonresponder: a Behavioral Approach to Improvement and Wellness.

PubMed

Riehl, Megan E; Chen, Joan W

2018-06-09

Gastroesophageal reflux disease (GERD) is a difficult to treat medical condition, where nearly 40% of patients are refractory to standard medical intervention, which typically begins with a proton pump inhibitor (PPI). These PPI nonresponders represent a population of patients, where treatment planning must be individualized; multidisciplinary and psychiatric comorbidities should be considered. This review highlights treatment options that include neuromodulators, lifestyle, and psychological interventions for the PPI nonresponder. Mental health specialists in the field of psychogastroenterology can aid in the management of esophageal hypersensitivity, which can drive the symptom experience of a PPI nonresponder. Considerations for comorbid anxiety and depression in this population require careful assessment and treatment. Physicians are encouraged to create realistic expectations for symptom management and offer multidisciplinary options for treatment early in care. Patients will frequently benefit from working with a GI psychologist and find value in behavioral interventions.

Fixed-base flywheel storage systems for electric-utility applications: An assessment of economic viability and R and D priorities

NASA Astrophysics Data System (ADS)

Olszewski, M.; Steele, R. S.

1983-02-01

Electric utility side meter storage options were assessed for the daily 2 h peaking spike application. The storage options considered included compressed air, batteries, and flywheels. The potential role for flywheels in this application was assessed and research and development (R and D) priorities were established for fixed base flywheel systems. Results of the worth cost analysis indicate that where geologic conditions are favorable, compressed air energy storage (CAES) is a strong competitor against combustion turbines. Existing battery and flywheel systems rated about equal, both being, at best, marginally uncompetitive with turbines. Advanced batteries, if existing cost and performance goals are met, could be competitive with CAES. A three task R and D effort for flywheel development appears warranted. The first task, directed at reducing fabrication coss and increasing performance of a chopped fiber, F-glass, solid disk concept, could produce a competitive flywheel system.

Salvage prostatectomy in patients who have failed radiation therapy or cryotherapy as primary treatment for prostate cancer.

PubMed

Chen, Bert T; Wood, David P

2003-12-29

Asymptomatic prostate-specific antigen (PSA) recurrence after radiation therapy for prostate carcinoma poses a diagnostic and therapeutic dilemma for clinicians. Patients with locally recurrent disease can consider treatment options of salvage surgery, cryotherapy, watchful waiting, or androgen deprivation. Of these options, only salvage surgery has been shown to result in long-term disease-free survival for selected patients. However, salvage surgery is associated with significant morbidity, including urinary incontinence and rectal injuries. Ideally, salvage surgery outcomes can be optimized with careful patient selection according to clinical stage, serum PSA levels before radiation and surgery, the medical condition of the patient, and clear expectations of the physician and patient. Among patients with locally recurrent disease, those with localized prostate carcinoma amenable to radical prostatectomy before radiation or cryotherapy would be the most suitable candidates for salvage surgery.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kaufmann, John R.; Hand, James R.; Halverson, Mark A.

This report evaluates how and when to best integrate renewable energy requirements into building energy codes. The basic goals were to: (1) provide a rough guide of where we’re going and how to get there; (2) identify key issues that need to be considered, including a discussion of various options with pros and cons, to help inform code deliberations; and (3) to help foster alignment among energy code-development organizations. The authors researched current approaches nationally and internationally, conducted a survey of key stakeholders to solicit input on various approaches, and evaluated the key issues related to integration of renewable energymore » requirements and various options to address those issues. The report concludes with recommendations and a plan to engage stakeholders. This report does not evaluate whether the use of renewable energy should be required on buildings; that question involves a political decision that is beyond the scope of this report.« less

Modelling a hydropower plant with reservoir with the micropower optimisation model (HOMER)

NASA Astrophysics Data System (ADS)

Canales, Fausto A.; Beluco, Alexandre; Mendes, Carlos André B.

2017-08-01

Hydropower with water accumulation is an interesting option to consider in hybrid systems, because it helps dealing with the intermittence characteristics of renewable energy resources. The software HOMER (version Legacy) is extensively used in research works related to these systems, but it does not include a specific option for modelling hydro with reservoir. This paper describes a method for modelling a hydropower plant with reservoir with HOMER by adapting an existing procedure used for modelling pumped storage. An example with two scenarios in southern Brazil is presented for illustrating and validating the method explained in this paper. The results validate the method by showing a direct correspondence between an equivalent battery and the reservoir. The refill of the reservoir, its power output as a function of the flow rate and installed hydropower capacity are effectively simulated, indicating an adequate representation of a hydropower plant with reservoir is possible with HOMER.

More Is Not Always Better: Intuitions About Effective Public Policy Can Lead to Unintended Consequences

PubMed Central

Peters, Ellen; Klein, William; Kaufman, Annette; Meilleur, Louise; Dixon, Anna

2013-01-01

Public policy decisions often appear based on an assumption that providing more options, more information, and greater decision-making autonomy to consumers will produce better outcomes. We examine reasons why this “more-is-better” approach exists based on the psychological literature. Although better outcomes can result from informed consumer choice, we argue that more options, information, and autonomy can also lead to unintended negative consequences. We use mostly health-related policies and guidelines from the United States and elsewhere as exemplars. We consider various psychological mechanisms that cause these unintended consequences including cognitive overload, affect, and anticipated regret, information salience and availability, and trust in governments as authoritative information providers. We also point toward potential solutions based on psychological research that may reduce the negative unintended consequences of a “more-is-better” approach. PMID:24000291

Space Station Systems Analysis Study. Volume 2: Program options, book 1, parts 1 and 2

NASA Technical Reports Server (NTRS)

1977-01-01

Program options are defined and requirements are determined for integrating crew, mass, volume, and electrical power for a space construction base which incorporates the space shuttle external tanks. Orbits, stabilization, flight control hardware, as well as modules and aids for orbital assembly and servicing are considered. The effectiveness of various program options for life science and radio astronomy missions, for the solar terrestrial observatory, and for public service platforms is assessed. Technology development items are identified and costs are estimated.

SINGLE EVENT EFFECTS TEST FACILITY AT OAK RIDGE NATIONAL LABORATORY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Riemer, Bernie; Gallmeier, Franz X; Dominik, Laura J

2015-01-01

Increasing use of microelectronics of ever diminishing feature size in avionics systems has led to a growing Single Event Effects (SEE) susceptibility arising from the highly ionizing interactions of cosmic rays and solar particles. Single event effects caused by atmospheric radiation have been recognized in recent years as a design issue for avionics equipment and systems. To ensure a system meets all its safety and reliability requirements, SEE induced upsets and potential system failures need to be considered, including testing of the components and systems in a neutron beam. Testing of ICs and systems for use in radiation environments requiresmore » the utilization of highly advanced laboratory facilities that can run evaluations on microcircuits for the effects of radiation. This paper provides a background of the atmospheric radiation phenomenon and the resulting single event effects, including single event upset (SEU) and latch up conditions. A study investigating requirements for future single event effect irradiation test facilities and developing options at the Spallation Neutron Source (SNS) is summarized. The relatively new SNS with its 1.0 GeV proton beam, typical operation of 5000 h per year, expertise in spallation neutron sources, user program infrastructure, and decades of useful life ahead is well suited for hosting a world-class SEE test facility in North America. Emphasis was put on testing of large avionics systems while still providing tunable high flux irradiation conditions for component tests. Makers of ground-based systems would also be served well by these facilities. Three options are described; the most capable, flexible, and highest-test-capacity option is a new stand-alone target station using about one kW of proton beam power on a gas-cooled tungsten target, with dual test enclosures. Less expensive options are also described.« less

Clinical use of patient decision-making aids for stone patients.

PubMed

Lim, Amy H; Streeper, Necole M; Best, Sara L; Penniston, Kristina L; Nakada, Stephen Y

2017-08-01

Patient decision-making aids (PDMAs) help patients make informed healthcare decisions and improve patient satisfaction. The utility of PDMAs for patients considering treatments for urolithiasis has not yet been published. We report our experience using PDMAs developed at our institution in the outpatient clinical setting in patients considering a variety of treatment options for stones. Patients with radiographically confirmed urolithiasis were given PDMAs regarding treatment options for their stone(s) based on their clinical profile. We assessed patients' satisfaction, involvedness, and feeling of making a more informed decision with utilization of the PDMAs using a Likert Scale Questionnaire. Information was also collected regarding previous stone passage, history and type of surgical intervention for urolithiasis, and level of education. Patients (n = 43; 18 males, 23 females and two unknown) 53 +/- 14years old were included. Patients reported that they understood the advantages and disadvantages outlined in the PDMAs (97%), that the PDMAs helped them make a more informed decision (83%) and felt more involved in the decision making process (88%). Patients reported that the aids were presented in a balanced manner and used up-to-date scientific information (100%, 84% respectively). Finally, a majority of the patients prefer an expert's opinion when making a treatment decision (98%) with 73% of patients preferring to form their own opinion based on available information. Previous stone surgery was associated with patients feeling more involved with the decision making process (p = 0.0465). PDMAs have a promising role in shared decision-making in the setting of treatment options for nephrolithiasis.

Deep UV to NIR Space Telescopes and Exoplanet Coronagraphs: A Trade Study on Throughput, Polarization, Mirror Coating Options and Requirements

NASA Technical Reports Server (NTRS)

Balasubramanian, Kunjithapatham; Shaklan, Stuart; Give'on, Amir; Cady, Eric; Marchen, Luis

2011-01-01

The NASA Exoplanet program and the Cosmic Origins program are exploring technical options to combine the visible to NIR performance requirements of a space coronagraph with the general astrophysics requirements of a space telescope covering the deep UV spectrum. Are there compatible options in terms of mirror coatings and telescope architecture to satisfy both goals? In this paper, we address some of the main concerns, particularly relating to polarization in the visible and throughput in the UV. Telescope architectures employing different coating options compatible with current technology are considered in this trade study.

[Quadriceps tendon insufficiency and rupture : Treatment options in total knee arthroplasty].

PubMed

Thiele, K; von Roth, P; Pfitzner, T; Preininger, B; Perka, C

2016-05-01

Quadriceps tendon injuries and insufficiencies in total knee arthroplasty are rare, but are followed by a devastating complication that left untreated leads to a complete loss of function of the knee. This review article summarizes the functional anatomy, risk factors, and the prevalence and diagnosis of quadriceps tendon injuries, in addition to the possible management options for partial and complete ruptures. The treatment options are adapted according to the extent of the loss of function (partial, complete) and the duration of the injury (acute vs chronic). Furthermore, the choice of treatment should take into account the quality and availability of primary tissue, the patient's general health, along with their likely functional requirements. Conservative treatment is often justified in partial ruptures with good results. Complete ruptures require surgical intervention and multiple operative techniques are described. Treatment options for acute ruptures include direct primary repair with autogenous or synthetic tissue augmentation. In the case of chronic insufficiency and a lack of soft-tissue surroundings, reconstruction with the aid of a muscle flap or allograft tissue can be considered. All surgical intervention techniques used so far have been fraught with complications and rarely lead to satisfactory results. A new surgical approach to the reconstruction and augmentation of the extensor mechanism consists of the use of a synthetic mesh. The technique is described here in detail.

76 FR 38237 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-29

... Change To Include Text in Its Options Rules Governing the Use of Its Affiliate Broker-Dealer, Archipelago Securities LLC for Outbound Routing of Option Orders, and To Adopt Text in Its Options Rules To Permit the... include text in its options rules governing the use of its affiliate broker-dealer, Archipelago Securities...

An Alternative Option to Dedicated Braille Notetakers for People with Visual Impairments: Universal Technology for Better Access

ERIC Educational Resources Information Center

Hong, Sunggye

2012-01-01

Technology provides equal access to information and helps people with visual impairments to complete tasks more independently. Among various assistive technology options for people with visual impairments, braille notetakers have been considered the most significant because of their technological innovation. Braille notetakers allow users who are…

The wave-equivalent of the Black-Scholes option price: an interpretation

NASA Astrophysics Data System (ADS)

Haven, Emmanuel

2004-12-01

We propose an interpretation of the wave-equivalent of the Black-Scholes option price. We consider Nelson's version of the Brownian motion (Dynamical Theories of Brownian Motion, Princeton University Press, Princeton, NJ, 1967) and we use this specific motion as an input to produce a Black-Scholes PDE with a risk premium.

76 FR 8794 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-15

... (market-makers trading for their own account shall not be considered when determining customer interest... change from week-to-week. CBOE believes that these class pick changes have negatively impacted investors... investor recently requested another exchange to reinstate a Weekly option class that that exchange had...

Options for Vocabulary Learning Through Communication Tasks.

ERIC Educational Resources Information Center

Newton, Jonathan

2001-01-01

In a task-based approach to learning, learners will often meet new vocabulary "in passing" as they pursue communicative goals. Argues that such encounters can be turned to the learners' advantage and that rather than remove difficult words, teachers should consider a number of cooperative options for exposing learners to new words during…

Accelerated Learning Options: A Promising Strategy for States. Policy Insights

ERIC Educational Resources Information Center

Michelau, Demaree

2006-01-01

This issue of Policy Insights draws on findings from WICHE's report Accelerated Learning Options: Moving the Needle on Access and Success, to lay out some of the important policy issues that decision makers might consider when adopting new state policy related to accelerated learning or modifying policies already in existence. The publication…

Do School Boards Still Have Options? The Erosion of Management Authority.

ERIC Educational Resources Information Center

Lieberman, Myron

1997-01-01

School boards are woefully unprepared to deal with "make or buy" issues, due to massive union efforts to eliminate or restrict board freedom to contract for services. Teachers neither understand nor support a market economy. School boards' contracting out ability will not be secure until favorable legislative options are considered and…

A Diversity of Grammars: Breaking the Boundaries of "The Well Made Box."

ERIC Educational Resources Information Center

Sidler, Michelle

In his 1976 article, "Grammars of Style: New Options in Composition," Winston Weathers calls for a Grammar B, an alternate set of conventions which govern the construction of whole compositions. He urges compositionists to look beyond the "well-made box" and consider other options for compositional patterns and discourse…

White Flight from School Desegregation: Magnitude, Sources, and Policy Options. Final Report.

ERIC Educational Resources Information Center

Rossell, Christine H.; Hawley, Willis D.

Discussed in this report are the extent and causes of white flight from school desegregation and policy options for controlling it. After an introductory section, the report considers the extent of white flight from desegregating schools, taking into account the effects of suburbanization, interregional migration, and differentials in…

Enhanced Decision-Making: The Use of a Videotape Decision-Aid for Patients with Prostate Cancer.

ERIC Educational Resources Information Center

Schapira, Marilyn M.; Meade, Cathy; Nattinger, Ann B.

1997-01-01

The development of a videotape for patients considering treatment options for clinically localized prostate cancer is described. The effectiveness of videotape in improving short-term recall of treatment options and outcomes was assessed quantitatively; qualitative analysis was used to assess the likelihood of patient's active participation in the…

Wireless Power Transmission Options for Space Solar Power

NASA Technical Reports Server (NTRS)

Henley, Mark; Potter, Seth; Howell, Joseph; Mankins, John

2002-01-01

Space Solar Power (SSP), combined with Wireless Power Transmission (WPT), offers the far-term potential to solve major energy problems on Earth. In this paper two basic WPT options, using radio waves and light waves, are considered for both long-term and near-term SSP applications. In the long-term, we aspire to beam energy to Earth from geostationary Earth orbit (GEO), or even further distances in space. Accordingly, radio- and light- wave WPT options are compared through a wide range of criteria, each showing certain strengths. In the near-term, we plan to beam power over more moderate distances, but still stretch the limits of today's technology. For the near-term, a 100 kWe-class 'Power Plug' Satellite and a 10 kWe-class Lunar Polar Solar Power outpost are considered as the first steps in using these WPT options for SSP. By using SSP and WPT technology in near-term space science and exploration missions, we gain experience needed for sound decisions in designing and developing larger systems to send power from Space to Earth.

Wireless Power Transmission Options for Space Solar Power

NASA Technical Reports Server (NTRS)

Henley, Mark; Potter, Seth; Howell, Joseph; Mankins, John

2007-01-01

Space Solar Power (SSP), combined with Wireless Power Transmission (WPT), offers the far-term potential to solve major energy problems on Earth. In this presentation, two basic WPT options, using radio waves an d light waves, are considered for both long-term and near-term SSP applications. In the long-term, we aspire to beam energy to Earth from geostationary Earth orbit (GEO), or even further distances in space. Accordingly, radio- and light- wave WPT options are compared through a wide range of criteria, each showing certain strengths. In the near-term, we plan to beam power over more moderate distances, but still stretch the limits of today's technology. For the near-term, a 100 kWe-class "Power Plug" Satellite and a 10 kWe-class Lunar Polar Solar Power outpost are considered as the first steps in using these WPT options for SSP. By using SSP and WPT technology in nearterm space science and exploration missions, we gain experience needed for sound decisions in designing and developing larger systems to send power from Space to Earth.

Project coalitions in healthcare construction projects and the application of real options: an exploratory survey.

PubMed

van Reedt Dortland, Maartje; Dewulf, Geert; Voordijk, Hans

2013-01-01

Exploring the impact of the type of project coalition on types of flexibility by analyzing considered and exercised flexibilities in separated and integrated project coalitions in the design and construction phase and the operations and maintenance phase of a healthcare construction project. Flexibility in healthcare construction projects is increasingly needed in order to deal with growing uncertainties. Until now, little research has been carried out on how and to what extent flexibility is incorporated in different types of project coalitions chosen by healthcare organizations. An exploratory survey was conducted among health organizations in both cure and care. Questions were asked on the position of the real estate department within the organization, the type of project coalitions chosen and the rationale behind this choice, and the extent to which flexibility in terms of a real option was considered and to what extent it had been exercised in a project coalition. Integrated project coalitions pay more attention to flexibility in advance in both the process and the product, but exercise them to a lesser extent than separated project coalitions. The economic feasibility of real options is higher in integrated project coalitions. The study shows that real options thinking is already incorporated in real estate management of healthcare organizations, although more flexibility is considered in advance of the project than is actually realized during and after construction. Built environment, construction, decision making, hospitals, planning.

Flexibility in Flood Management Design: Proactive Planning Under Climate Change Uncertainty

NASA Astrophysics Data System (ADS)

Smet, K.; de Neufville, R.; van der Vlist, M.

2015-12-01

This paper presents an innovative, value-enhancing procedure for effective planning and design of long-lived flood management infrastructure given uncertain future flooding threats due to climate change. Designing infrastructure that can be adapted over time is a method to safeguard the efficacy of current design decisions given uncertainty about rates and future impacts of climate change. This paper explores the value of embedding "options" in a physical structure, where an option is the right but not the obligation to do something at a later date (e.g. over-dimensioning a floodwall foundation now facilitates a future height addition in response to observed increases in sea level; building of extra pump bays in a pumping station now enables the addition of pumping capacity whenever increased precipitation warrants an expansion.) The proposed procedure couples a simulation model that captures future climate induced changes to the hydrologic operating environment of a structure, with an economic model that estimates the lifetime economic performance of alternative investments. The economic model uses Real "In" Options analysis, a type of cash flow analysis that quantifies the implicit value of options and the flexibility they provide. This procedure is demonstrated using replacement planning for the multi-functional pumping station IJmuiden on the North Sea Canal in the Netherlands. Flexibility in design decisions is modelled, varying the size and specific options included in the new structure. Results indicate that the incorporation of options within the structural design has the potential to improve its economic performance, as compared to more traditional, "build it once and build it big" designs where flexibility is not an explicit design criterion. The added value resulting from the incorporation of flexibility varies with the range of future conditions considered, as well as the options examined. This procedure could be applied more broadly to explore investment strategies for the design of other flood management structures.

Flexibility in flood management design: proactive planning under uncertainty

NASA Astrophysics Data System (ADS)

Smet, K.; de Neufville, R.; van der Vlist, M.

2016-12-01

This paper presents a value-enhancing approach for proactive planning and design of long-lived flood management infrastructure given uncertain future flooding threats. Designing infrastructure that can be adapted over time is a method to safeguard the efficacy of current design decisions given future uncertainties. We explore the value of embedding "options" in a physical structure, where an option is the right but not the obligation to do something at a later date (e.g. over-dimensioning a floodwall foundation now facilitates a future height addition in response to observed increases in sea level; building extra pump bays in a drainage pumping station enables the easy addition of pumping capacity whenever increased precipitation warrants an expansion.) The proposed approach couples a simulation model that captures future climate induced changes to the hydrologic operating environment of a structure, with an economic model that estimates the lifetime economic performance of alternative investment strategies. The economic model uses Real "In" Options analysis, a type of cash flow analysis that quantifies the implicit value of options and the flexibility they provide. We demonstrate the approach using replacement planning for the multi-functional pumping station IJmuiden on the North Sea Canal in the Netherlands. The analysis models flexibility in design decisions, varying the size and specific options included in the new structure. Results indicate that the incorporation of options within the structural design has the potential to improve its economic performance, as compared to more traditional, "build it once and build it big" designs where flexibility is not an explicit design criterion. The added value resulting from the incorporation of flexibility varies with the range of future conditions considered, and the specific options examined. This approach could be applied to explore investment strategies for the design of other flood management structures, as well as be expanded to look more at flexibility within an infrastructure network rather than a single structure. Flexibility in flood management design:proactive planning under uncertainty

Neural substrates of decision-making.

PubMed

Broche-Pérez, Y; Herrera Jiménez, L F; Omar-Martínez, E

2016-06-01

Decision-making is the process of selecting a course of action from among 2 or more alternatives by considering the potential outcomes of selecting each option and estimating its consequences in the short, medium and long term. The prefrontal cortex (PFC) has traditionally been considered the key neural structure in decision-making process. However, new studies support the hypothesis that describes a complex neural network including both cortical and subcortical structures. The aim of this review is to summarise evidence on the anatomical structures underlying the decision-making process, considering new findings that support the existence of a complex neural network that gives rise to this complex neuropsychological process. Current evidence shows that the cortical structures involved in decision-making include the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and dorsolateral prefrontal cortex (DLPFC). This process is assisted by subcortical structures including the amygdala, thalamus, and cerebellum. Findings to date show that both cortical and subcortical brain regions contribute to the decision-making process. The neural basis of decision-making is a complex neural network of cortico-cortical and cortico-subcortical connections which includes subareas of the PFC, limbic structures, and the cerebellum. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Current maternal age recommendations for prenatal diagnosis: a reappraisal using the expected utility theory.

PubMed

Sicherman, N; Bombard, A T; Rappoport, P

1995-01-01

The expected utility theory suggests eliminating an age-specific criterion for recommending prenatal diagnosis to patients. We isolate the factors which patients and physicians need to consider intelligently in prenatal diagnosis, and show that the sole use of a threshold age as a screening device is inadequate. Such a threshold fails to consider adequately patients' attitudes regarding many of the possible outcomes of prenatal diagnosis; in particular, the birth of a chromosomally abnormal child and procedural-related miscarriages. It also precludes testing younger women and encourages testing in patients who do not necessarily require or desire it. All pregnant women should be informed about their prenatal diagnosis options, screening techniques, and diagnostic procedures, including their respective limitations, risks, and benefits.

New advances in ovarian autotransplantation to restore fertility in cancer patients

PubMed Central

2016-01-01

Human ovary autotransplantation is a promising option for fertility preservation of young women and girls undergoing gonadotoxic treatments for cancer or some autoimmune diseases. Although experimental, it resulted in at least 42 healthy babies worldwide. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was performed for all relevant full-text articles published in English from 1 January 2000 to 01 October 2015 in PubMed to explore the latest clinical and research advances of human ovary autotransplantation. Human ovary autotransplantation involves ovarian tissue extraction, freezing/thawing, and transplantation back into the same patient. Three major forms of human ovary autotransplantation exist including (a) transplantation of cortical ovarian tissue, (b) transplantation of whole ovary, and (c) transplantation of ovarian follicles (artificial ovary). According to the recent guidelines, human ovary autotransplantation is still considered experimental; however, it has unique advantages in comparison to other options of female fertility preservation. Human ovary autotransplantation (i) does not need prior ovarian stimulation, (ii) allows immediate initiation of cancer therapy, (iii) can restore both endocrine and reproductive ovarian functions, and (iv) may be the only fertility preservation option suitable for prepubertal girls or for young women with estrogen-sensitive malignancies. As any other fertility preservation option, human ovary autotransplantation has both advantages and disadvantages and may not be feasible for all cases. The major challenges facing this option are how to avoid the risk of reintroducing malignant cells and how to prolong the lifespan of ovarian transplant as well as how to improve artificial ovary results. PMID:26589603

New advances in ovarian autotransplantation to restore fertility in cancer patients.

PubMed

Salama, Mahmoud; Woodruff, Teresa K

2015-12-01

Human ovary autotransplantation is a promising option for fertility preservation of young women and girls undergoing gonadotoxic treatments for cancer or some autoimmune diseases. Although experimental, it resulted in at least 42 healthy babies worldwide. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was performed for all relevant full-text articles published in English from 1 January 2000 to 01 October 2015 in PubMed to explore the latest clinical and research advances of human ovary autotransplantation. Human ovary autotransplantation involves ovarian tissue extraction, freezing/thawing, and transplantation back into the same patient. Three major forms of human ovary autotransplantation exist including (a) transplantation of cortical ovarian tissue, (b) transplantation of whole ovary, and (c) transplantation of ovarian follicles (artificial ovary). According to the recent guidelines, human ovary autotransplantation is still considered experimental; however, it has unique advantages in comparison to other options of female fertility preservation. Human ovary autotransplantation (i) does not need prior ovarian stimulation, (ii) allows immediate initiation of cancer therapy, (iii) can restore both endocrine and reproductive ovarian functions, and (iv) may be the only fertility preservation option suitable for prepubertal girls or for young women with estrogen-sensitive malignancies. As any other fertility preservation option, human ovary autotransplantation has both advantages and disadvantages and may not be feasible for all cases. The major challenges facing this option are how to avoid the risk of reintroducing malignant cells and how to prolong the lifespan of ovarian transplant as well as how to improve artificial ovary results.

The role of integrated scientific approach facing the changing ocean policy. The case of the Mediterranean

NASA Astrophysics Data System (ADS)

Vallega, Adalberto

1999-08-01

In the mid-1980s the debate about the role of oceanography vis-à-vis the evolving demand for ocean research was initiated in the framework of the Intergovernmental Oceanographic Commission (IOC) of UNESCO. That discussion was basically triggered by the need to meet the demand for research generated by the United Nations Conference on the Human Environment (1972). More recently, also as a consequence of the inputs from the United Nations Conference on Environment and Development (UNCED, 1992), the discussion of the role of oceanography in the framework of the co-operation between physical and social disciplines was initiated focusing on the prospect of building up the ocean science. The prospect of the ocean science as designed by IOC (1984) was finalised only to integrate the branches of oceanography. To discuss how that design could be implemented on the basis of progress in epistemology and ocean policy, the subject is focused on considering three levels: i) the epistemological level, where the option between positivism- and constructivism- based epistemologies has arisen; ii) the logical level, where the option is concerned with disjunctive and conjunctive logic; and iii) the methodological level, where the option regards the analytical-deductive and the inductive-axiomatic methods. The thesis is sustained that, to meet the demand for management-oriented research, the pathway including constructivist epistemology, conjunctive logic and inductive-axiomatic methods could be usefully adopted as the cement of inter-disciplinarity. The second part of the paper is concerned with the Mediterranean, and how holism-referred and management-aimed investigations might be conducted by applying the above conceptual approach is considered: i) presenting the individual emerging subject areas on which the demand for management patterns is expected to focus in the mid- and long-run; ii) illustrating the major aspects of the individual subject areas to be investigated; iii) deducing what leading role might be assigned to oceanography in building up inter-disciplinary approaches; iv) which disciplines might be stimulated to co-operate. The subject areas considered with reference to the Mediterranean include: i) integrated coastal management; ii) the deep-ocean coastal uses with special consideration of living resources management; iii) the protection of biodiversity. Ocean Geographical Information Systems (OGIS), data management, and education and training are presented as intersecting research areas calling for inter-disciplinary approaches. As a conclusion, a breakdown of questions on which discussion might be concentrated is considered.

Investigation of lunar base thermal control system options

NASA Technical Reports Server (NTRS)

Ewart, Michael K.

1993-01-01

Long duration human exploration missions to the Moon will require active thermal control systems which have not previously been used in space. The two technologies which are most promising for long term lunar base thermal control are heat pumps and radiator shades. Recent trade-off studies at the Johnson Space Center have focused development efforts on the most promising heat pump and radiator shade technologies. Since these technologies are in the early stages of development and many parameters used in the study are not well defined, a parametric study was done to test the sensitivity to each assumption. The primary comparison factor in these studies was the total mass system, with power requirements included in the form of a mass penalty for power. Heat pump technologies considered were thermally driven heat pumps such as metal hydride, complex compound, absorption and zeolite. Also considered were electrically driven Stirling and vapor compression heat pumps. Radiator shade concepts considered included step shaped, V-shaped and parabolic (or catenary) shades and ground covers. A further trade study compared the masses of heat pump and radiator shade systems.

What types of investors generate the two-phase phenomenon?

NASA Astrophysics Data System (ADS)

Ryu, Doojin

2013-12-01

We examine the two-phase phenomenon described by Plerou, Gopikrishnan, and Stanley (2003) [1] in the KOSPI 200 options market, one of the most liquid options markets in the world. By analysing a unique intraday dataset that contains information about investor type for each trade and quote, we find that the two-phase phenomenon is generated primarily by domestic individual investors, who are generally considered to be uninformed and noisy traders. In contrast, our empirical results indicate that trades by foreign institutions, who are generally considered informed and sophisticated investors, do not exhibit two-phase behaviour.

Redistributive effects in public health care financing.

PubMed

Honekamp, Ivonne; Possenriede, Daniel

2008-11-01

This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.

Proceedings of the conference on coastal erosion and wetland modification in Louisiana: causes, consequences, and options

USGS Publications Warehouse

Boesch, Donald F.

1982-01-01

This volume contains 16 papers and panel discussions from a conference held in Baton Rouge, La., 5-6 October 1981. The presentations consider the causes and consequences of coastal erosion and wetland modification in Louisiana and the mitigative options available to slow or reverse the rapid rate of coastal land loss. Detailed habitat mapping studies have allowed accurate estimates of coastal habitat change and land loss through 1978. Projections from these rates of change indicate an annual rate of land loss in coastal Louisiana in the early 1980's of approximately 130 km2/yr (50 m2/yr).The projected effects of wetland modification on the bountiful living resources of coastal Louisiana (fisheries, fur and hide bearers and waterfowl) are major because of the close dependence of these resources on estuarine wetlands. These changes and others related to flood protection, transportation and ownership of mineral resources are projected to have extensive social and economic consequences.Options proposed to slow coastal land loss include major and minor diversion of the Mississippi River, barrier island and shoreline restoration protection, hydrological management of wetlands and more restrictive permitting of dredging activities.

Reform by subtraction: the path of denunciation of international drug treaties and reaccession with reservations.

PubMed

Room, Robin

2012-09-01

Almost all countries are parties to the international drug conventions of 1961, 1971 and 1988. These strongly bind parties with respect to their domestic regulation of controlled substances, including requirements that possession, growing or use be a criminal offense and that any regulated market in the substances be limited to use only for medical or scientific purposes. Even where countries have argued they have "wiggle room", reform within the bounds of the conventions has often resulted in "net-widening" which nullifies the intent of the reform. Among the options for effective reform, probably the most immediately viable is the route of denunciation and reaccession with reservations--the route which Bolivia has now taken in order to legalise a regulated domestic market in coca leaves for chewing. The paper considers the existing record of reservations (by more than 30 parties to each of the conventions). Also discussed are the options for response to the reservations by other parties, which vary between the treaties, and how pursuing the option of denunciation and reaccession with reservation might potentially play out. Copyright © 2012 Elsevier B.V. All rights reserved.

A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology.

PubMed

Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T

2017-06-01

Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.

Editorial Commentary: Graft Removal Versus Retention for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Accounting for Patient Preference Flips the Script on Current Practice.

PubMed

Cote, Mark P

2018-03-01

Septic arthritis is a rare but potentially devastating complication after anterior cruciate ligament (ACL) reconstruction. Studies examining surgical treatment options including graft retention and removal are largely inconclusive. Although the literature indicated that 43.8% of patients who have the graft removed later go on to have a revision ACL reconstruction compared with only 6.5% among those whose graft is retained, this expected-value decision analysis found removal to be the optimal treatment for patients with septic arthritis after ACL reconstruction. This is largely based on patient preference to avoid a late reoperation for residual knee infection. These findings support the concept of utility when considering treatment options for patients with a septic knee. For some, avoiding a late reoperation for a persistent infection is the most important factor and as such graft removal may be the most appropriate treatment to produce a positive outcome among these patients despite the fact that currently, an attempt at graft retention could represent the generally preferred treatment option among practicing surgeons. Copyright © 2017. Published by Elsevier Inc.

Evidence-Based Recommendations for Fertility Preservation Options for Inclusion in Treatment Protocols for Pediatric and Adolescent Patients Diagnosed With Cancer.

PubMed

Fernbach, Alison; Lockart, Barbara; Armus, Cheryl L; Bashore, Lisa M; Levine, Jennifer; Kroon, Leah; Sylvain, Genevieve; Rodgers, Cheryl

2014-07-01

As survival rates improve for pediatric cancers, increased attention has been paid to late effects of cancer therapy, in particular, infertility. Fertility preservation options are available for pre- and postpubertal cancer patients; however, many providers lack knowledge regarding options. The aim of this article is to provide a comprehensive synthesis of current evidence and recommendations regarding fertility preservation options for children, adolescents, and young adults undergoing cancer treatment. A systematic search was performed to identify fertility preservation evidence. Fifty-three studies and 4 clinical guidelines were used for the review. Final recommendations consisted of 2 strong and 1 weak recommendation for both female and male fertility preservation options. The treatment team should be knowledgeable about fertility preservation so that they can educate patients and families about available fertility preservation options. It is important to consider and discuss all available fertility options with patients at the time of diagnosis. © 2014 by Association of Pediatric Hematology/Oncology Nurses.

Numerical pricing of options using high-order compact finite difference schemes

NASA Astrophysics Data System (ADS)

Tangman, D. Y.; Gopaul, A.; Bhuruth, M.

2008-09-01

We consider high-order compact (HOC) schemes for quasilinear parabolic partial differential equations to discretise the Black-Scholes PDE for the numerical pricing of European and American options. We show that for the heat equation with smooth initial conditions, the HOC schemes attain clear fourth-order convergence but fail if non-smooth payoff conditions are used. To restore the fourth-order convergence, we use a grid stretching that concentrates grid nodes at the strike price for European options. For an American option, an efficient procedure is also described to compute the option price, Greeks and the optimal exercise curve. Comparisons with a fourth-order non-compact scheme are also done. However, fourth-order convergence is not experienced with this strategy. To improve the convergence rate for American options, we discuss the use of a front-fixing transformation with the HOC scheme. We also show that the HOC scheme with grid stretching along the asset price dimension gives accurate numerical solutions for European options under stochastic volatility.

The europa initiative for esa's cosmic vision: a potential european contribution to nasa's Europa mission

NASA Astrophysics Data System (ADS)

Blanc, Michel; Jones, Geraint H.; Prieto-Ballesteros, Olga; Sterken, Veerle J.

2016-04-01

The assessment of the habitability of Jupiter's icy moons is considered of high priority in the roadmaps of the main space agencies, including the decadal survey and esa's cosmic vision plan. the voyager and galileo missions indicated that europa and ganymede may meet the requirements of habitability, including deep liquid aqueous reservoirs in their interiors. indeed, they constitute different end-terms of ocean worlds, which deserve further characterization in the next decade. esa and nasa are now both planning to explore these ice moons through exciting and ambitious missions. esa selected in 2012 the juice mission mainly focused on ganymede and the jupiter system, while nasa is currently studying and implementing the europa mission. in 2015, nasa invited esa to provide a junior spacecraft to be carried on board its europa mission, opening a collaboration scheme similar to the very successful cassini-huygens approach. in order to define the best contribution that can be made to nasa's europa mission, a europa initiative has emerged in europe. its objective is to elaborate a community-based strategy for the proposition of the best possible esa contribution(s) to nasa's europa mission, as a candidate for the upcoming selection of esa's 5th medium-class mission . the science returns of the different potential contributions are analysed by six international working groups covering complementary science themes: a) magnetospheric interactions; b) exosphere, including neutrals, dust and plumes; c) geochemistry; d) geology, including expressions of exchanges between layers; e) geophysics, including characterization of liquid water distribution; f) astrobiology. each group is considering different spacecraft options in the contexts of their main scientific merits and limitations, their technical feasibility, and of their interest for the development of esa-nasa collaborations. there are five options under consideration: (1) an augmented payload to the europa mission main spacecraft itself. (2) a free-flyer released from the main craft and staying on a jupiter orbit. (3) a small autonomous satellite injected into europan orbit. (4) a penetrator of europa's surface (including instrumentation on the descent module). (5) contributions to a soft lander, if developed by nasa in an increased europa mission scenario. in this talk we will report on the conclusions of the crossed analysis between science themes and spacecraft options performed during a dedicated project workshop held in madrid on feb. 29 and march 1st, which will be the scientific and technical base for any relevant europa-related response to the upcoming esa call.

The Assumption of a Reliable Instrument and Other Pitfalls to Avoid When Considering the Reliability of Data

PubMed Central

Nimon, Kim; Zientek, Linda Reichwein; Henson, Robin K.

2012-01-01

The purpose of this article is to help researchers avoid common pitfalls associated with reliability including incorrectly assuming that (a) measurement error always attenuates observed score correlations, (b) different sources of measurement error originate from the same source, and (c) reliability is a function of instrumentation. To accomplish our purpose, we first describe what reliability is and why researchers should care about it with focus on its impact on effect sizes. Second, we review how reliability is assessed with comment on the consequences of cumulative measurement error. Third, we consider how researchers can use reliability generalization as a prescriptive method when designing their research studies to form hypotheses about whether or not reliability estimates will be acceptable given their sample and testing conditions. Finally, we discuss options that researchers may consider when faced with analyzing unreliable data. PMID:22518107

Space radiator simulation manual for computer code

NASA Technical Reports Server (NTRS)

Black, W. Z.; Wulff, W.

1972-01-01

A computer program that simulates the performance of a space radiator is presented. The program basically consists of a rigorous analysis which analyzes a symmetrical fin panel and an approximate analysis that predicts system characteristics for cases of non-symmetrical operation. The rigorous analysis accounts for both transient and steady state performance including aerodynamic and radiant heating of the radiator system. The approximate analysis considers only steady state operation with no aerodynamic heating. A description of the radiator system and instructions to the user for program operation is included. The input required for the execution of all program options is described. Several examples of program output are contained in this section. Sample output includes the radiator performance during ascent, reentry and orbit.

[Genetic obesity: new diagnostic options].

PubMed

de Vries, T I; Alsters, S I M; Kleinendorst, L; van Haaften, G; van der Zwaag, B; Van Haelst, M M

2017-01-01

- Obesity is an important risk factor for morbidity and premature death, as well as a contributing factor to psychosocial problems. The incidence of obesity has increased dramatically over the last few decades.- Obesity is considered to be a multifactorial condition in which both environmental factors and genetic factors play a part.- In approximately 5% of patients with morbid obesity, a monogenic cause can be identified. Mutations in the MC4R gene are the most frequently occurring monogenic cause of obesity.- The department of Genetics at the VU University Medical Center Amsterdam offers morbidly obese patients a diagnostic analysis of 50 obesity-associated genes. - An underlying obesity-associated genetic defect can influence patient response to certain treatments. Therefore, if the gene defect is known, it can be taken into account when considering treatment options.- The understanding of the genetics of obesity will significantly contribute to research into the development of personalized treatment options.

National Offshore Wind Energy Grid Interconnection Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Daniel, John P.; Liu, Shu; Ibanez, Eduardo

2014-07-30

The National Offshore Wind Energy Grid Interconnection Study (NOWEGIS) considers the availability and potential impacts of interconnecting large amounts of offshore wind energy into the transmission system of the lower 48 contiguous United States. A total of 54GW of offshore wind was assumed to be the target for the analyses conducted. A variety of issues are considered including: the anticipated staging of offshore wind; the offshore wind resource availability; offshore wind energy power production profiles; offshore wind variability; present and potential technologies for collection and delivery of offshore wind energy to the onshore grid; potential impacts to existing utility systemsmore » most likely to receive large amounts of offshore wind; and regulatory influences on offshore wind development. The technologies considered the reliability of various high-voltage ac (HVAC) and high-voltage dc (HVDC) technology options and configurations. The utility system impacts of GW-scale integration of offshore wind are considered from an operational steady-state perspective and from a regional and national production cost perspective.« less

Preventing recurrence of endometriosis by means of long-acting progestogen therapy (PRE-EMPT): report of an internal pilot, multi-arm, randomised controlled trial incorporating flexible entry design and adaption of design based on feasibility of recruitment.

PubMed

Middleton, Lee J; Daniels, Jane P; Weckesser, Annalise; Bhattacharya, Siladitya

2017-03-11

Endometriosis is associated with the growth of endometrium in ectopic sites mainly within the pelvis. This results in inflammation and scarring, causing pain and impaired quality of life. Endometriotic lesions can be excised or ablated surgically, but the risk of recurrence is high. A Heath Technology Assessment commissioning call in 2011 sought applications for trials aimed at evaluating long-term effectiveness of postoperative, long-acting, reversible contraceptives (LARCs) in preventing recurrence of endometriosis. A survey of gynaecologists indicated that there was no consensus about which LARC (Levonorgestrel Intrauterine System (LNG-IUS) or depot medroxyprogesterone acetate injection (DMPA)) or comparator (combined oral contraceptive pill (COCP) or no treatment) should be evaluated. Hence, we designed a 'flexible-entry' internal pilot to assess whether a four-arm trial was feasible including a possible design adaption based on pilot findings. In this pilot, women could be randomised to two, three or four treatment options provided that one was a LARC and one was a non-LARC. An assessment of feasibility based on recruitment to these options and a revised substantive trial design was considered by an independent oversight committee. The study ran for 1 year from April 2014 and 77 women were randomised. Only 5 (6%) women accepted randomisation to all groups, with 63 (82%) having a LARC preference and 55 (71%) a non-LARC preference. Four-way and three-way designs were ruled out with a two-way LARC versus COCP design, stratified by prerandomisation choice of LARC and optional subrandomisation to LNG-IUS versus DMPA considered a feasible substantive study. Multi-arm studies are potentially efficient as they can answer multiple questions simultaneously but are difficult to recruit to if there are strong patient or clinician preferences. A flexible approach to randomisation in a pilot phase can be used to assess feasibility of such studies and modify a trial design based on chosen recruitment options, but trialists should consider carefully any practical arrangements should groups need to be dropped during a study. International Standard Randomised Controlled Trial Number, ISRCTN97865475 . Registered on 20 March 2014.

Exploring Options in Early Childhood Care in Singapore: Programs and Roles

ERIC Educational Resources Information Center

Zhang, Kaili C.

2016-01-01

Early childhood care options and practices differ around the world, as influenced by societal perspectives and needs. As early educators and policymakers around the world work to improve education and care services to better serve young children and their families, we must consider context-specific values and standards of quality to ensure early…

77 FR 28455 - National Standards for Traffic Control Devices; the Manual on Uniform Traffic Control Devices for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-14

... Options for design and applications of traffic control devices, this Manual should not be considered a... application of traffic control devices, as well as in the location and design of roads and streets that the..., while this Manual provides Standards, Guidance, and Options for design and applications of traffic...

Deciding How to Stay Independent at Home in Later Years: Development and Acceptability Testing of an Informative Web-Based Module

PubMed Central

Garvelink, Mirjam Marjolein; Jones, C Allyson; Archambault, Patrick M; Roy, Noémie; Blair, Louisa

2017-01-01

Background Seniors with loss of autonomy may face decisions about whether they should stay at home or move elsewhere. Most seniors would prefer to stay home and be independent for as long as possible, but most are unaware of options that would make this possible. Objective The study aimed to develop and test the acceptability of an interactive website for seniors, their caregivers, and health professionals with short interlinked videos presenting information about options for staying independent at home. Methods The approach for design and data collection varied, involving a multipronged, user-centered design of the development process, qualitative interviews, and end-user feedback to determine content (ie, needs assessment) in phase I; module development (in English and French) in phase II; and survey to test usability and acceptability with end users in phase III. Phase I participants were a convenience sample of end users, that is, seniors, caregivers, and professionals with expertise in modifiable factors (eg, day centers, home redesign, equipment, community activities, and finances), enabling seniors to stay independent at home for longer in Quebec and Alberta, Canada. Phase II participants were bilingual actors; phase III participants included phase I participants and new participants recruited through snowballing. Qualitative interviews were thematically analyzed in phase II to determine relevant topics for the video-scripts, which were user-checked by interview participants. In phase III, the results of a usability questionnaire were analyzed using descriptive statistics. Results In phase I, interviews with 29 stakeholders, including 4 seniors, 3 caregivers, and 22 professionals, showed a need for a one-stop information resource about options for staying independent at home. They raised issues relating to 6 categories: cognitive autonomy, psychological or mental well-being, functional autonomy, social autonomy, financial autonomy, and people involved. A script was developed and evaluated by participants. In phase II, after 4 days in a studio with 15 bilingual actors, 30 videos were made of various experts (eg, family doctor, home care nurse, and social worker) presenting options and guidance for the decision-making process. These were integrated into an interactive website, which included a comments tool for visitors to add information. In phase III (n=21), 8 seniors (7 women, mean age 75 years), 7 caregivers, and 6 professionals evaluated the acceptability of the module and suggested improvements. Clarity of the videos scored 3.6 out of 4, length was considered right by 17 (separate videos) and 13 participants (all videos together), and 18 participants considered the module acceptable. They suggested that information should be tailored more, and that seniors may need someone to help navigate it. Conclusions Our interactive website with interlinked videos presenting information about options for staying independent at home was deemed acceptable and potentially helpful by a diverse group of stakeholders. PMID:29242178

Affordable Development and Demonstration of a Small Nuclear Thermal Rocket (NTR) Engine and Stage: How Small Is Big Enough?

NASA Technical Reports Server (NTRS)

Borowski, Stanley K.; Sefcik, Robert J.; Fittje, James E.; McCurdy, David R.; Qualls, Arthur L.; Schnitzler, Bruce G.; Werner, James E.; Weitzberg, Abraham; Joyner, Claude R.

2016-01-01

The Nuclear Thermal Rocket (NTR) derives its energy from fission of uranium-235 atoms contained within fuel elements that comprise the engine's reactor core. It generates high thrust and has a specific impulse potential of approximately 900 specific impulse - a 100 percent increase over today's best chemical rockets. The Nuclear Thermal Propulsion (NTP) project, funded by NASA's Advanced Exploration Systems (AES) program, includes five key task activities: (1) Recapture, demonstration, and validation of heritage graphite composite (GC) fuel (selected as the Lead Fuel option); (2) Engine Conceptual Design; (3) Operating Requirements Definition; (4) Identification of Affordable Options for Ground Testing; and (5) Formulation of an Affordable Development Strategy. During fiscal year (FY) 2014, a preliminary Design Development Test and Evaluation (DDT&E) plan and schedule for NTP development was outlined by the NASA Glenn Research Center (GRC), Department of Energy (DOE) and industry that involved significant system-level demonstration projects that included Ground Technology Demonstration (GTD) tests at the Nevada National Security Site (NNSS), followed by a Flight Technology Demonstration (FTD) mission. To reduce cost for the GTD tests and FTD mission, small NTR engines, in either the 7.5 or 16.5 kilopound-force thrust class, were considered. Both engine options used GC fuel and a common fuel element (FE) design. The small approximately 7.5 kilopound-force criticality-limited engine produces approximately157 thermal megawatts and its core is configured with parallel rows of hexagonal-shaped FEs and tie tubes (TTs) with a FE to TT ratio of approximately 1:1. The larger approximately 16.5 kilopound-force Small Nuclear Rocket Engine (SNRE), developed by Los Alamos National Laboratory (LANL) at the end of the Rover program, produces approximately 367 thermal megawatts and has a FE to TT ratio of approximately 2:1. Although both engines use a common 35-inch (approximately 89-centimeters) -long FE, the SNRE's larger diameter core contains approximately 300 more FEs needed to produce an additional 210 thermal megawatts of power. To reduce the cost of the FTD mission, a simple one-burn lunar flyby mission was considered to reduce the liquid hydrogen (LH2) propellant loading, the stage size and complexity. Use of existing and flight proven liquid rocket and stage hardware (e.g., from the RL10B-2 engine and Delta Cryogenic Second Stage) was also maximized to further aid affordability. This paper examines the pros and cons of using these two small engine options, including their potential to support future human exploration missions to the Moon, near Earth asteroids (NEA), and Mars, and recommends a preferred size. It also provides a preliminary assessment of the key activities, development options, and schedule required to affordably build, ground test and fly a small NTR engine and stage within a 10-year timeframe.

Patients' views on the use of an Option Grid for knee osteoarthritis in physiotherapy clinical encounters: An interview study.

PubMed

Kinsey, Katharine; Firth, Jill; Elwyn, Glyn; Edwards, Adrian; Brain, Katherine; Marrin, Katy; Nye, Alan; Wood, Fiona

2017-12-01

Patient decision support tools have been developed as a means of providing accurate and accessible information in order for patients to make informed decisions about their care. Option Grids ™ are a type of decision support tool specifically designed to be used during clinical encounters. To explore patients' views of the Option Grid encounter tool used in clinical consultations with physiotherapists, in comparison with usual care, within a patient population who are likely to be disadvantaged by age and low health literacy. Semi-structured interviews with 72 patients (36 who had been given an Option Grid in their consultation and 36 who had not). Thematic analysis explored patients' understanding of treatment options, perceptions of involvement, and readability and utility of the Option Grid. Interviews suggested that the Option Grid facilitated more detailed discussion about the risks and benefits of a wider range of treatment options for osteoarthritis of the knee. Participants indicated that the Option Grid was clear and aided their understanding of a structured progression of the options as their condition advanced, although it was not clear whether the Option Grid facilitated greater engagement in shared decision making. The Option Grid for osteoarthritis of the knee was well received by patient participants who reported that it helped them to understand their options, and made the notion of choice explicit. Use of Option Grids should be considered within routine consultations. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Prevention of mother-to-child transmission of HIV: Postpartum adherence to Option B+ until 18 months in Western Uganda.

PubMed

Decker, Sarah; Rempis, Eva; Schnack, Alexandra; Braun, Vera; Rubaihayo, John; Busingye, Priscilla; Tumwesigye, Nazarius Mbona; Harms, Gundel; Theuring, Stefanie

2017-01-01

Since 2012, the WHO recommends Option B+ for the prevention of mother-to-child transmission of HIV. This approach entails the initiation of lifelong antiretroviral therapy in all HIV-positive pregnant women, also implying protection during breastfeeding for 12 months or longer. Research on long-term adherence to Option B+ throughout breastfeeding is scarce to date. Therefore, we conducted a prospective observational cohort study in Fort Portal, Western Uganda, to assess adherence to Option B+ until 18 months postpartum. In 2013, we recruited 67 HIV-positive, Option B+ enrolled women six weeks after giving birth and scheduled them for follow-up study visits after six, twelve and 18 months. Two adherence measures, self-reported drug intake and amount of drug refill visits, were combined to define adherence, and were assessed together with feeding information at all study visits. At six months postpartum, 51% of the enrolled women were considered to be adherent. Until twelve and 18 months postpartum, adherence for the respective follow-up interval decreased to 19% and 20.5% respectively. No woman was completely adherent until 18 months. At the same time, 76.5% of the women breastfed for ≥12 months. Drug adherence was associated with younger age (p<0.01), lower travel costs (p = 0.02), and lower number of previous deliveries (p = 0.04). Long-term adherence to Option B+ seems to be challenging. Considering that in our cohort, prolonged breastfeeding until ≥12 months was widely applied while postpartum adherence until the end of breastfeeding was poor, a potential risk of postpartum vertical transmission needs to be taken seriously into account for Option B+ implementation.

Wireless Power Transmission Options for Space Solar Power

NASA Technical Reports Server (NTRS)

Henley, M. W.; Potter, Seth D.; Howell, J.; Mankins, J. C.; Fikes, John C. (Technical Monitor)

2002-01-01

Space Solar Power (SSP). combined with Wireless Power Transmission (WPT), offers the far-term potential to solve major energy problems on Earth. In this paper WPT options using radio waves and light waves are considered for both long-term and near-term SSP applications. In the long-term, we aspire to beam energy to Earth from geostationary Earth orbit (GEO), or even from the moon. Accordingly, radio- and light- wave WPT options are compared through a wide range of criteria, each showing certain strengths. In the near-term. we plan to beam power over more moderate distances, but still stretch the limits of today's technology. For the near-term, a 100 kWe-class 'Power Plug' Satellite and a 10 kWe-class Lunar Polar Solar Power outpost are considered as the first steps in using these WPT options for SSP. By using SSP and WPT technology in near-term space science and exploration missions, we gain experience needed for sound decisions in designing and developing larger systems to send power from Space to Earth. Power Relay Satellites are also considered as a potential near- to mid-term means to transmit power from Earth to Space and back to distant receiving sites on Earth. This paper briefly considers microwave and laser beaming for an initial Power Relay Satellite system, and concludes that anticipated advancements in laser technology make laser-based concepts more attractive than microwave-based concepts. Social and economic considerations are briefly discussed, and a conceptual description for a laser-based system is offered for illustrative purposes. Continuing technological advances are needed if laser-based systems are to become practical and efficient or near- and far-term applications.

Spacecraft attitude control for a solar electric geosynchronous transfer mission

NASA Technical Reports Server (NTRS)

Leroy, B. E.; Regetz, J. D., Jr.

1975-01-01

A study of the Attitude Control System (ACS) is made for a solar electric propulsion geosynchronous transfer mission. The basic mission considered is spacecraft injection into a low altitude, inclined orbit followed by low thrust orbit changing to achieve geosynchronous orbit. Because of the extended thrusting time, the mission performance is a strong function of the attitude control system. Two attitude control system design options for an example mission evolve from consideration of the spacecraft configuration, the environmental disturbances, and the probable ACS modes of operation. The impact of these design options on other spacecraft subsystems is discussed. The factors which must be considered in determining the ACS actuation and sensing subsystems are discussed. The effects of the actuation and sensing subsystems on the mission performance are also considered.

Childcare Programs Benefit Employers, Too.

ERIC Educational Resources Information Center

Petersen, Donald J.; Massengill, Douglas

1988-01-01

The person selecting a childcare program should consider how various plans would benefit employers as well as employees. The needs of the employees and the company must be considered and the options, benefits, and drawbacks of programs must be studied. (JOW)

Laparoscopic Heller Myotomy for Achalasia Technical Aspects.

PubMed

Schlottmann, Francisco; Allaix, Marco E; Patti, Marco G

2018-04-01

Esophageal achalasia is a primary esophageal motility disorder defined by the lack of esophageal peristalsis, and by a lower esophageal sphincter that fails to relax in response to swallowing. Patients' symptoms include dysphagia, regurgitation, aspiration, heartburn, and chest pain. Achalasia is a chronic condition without cure, and treatment options are aimed at providing symptomatic relief, improving esophageal emptying, and preventing the development of megaesophagus. Presently, a laparoscopic Heller myotomy with a partial fundoplication is considered the best treatment modality. A properly executed operation is key for the success of a laparoscopic Heller myotomy.

Courtyards Should Be Green Today

NASA Astrophysics Data System (ADS)

Dorozhkina, E.

2017-11-01

The article raises domestic space organization issues. Courtyards are considered as available recreational space in the structure of urban development affected by the environmental, spatial, physical and technical aspects of yard space. Special attention is paid to the improvement of the quality of the living environment. Phytoecological environment is seen as a way to improve the qualitative characteristics of residential development. The options proposed for modern residential development include indoor type courtyards. In the described embodiment the construction of the environment anthropogenic characteristics are decreased in comparison with the traditional type of buildings.

Reducing the cost of headache medication.

PubMed

Solomon, Glen D

2009-06-01

Although medication costs make up one of the smallest portions of the overall expense of headache care, it is the segment of expense that often impacts the patient most directly. The advent of triptans marked a major advance in migraine therapy, but their high cost has limited their widespread use. Four options can be considered as potential means to reduce the cost of triptans. These include compulsory licensing, exclusive contracting, over-the-counter -availability, and the introduction of generic triptans. Each method impacts the consumer, third-party payer, or pharmaceutical company in a different manner.

Small-Maturity Asymptotics for the At-The-Money Implied Volatility Slope in Lévy Models

PubMed Central

Gerhold, Stefan; Gülüm, I. Cetin; Pinter, Arpad

2016-01-01

ABSTRACT We consider the at-the-money (ATM) strike derivative of implied volatility as the maturity tends to zero. Our main results quantify the behaviour of the slope for infinite activity exponential Lévy models including a Brownian component. As auxiliary results, we obtain asymptotic expansions of short maturity ATM digital call options, using Mellin transform asymptotics. Finally, we discuss when the ATM slope is consistent with the steepness of the smile wings, as given by Lee’s moment formula. PMID:27660537

Security in the Middle East

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wells, S.F. Jr.; Bruzonsky, M.A.

1986-01-01

The full range of U.S. security interests in the Middle East is covered in this volume of original contributions from prominent international scholars. Case studies of key countries emphasize the prospects for peaceful political, economic, and cultural change in the region. The Arab-Israeli conflict is examined with particular attention to the ''Palestine problem,'' U.S. policy and diplomacy, and the peace process. Finally, the involvement of the U.S. and the USSR and the policy options open to them are considered. Includes chapters on oil and its role in Middle-East security issues.

The Pricing of European Options Under the Constant Elasticity of Variance with Stochastic Volatility

NASA Astrophysics Data System (ADS)

Bock, Bounghun; Choi, Sun-Yong; Kim, Jeong-Hoon

This paper considers a hybrid risky asset price model given by a constant elasticity of variance multiplied by a stochastic volatility factor. A multiscale analysis leads to an asymptotic pricing formula for both European vanilla option and a Barrier option near the zero elasticity of variance. The accuracy of the approximation is provided in a rigorous manner. A numerical experiment for implied volatilities shows that the hybrid model improves some of the well-known models in view of fitting the data for different maturities.

How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland.

PubMed

Kazemian, Ali; Berg, Isabelle; Finkel, Christina; Yazdani, Shahram; Zeilhofer, Hans-Florian; Juergens, Philipp; Reiter-Theil, Stella

2015-06-19

Overtreatment (or unnecessary treatment) is when medical or dental services are provided with a higher volume or cost than is appropriate. This study aimed to investigate how a group of dentists in Switzerland, a wealthy country known to have high standards of healthcare including dentistry, evaluated the meaning of unnecessary treatments from an ethical perspective and, assessed the expected frequency of different possible behaviors among their peers. A vignette describing a situation that is susceptible for overtreatment of a patient was presented to a group of dentists. The vignette was followed by five options. A questionnaire including the vignette was posted to 2482 dentists in the German-speaking areas of Switzerland. The respondents were asked to rate each option according to their estimation about its prevalence and their judgment about the degree to which the behavior is ethically sound. 732 completed questionnaires were returned. According to the responses, the most ethical and the most unethical options are considered to be the most and the least prevalent behaviors among dentists practicing in Switzerland, respectively. Suggesting unnecessary treatments to patients seems to be an ethically unacceptable conduct in the eyes of a sample of dentists in Switzerland. Although the respondents believed their colleagues were very likely to behave in an ethical way in response to a situation that is susceptible to overtreatment, they still seemed to be concerned about the prevalence of unethical behaviors in this regard.

Computing in Higher Education: A Planning Perspective for Administrators. CAUSE Monograph Series.

ERIC Educational Resources Information Center

Chachra, Vinod; Heterick, Robert C.

Options for using computers in managing higher education institutions and technological questions are considered in a collection of nine essays developed by the authors for this monograph. An introduction considers historical developments and provides an overview of computing modes and languages. After considering some of the economic and…

Considerations on long-term immuno-intervention in the treatment of multiple sclerosis: an expert opinion.

PubMed

Grigoriadis, Nikolaos; Linnebank, Michael; Alexandri, Nektaria; Muehl, Sarah; Hofbauer, Günther F L

2016-10-01

As management of multiple sclerosis (MS) requires life-long treatment with disease-modifying agents, any risks associated with long-term use should be considered when evaluating therapeutic options. Immune cells of the innate and adaptive immune systems play various roles in the pathogenesis of MS. MS therapies affect the immune system, each with a unique mode of action, and consequently possess different long-term safety profiles. Rare, but serious safety concerns, including an increased risk of infection and cancer, have been associated with immunosuppressant use. The risks associated with newer immunosuppressive agents, which target specific elements of MS disease pathophysiology, are not yet fully established as the duration of clinical trials is relatively short and post-marketing experience is limited. Non-immunosuppressants used to treat MS have well-defined safety profiles established over a large number of patient-years demonstrating them to be well-tolerated long-term treatment options. When considering the long-term use of disease-modifying agents for treating MS, classification as immunosuppressants or non-immunosuppressants can be useful when evaluating potential risks associated with chronic use. A successful therapeutic strategy for any serious, chronic disease such as MS should weigh effectiveness versus long-term safety of available treatments.

Improving care and treatment options for women and girls with bleeding disorders.

PubMed

Kulkarni, Roshni

2015-12-01

Women and girls may experience increased bleeding symptoms as carriers of haemophilia. They can also be affected by other hereditary bleeding diatheses such as von Willebrand disease, platelet dysfunction defects or deficiencies of coagulation factors (F) such as FI, FII, FV, FVII, FX, FXI and FXIII. In addition to general bleeding symptoms, such disorders pose unique problems for women due to their impact on reproductive health. Women and adolescent girls with undiagnosed bleeding disorders frequently experience heavy menstrual bleeding (HMB; menorrhagia), leading to impairment of daily activities. Other gynaecological and obstetric manifestations, for example miscarriage, bleeding during pregnancy and postpartum haemorrhage (PPH), can occur. Treatment for HMB should consider patient wishes relating to preservation of fertility, and management options include hormonal measures, desmopressin, antifibrinolytics, platelet concentrate transfusions and clotting factor therapy. During pregnancy, monitoring clotting factor levels informs the need for prophylactic therapy; subsequent haemostatic cover can minimise PPH. Under-recognition of bleeding disorders in females may lead to inappropriate, or lack of, treatment. This may be avoided by increased disease awareness, prompt and accurate diagnosis, and a multidisciplinary approach to patient care. This review considers the range of hereditary bleeding disorders that may affect women and adolescent girls, and their evaluation and management. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

48 CFR 17.202 - Use of options.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Use of options. 17.202... AND CONTRACT TYPES SPECIAL CONTRACTING METHODS Options 17.202 Use of options. (a) Subject to the..., the contracting officer may include options in contracts when it is in the Government's interest. When...

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

42 CFR 436.229 - Optional targeted low-income children.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Optional targeted low-income children. 436.229... Options for Coverage as Categorically Needy Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women § 436.229 Optional targeted low-income children...

Space station data system analysis/architecture study. Task 2: Options development, DR-5. Volume 2: Design options

NASA Technical Reports Server (NTRS)

1985-01-01

The primary objective of Task 2 is the development of an information base that will support the conduct of trade studies and provide sufficient data to make key design/programmatic decisions. This includes: (1) the establishment of option categories that are most likely to influence Space Station Data System (SSDS) definition; (2) the identification of preferred options in each category; and (3) the characterization of these options with respect to performance attributes, constraints, cost and risk. This volume contains the options development for the design category. This category comprises alternative structures, configurations and techniques that can be used to develop designs that are responsive to the SSDS requirements. The specific areas discussed are software, including data base management and distributed operating systems; system architecture, including fault tolerance and system growth/automation/autonomy and system interfaces; time management; and system security/privacy. Also discussed are space communications and local area networking.

47 CFR 32.5002 - Optional extended area revenue.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 2 2013-10-01 2013-10-01 false Optional extended area revenue. 32.5002 Section... Optional extended area revenue. This account shall include total revenue derived from the provision of optional extended area service. ...

47 CFR 32.5002 - Optional extended area revenue.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 2 2014-10-01 2014-10-01 false Optional extended area revenue. 32.5002 Section... Optional extended area revenue. This account shall include total revenue derived from the provision of optional extended area service. ...

47 CFR 32.5002 - Optional extended area revenue.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 2 2012-10-01 2012-10-01 false Optional extended area revenue. 32.5002 Section... Optional extended area revenue. This account shall include total revenue derived from the provision of optional extended area service. ...

47 CFR 32.5002 - Optional extended area revenue.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Optional extended area revenue. 32.5002 Section... Optional extended area revenue. This account shall include total revenue derived from the provision of optional extended area service. ...

Patient Perceptions About Prediabetes and Preferences for Diabetes Prevention.

PubMed

O'Brien, Matthew J; Moran, Margaret R; Tang, Joyce W; Vargas, Maria C; Talen, Mary; Zimmermann, Laura J; Ackermann, Ronald T; Kandula, Namratha R

2016-12-01

The purpose of this study was to explore how adults with prediabetes perceive their risk of developing diabetes and examine their preferences for evidence-based treatment options to prevent diabetes. A qualitative study was conducted in 2 large Midwest primary care practices, involving in-depth semistructured interviews with 35 adult patients with prediabetes. This ethnically diverse (77% nonwhite) sample of middle-aged primary care patients exhibited multiple diabetes risk factors. Knowledge gaps about prediabetes and its medical management were pervasive. Most patients overestimated the risk of developing diabetes and were not familiar with evidence-based treatment options for prediabetes. They suggested that receiving brief, yet specific information about these topics during the study interview motivated them to act. The majority of participants considered both intensive lifestyle intervention and metformin acceptable treatment options. Many preferred initial treatment with intensive lifestyle intervention but would take metformin if their efforts at lifestyle change failed and their primary care physician recommended it. Some participants expressed wanting to combine both treatments. This qualitative study highlights potential opportunities to promote patient-centered dialogue about prediabetes in primary care settings. Providing patients specific information about the risk of developing diabetes and evidence-based treatment options to prevent or delay its onset may encourage action. Physicians' prediabetes counseling efforts should be informed by the finding that most patients consider both intensive lifestyle intervention and metformin acceptable treatment options. © 2016 The Author(s).

The contemporary role of 1 vs. 2-stage repair for proximal hypospadias

PubMed Central

Dason, Shawn; Wong, Nathan

2014-01-01

This review discusses the most commonly employed techniques in the repair of proximal hypospadias, highlighting the advantages and disadvantages of single versus staged surgical techniques. Hypospadias can have a spectrum of severity with a urethral meatus ranging from the perineum to the glans. Associated abnormalities are commonly found with proximal hypospadias and encompass a large spectrum, including ventral curvature (VC) up to 50 degrees or more, ventral skin deficiency, a flattened glans, penile torsion and penoscrotal transposition. Our contemporary understanding of hypospadiology is comprised of a foundation built by experts who have described a number of techniques and their outcomes, combined with survey data detailing practice patterns. The two largest components of hypospadias repair include repair of VC and urethroplasty. VC greater than 20 degrees is considered clinically relevant to warrant surgical correction. To repair VC, the penis is first degloved—a procedure that may reduce or remove curvature by itself in some cases. Residual curvature is then repaired with dorsal plication techniques, transection of the urethral plate, and/or ventral lengthening techniques. Urethroplasty takes the form of 1- or 2-stage repairs. One-stage options include the tubularized incised urethroplasty (TIP) or various graft or flap-based techniques. Two-stage options also include grafts or flaps, including oral mucosal and preputial skin grafting. One stage repairs are an attractive option in that they may reduce cost, hospital stay, anesthetic risks, and time to the final result. The downside is that these repairs require mastery of multiple techniques may be more complex, and—depending on technique—have higher complication rates. Two-stage repairs are preferred by the majority of surveyed hypospadiologists. The 2-stage repair is versatile and has satisfactory outcomes, but necessitates a second procedure. Given the lack of clear high-quality evidence supporting the superiority of one approach over the others, hypospadiologists should develop their own algorithm, which gives them the best outcomes. PMID:26813851

The contemporary role of 1 vs. 2-stage repair for proximal hypospadias.

PubMed

Dason, Shawn; Wong, Nathan; Braga, Luis H

2014-12-01

This review discusses the most commonly employed techniques in the repair of proximal hypospadias, highlighting the advantages and disadvantages of single versus staged surgical techniques. Hypospadias can have a spectrum of severity with a urethral meatus ranging from the perineum to the glans. Associated abnormalities are commonly found with proximal hypospadias and encompass a large spectrum, including ventral curvature (VC) up to 50 degrees or more, ventral skin deficiency, a flattened glans, penile torsion and penoscrotal transposition. Our contemporary understanding of hypospadiology is comprised of a foundation built by experts who have described a number of techniques and their outcomes, combined with survey data detailing practice patterns. The two largest components of hypospadias repair include repair of VC and urethroplasty. VC greater than 20 degrees is considered clinically relevant to warrant surgical correction. To repair VC, the penis is first degloved-a procedure that may reduce or remove curvature by itself in some cases. Residual curvature is then repaired with dorsal plication techniques, transection of the urethral plate, and/or ventral lengthening techniques. Urethroplasty takes the form of 1- or 2-stage repairs. One-stage options include the tubularized incised urethroplasty (TIP) or various graft or flap-based techniques. Two-stage options also include grafts or flaps, including oral mucosal and preputial skin grafting. One stage repairs are an attractive option in that they may reduce cost, hospital stay, anesthetic risks, and time to the final result. The downside is that these repairs require mastery of multiple techniques may be more complex, and-depending on technique-have higher complication rates. Two-stage repairs are preferred by the majority of surveyed hypospadiologists. The 2-stage repair is versatile and has satisfactory outcomes, but necessitates a second procedure. Given the lack of clear high-quality evidence supporting the superiority of one approach over the others, hypospadiologists should develop their own algorithm, which gives them the best outcomes.

Modelling the affordability and distributional implications of future health care financing options in South Africa.

PubMed

McIntyre, Di; Ataguba, John E

2012-03-01

South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependents with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but needs careful design to ensure its long-term sustainability.

Mass discharge estimation from contaminated sites: Multi-model solutions for assessment of conceptual uncertainty

NASA Astrophysics Data System (ADS)

Thomsen, N. I.; Troldborg, M.; McKnight, U. S.; Binning, P. J.; Bjerg, P. L.

2012-04-01

Mass discharge estimates are increasingly being used in the management of contaminated sites. Such estimates have proven useful for supporting decisions related to the prioritization of contaminated sites in a groundwater catchment. Potential management options can be categorised as follows: (1) leave as is, (2) clean up, or (3) further investigation needed. However, mass discharge estimates are often very uncertain, which may hamper the management decisions. If option 1 is incorrectly chosen soil and water quality will decrease, threatening or destroying drinking water resources. The risk of choosing option 2 is to spend money on remediating a site that does not pose a problem. Choosing option 3 will often be safest, but may not be the optimal economic solution. Quantification of the uncertainty in mass discharge estimates can therefore greatly improve the foundation for selecting the appropriate management option. The uncertainty of mass discharge estimates depends greatly on the extent of the site characterization. A good approach for uncertainty estimation will be flexible with respect to the investigation level, and account for both parameter and conceptual model uncertainty. We propose a method for quantifying the uncertainty of dynamic mass discharge estimates from contaminant point sources on the local scale. The method considers both parameter and conceptual uncertainty through a multi-model approach. The multi-model approach evaluates multiple conceptual models for the same site. The different conceptual models consider different source characterizations and hydrogeological descriptions. The idea is to include a set of essentially different conceptual models where each model is believed to be realistic representation of the given site, based on the current level of information. Parameter uncertainty is quantified using Monte Carlo simulations. For each conceptual model we calculate a transient mass discharge estimate with uncertainty bounds resulting from the parametric uncertainty. To quantify the conceptual uncertainty from a given site, we combine the outputs from the different conceptual models using Bayesian model averaging. The weight for each model is obtained by integrating available data and expert knowledge using Bayesian belief networks. The multi-model approach is applied to a contaminated site. At the site a DNAPL (dense non aqueous phase liquid) spill consisting of PCE (perchloroethylene) has contaminated a fractured clay till aquitard overlaying a limestone aquifer. The exact shape and nature of the source is unknown and so is the importance of transport in the fractures. The result of the multi-model approach is a visual representation of the uncertainty of the mass discharge estimates for the site which can be used to support the management options.

Adoption as an option for unmarried pregnant teens.

PubMed

Custer, M

1993-01-01

Adolescent parenthood reduces the opportunities and optimal outcomes for both mother and child, yet pregnant teenagers rarely consider adoption. This paper reports a qualitative study that explored the reasons this option is so rarely examined. Twenty-one unmarried pregnant adolescents and their significant others were interviewed twice to determine the meaning adoption has for them. Four phenomena were found to be pivotal to the their willingness to consider adoption: (1) societal sanctions, (2) low level of knowledge, (3) anticipated psychological discomfort, and (4) lack of support from helping professionals. Information generated should be useful at health and social policy levels as well as to professionals who work with pregnant teenagers.

Have You Considered Accounting? Opportunities for Women Are Expanding. Career Options Series for Undergraduate Women.

ERIC Educational Resources Information Center

Rowes, Barbara

This booklet is part of a set of self-guidance publications prepared by Catalyst, a national nonprofit organization. It is written specifically for undergraduate women to help them bring their aspirations into focus, develop realistic career goals and plan for career options in fields which, at the managerial and professional levels, have been…

The Fixed-Links Model in Combination with the Polynomial Function as a Tool for Investigating Choice Reaction Time Data

ERIC Educational Resources Information Center

Schweizer, Karl

2006-01-01

A model with fixed relations between manifest and latent variables is presented for investigating choice reaction time data. The numbers for fixation originate from the polynomial function. Two options are considered: the component-based (1 latent variable for each component of the polynomial function) and composite-based options (1 latent…

26 CFR 1.544-7 - Option rule in lieu of family and partnership rule.

Code of Federal Regulations, 2010 CFR

2010-04-01

... family relationship between A and AW. If A is considered as owning the stock of his wife by application... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Option rule in lieu of family and partnership... in lieu of family and partnership rule. (a) If, in determining the ownership of stock, such stock may...

Postsecondary Education Options for Students with Intellectual Disabilities. Research to Practice. Issue 45

ERIC Educational Resources Information Center

Hart, Debra; Grigal, Meg; Sax, Caren; Martinez, Donna; Will, Madeleine

2006-01-01

Exiting high school is an exciting and tense experience for all students and families. But when students with intellectual disabilities consider what will happen next, the possibility of college is usually not promoted as a viable option. This needs to change. Receiving a college education and experiencing that very exciting time in life is as…

NSUF Ion Beam Investment Options Workshop Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heidrich, Brenden John

2016-03-01

The workshop that generated this data was convened to develop a set of recommendations (a priority list) for possible funding in the area of US domestic ion beam irradiation capabilities for nuclear energy-focused RD&D. The results of this workshop were intended for use by the Department of Energy - Office of Nuclear Energy (DOE-NE) for consideration of support for these facilities. The workshop considered, as part of the initial potential future support discussions, input submitted through the Office of Nuclear Energy Request for Information (RFI) (DE-SOL-0008318, April 13, 2015), but welcomed discussion (and presentation) of other options, whether specific ormore » general in scope. Input from users, including DOE-NE program interests and needs for ion irradiation RD&D were also included. Participants were selected from various sources: RFI respondents, NEUP/NEET infrastructure applicants, universities with known expertise in nuclear engineering and materials science and other developed sources. During the three days from March 22-24, 2016, the workshop was held at the Idaho National Laboratory Meeting Center in the Energy Innovation Laboratory at 775 University Drive, Idaho Falls, ID 83401. Thirty-one members of the ion beam community attended the workshop, including 15 ion beam facilities, six representatives of Office of Nuclear Energy R&D programs, an industry representative from EPRI and the chairs of the NSUF User’s Organization and the NSUF Scientific Review Board. Another four ion beam users were in attendance acting as advisors to the process, but did not participate in the options assessment. Three members of the sponsoring agency, the Office of Science and Technology Innovation (NE-4) also attended the workshop.« less

Phenotype, penetrance, and treatment of 133 CTLA-4-insufficient individuals.

PubMed

Schwab, Charlotte; Gabrysch, Annemarie; Olbrich, Peter; Patiño, Virginia; Warnatz, Klaus; Wolff, Daniel; Hoshino, Akihiro; Kobayashi, Masao; Imai, Kohsuke; Takagi, Masatoshi; Dybedal, Ingunn; Haddock, Jamanda A; Sansom, David; Lucena, Jose M; Seidl, Maximilian; Schmitt-Gräff, Annette; Reiser, Veronika; Emmerich, Florian; Frede, Natalie; Bulashevska, Alla; Salzer, Ulrich; Schubert, Desirée; Hayakawa, Seiichi; Okada, Satoshi; Kanariou, Maria; Kucuk, Zeynep Yesim; Chapdelaine, Hugo; Petruzelkova, Lenka; Sumnik, Zdenek; Sediva, Anna; Slatter, Mary; Arkwright, Peter D; Cant, Andrew; Lorenz, Hanns-Martin; Giese, Thomas; Lougaris, Vassilios; Plebani, Alessandro; Price, Christina; Sullivan, Kathleen E; Moutschen, Michel; Litzman, Jiri; Freiberger, Tomas; van de Veerdonk, Frank L; Recher, Mike; Albert, Michael H; Hauck, Fabian; Seneviratne, Suranjith; Schmid, Jana Pachlopnik; Kolios, Antonios; Unglik, Gary; Klemann, Christian; Speckmann, Carsten; Ehl, Stephan; Leichtner, Alan; Blumberg, Richard; Franke, Andre; Snapper, Scott; Zeissig, Sebastian; Cunningham-Rundles, Charlotte; Giulino-Roth, Lisa; Elemento, Olivier; Dückers, Gregor; Niehues, Tim; Fronkova, Eva; Kanderová, Veronika; Platt, Craig D; Chou, Janet; Chatila, Talal; Geha, Raif; McDermott, Elizabeth; Bunn, Su; Kurzai, Monika; Schulz, Ansgar; Alsina, Laia; Casals, Ferran; Deyà-Martinez, Angela; Hambleton, Sophie; Kanegane, Hirokazu; Taskén, Kjetil; Neth, Olaf; Grimbacher, Bodo

2018-05-04

Cytotoxic-T-lymphocyte-antigen-4 (CTLA-4) is a negative immune regulator. Heterozygous CTLA4 germline mutations can cause a complex immune dysregulation syndrome in humans. To characterize the penetrance, the clinical features and the best treatment options in 133 CTLA4 mutation carriers. Genetics, clinical features, laboratory values, and outcome of treatment options were assessed in a worldwide cohort of CTLA4 mutation carriers. We identified 133 individuals from 54 unrelated families carrying 45 different heterozygous CTLA4 mutations, including 28 previously undescribed mutations. Ninety mutation carriers were considered affected, suggesting the clinical penetrance of at least 67%; median age of onset was 11 years, and mortality rate within affected mutation carriers was 16% (n=15). Main clinical manifestations included hypogammaglobulinemia (84%), lymphoproliferation (73%), autoimmune cytopenia (62%), respiratory- (68%), gastrointestinal- (59%), or neurological features (29%). Eight affected mutation carriers developed lymphoma, three gastric cancer. An EBV association was found in six malignancies. CTLA4 mutations were associated with lymphopenia and decreased T-, B-, and NK-cell counts. Successful targeted therapies included the application of CTLA-4-fusion-proteins, mTOR-inhibitors, and hematopoietic stem cell transplantation. EBV reactivation occurred in two affected mutation carriers under immunosuppression. Affected mutation carriers with CTLA-4 insufficiency may present in any medical specialty. Family members should be counseled, as disease manifestation may occur as late as age 50. EBV- and CMV-associated complications must be closely monitored. Treatment interventions should be coordinated in clinical trials. This large cohort of affected CTLA4 mutation carriers gives first insights into different possible treatment options and presents available clinical information on treatment response and survival. With this knowledge, affected mutation carriers will benefit from an individualized management. Copyright © 2018 American Academy of Allergy, Asthma & Immunology. All rights reserved.

Assessing the potential of translocating vulnerable forest birds by searching for novel and enduring climatic ranges

USGS Publications Warehouse

Fortini, Lucas B.; Kaiser, Lauren R.; Vorsino, Adam E.; Paxton, Eben H.; Jacobi, James D.

2017-01-01

Hawaiian forest birds are imperiled, with fewer than half the original >40 species remaining extant. Recent studies document ongoing rapid population decline and pro- ject complete climate-based range losses for the critically endangered Kaua’i endemics ‘akeke’e (Loxops caeruleirostris) and ‘akikiki (Oreomystis bairdi) by end-of-century due to projected warming. Climate change facilitates the upward expansion of avian malaria into native high elevation forests where disease was historically absent. While intensi- fied conservation efforts attempt to safeguard these species and their habitats, the magnitude of potential loss and the urgency of this situation require all conservation options to be seriously considered. One option for Kaua’i endemics is translocation to islands with higher elevation habitats. We explored the feasibility of interisland translocation by projecting baseline and future climate-based ranges of ‘akeke’e and ‘akikiki across the Hawaiian archipelago. For islands where compatible climates for these spe- cies were projected to endure through end-of-century, an additional climatic niche overlap analysis compares the spatial overlap between Kaua’i endemics and current native species on prospective destination islands. Suitable climate-based ranges exist on Maui and Hawai’i for these Kaua’i endemics that offer climatically distinct areas compared to niche distributions of destination island endemics. While we recognize that any decision to translocate birds will include assessing numerous additional social, political, and biological factors, our focus on locations of enduring and ecologically compatible climate-based ranges represents the first step to evaluate this potential conservation option. Our approach considering baseline and future distributions of species with climatic niche overlap metrics to identify undesirable range overlap provides a method that can be utilized for other climate-vulnerable species with disjointed compatible environments beyond their native range.

Update on best available options in obstetrics anaesthesia: perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review.

PubMed

Gizzo, Salvatore; Noventa, Marco; Fagherazzi, Simone; Lamparelli, Laura; Ancona, Emanuele; Di Gangi, Stefania; Saccardi, Carlo; D'Antona, Donato; Nardelli, Giovanni Battista

2014-07-01

In modern obstetrics, different pharmacological and non-pharmacological options allow to obtain pain relief during labour, one of the most important goals in women satisfaction about medical care. The aim of this review is to compare all the analgesia administration schemes in terms of effectiveness in pain relief, length of labour, mode of delivery, side effects and neonatal outcomes. A systematic literature search was conducted in electronic databases in the interval time between January 1999 and March 2013. Key search terms included: “labour analgesia”, “epidural anaesthesia during labour” (excluding anaesthesia for Caesarean section), “epidural analgesia and labour outcome” and “intra-thecal analgesia”. 10,331 patients were analysed: 5,578 patients underwent Epidural-Analgesia, 259 patients spinal analgesia, 2,724 combined spinal epidural analgesia, 322 continuous epidural infusion (CEI), 168 intermittent epidural bolus, 684 patient-controlled infusion epidural analgesia and 152 intra-venous patient-controlled epidural analgesia. We also considered 341 women who underwent patient-controlled infusion epidural analgesia in association with CEI and 103 patients who underwent patient-controlled infusion epidural analgesia in association with automatic mandatory bolus. No significant differences occurred among all the available administration schemes of neuraxial analgesia. In absence of obstetrical contraindication, neuraxial analgesia has to be considered as the gold standard in obtaining maternal pain relief during labour. The options available in the administration of analgesia should be known and evaluated together by both gynaecologists and anaesthesiologists to choose the best personalized scheme and obtain the best women satisfaction. Since it is difficult to identify comparable circumstances during labour, it is complicate to standardize drugs schemes and their combinations.

Evaluation of alternatives for best available technology treatment and retreatment of uranium-contaminated wastewater at the Paducah Gaseous Diffusion Plant C-400 Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Del Cul, G.D.; Osborne, P.E.; Beck, D.E.

1991-01-01

The Paducah Gaseous Diffusion Plant (PGDP) C-400 Decontamination Facility generates aqueous solutions that originate in drum washing, machine parts and equipment cleaning, and other decontamination processes. The chemical composition of the waste depends on the particular operation involved. In general, the waste contains uranyl, fluoride, carbonate, and nitrate ions, plus soaps, detergents, secondary contaminants, and particulate matter. The uranium content is rather variable ranging between 0.5 and 30 g/l. The main contaminants are fluoride, technetium, uranium, and other heavy metals. The plan included (1) a literature search to support best available technology (BAT) evaluation of treatment alternatives, (2) a qualitymore » assurance/quality control plan, (3) suggestion of alternative treatment options, (4) bench-scale tests studies of the proposed treatment alternatives, and (5) establishment of the final recommendation. The following report records the evaluation of items (1) to (3) of the action plan for the BAT evaluation of alternatives for the treatment and retreatment of uranium-contaminated wastewater at the PGDP C-400 treatment facility. After a thorough literature search, five major technologies were considered: (1) precipitation/coprecipitation, (2) reverse osmosis, (3) ultrafiltration, (4) supported liquid membranes, and (5) ion exchange. Biosorption was also considered, but as it is a fairly new technology with few demonstrations of its capabilities, it is mentioned only briefly in the report. Based on C-400's requirements and facilities, the precipitation/coprecipitation process appears to be the best suited for use at the plant. Four different treatment options using the precipitation/coprecipitation technology are proposed. Bench-scale studies of the four options are suggested. 37 refs.« less

Characterizing the Public's Preferential Attitudes Toward End-of-Life Care Options: A Role for the Threshold Technique?

PubMed Central

Trafford Crump, R; Llewellyn-Thomas, H

2013-01-01

Objectives. To assess the Threshold Technique's (TT) feasibility in community-wide surveys of U.S. Medicare beneficiaries' preferences for end-of-life (EOL) care options. Study Setting. Study participants were community-dwelling Medicare beneficiaries in four different regions in the United States. Study Design. During personal interviews, participants considered four EOL scenarios, each presenting a choice between a less intense and more intense care option. Data Collection. Participants selected their initially favored option. Depending on that choice, in the subsequent TT the length of life offered by the more intense option was systematically increased or decreased until the participant “switched” to his or her initially rejected option. Principal Findings. Participants were able to select an initially favored option (in 3 of the 4 scenarios; this was the less intense option). The majority of participants were able to engage with the subsequent TT. In all scenarios, regardless of the increase/decrease in the length of life offered by the more intense option, the majority of participants were unwilling to “switch” to their initially rejected option. Conclusions. In surveys of populations' preferential attitudes toward EOL care options, the TT was a feasible elicitation method, engaging most participants and measuring the strength of their attitudes. Further methodological work is merited, involving (1) populations with various participant characteristics, and (2) different attributes in the TT task itself. PMID:23444844

How and when I do allogeneic transplant in CLL.

PubMed

Gribben, John G

2018-05-11

Allogenic stem cell transplantation (allo-SCT) has been considered the treatment of choice for high-risk patients with chronic lymphocytic leukemia (CLL) and the only approach offered with curative intent in this disease. The availability novel agents including the B cell receptor inhibitors (BCRi) ibrutinib, acalabrutinib and idelalisib, as well as venetoclax which targets the BCL2 pathway and the success of these agents in treating high-risk disease patients has made it more difficult to assess who and when in their treatment course allo-SCT should be considered. In this review, I will discuss the different treatment options available for the treatment of high-risk CLL and how allo-SCT fits into the treatment algorithm in the era of novel agents. Copyright © 2018 American Society of Hematology.

Potentials for sustainable transportation in cities to alleviate climate change impacts.

PubMed

Mashayekh, Yeganeh; Jaramillo, Paulina; Samaras, Constantine; Hendrickson, Chris T; Blackhurst, Michael; MacLean, Heather L; Matthews, H Scott

2012-03-06

Reducing greenhouse gas emissions (GHG) is an important social goal to mitigate climate change. A common mitigation paradigm is to consider strategy "wedges" that can be applied to different activities to achieve desired GHG reductions. In this policy analysis piece, we consider a wide range of possible strategies to reduce light-duty vehicle GHG emissions, including fuel and vehicle options, low carbon and renewable power, travel demand management and land use changes. We conclude that no one strategy will be sufficient to meet GHG emissions reduction goals to avoid climate change. However, many of these changes have positive combinatorial effects, so the best strategy is to pursue combinations of transportation GHG reduction strategies to meet reduction goals. Agencies need to broaden their agendas to incorporate such combination in their planning.

Comparison of different target material options for the European Spallation Source based on certain aspects related to the final disposal

NASA Astrophysics Data System (ADS)

Kókai, Zsófia; Török, Szabina; Zagyvai, Péter; Kiselev, Daniela; Moormann, Rainer; Börcsök, Endre; Zanini, Luca; Takibayev, Alan; Muhrer, Günter; Bevilacqua, Riccardo; Janik, József

2018-02-01

Different target options have been examined for the European Spallation Source, which is under construction in Lund, Sweden. During the design update phase, parameters and characteristics for the target design have been optimized not only for neutronics but also with respect to the waste characteristics related to the final disposal of the target. A rotating, solid tungsten target was eventually selected as baseline concept; the other options considered included mercury and lead-bismuth (LBE) targets suitable for a pulsed source. Since the licensee is obliged to present a decommissioning plan even before the construction phase starts, the radioactive waste category of the target after full operation time is of crucial importance. The results obtained from a small survey among project partners of 7th Framework Program granted by EU 202247 contract have been used. Waste characteristics of different potential spallation target materials were compared. Based on waste index, the tungsten target is the best alternative and the second one is the mercury target. However, all alternatives have HLW category after a 10 year cooling. Based on heat generation alone all of the options would be below the HLW limit after this cooling period. The LBE is the least advantageous alternative based on waste index and heat generation comparison. These results can be useful in compiling the licensing documents of the ESS facility as the target alternatives can be compared from various aspects related to their disposal.

Mixed messages: presentation of information in cystic fibrosis-screening pamphlets.

PubMed Central

Loeben, G L; Marteau, T M; Wilfond, B S

1998-01-01

Written pamphlets are an important source of information for individuals deciding whether to undergo carrier testing for cystic fibrosis (CF). Adequate understanding of the condition and reproductive options following the diagnosis of a fetus with CF are critical to informed decision making. The information given about CF and reproductive options in 28 pamphlets about carrier testing, from commercial and noncommercial organizations in the United States and the United Kingdom, aimed at prenatal and other populations, was assessed. The amount of information provided about CF showed a range of 1-37 sentences (median 6.5), with most being relatively neutral and with a minority conveying a positive or a negative image. Positive sentences were less common in British, U.S. commercial, and prenatal pamphlets. Statements about life expectancy also varied considerably, both in the ages provided and in the degree of optimism conveyed. In addition, the pamphlets varied in the amount of information they provided about reproductive options following the diagnosis of a fetus with CF. Abortion was mentioned in just 15 pamphlets, more often in the United Kingdom than in the United States and more frequently in pamphlets from noncommercial than in those from commercial organizations. Wide variation in the descriptions of CF and the reproductive options presented raises concerns about the extent to which any one pamphlet may present balanced information. The choices about what information to include in educational materials need to be explicitly considered on the basis of the message intended to be sent. PMID:9758594

Mixed messages: presentation of information in cystic fibrosis-screening pamphlets.

PubMed

Loeben, G L; Marteau, T M; Wilfond, B S

1998-10-01

Written pamphlets are an important source of information for individuals deciding whether to undergo carrier testing for cystic fibrosis (CF). Adequate understanding of the condition and reproductive options following the diagnosis of a fetus with CF are critical to informed decision making. The information given about CF and reproductive options in 28 pamphlets about carrier testing, from commercial and noncommercial organizations in the United States and the United Kingdom, aimed at prenatal and other populations, was assessed. The amount of information provided about CF showed a range of 1-37 sentences (median 6.5), with most being relatively neutral and with a minority conveying a positive or a negative image. Positive sentences were less common in British, U.S. commercial, and prenatal pamphlets. Statements about life expectancy also varied considerably, both in the ages provided and in the degree of optimism conveyed. In addition, the pamphlets varied in the amount of information they provided about reproductive options following the diagnosis of a fetus with CF. Abortion was mentioned in just 15 pamphlets, more often in the United Kingdom than in the United States and more frequently in pamphlets from noncommercial than in those from commercial organizations. Wide variation in the descriptions of CF and the reproductive options presented raises concerns about the extent to which any one pamphlet may present balanced information. The choices about what information to include in educational materials need to be explicitly considered on the basis of the message intended to be sent.

Opportunities to integrate solar technologies into the Chilean lithium mining industry - reducing process related GHG emissions of a strategic storage resource

NASA Astrophysics Data System (ADS)

Telsnig, Thomas; Potz, Christian; Haas, Jannik; Eltrop, Ludger; Palma-Behnke, Rodrigo

2017-06-01

The arid northern regions of Chile are characterized by an intensive mineral mining industry and high solar irradiance levels. Besides Chile's main mining products, copper, molybdenum and iron, the production of lithium carbonate from lithium containing brines has become strategically important due to the rising demand for battery technologies worldwide. Its energy-intensive production may affect the ecological footprint of the product and the country's climate targets. Thus, the use of solar technologies for electricity and heat production might constitute an interesting option for CO2 mitigation. This study aims to quantify the impacts of the lithium carbonate production processes in Chile on climate change, and to identify site-specific integration options of solar energy technologies to reduce GHG life-cycle emissions. The considered solar integration options include a parabolic trough power plant with a molten salt storage, a solar tower power plant with molten salt receiver and molten salt storage, a one-axis tracking photovoltaic energy system for electricity, and two solar thermal power plants with Ruths storage (steam accumulator) for thermal heat production. CSP plants were identified as measures with the highest GHG mitigation potential reducing the CO2 emissions for the entire production chain and the lithium production between 16% and 33%. In a scenario that combines solar technologies for electricity and thermal energy generation, up to 59% of the CO2 emissions at the lithium production sites in Chile can be avoided. A comparison of the GHG abatement costs of the proposed solar integration options indicates that the photovoltaic system, the solar thermal plant with limited storage and the solar tower power plant are the most cost effective options.

75 FR 40005 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Granting...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-13

... including, but not limited to, stock index futures contracts, options on futures, options on securities and... holding and/ or managing portfolios or baskets of securities, commodity futures contracts, options on commodity futures contracts, swaps, forward contracts and/or options on physical commodities and/or non-U.S...

77 FR 20867 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-06

... Index, Equity and Currency Options) to extend a pilot program that eliminates minimum value sizes for... FLEX Options, FLEX currency options are also traded on the Exchange. These flexible index, equity, and currency options provide investors the ability to customize basic option features including size...

77 FR 33796 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-07

... Index, Equity and Currency Options) to extend a pilot program that eliminates minimum value sizes for... FLEX Options, FLEX currency options are also traded on the Exchange. These flexible index, equity, and currency options provide investors the ability to customize basic option features including size...

Should a colon cancer screening decision aid include the option of no testing? A comparative trial of two decision aids

PubMed Central

Griffith, Jennifer M; Fichter, Marlie; Fowler, Floyd J; Lewis, Carmen; Pignone, Michael P

2008-01-01

Background An important question in the development of decision aids about colon cancer (CRC) screening is whether to include an explicit discussion of the option of not being screened. We examined the effect of including or not including an explicit discussion of the option of deciding not to be screened in a CRC screening decision aid on subjective measures of decision aid content; interest in screening; and knowledge. Methods Adults ages 50–85 were assigned to view one of two versions of the decision aid. The two versions differed only in the inclusion of video segments of two men, one of whom decided against being screened. Participants completed questionnaires before and after viewing the decision aid to compare subjective measures of content, screening interest and intent, and knowledge between groups. Likert response categories (5-point) were used for subjective measures of content (eg. clarity, balance in favor/against screening, and overall rating), and screening interest. Knowledge was measured with a three item index and individual questions. Higher scores indicated favorable responses for subjective measures, greater interest, and better knowledge. For the subjective balance, lower numbers were associated with the impression of the decision aid favoring CRC screening. Results 57 viewed the "with" version which included the two segments and 49 viewed the "without" version. After viewing, participants found the "without" version to have better subjective clarity about benefits of screening ("with" 3.4, "without" 4.1, p < 0.01), and to have greater clarity about downsides of screening ("with" 3.2, "without" 3.6, p = 0.03). The "with" version was considered to be less strongly balanced in favor of screening. ("with" 1.8, "without" 1.6, p = 0.05); but the "without" version received a better overall rating ("with" 3.5, "without" 3.8, p = 0.03). Groups did not differ in screening interest after viewing a decision aid or knowledge. Conclusion A decision aid with the explicit discussion of the option of deciding not to be screened appears to increase the impression that the program was not as strongly in favor of screening, but decreases the impression of clarity and resulted in a lower overall rating. We did not observe clinically important or statistically significant differences in interest in screening or knowledge. PMID:18321377

Penile anomalies in adolescence.

PubMed

Wood, Dan; Woodhouse, Christopher

2011-03-07

This article considers the impact and outcomes of both treatment and underlying condition of penile anomalies in adolescent males. Major congenital anomalies (such as exstrophy/epispadias) are discussed, including the psychological outcomes, common problems (such as corporal asymmetry, chordee, and scarring) in this group, and surgical assessment for potential surgical candidates. The emergence of new surgical techniques continues to improve outcomes and potentially raises patient expectations. The importance of balanced discussion in conditions such as micropenis, including multidisciplinary support for patients, is important in order to achieve appropriate treatment decisions. Topical treatments may be of value, but in extreme cases, phalloplasty is a valuable option for patients to consider. In buried penis, the importance of careful assessment and, for the majority, a delay in surgery until puberty has completed is emphasised. In hypospadias patients, the variety of surgical procedures has complicated assessment of outcomes. It appears that true surgical success may be difficult to measure as many men who have had earlier operations are not reassessed in either puberty or adult life. There is also a brief discussion of acquired penile anomalies, including causation and treatment of lymphoedema, penile fracture/trauma, and priapism.

Stock price dynamics and option valuations under volatility feedback effect

NASA Astrophysics Data System (ADS)

Kanniainen, Juho; Piché, Robert

2013-02-01

According to the volatility feedback effect, an unexpected increase in squared volatility leads to an immediate decline in the price-dividend ratio. In this paper, we consider the properties of stock price dynamics and option valuations under the volatility feedback effect by modeling the joint dynamics of stock price, dividends, and volatility in continuous time. Most importantly, our model predicts the negative effect of an increase in squared return volatility on the value of deep-in-the-money call options and, furthermore, attempts to explain the volatility puzzle. We theoretically demonstrate a mechanism by which the market price of diffusion return risk, or an equity risk-premium, affects option prices and empirically illustrate how to identify that mechanism using forward-looking information on option contracts. Our theoretical and empirical results support the relevance of the volatility feedback effect. Overall, the results indicate that the prevailing practice of ignoring the time-varying dividend yield in option pricing can lead to oversimplification of the stock market dynamics.

5 CFR 582.103 - Exclusions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... retirement benefits are considered to be supplementary; (f) Are deducted as normal life insurance premiums... coverage. Federal Employees' Group Life Insurance premiums for “Basic Life” coverage are considered to be normal life insurance premiums; all optional Federal Employees' Group Life Insurance premiums and any...

5 CFR 582.103 - Exclusions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... retirement benefits are considered to be supplementary; (f) Are deducted as normal life insurance premiums... coverage. Federal Employees' Group Life Insurance premiums for “Basic Life” coverage are considered to be normal life insurance premiums; all optional Federal Employees' Group Life Insurance premiums and any...

Pharmacotherapy for Parkinson's disease.

PubMed

Chen, Jack J; Swope, David M

2007-12-01

The available pharmacotherapies for Parkinson's disease address symptomatology because no agent has been demonstrated to provide definite neuroprotection against the disease. Choice of pharmacotherapy must include consideration of short-term benefits as well as long-term consequences. Patients with mild Parkinson's disease often function adequately without symptomatic treatment. However, recent data suggest that initiation of treatment with a well-tolerated agent (e.g., the monoamine oxidase [MAO]-B inhibitor rasagiline) in the absence of functional impairment is associated with improved long-term outcomes. Consideration should also be given to many patient-specific factors, including patient expectations, level of disability, employment status, functional as well as chronologic age, expected efficacy and tolerability of drugs, and response to previous Parkinson's disease therapies. Increasingly, initial monotherapy begins with a nondopaminergic agent or, if the patient is considered functionally young, a dopamine agonist. Since Parkinson's disease is a progressive disorder, adjustments to pharmacotherapy must be expected over time. When greater symptomatic relief is desired, or in the more frail elderly patient, levodopa therapy should be considered. If motor fluctuations develop, addition of a catechol-O-methyltransferase inhibitor or MAO-B inhibitor should be considered. For management of levodopa-induced dyskinesias, addition of amantadine is an option. Surgery may be considered when patients need additional symptomatic control or are experiencing severe motor complications despite pharmacologically optimized therapy.

Study of the feasibility of utilizing solar, wind, and geothermal energy in Hobbs, New Mexico. Final report. Volume 2

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taylor, B.J.; Huettner, D.A.; Murry, D.

The objective of this study was to provide an economic analysis of the various solar options for Hobbs, New Mexico. In so doing, an assessment of the current state of the art in solar research was obtained. Cost estimates were provided assuming capacity 100 MW. These options were: Central Receiver, Cylindrical Trough, Parabolic Dish Non-Brayton, Parabolic Dish Brayton, Fixed Mirror Distributed Focus, Dispersed Photovoltaic ERDA Goal, and Dispersed Photovoltaic Present Quote. Three scenarios were used to analyze all of the solar options relative to conventional fossil systems and nuclear alternatives. A total of thirty-two different options were considered. Results andmore » conclusions are presented. (MHR)« less

Children’s recalls from five dietary-reporting validation studies: Intrusions in correctly reported and misreported options in school breakfast reports

PubMed Central

Baxter, Suzanne Domel; Hardin, James W.; Royer, Julie A.; Guinn, Caroline H.; Smith, Albert F.

2008-01-01

For school breakfast each day, many elementary schools offer a choice between a cold option that includes ready-to-eat (RTE) cereal and a hot option that includes a non-RTE-cereal entrée such as waffles. For breakfast reports, intrusions (reports of uneaten items) in correctly reported and misreported breakfast options were examined using data from five dietary-reporting validation studies. In each study, fourth-grade children were observed eating school breakfast and school lunch and then interviewed to obtain a dietary recall. A breakfast option was correctly reported in 240 breakfast reports for 203 intrusions total, and misreported in 97 breakfast reports for 189 intrusions total. Asymmetry was evident in misreported options; specifically, children observed eating a cold option almost never misreported a hot option, but children observed eating a hot option often misreported a cold option. Proportionately more breakfast reports were intrusion-free when a breakfast option was correctly reported than misreported. Linking of intrusions (i.e., multiple intrusions from the same option in a breakfast report) was especially evident with misreported breakfast options. Methodological aspects of dietary recalls such as target period (prior 24 hours; previous day), interview time (morning; afternoon; evening), and interview format (meal; open) had implications for intrusions and misreported breakfast options. PMID:18501992

Diagnosis and Treatment Strategy of Achalasia Subtypes and Esophagogastric Junction Outflow Obstruction Based on High-Resolution Manometry.

PubMed

Ihara, Eikichi; Muta, Kazumasa; Fukaura, Keita; Nakamura, Kazuhiko

2017-01-01

Based on Chicago Classification version 3.0, the disorders of esophagogastric junction outflow obstruction (EGJOO) include achalasia (types I, II and III) and EGJOO. Although no curative treatments are currently available for the treatment of the disorders of EGJOO, medical treatments, endoscopic pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), and per-oral endoscopic myotomy (POEM) are usually the sought-after modes of treatment. Since the etiology and pathogenesis might vary depending on the types of EGJOO disorders, treatment strategies should be considered based on those subtypes. Based on the accumulated evidences, the treatment strategies of our institution are as follows: effects of medical treatments on achalasia are limited. Either PD or LHM/POEM can be considered a first-line in achalasia type I, according to the patient's wish. PD and POEM can be considered first-line in achalasia types II and III, respectively. Conversely, In EGJOO, medical treatments including drugs like acotiamide and/or diltiazem can be tested as a first-line, and PD and POEM will be considered second and third-line treatments, respectively. Key Messages: The classification of subtypes based on high-resolution manometry will help us consider which treatment option can be selected as a first-line treatment depending upon the subtypes of disorders of EGJOO. Acotiamide has the potential to cure patients with EGJOO. © 2016 S. Karger AG, Basel.

Behavioral Modeling of Adversaries with Multiple Objectives in Counterterrorism.

PubMed

Mazicioglu, Dogucan; Merrick, Jason R W

2018-05-01

Attacker/defender models have primarily assumed that each decisionmaker optimizes the cost of the damage inflicted and its economic repercussions from their own perspective. Two streams of recent research have sought to extend such models. One stream suggests that it is more realistic to consider attackers with multiple objectives, but this research has not included the adaption of the terrorist with multiple objectives to defender actions. The other stream builds off experimental studies that show that decisionmakers deviate from optimal rational behavior. In this article, we extend attacker/defender models to incorporate multiple objectives that a terrorist might consider in planning an attack. This includes the tradeoffs that a terrorist might consider and their adaption to defender actions. However, we must also consider experimental evidence of deviations from the rationality assumed in the commonly used expected utility model in determining such adaption. Thus, we model the attacker's behavior using multiattribute prospect theory to account for the attacker's multiple objectives and deviations from rationality. We evaluate our approach by considering an attacker with multiple objectives who wishes to smuggle radioactive material into the United States and a defender who has the option to implement a screening process to hinder the attacker. We discuss the problems with implementing such an approach, but argue that research in this area must continue to avoid misrepresenting terrorist behavior in determining optimal defensive actions. © 2017 Society for Risk Analysis.

Body Dysmorphic Disorder: Some Key Issues for DSM-V

PubMed Central

Phillips, Katharine A.; Wilhelm, Sabine; Koran, Lorrin M.; Didie, Elizabeth R.; Fallon, Brian A.; Feusner, Jamie; Stein, Dan J.

2014-01-01

Body dysmorphic disorder (BDD), a distressing or impairing preoccupation with an imagined or slight defect in appearance, has been described for more than a century and increasingly studied over the past several decades. This paper provides a focused review of issues pertaining to BDD that are relevant to DSM-V. The review presents a number of options and preliminary recommendations to be considered for DSM-V: 1) Criterion A may benefit from some rewording, without changing its focus or meaning; 2) Potential disadvantages of adding a new criterion to reflect BDD compulsive behaviors seem to outweigh potential advantages, but adding such a criterion remains an option that can be considered; 3) A clinical significance criterion seems necessary for BDD to differentiate it from normal appearance concerns; 4) BDD and eating disorders have some overlapping features and need to be differentiated; some minor changes to DSM-IV’s criterion C are suggested; 5) BDD should not be broadened to include body integrity identity disorder (apotemnophilia) or olfactory reference syndrome; 6) There is no compelling evidence for including diagnostic features or subtypes that are specific to gender-related, age-related, or cultural manifestations of BDD; 7) Adding muscle dysmorphia as a specifier may have clinical utility; and 8) The ICD-10 criteria for hypochondriacal disorder are not suitable for BDD, and there is no empirical evidence that BDD and hypochondriasis are the same disorder. The issue of how BDD’s delusional variant should be classified in DSM-V is briefly discussed and will be addressed more extensively in a separate paper. PMID:20533368

The Wild Side of Disease Control at the Wildlife-Livestock-Human Interface: A Review

PubMed Central

Gortazar, Christian; Diez-Delgado, Iratxe; Barasona, Jose Angel; Vicente, Joaquin; De La Fuente, Jose; Boadella, Mariana

2015-01-01

The control of diseases shared with wildlife requires the development of strategies that will reduce pathogen transmission between wildlife and both domestic animals and human beings. This review describes and criticizes the options currently applied and attempts to forecast wildlife disease control in the coming decades. Establishing a proper surveillance and monitoring scheme (disease and population wise) is the absolute priority before even making the decision as to whether or not to intervene. Disease control can be achieved by different means, including: (1) preventive actions, (2) arthropod vector control, (3) host population control through random or selective culling, habitat management or reproductive control, and (4) vaccination. The alternative options of zoning or no-action should also be considered, particularly in view of a cost/benefit assessment. Ideally, tools from several fields should be combined in an integrated control strategy. The success of disease control in wildlife depends on many factors, including disease ecology, natural history, and the characteristics of the pathogen, the availability of suitable diagnostic tools, the characteristics of the domestic and wildlife host(s) and vectors, the geographical spread of the problem, the scale of the control effort and stakeholders’ attitudes. PMID:26664926

How can primary care providers manage pediatric obesity in the real world?

PubMed

Hopkins, Kristy F; Decristofaro, Claire; Elliott, Lydia

2011-06-01

To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered. Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

Phase II drugs currently being investigated for the treatment of hypogonadism.

PubMed

Udedibia, Emeka; Kaminetsky, Jed

2014-12-01

Hypogonadism is the most common endocrine disorder, which affects men of all age groups. Recent shifts in public awareness, increased screening and recognition of symptoms and updated diagnostic criteria have led to an increase in men diagnosed as hypogonadal, including middle-aged and older men who previously would have been considered eugonadal. The increase in testosterone replacement therapy (TRT) has paralleled an increase in advancements of treatment options. Although current therapies are highly efficacious for many men, there remains a need for newer therapies that are more cost-effective, preserve ease of use and administration, mitigate undesirable effects and closely mimic physiological levels of testosterone. In this review, the authors discuss current TRTs and therapies in development for the treatment of hypogonadism. The focus is on therapies under Phase II investigation or those who have recently completed Phase II study. With several new therapies in development, the authors expect advancements in achieving treatment benchmarks that meet the needs of the individual symptomatic hypogonadal male. Increased public awareness of hypogonadism and TRT has led to a welcomed expansion in the choice of TRT options. These include new delivery systems, formulations, routes of administration and non-testosterone modalities.

Identification and management of eating disorders in children and adolescents.

PubMed

Rosen, David S

2010-12-01

The incidence and prevalence of eating disorders in children and adolescents has increased significantly in recent decades, making it essential for pediatricians to consider these disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders, and to manage (or refer) patients in whom eating disorders are diagnosed. This clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with disordered eating. Medical complications of eating disorders may affect any organ system, and careful monitoring for these complications is required. The range of treatment options, including pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for legislation and policies that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination.

Coupling Adaptation Tipping Points and Engineering Options: New Insights for Resilient Water Infrastructure Replacement Planning

NASA Astrophysics Data System (ADS)

Smet, K.; de Neufville, R.; van der Vlist, M.

2017-12-01

This work presents an innovative approach for replacement planning for aging water infrastructure given uncertain future conditions. We draw upon two existing methodologies to develop an integrated long-term replacement planning framework. We first expand the concept of Adaptation Tipping Points to generate long-term planning timelines that incorporate drivers of investment related to both internal structural processes as well as changes in external operating conditions. Then, we use Engineering Options to explore different actions taken at key moments in this timeline. Contrasting to the traditionally more static approach to infrastructure design, designing the next generation of infrastructure so it can be changed incrementally is a promising method to safeguard current investments given future uncertainty. This up-front inclusion of structural options in the system actively facilitates future adaptation, transforming uncertainty management in infrastructure planning from reactive to more proactive. A two-part model underpins this approach. A simulation model generates diverse future conditions, allowing development of timelines of intervention moments in the structure's life. This feeds into an economic model, evaluating the lifetime performance of different replacement strategies, making explicit the value of different designs and their flexibility. A proof of concept study demonstrates this approach for a pumping station. The strategic planning timelines for this structure demonstrate that moments when capital interventions become necessary due to reduced functionality from structural degradation or changed operating conditions are widely spread over the structure's life. The disparate timing of these necessary interventions supports an incremental, adaptive mindset when considering end-of-life and replacement decisions. The analysis then explores different replacement decisions, varying the size and specific options included in the proposed new structure. Results show that incremental adaptive designs and incorporating options can improve economic performance, as compared to traditional, "build it once & build it big" designs. The benefit from incorporating flexibility varies with structural functionality, future conditions and the specific options examined.

Lack of tolerable treatment options for patients with schizophrenia.

PubMed

Citrome, Leslie; Eramo, Anna; Francois, Clement; Duffy, Ruth; Legacy, Susan N; Offord, Steve J; Krasa, Holly B; Johnston, Stephen S; Guiraud-Diawara, Alice; Kamat, Siddhesh A; Rohman, Patricia

2015-01-01

Atypical antipsychotics (AAs), an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE) or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. A high proportion of patients (>80%) were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60%) and obesity (>40%). From the nine treatment options available, the number of optimal choices for individual patient segments were limited based on their prior history, including those with cardiometabolic and cardiovascular comorbidities (four); experiencing prolactin elevation-related problems (seven); needing to avoid excessive sedation (four); or at risk of extrapyramidal symptoms or akathisia (two). Options were then further restricted among patients in more than one segment when multiple pre-index AE risk factors were combined. When combining patient risk profile with antipsychotic AE profile, physicians may quickly run out of tolerable treatment options for individual patients, despite the availability of many AAs, suggesting a need for additional treatment options with better tolerability and without compromising efficacy.

Practical issues surrounding the explosion of tyrosine kinase inhibitors for the management of chronic myeloid leukemia.

PubMed

Mathisen, Michael S; Kantarjian, Hagop M; Cortes, Jorge; Jabbour, Elias J

2014-09-01

The advent of tyrosine kinase inhibitors (TKIs) has drastically changed the treatment outcome of chronic myeloid leukemia (CML). Imatinib was the first TKI approved, and has been considered the standard of care for more than a decade. Second generation compounds, namely dasatinib and nilotinib, are highly effective in newly diagnosed patients as well as those who fail imatinib. Bosutinib and ponatinib have also become available as second line options. With five agents from which to choose, selecting a TKI has become a challenge. Multiple tests are now available to determine a patient's disease status, making the ideal monitoring strategy unclear. The gold standard for response to TKI therapy remains the achievement of complete cytogenetic response. This review will discuss the practical aspects of selecting a TKI and monitoring a patient once on therapy, including when to consider a treatment change. Other relevant issues, including cost, compliance, role of allogeneic hematopoietic cell transplantation, and discontinuation of TKIs will also be covered. Copyright © 2014. Published by Elsevier Ltd.

78 FR 77185 - Self-Regulatory Organizations; BOX Options Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-20

... options, including NDX. Rule 6090 permits the Exchange to list up to seven expiration months at any one...) specifically references options on NDX as one of the European-style index options approved for trading on BOX...

Using Priced Options to Solve the Exposure Problem in Sequential Auctions

NASA Astrophysics Data System (ADS)

Mous, Lonneke; Robu, Valentin; La Poutré, Han

This paper studies the benefits of using priced options for solving the exposure problem that bidders with valuation synergies face when participating in multiple, sequential auctions. We consider a model in which complementary-valued items are auctioned sequentially by different sellers, who have the choice of either selling their good directly or through a priced option, after fixing its exercise price. We analyze this model from a decision-theoretic perspective and we show, for a setting where the competition is formed by local bidders, that using options can increase the expected profit for both buyers and sellers. Furthermore, we derive the equations that provide minimum and maximum bounds between which a synergy buyer's bids should fall in order for both sides to have an incentive to use the options mechanism. Next, we perform an experimental analysis of a market in which multiple synergy bidders are active simultaneously.

Pricing the property claim service (PCS) catastrophe insurance options using gamma distribution

NASA Astrophysics Data System (ADS)

Noviyanti, Lienda; Soleh, Achmad Zanbar; Setyanto, Gatot R.

2017-03-01

The catastrophic events like earthquakes, hurricanes or flooding are characteristics for some areas, a properly calculated annual premium would be closely as high as the loss insured. From an actuarial perspective, such events constitute the risk that are not insurable. On the other hand people living in such areas need protection. In order to securitize the catastrophe risk, futures or options based on a loss index could be considered. Chicago Board of Trade launched a new class of catastrophe insurance options based on new indices provided by Property Claim Services (PCS). The PCS-option is based on the Property Claim Service Index (PCS-Index). The index are used to determine and payout in writing index-based insurance derivatives. The objective of this paper is to price PCS Catastrophe Insurance Option based on PCS Catastrophe index. Gamma Distribution is used to estimate PCS Catastrophe index distribution.

Space station data system analysis/architecture study. Task 2: Options development, DR-5. Volume 3: Programmatic options

NASA Technical Reports Server (NTRS)

1985-01-01

Task 2 in the Space Station Data System (SSDS) Analysis/Architecture Study is the development of an information base that will support the conduct of trade studies and provide sufficient data to make design/programmatic decisions. This volume identifies the preferred options in the programmatic category and characterizes these options with respect to performance attributes, constraints, costs, and risks. The programmatic category includes methods used to administrate/manage the development, operation and maintenance of the SSDS. The specific areas discussed include standardization/commonality; systems management; and systems development, including hardware procurement, software development and system integration, test and verification.

A maximum (non-extensive) entropy approach to equity options bid-ask spread

NASA Astrophysics Data System (ADS)

Tapiero, Oren J.

2013-07-01

The cross-section of options bid-ask spreads with their strikes are modelled by maximising the Kaniadakis entropy. A theoretical model results with the bid-ask spread depending explicitly on the implied volatility; the probability of expiring at-the-money and an asymmetric information parameter (κ). Considering AIG as a test case for the period between January 2006 and October 2008, we find that information flows uniquely from the trading activity in the underlying asset to its derivatives. Suggesting that κ is possibly an option implied measure of the current state of trading liquidity in the underlying asset.

Surgical Treatment as a First Option of the Lower Eyelid Xanthelasma.

PubMed

Obradovic, Bojan

2017-10-01

Xanthelasma palpebrarum represents yellowish plaques, which mostly appear near the inner cantus of the eyelid. In most patients, cosmetic reasons are the main purpose for their removal.The author presents a patient with a lower eyelid xanthelasma where surgical excision was used as a first treatment option. Cosmetic reasons, fast recovery, and possibility of a 1-stage procedure were the main requests of the patient for the removal of xanthelasma. Treatment and postrecovery period were routine.In the treatment of xanthelasma palpebrarum of the lower eyelids, it is necessary to consider surgical excision as a first treatment option.

Age Differences in Consumer Decision Making under Option Framing: From the Motivation Perspective

PubMed Central

Peng, Huamao; Xia, Shiyong; Ruan, Fanglin; Pu, Bingyan

2016-01-01

Option framing effect is the phenomena that participants often accept more options when they are asked to delete undesired options from a full model (subtractive framing) than they do when they are instructed to add desired options to a base model (additive framing). Whether the same effect exists in different age groups is less well known. To explore the roles of age and purchase motivations on the option framing effect for automobiles purchases, this study adopted a 3 (age group: younger, middle-aged, vs. older) × 2 (option framing: additive vs. subtractive) × 2 (focus condition: information vs. emotion) mixed design. To manipulate purchase motivations, participants in the three age groups were instructed to focus on the ratio of utility and price of options (information-focus) or the extent of pleasure induced by the options (emotion-focus) when they made purchase decisions in two framing conditions. The results revealed similar option framing effect across all age groups in the information-focus condition regarding the total price paid for accepted options. In contrast, the framing effect was not found in the emotion-focus condition. In addition, older adults accepted more options and an overall higher price than younger and middle-aged adults in both focus conditions. This difference was more obvious in the emotion-focus condition than in the information-focus condition. Moreover, both the number of accepted options and the total accepted price of the younger group in the information-focus condition were higher than those in the emotion-focus condition, whereas the older and middle-aged groups accepted same number of options and price between two focus conditions. These results imply that purchase motivation is a moderator of the option framing effect and age characteristics linked with motivations must be considered in sales. PMID:27872603

Age Differences in Consumer Decision Making under Option Framing: From the Motivation Perspective.

PubMed

Peng, Huamao; Xia, Shiyong; Ruan, Fanglin; Pu, Bingyan

2016-01-01

Option framing effect is the phenomena that participants often accept more options when they are asked to delete undesired options from a full model (subtractive framing) than they do when they are instructed to add desired options to a base model (additive framing). Whether the same effect exists in different age groups is less well known. To explore the roles of age and purchase motivations on the option framing effect for automobiles purchases, this study adopted a 3 (age group: younger, middle-aged, vs. older) × 2 (option framing: additive vs. subtractive) × 2 (focus condition: information vs. emotion) mixed design. To manipulate purchase motivations, participants in the three age groups were instructed to focus on the ratio of utility and price of options (information-focus) or the extent of pleasure induced by the options (emotion-focus) when they made purchase decisions in two framing conditions. The results revealed similar option framing effect across all age groups in the information-focus condition regarding the total price paid for accepted options. In contrast, the framing effect was not found in the emotion-focus condition. In addition, older adults accepted more options and an overall higher price than younger and middle-aged adults in both focus conditions. This difference was more obvious in the emotion-focus condition than in the information-focus condition. Moreover, both the number of accepted options and the total accepted price of the younger group in the information-focus condition were higher than those in the emotion-focus condition, whereas the older and middle-aged groups accepted same number of options and price between two focus conditions. These results imply that purchase motivation is a moderator of the option framing effect and age characteristics linked with motivations must be considered in sales.

Geosynchronous platform definition study. Volume 4, Part 1: Traffic analysis and system requirements for the baseline traffic model

NASA Technical Reports Server (NTRS)

1973-01-01

The traffic analyses and system requirements data generated in the study resulted in the development of two traffic models; the baseline traffic model and the new traffic model. The baseline traffic model provides traceability between the numbers and types of geosynchronous missions considered in the study and the entire spectrum of missions foreseen in the total national space program. The information presented pertaining to the baseline traffic model includes: (1) definition of the baseline traffic model, including identification of specific geosynchronous missions and their payload delivery schedules through 1990; (2) Satellite location criteria, including the resulting distribution of the satellite population; (3) Geosynchronous orbit saturation analyses, including the effects of satellite physical proximity and potential electromagnetic interference; and (4) Platform system requirements analyses, including satellite and mission equipment descriptions, the options and limitations in grouping satellites, and on-orbit servicing criteria (both remotely controlled and man-attended).

78 FR 30948 - Self-Regulatory Organizations; Fixed Income Clearing Corporation; Notice of Filing of Advance...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-23

... Options on Interest Rate Futures Contracts With Maturities Not Longer Than Two Years in the One- Pot Cross... allow FICC to include options on interest rate futures contracts with maturities not longer than two...) The purpose of the advance notice is to include options on interest rate futures contracts with...

People, Things, and Places for Young Children. Selecting Toys for Handicapped Children [and] Playgrounds for Exceptional Children: Considering the Options.

ERIC Educational Resources Information Center

Kemnitzer, Ronald B.; Williams, Ronald R.

The two papers focus on methods of selecting toys for handicapped children and options in playground equipment for this population. The qualities of a good toy, such as stimulation and safety, are examined. The author discusses various considerations in selecting toys for different handicaps; for example, toys for visually impaired children should…

Identifying Effective Design Approaches to Allocate Genotypes in Two-Phase Designs: A Case Study in Pelargonium zonale.

PubMed

Molenaar, Heike; Boehm, Robert; Piepho, Hans-Peter

2017-01-01

Robust phenotypic data allow adequate statistical analysis and are crucial for any breeding purpose. Such data is obtained from experiments laid out to best control local variation. Additionally, experiments frequently involve two phases, each contributing environmental sources of variation. For example, in a former experiment we conducted to evaluate production related traits in Pelargonium zonale , there were two consecutive phases, each performed in a different greenhouse. Phase one involved the propagation of the breeding strains to obtain the stem cutting count, and phase two involved the assessment of root formation. The evaluation of the former study raised questions regarding options for improving the experimental layout: (i) Is there a disadvantage to using exactly the same design in both phases? (ii) Instead of generating a separate layout for each phase, can the design be optimized across both phases, such that the mean variance of a pair-wise treatment difference (MVD) can be decreased? To answer these questions, alternative approaches were explored to generate two-phase designs either in phase-wise order (Option 1) or across phases (Option 2). In Option 1 we considered the scenarios (i) using in both phases the same experimental design and (ii) randomizing each phase separately. In Option 2, we considered the scenarios (iii) generating a single design with eight replicates and splitting these among the two phases, (iv) separating the block structure across phases by dummy coding, and (v) design generation with optimal alignment of block units in the two phases. In both options, we considered the same or different block structures in each phase. The designs were evaluated by the MVD obtained by the intra-block analysis and the joint inter-block-intra-block analysis. The smallest MVD was most frequently obtained for designs generated across phases rather than for each phase separately, in particular when both phases of the design were separated with a single pseudo-level. The joint optimization ensured that treatment concurrences were equally balanced across pairs, one of the prerequisites for an efficient design. The proposed alternative approaches can be implemented with any model-based design packages with facilities to formulate linear models for treatment and block structures.

Protecting Our Turf

ERIC Educational Resources Information Center

DeNisco, Alison

2013-01-01

Gone are the days of squishy grass and pothole-laden school fields: artificial turf fields are becoming an increasingly popular option for districts nationwide for their ease of use and cost-effective maintenance. When considering installing an artificial turf field in a district, administrators must consider funding, sustainability, potential…

Renewables-to-reefs? - Decommissioning options for the offshore wind power industry.

PubMed

Smyth, Katie; Christie, Nikki; Burdon, Daryl; Atkins, Jonathan P; Barnes, Richard; Elliott, Michael

2015-01-15

The offshore wind power industry is relatively new but increasing globally, hence it is important that the whole life-cycle is managed. The construction-operation-decommissioning cycle is likely to take 20-30 years and whilst decommissioning may not be undertaken for many years, its management needs to be addressed in both current and future marine management regimes. This can be defined within a Drivers-Activities-Pressures-State Changes-Impacts (on human Welfare)-Responses framework. This paper considers the main decommissioning options - partial or complete removal of all components. A SWOT analysis shows environmental and economic benefits in partial as opposed to complete removal, especially if habitat created on the structures has conservation or commercial value. Benefits (and repercussions) are defined in terms of losses and gains of ecosystem services and societal benefits. The legal precedents and repercussions of both options are considered in terms of the 10-tenets of sustainable marine management. Finally a 'renewables-to-reefs' programme is proposed. Copyright © 2014 Elsevier Ltd. All rights reserved.

The ClusPro web server for protein-protein docking

PubMed Central

Kozakov, Dima; Hall, David R.; Xia, Bing; Porter, Kathryn A.; Padhorny, Dzmitry; Yueh, Christine; Beglov, Dmitri; Vajda, Sandor

2017-01-01

The ClusPro server (https://cluspro.org) is a widely used tool for protein-protein docking. The server provides a simple home page for basic use, requiring only two files in Protein Data Bank format. However, ClusPro also offers a number of advanced options to modify the search that include the removal of unstructured protein regions, applying attraction or repulsion, accounting for pairwise distance restraints, constructing homo-multimers, considering small angle X-ray scattering (SAXS) data, and finding heparin binding sites. Six different energy functions can be used depending on the type of proteins. Docking with each energy parameter set results in ten models defined by centers of highly populated clusters of low energy docked structures. This protocol describes the use of the various options, the construction of auxiliary restraints files, the selection of the energy parameters, and the analysis of the results. Although the server is heavily used, runs are generally completed in < 4 hours. PMID:28079879

Post-traumatic female urethral reconstruction.

PubMed

Blaivas, Jerry G; Purohit, Rajveer S

2008-09-01

Post-traumatic urethral damage resulting in urethrovaginal fistulas or strictures, though rare, should be suspected in patients who have unexpected urinary incontinence or lower urinary tract symptoms after pelvic surgery, pelvic fracture, a long-term indwelling urethral catheter, or pelvic radiation. Careful physical examination and cystourethroscopy are critical to diagnose and assess the extent of the fistula. A concomitant vesicovaginal or ureterovaginal fistula should also be ruled out. The two main indications for reconstruction are sphincteric incontinence and urethral obstruction. Surgical correction intends to create a continent urethra that permits volitional, painless, and unobstructed passage of urine. An autologous pubovaginal sling, with or without a Martius flap at time of reconstruction, should be considered. The three approaches to urethral reconstruction are anterior bladder flaps, posterior bladder flaps, and vaginal wall flaps. We believe vaginal flaps are usually the best option. Options for vaginal repair of fistula include primary closure, peninsula flaps, bilateral labial pedicle flaps, and labial island flaps. Outcomes are optimized by using exacting surgical principles during repair and careful postoperative management by an experienced reconstructive surgeon.

Fusion energy for space missions in the 21st Century

NASA Technical Reports Server (NTRS)

Schulze, Norman R.

1991-01-01

Future space missions were hypothesized and analyzed and the energy source for their accomplishment investigated. The mission included manned Mars, scientific outposts to and robotic sample return missions from the outer planets and asteroids, as well as fly-by and rendezvous mission with the Oort Cloud and the nearest star, Alpha Centauri. Space system parametric requirements and operational features were established. The energy means for accomplishing the High Energy Space Mission were investigated. Potential energy options which could provide the propulsion and electric power system and operational requirements were reviewed and evaluated. Fusion energy was considered to be the preferred option and was analyzed in depth. Candidate fusion fuels were evaluated based upon the energy output and neutron flux. Reactors exhibiting a highly efficient use of magnetic fields for space use while at the same time offering efficient coupling to an exhaust propellant or to a direct energy convertor for efficient electrical production were examined. Near term approaches were identified.

48 CFR 17.107 - Options.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Options. 17.107 Section 17... CONTRACT TYPES SPECIAL CONTRACTING METHODS Multiyear Contracting 17.107 Options. Benefits may accrue by including options in a multiyear contract. In that event, contracting officers must follow the requirements...

Optimal Lease Contract for Remanufactured Equipment

NASA Astrophysics Data System (ADS)

Iskandar, B. P.; Wangsaputra, R.; Pasaribu, U. S.; Husniah, H.

2018-03-01

In the last two decades, the business of lease products (or equipment) has grown significantly, and many companies acquire equipment through leasing. In this paper, we propose a new lease contract under which a product (or equipment) is leased for a period of time with maximum usage per period (e.g. 1 year). This lease contract has only a time limit but no usage limit. If the total usage per period exceeds the maximum usage allowed in the contract, then the customer (as a lessee) will be charged an additional cost. In general, the lessor (OEM) provides a full coverage of maintenance, which includes PM and CM under the lease contract. It is considered that the lessor offers the lease contract for a remanufactured product. We presume that the price of the lease contract for the remanufactured product is much lower than that of a new one, and hence it would be a more attractive option to the customer. The decision problem for the lessee is to select the best option offered that fits to its requirement, and the decision problem for the lessor is find the optimal maintenance efforts for a given price of the lease option offered. We first find the optimal decisions independently for each party, and then the joint optimal decisions for both parties.

Identifying patients and clinical scenarios for use of long-acting injectable antipsychotics - expert consensus survey part 1.

PubMed

Sajatovic, Martha; Ross, Ruth; Legacy, Susan N; Correll, Christoph U; Kane, John M; DiBiasi, Faith; Fitzgerald, Heather; Byerly, Matthew

2018-01-01

To assess expert consensus on barriers and facilitators for long-acting injectable antipsychotic (LAI) use and provide clinical recommendations on issues where clinical evidence is lacking, including identifying appropriate clinical situations for LAI use. A 50-question survey comprising 916 response options was distributed to 42 research experts and high prescribers with extensive LAI experience. Respondents rated options on relative appropriateness/importance using a 9-point scale. Consensus was determined using chi-square test of score distributions. Mean (standard deviation) ratings were calculated. Responses to 29 questions (577 options) relating to appropriate patients and clinical scenarios for LAI use are reported. Recommendations aligned with research on risk factors for nonadherence and poor outcomes for patients with schizophrenia/schizoaffective or bipolar disorder. Findings suggested, contrary to general practice patterns, that LAI use may be appropriate earlier in the disease course and in younger patients. Results for bipolar disorder were similar to those for schizophrenia but with less consensus. Numerous facilitators of LAI prescribing were considered important, particularly that LAIs may reduce relapses and improve outcomes. Findings support wider use of LAIs in patients with schizophrenia/schizoaffective and bipolar disorders beyond the setting of poor adherence and earlier use in the disease course.

Current status in the treatment options for esophageal achalasia

PubMed Central

Chuah, Seng-Kee; Chiu, Chien-Hua; Tai, Wei-Chen; Lee, Jyong-Hong; Lu, Hung-I; Changchien, Chi-Sin; Tseng, Ping-Huei; Wu, Keng-Liang

2013-01-01

Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy (POEM). The first multicenter randomized, controlled, 2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy (LHM) was not superior to pneumatic dilations (PD). Publications on the long-term success of laparoscopic surgery continue to emerge. In addition, laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication. The optimal treatment option is an ongoing matter of debate. In this review, we provide an update of the current progress in the treatment of esophageal achalasia. Unless new conclusive data prove otherwise, LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications. However, PD is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an “on-demand” strategy based on symptom recurrence can achieve long-term remission. Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options. POEM has shown promise but its long-term efficacy and safety need to be assessed further. PMID:24023484

Current status in the treatment options for esophageal achalasia.

PubMed

Chuah, Seng-Kee; Chiu, Chien-Hua; Tai, Wei-Chen; Lee, Jyong-Hong; Lu, Hung-I; Changchien, Chi-Sin; Tseng, Ping-Huei; Wu, Keng-Liang

2013-09-07

Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy (POEM). The first multicenter randomized, controlled, 2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy (LHM) was not superior to pneumatic dilations (PD). Publications on the long-term success of laparoscopic surgery continue to emerge. In addition, laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication. The optimal treatment option is an ongoing matter of debate. In this review, we provide an update of the current progress in the treatment of esophageal achalasia. Unless new conclusive data prove otherwise, LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications. However, PD is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an "on-demand" strategy based on symptom recurrence can achieve long-term remission. Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options. POEM has shown promise but its long-term efficacy and safety need to be assessed further.

The treatment of irritable bowel syndrome.

PubMed

Lacy, Brian E; Weiser, Kirsten; De Lee, Ryan

2009-07-01

Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder routinely encountered by healthcare providers. Although not life-threatening, this chronic disorder reduces patients' quality of life and imposes a significant economic burden to the healthcare system. IBS is no longer considered a diagnosis of exclusion that can only be made after performing a battery of expensive diagnostic tests. Rather, IBS should be confidently diagnosed in the clinic at the time of the first visit using the Rome III criteria and a careful history and physical examination. Treatment options for IBS have increased in number in the past decade and clinicians should not be limited to using only fiber supplements and smooth muscle relaxants. Although all patients with IBS have symptoms of abdominal pain and disordered defecation, treatment needs to be individualized and should focus on the predominant symptom. This paper will review therapeutic options for the treatment of IBS using a tailored approach based on the predominant symptom. Abdominal pain, bloating, constipation and diarrhea are the four main symptoms that can be addressed using a combination of dietary interventions and medications. Treatment options include probiotics, antibiotics, tricyclic antidepressants, selective serotonin reuptake inhibitors and agents that modulate chloride channels and serotonin. Each class of agent will be reviewed using the latest data from the literature.

Pedicled Extranasal Flaps in Skull Base Reconstruction

PubMed Central

Kim, Grace G.; Hang, Anna X.; Mitchell, Candace; Zanation, Adam M.

2013-01-01

Cerebrospinal fluid (CSF) leaks most commonly arise during or after skull base surgery, although they occasionally present spontaneously. Recent advances in the repair of CSF leaks have enabled endoscopic endonasal surgery to become the preferred option for management of skull base pathology. Small defects (<1cm) can be repaired by multilayered free grafts. For large defects (>3cm), pedicled vascular flaps are the repair method of choice, resulting in much lower rates of postoperative CSF leaks. The pedicled nasoseptal flap (NSF) constitutes the primary reconstructive option for the vast majority of skull base defects. It has a large area of potential coverage and high rates of success. However, preoperative planning is required to avoid sacrificing the NSF during resection. In cases where the NSF is unavailable, often due to tumor involvement of the septum or previous resection removing or compromising the flap, other flaps may be considered. These flaps include intranasal options—inferior turbinate (IT) or middle turbinate (MT) flaps—as well as regional pedicled flaps: pericranial flap (PCF), temporoparietal fascial flap (TPFF), or palatal flap (PF). More recently, novel alternatives such as the pedicled facial buccinator flap (FAB) and the pedicled occipital galeopericranial flap (OGP) have been added to the arsenal of options for skull base reconstruction. Characteristics of and appropriate uses for each flap are described. PMID:23257554