Identifying causes of adverse events detected by an automated trigger tool through in-depth analysis.

PubMed

Muething, S E; Conway, P H; Kloppenborg, E; Lesko, A; Schoettker, P J; Seid, M; Kotagal, U

2010-10-01

To describe how in-depth analysis of adverse events can reveal underlying causes. Triggers for adverse events were developed using the hospital's computerised medical record (naloxone for opiate-related oversedation and administration of a glucose bolus while on insulin for insulin-related hypoglycaemia). Triggers were identified daily. Based on information from the medical record and interviews, a subject expert determined if an adverse drug event had occurred and then conducted a real-time analysis to identify event characteristics. Expert groups, consisting of frontline staff and specialist physicians, examined event characteristics and determined the apparent cause. 30 insulin-related hypoglycaemia events and 34 opiate-related oversedation events were identified by the triggers over 16 and 21 months, respectively. In the opinion of the experts, patients receiving continuous-infusion insulin and those receiving dextrose only via parenteral nutrition were at increased risk for insulin-related hypoglycaemia. Lack of standardisation in insulin-dosing decisions and variation regarding when and how much to adjust insulin doses in response to changing glucose levels were identified as common causes of the adverse events. Opiate-related oversedation events often occurred within 48 h of surgery. Variation in pain management in the operating room and post-anaesthesia care unit was identified by the experts as potential causes. Variations in practice, multiple services writing orders, multidrug regimens and variations in interpretation of patient assessments were also noted as potential contributing causes. Identification of adverse drug events through an automated trigger system, supplemented by in-depth analysis, can help identify targets for intervention and improvement.

Interhospital transfer of children in respiratory failure: a clinician interview qualitative study.

PubMed

Odetola, Folafoluwa O; Anspach, Renee R; Han, Yong Y; Clark, Sarah J

2017-02-01

To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care. Interviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao 2 )/Fio 2 (32%), and inflation pressure (16%). Poor clinical response was signified by high OI, inflation pressure, and Fio 2 , and low Pao 2 /Fio 2 . At EP 1, 18 of 19 respondents would initiate high-frequency oscillatory ventilation, and 1 would transfer. At EP 2, 15 of 18 respondents would maintain high-frequency oscillatory ventilation, 9 of them calling to discuss transfer. All respondents would transfer if escalated therapies failed to reverse the patient's clinical deterioration. Interhospital transfer of children in respiratory failure is triggered by poor response to escalation of locally available care modalities. This finding provides new insight into decision making underlying interhospital transfer of children with respiratory failure. Copyright © 2016 Elsevier Inc. All rights reserved.

Criticality triggers the emergence of collective intelligence in groups.

PubMed

De Vincenzo, Ilario; Giannoccaro, Ilaria; Carbone, Giuseppe; Grigolini, Paolo

2017-08-01

A spinlike model mimicking human behavior in groups is employed to investigate the dynamics of the decision-making process. Within the model, the temporal evolution of the state of systems is governed by a time-continuous Markov chain. The transition rates of the resulting master equation are defined in terms of the change of interaction energy between the neighboring agents (change of the level of conflict) and the change of a locally defined agent fitness. Three control parameters can be identified: (i) the social interaction strength βJ measured in units of social temperature, (ii) the level of confidence β^{'} that each individual has on his own expertise, and (iii) the level of knowledge p that identifies the expertise of each member. Based on these three parameters, the phase diagrams of the system show that a critical transition front exists where a sharp and concurrent change in fitness and consensus takes place. We show that at the critical front, the information leakage from the fitness landscape to the agents is maximized. This event triggers the emergence of the collective intelligence of the group, and in the end it leads to a dramatic improvement in the decision-making performance of the group. The effect of size M of the system is also investigated, showing that, depending on the value of the control parameters, increasing M may be either beneficial or detrimental.

Criticality triggers the emergence of collective intelligence in groups

NASA Astrophysics Data System (ADS)

De Vincenzo, Ilario; Giannoccaro, Ilaria; Carbone, Giuseppe; Grigolini, Paolo

2017-08-01

A spinlike model mimicking human behavior in groups is employed to investigate the dynamics of the decision-making process. Within the model, the temporal evolution of the state of systems is governed by a time-continuous Markov chain. The transition rates of the resulting master equation are defined in terms of the change of interaction energy between the neighboring agents (change of the level of conflict) and the change of a locally defined agent fitness. Three control parameters can be identified: (i) the social interaction strength β J measured in units of social temperature, (ii) the level of confidence β' that each individual has on his own expertise, and (iii) the level of knowledge p that identifies the expertise of each member. Based on these three parameters, the phase diagrams of the system show that a critical transition front exists where a sharp and concurrent change in fitness and consensus takes place. We show that at the critical front, the information leakage from the fitness landscape to the agents is maximized. This event triggers the emergence of the collective intelligence of the group, and in the end it leads to a dramatic improvement in the decision-making performance of the group. The effect of size M of the system is also investigated, showing that, depending on the value of the control parameters, increasing M may be either beneficial or detrimental.

Alcohol Consumption Decisions among Nonabusing Drinkers Diagnosed with Hepatitis C: An Exploratory Sequential Mixed Methods Study

PubMed Central

Stoller, Eleanor Palo; Webster, Noah J.; Blixen, Carol E.; McCormick, Richard A.; Hund, Andrew J.; Perzynski, Adam T.; Kanuch, Stephanie W.; Thomas, Charles L.; Kercher, Kyle; Dawson, Neal V.

2009-01-01

Most studies of decisions to curtail alcohol consumption reflect experiences of abusing drinkers. We employ an exploratory sequential research design to explore the applicability of this research to the experience of nonabusing drinkers advised to curtail alcohol consumption after a Hepatitis C diagnosis. A qualitative component identified 17 new decision factors not reflected in an inventory of factors based on synthesis of existing scales. We triangulated qualitative data by supplementing semi-structured interviews with Internet postings. A quantitative component estimated prevalence and association with current drinking of these new decision factors. Patients who quit drinking tended to attribute post-diagnosis drinking to occasional triggers, whereas patients who were still drinking were more likely to endorse rationales not tied to specific triggers. PMID:20046861

Torts to contract? Moving from informed consent to shared decision-making.

PubMed

Monico, Edward P; Calise, Arthur; Calabro, Joseph

2008-01-01

Many claims of medical malpractice arise from a breakdown in communication between physician and patient. As a result, medical decision-making may change from an informed consent model to a shared decision-making strategy. Shared decision-making, a contract derivative, will trigger contract obligations and change the face of medical malpractice from tort to contract.

Managing wildfire events: risk-based decision making among a group of federal fire managers

Treesearch

Robyn S. Wilson; Patricia L. Winter; Lynn A. Maguire; Timothy Ascher

2011-01-01

Managing wildfire events to achieve multiple management objectives involves a high degree of decision complexity and uncertainty, increasing the likelihood that decisions will be informed by experience-based heuristics triggered by available cues at the time of the decision. The research reported here tests the prevalence of three risk-based biases among 206...

DECISION-MAKING SPARK CHAMBERS,

DTIC Science & Technology

of scattering of a particle and coplanarity of two particles. Decision - making spark chambers are used to trigger an optical spark chamber of two...the position of a spark and the separation of two sparks. Many other kinds of spatial decisions can be made with these devices such as the recognition

Graphics Processing Units for HEP trigger systems

NASA Astrophysics Data System (ADS)

Ammendola, R.; Bauce, M.; Biagioni, A.; Chiozzi, S.; Cotta Ramusino, A.; Fantechi, R.; Fiorini, M.; Giagu, S.; Gianoli, A.; Lamanna, G.; Lonardo, A.; Messina, A.; Neri, I.; Paolucci, P. S.; Piandani, R.; Pontisso, L.; Rescigno, M.; Simula, F.; Sozzi, M.; Vicini, P.

2016-07-01

General-purpose computing on GPUs (Graphics Processing Units) is emerging as a new paradigm in several fields of science, although so far applications have been tailored to the specific strengths of such devices as accelerator in offline computation. With the steady reduction of GPU latencies, and the increase in link and memory throughput, the use of such devices for real-time applications in high-energy physics data acquisition and trigger systems is becoming ripe. We will discuss the use of online parallel computing on GPU for synchronous low level trigger, focusing on CERN NA62 experiment trigger system. The use of GPU in higher level trigger system is also briefly considered.

History dependence in insect flight decisions during odor tracking.

PubMed

Pang, Rich; van Breugel, Floris; Dickinson, Michael; Riffell, Jeffrey A; Fairhall, Adrienne

2018-02-01

Natural decision-making often involves extended decision sequences in response to variable stimuli with complex structure. As an example, many animals follow odor plumes to locate food sources or mates, but turbulence breaks up the advected odor signal into intermittent filaments and puffs. This scenario provides an opportunity to ask how animals use sparse, instantaneous, and stochastic signal encounters to generate goal-oriented behavioral sequences. Here we examined the trajectories of flying fruit flies (Drosophila melanogaster) and mosquitoes (Aedes aegypti) navigating in controlled plumes of attractive odorants. While it is known that mean odor-triggered flight responses are dominated by upwind turns, individual responses are highly variable. We asked whether deviations from mean responses depended on specific features of odor encounters, and found that odor-triggered turns were slightly but significantly modulated by two features of odor encounters. First, encounters with higher concentrations triggered stronger upwind turns. Second, encounters occurring later in a sequence triggered weaker upwind turns. To contextualize the latter history dependence theoretically, we examined trajectories simulated from three normative tracking strategies. We found that neither a purely reactive strategy nor a strategy in which the tracker learned the plume centerline over time captured the observed history dependence. In contrast, "infotaxis", in which flight decisions maximized expected information gain about source location, exhibited a history dependence aligned in sign with the data, though much larger in magnitude. These findings suggest that while true plume tracking is dominated by a reactive odor response it might also involve a history-dependent modulation of responses consistent with the accumulation of information about a source over multi-encounter timescales. This suggests that short-term memory processes modulating decision sequences may play a role in natural plume tracking.

History dependence in insect flight decisions during odor tracking

PubMed Central

van Breugel, Floris; Dickinson, Michael; Riffell, Jeffrey A.; Fairhall, Adrienne

2018-01-01

Natural decision-making often involves extended decision sequences in response to variable stimuli with complex structure. As an example, many animals follow odor plumes to locate food sources or mates, but turbulence breaks up the advected odor signal into intermittent filaments and puffs. This scenario provides an opportunity to ask how animals use sparse, instantaneous, and stochastic signal encounters to generate goal-oriented behavioral sequences. Here we examined the trajectories of flying fruit flies (Drosophila melanogaster) and mosquitoes (Aedes aegypti) navigating in controlled plumes of attractive odorants. While it is known that mean odor-triggered flight responses are dominated by upwind turns, individual responses are highly variable. We asked whether deviations from mean responses depended on specific features of odor encounters, and found that odor-triggered turns were slightly but significantly modulated by two features of odor encounters. First, encounters with higher concentrations triggered stronger upwind turns. Second, encounters occurring later in a sequence triggered weaker upwind turns. To contextualize the latter history dependence theoretically, we examined trajectories simulated from three normative tracking strategies. We found that neither a purely reactive strategy nor a strategy in which the tracker learned the plume centerline over time captured the observed history dependence. In contrast, “infotaxis”, in which flight decisions maximized expected information gain about source location, exhibited a history dependence aligned in sign with the data, though much larger in magnitude. These findings suggest that while true plume tracking is dominated by a reactive odor response it might also involve a history-dependent modulation of responses consistent with the accumulation of information about a source over multi-encounter timescales. This suggests that short-term memory processes modulating decision sequences may play a role in natural plume tracking. PMID:29432454

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

Marnay, Chris; Siddiqui, Afzal; Marnay, Chris

This paper examines a California-based microgrid?s decision to invest in a distributed generation (DG) unit fuelled by natural gas. While the long-term natural gas generation cost is stochastic, we initially assume that the microgrid may purchase electricity at a fixed retail rate from its utility. Using the real options approach, we find a natural gas generation cost threshold that triggers DG investment. Furthermore, the consideration of operational flexibility by the microgrid increases DG investment, while the option to disconnect from the utility is not attractive. By allowing the electricity price to be stochastic, we next determine an investment threshold boundarymore » and find that high electricity price volatility relative to that of natural gas generation cost delays investment while simultaneously increasing the value of the investment. We conclude by using this result to find the implicit option value of the DG unit when two sources of uncertainty exist.« less

Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis

PubMed Central

2011-01-01

Background School closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making. Methods We identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members. Results There was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance. Conclusions The use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly. PMID:21284865

Dynamic adjustments of cognitive control during economic decision making.

PubMed

Soutschek, Alexander; Schubert, Torsten

2014-10-01

Decision making in the Ultimatum game requires the resolution of conflicts between economic self-interest and fairness intuitions. Since cognitive control processes play an important role in conflict resolution, the present study examined how control processes that are triggered by conflicts between fairness and self-interest in unfair offers affect subsequent decisions in the Ultimatum game. Our results revealed that more unfair offers were accepted following previously unfair, compared to previously fair offers. Interestingly, the magnitude of this conflict adaptation effect correlated with the individual subjects' focus on economic self-interest. We concluded that conflicts between fairness and self-interest trigger cognitive control processes, which reinforce the focus on the current task goal. Copyright © 2014 Elsevier B.V. All rights reserved.

The Hare and the Tortoise: Emphasizing Speed Can Change the Evidence Used to Make Decisions

ERIC Educational Resources Information Center

Rae, Babette; Heathcote, Andrew; Donkin, Chris; Averell, Lee; Brown, Scott

2014-01-01

Decision-makers effortlessly balance the need for urgency against the need for caution. Theoretical and neurophysiological accounts have explained this tradeoff solely in terms of the "quantity" of evidence required to trigger a decision (the "threshold"). This explanation has also been used as a benchmark test for evaluating…

Internationally recruited nurses from India and the Philippines in the United Kingdom: the decision to emigrate

PubMed Central

Alonso-Garbayo, Álvaro; Maben, Jill

2009-01-01

Background The United Kingdom has recruited nurses from countries with a reported surplus in their nursing workforce, such as India and the Philippines. However, little is known about the decision to emigrate made by nurses from these countries. One theory suggests that individuals weigh the benefits and costs of migration: the push and pull factors. This paper challenges the restricted economic focus of this predominant theory and compares the diverse motivations of nurses from different countries as well as those of nurses with previous migratory experience and first-time migrants. Methods This research was undertaken in a National Health Service acute trust in London by means of a qualitative interpretative approach. Data were collected through face-to-face longitudinal and cross-sectional interviews with internationally recruited nurses from India (n = 6) and the Philippines (n = 15); and analysis of their narratives was used to generate data about their expectations and experiences. Data were analysed by means of a framework approach that allowed for intra-case and cross-case analysis. Results From an individual perspective, nurses in this study reported economic reasons as the main trigger for migration in the first instance. Yet this doesn't entirely explain the decision to move from previous migratory destinations (e.g. Saudi Arabia) where economic needs are already fulfilled. In these cases migration is influenced by professional and social aspirations that highlight the influence of the cultural environment – specifically some religious and gender-related issues. Family support and support from migratory networks in the country of origin and destination were also important elements conducive to and supportive of migration. Nurses from India report coming to the United Kingdom to stay, while Filipina nurses come as temporary migrants sending remittances to support their families in the Philippines. Conclusion This study shows the diverse motivations of nurses from different countries and with different migratory backgrounds and provides evidence that factors other than economic factors influence nurses' decision to emigrate. This information can help developing countries increase retention of this essential and often scarce resource and can also help the United Kingdom's National Health Service to improve the experience of internationally recruited nurses and therefore increase their retention in the United Kingdom. PMID:19393080

Decision making.

PubMed

Chambers, David W

2011-01-01

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

A Multidisciplinary Sepsis Program Enabled by a Two-Stage Clinical Decision Support System: Factors That Influence Patient Outcomes.

PubMed

Amland, Robert C; Haley, James M; Lyons, Jason J

2016-11-01

Sepsis is an inflammatory response triggered by infection, with risk of in-hospital mortality fueled by disease progression. Early recognition and intervention by multidisciplinary sepsis programs may reverse the inflammatory response among at-risk patient populations, potentially improving outcomes. This retrospective study of a sepsis program enabled by a 2-stage sepsis Clinical Decision Support (CDS) system sought to evaluate the program's impact, identify early indicators that may influence outcomes, and uncover opportunities for quality improvement. Data encompassed 16 527 adult hospitalizations from 2014 and 2015. Of 2108 non-intensive care unit patients screened-in by sepsis CDS, 97% patients were stratified by 177 providers. Risk of adverse outcome improved 30% from baseline to year end, with gains materializing and stabilizing at month 7 after sepsis program go-live. Early indicators likely to influence outcomes include patient age, recent hospitalization, electrolyte abnormalities, hypovolemic shock, hypoxemia, patient location when sepsis CDS activated, and specific alert patterns. © The Author(s) 2015.

Private information alone can trigger trapping of ant colonies in local feeding optima.

PubMed

Czaczkes, Tomer J; Salmane, Anete K; Klampfleuthner, Felicia A M; Heinze, Jürgen

2016-03-01

Ant colonies are famous for using trail pheromones to make collective decisions. Trail pheromone systems are characterised by positive feedback, which results in rapid collective decision making. However, in an iconic experiment, ants were shown to become 'trapped' in exploiting a poor food source, if it was discovered earlier. This has conventionally been explained by the established pheromone trail becoming too strong for new trails to compete. However, many social insects have a well-developed memory, and private information often overrules conflicting social information. Thus, route memory could also explain this collective 'trapping' effect. Here, we disentangled the effects of social and private information in two 'trapping' experiments: one in which ants were presented with a good and a poor food source, and one in which ants were presented with a long and a short path to the same food source. We found that private information is sufficient to trigger trapping in selecting the poorer of two food sources, and may be sufficient to cause it altogether. Memories did not trigger trapping in the shortest path experiment, probably because sufficiently detailed memories did not form. The fact that collective decisions can be triggered by private information alone may require other collective patterns previously attributed solely to social information use to be reconsidered. © 2016. Published by The Company of Biologists Ltd.

Decision Making in the Reward and Punishment Variants of the Iowa Gambling Task: Evidence of “Foresight” or “Framing”?

PubMed Central

Singh, Varsha; Khan, Azizuddin

2012-01-01

Surface-level differences in the reward and punishment variants, specifically greater long-term decision making in the punishment variant of the Iowa Gambling Task (IGT) observed in previous studies led to the present comparison of long-term decision making in the two IGT variants (n = 320, male = 160). It was contended that risk aversion triggered by a positive frame of the reward variant and risk seeking triggered by a negative frame of the punishment variant appears as long-term decision making in the two IGT variants. Apart from the frame of the variant as a within-subjects factor (variant type: reward and punishment), the order in which the frame was triggered (order type: reward–punishment or punishment–reward), and the four types of instructions that delineated motivation toward reward from that of punishment (reward, punishment, reward and punishment, and no-hint) were hypothesized to have an effect on foresighted decision making in the IGT. As expected, long-term decision making differed across the two IGT variants suggesting that the frame of the variant has an effect on long-term decision making in the IGT (p < 0.001). The order in which a variant was presented, and the type of the instructions that were used both had an effect on long-term decision making in the two IGT variants (p < 0.05). A post hoc test suggested that the instructions that differentiated between reward and punishment resulted in greater foresight than the commonly used IGT instructions that fail to distinguish between reward and punishment. As observed in previous studies, there were more number of participants (60%) who showed greater foresight in the punishment variant than in the reward variant (p < 0.001). The results suggest that foresight in IGT decision making is sensitive to reward and punishment frame in an asymmetric manner, an observation that is aligned with the behavioral decision making framework. Benefits of integrating findings from behavioral studies in decision neuroscience are discussed, and a need to investigate cultural differences in the IGT studies is pointed out. PMID:22833714

Decision making in the reward and punishment variants of the iowa gambling task: evidence of "foresight" or "framing"?

PubMed

Singh, Varsha; Khan, Azizuddin

2012-01-01

Surface-level differences in the reward and punishment variants, specifically greater long-term decision making in the punishment variant of the Iowa Gambling Task (IGT) observed in previous studies led to the present comparison of long-term decision making in the two IGT variants (n = 320, male = 160). It was contended that risk aversion triggered by a positive frame of the reward variant and risk seeking triggered by a negative frame of the punishment variant appears as long-term decision making in the two IGT variants. Apart from the frame of the variant as a within-subjects factor (variant type: reward and punishment), the order in which the frame was triggered (order type: reward-punishment or punishment-reward), and the four types of instructions that delineated motivation toward reward from that of punishment (reward, punishment, reward and punishment, and no-hint) were hypothesized to have an effect on foresighted decision making in the IGT. As expected, long-term decision making differed across the two IGT variants suggesting that the frame of the variant has an effect on long-term decision making in the IGT (p < 0.001). The order in which a variant was presented, and the type of the instructions that were used both had an effect on long-term decision making in the two IGT variants (p < 0.05). A post hoc test suggested that the instructions that differentiated between reward and punishment resulted in greater foresight than the commonly used IGT instructions that fail to distinguish between reward and punishment. As observed in previous studies, there were more number of participants (60%) who showed greater foresight in the punishment variant than in the reward variant (p < 0.001). The results suggest that foresight in IGT decision making is sensitive to reward and punishment frame in an asymmetric manner, an observation that is aligned with the behavioral decision making framework. Benefits of integrating findings from behavioral studies in decision neuroscience are discussed, and a need to investigate cultural differences in the IGT studies is pointed out.

Influence of Age on Decision-Making Process to Limit or Withdraw Life-Sustaining Treatment in the Intensive Care Unit - A Single Center Prospective Observational Study.

PubMed

Ducos, G; Mathe, O; Balardy, L; Lozano, S; Kurrek, M; Ruiz, J; Riu-Poulenc, B; Fourcade, O; Silva, S; Minville, V

2017-01-01

The increasing age in the industrialized countries places significant demands on intensive care unit (ICU) resources and this triggers debates about end-of-life care for the elderly. We sought to determine the impact of age on the decision-making process to limit or withdraw life-sustaining treatment (DWLST) in an ICU in France. We hypothesized that there are differences in the decision-making process for young and old patients. We prospectively studied end-of-life decision-making for all consecutive admissions (n=390) to a tertiary care university ICU in Toulouse, France over a period of 11 months between January and October 2011. Among the 390 patients included in the study (age ≥70yo, n=95; age <70yo, n=295) DWLST were more common for patients 70 years or older (43% for age ≥70yo vs. 16% for age <70yo, p <0.0001). Reasons for DWLST were different in the 2 groups, with the 'no alternative treatment options' and 'severity of illness' as the most frequent reasons cited for the younger group whereas it was 'severity of illness' for the older group. 'Advanced age' led to DWLSTs in 43% of the decisions in the group ≥70yo (vs. 0% in the group <70yo, p <0.0001). Multivariate logistic regression showed a high SAPS II score and age ≥70yo as independent risk factors for DWLSTs in the ICU. We did not find age ≥70yo as an independent risk factor for mortality in ICU. We found that age ≥70yo was an independent risk factor for DWLSTs for patients in the ICU, but not for their mortality. Reasons leading to DWLSTs are different according to the age of patients.

Engaging with change: Information and communication technology professionals’ perspectives on change in the context of the ‘Brexit’ vote

PubMed Central

2017-01-01

Background Information and Communication Technology (ICT) has been a key agent of change in the 21st century. Given the role of ICT in changing society this research sought to explore the responses and attitudes to change from ICT professionals and ICT academics in dealing with the potentially far reaching political challenge triggered by the UK’s 2016 European Union Referendum and its decision to leave the European Union (referred to as Brexit). Whilst the vote was a UK based decision its ramifications have global implications and as such the research was not confined to the UK. Methods and findings Data was collected through a survey launched on the first working day after the Brexit referendum vote to leave the EU and kept open for four weeks. The survey contained qualitative and quantitative questions. It sought to understand the opportunities and threats that would exist post-Brexit for ICT professionals and academics triggered by the decision. The research captured a complex rich picture on ICT professionals’ responses to the potential challenge of change triggered by the Brexit vote. Immediately after the Brexit decision the research reveals uncertainties amongst ICT professionals regarding what the decision would mean, with just under half of the participants not identifying any opportunities or threats. For those who did, threats outweighed opportunities by just more than double. Whilst understanding the global possibilities and dangers, participants saw their position from national and organizational perspectives. The highest frequency coded threats related to areas outside the participants’ control and the highest frequency opportunities related to areas where there was the potential for ICT interventions. This survey is part of longitudinal piece of research. Using the same methodological approach two further surveys are planned. The second survey will be one year after Article 50 was triggered on 29 March 2017. The final survey will be one year after the UK exit from the EU, assuming this occurs. PMID:29117185

Engaging with change: Information and communication technology professionals' perspectives on change in the context of the 'Brexit' vote.

PubMed

Lomas, Elizabeth; McLeod, Julie

2017-01-01

Information and Communication Technology (ICT) has been a key agent of change in the 21st century. Given the role of ICT in changing society this research sought to explore the responses and attitudes to change from ICT professionals and ICT academics in dealing with the potentially far reaching political challenge triggered by the UK's 2016 European Union Referendum and its decision to leave the European Union (referred to as Brexit). Whilst the vote was a UK based decision its ramifications have global implications and as such the research was not confined to the UK. Data was collected through a survey launched on the first working day after the Brexit referendum vote to leave the EU and kept open for four weeks. The survey contained qualitative and quantitative questions. It sought to understand the opportunities and threats that would exist post-Brexit for ICT professionals and academics triggered by the decision. The research captured a complex rich picture on ICT professionals' responses to the potential challenge of change triggered by the Brexit vote. Immediately after the Brexit decision the research reveals uncertainties amongst ICT professionals regarding what the decision would mean, with just under half of the participants not identifying any opportunities or threats. For those who did, threats outweighed opportunities by just more than double. Whilst understanding the global possibilities and dangers, participants saw their position from national and organizational perspectives. The highest frequency coded threats related to areas outside the participants' control and the highest frequency opportunities related to areas where there was the potential for ICT interventions. This survey is part of longitudinal piece of research. Using the same methodological approach two further surveys are planned. The second survey will be one year after Article 50 was triggered on 29 March 2017. The final survey will be one year after the UK exit from the EU, assuming this occurs.

Parent Trigger Laws and the Promise of Parental Voice

ERIC Educational Resources Information Center

Smith, William C.; Rowland, Julie

2014-01-01

Parent trigger laws have gained momentum nationally under the premise that they will increase local authority by amplifying parental voice in the decision to turn around "failing" schools. Using Hirschman's exit, voice, and loyalty framework we create two conceptual models of voice and evaluate the promise of voice in California, home of…

Early labour services: changes, triggers, monitoring and evaluation.

PubMed

Spiby, Helen; Green, Josephine M; Richardson-Foster, Helen; Hucknall, Clare

2013-04-01

to identify the changes to early labour services, their triggers and monitoring. a mixed methods approach in two stages, firstly a postal questionnaire survey of Heads of Midwifery (HoM) services in NHS Trusts in England (cover sheet to each HoM and questionnaire for each unit in their jurisdiction) and, secondly, semi-structured telephone interviews with a purposive sample of senior midwives. The interviews sought further information about reasons for change; the impact of changes and explored the unit's particular innovations. PARTICIPANTS AND RESPONSE RATE: 145 (89%) NHS Trusts provided data (cover sheet and/or questionnaire); responses were received from all areas and types of unit. Seventeen HoMs or designated senior midwives were interviewed. 83 of 170 units (49%) had made changes to early labour service provision during the past 5 years, including home assessment; the introduction of triage units and telephone assessment tools. Changes were more likely in high volume units and in consultant units with midwifery-led care areas. Further changes were planned by 93/178 (25%) units. Triggers for changes to early labour services comprised local or unit-based factors, including Category X (non-labour) admissions, response to service users and research evidence. The impact of Category X admissions on workload contributed to the triggers for change. Fifty-six (31%) could provide a confirmed figure or estimate for category X admissions. Experiences of introducing change included issues related to engagement of the workforce and the contribution of clinical leadership. Thirty-eight (48%) units did not routinely monitor use of early labour services. Overall monitoring of services was not significantly more likely in units that had made changes. Audit activity was reported more frequently in units that had made changes to their early labour services. early labour services had undergone significant changes following a range of triggers but the extent of change was not reflected in monitoring and evaluation activity. Changes to service provision should be accompanied by monitoring and evaluation. Changes to services require utilisation of appropriate change management strategies. Copyright © 2012 Elsevier Ltd. All rights reserved.

Moral distress in end-of-life care in the intensive care unit.

PubMed

St Ledger, Una; Begley, Ann; Reid, Joanne; Prior, Lindsay; McAuley, Danny; Blackwood, Bronagh

2013-08-01

To explore moral distress in relatives doctors and nurses, in end-of-life care decision-making, in the adult intensive care unit. Many deaths in intensive care involve decisions about withholding and withdrawing therapy, potentially triggering moral distress. Moral distress occurs when individuals feel constrained from acting in accordance with moral choice, or act against moral judgement, generating painful, unresolved emotions, and problems that continue long after an event. Prior research has focused mainly on nurses; less is known about doctors' experiences and occurrence and impact on relatives is unknown. A narrative inquiry case study approach, funded by a Northern Ireland Health and Social Care Doctorate Fellowship Award (April 2011). In-depth digitally recorded interviews will be conducted with relatives, doctors, and nurses involved in end-of-life cases comprising: (1) withdrawal of therapy, including circulatory death organ donation; (2) non-escalation of therapy; and (3) brain stem death with a request for organ donation. Relatives will be offered the opportunity to share their experiences on 'Healthtalkonline' by copyrighting audio-visual interviews to the Health Experiences Research Group, Oxford University. Research Ethics Committee approval was obtained (April 2012). This is the first time that moral distress is explored, in a case approach, among relatives, doctors, and nurses intimately involved in end-of-life decisions in intensive care. Dissemination of findings will make a large contribution to international knowledge and understanding in this area and alert healthcare professionals and relatives to an otherwise under-recognized, but potentially detrimental, experience. Findings will inform education, practice, and policy. © 2012 Blackwell Publishing Ltd.

Patient-specific computer-based decision support in primary healthcare--a randomized trial.

PubMed

Kortteisto, Tiina; Raitanen, Jani; Komulainen, Jorma; Kunnamo, Ilkka; Mäkelä, Marjukka; Rissanen, Pekka; Kaila, Minna

2014-01-20

Computer-based decision support systems are a promising method for incorporating research evidence into clinical practice. However, evidence is still scant on how such information technology solutions work in primary healthcare when support is provided across many health problems. In Finland, we designed a trial where a set of evidence-based, patient-specific reminders was introduced into the local Electronic Patient Record (EPR) system. The aim was to measure the effects of such reminders on patient care. The hypothesis was that the total number of triggered reminders would decrease in the intervention group compared with the control group, indicating an improvement in patient care. From July 2009 to October 2010 all the patients of one health center were randomized to an intervention or a control group. The intervention consisted of patient-specific reminders concerning 59 different health conditions triggered when the healthcare professional (HCP) opened and used the EPR. In the intervention group, the triggered reminders were shown to the HCP; in the control group, the triggered reminders were not shown. The primary outcome measure was the change in the number of reminders triggered over 12 months. We developed a unique data gathering method, the Repeated Study Virtual Health Check (RSVHC), and used Generalized Estimation Equations (GEE) for analysing the incidence rate ratio, which is a measure of the relative difference in percentage change in the numbers of reminders triggered in the intervention group and the control group. In total, 13,588 participants were randomized and included. Contrary to our expectation, the total number of reminders triggered increased in both the intervention and the control groups. The primary outcome measure did not show a significant difference between the groups. However, with the inclusion of patients followed up over only six months, the total number of reminders increased significantly less in the intervention group than in the control group when the confounding factors (age, gender, number of diagnoses and medications) were controlled for. Computerized, tailored reminders in primary care did not decrease during the 12 months of follow-up time after the introduction of a patient-specific decision support system. ClinicalTrial.gov NCT00915304.

The amygdala and decision-making.

PubMed

Gupta, Rupa; Koscik, Timothy R; Bechara, Antoine; Tranel, Daniel

2011-03-01

Decision-making is a complex process that requires the orchestration of multiple neural systems. For example, decision-making is believed to involve areas of the brain involved in emotion (e.g., amygdala, ventromedial prefrontal cortex) and memory (e.g., hippocampus, dorsolateral prefrontal cortex). In this article, we will present findings related to the amygdala's role in decision-making, and differentiate the contributions of the amygdala from those of other structurally and functionally connected neural regions. Decades of research have shown that the amygdala is involved in associating a stimulus with its emotional value. This tradition has been extended in newer work, which has shown that the amygdala is especially important for decision-making, by triggering autonomic responses to emotional stimuli, including monetary reward and punishment. Patients with amygdala damage lack these autonomic responses to reward and punishment, and consequently, cannot utilize "somatic marker" type cues to guide future decision-making. Studies using laboratory decision-making tests have found deficient decision-making in patients with bilateral amygdala damage, which resembles their real-world difficulties with decision-making. Additionally, we have found evidence for an interaction between sex and laterality of amygdala functioning, such that unilateral damage to the right amygdala results in greater deficits in decision-making and social behavior in men, while left amygdala damage seems to be more detrimental for women. We have posited that the amygdala is part of an "impulsive," habit type system that triggers emotional responses to immediate outcomes. Copyright © 2010 Elsevier Ltd. All rights reserved.

A vertical handoff decision algorithm based on ARMA prediction model

NASA Astrophysics Data System (ADS)

Li, Ru; Shen, Jiao; Chen, Jun; Liu, Qiuhuan

2012-01-01

With the development of computer technology and the increasing demand for mobile communications, the next generation wireless networks will be composed of various wireless networks (e.g., WiMAX and WiFi). Vertical handoff is a key technology of next generation wireless networks. During the vertical handoff procedure, handoff decision is a crucial issue for an efficient mobility. Based on auto regression moving average (ARMA) prediction model, we propose a vertical handoff decision algorithm, which aims to improve the performance of vertical handoff and avoid unnecessary handoff. Based on the current received signal strength (RSS) and the previous RSS, the proposed approach adopt ARMA model to predict the next RSS. And then according to the predicted RSS to determine whether trigger the link layer triggering event and complete vertical handoff. The simulation results indicate that the proposed algorithm outperforms the RSS-based scheme with a threshold in the performance of handoff and the number of handoff.

Parent Trigger Policies, Representation, and the Public Good

ERIC Educational Resources Information Center

Allen, Ann; Saultz, Andrew

2015-01-01

Using theories of representation and democratic education, this article examines the impetus of parent trigger policies in the United States and their potential effects on public good goals for public education. The article also uses theories of representation and responsible democratic governance to assess the parent trigger policies, or what are…

Sampling and Control Circuit Board for an Inertial Measurement Unit

NASA Technical Reports Server (NTRS)

Chelmins, David T (Inventor); Sands, Obed (Inventor); Powis, Richard T., Jr. (Inventor)

2016-01-01

A circuit board that serves as a control and sampling interface to an inertial measurement unit ("IMU") is provided. The circuit board is also configured to interface with a local oscillator and an external trigger pulse. The circuit board is further configured to receive the external trigger pulse from an external source that time aligns the local oscillator and initiates sampling of the inertial measurement device for data at precise time intervals based on pulses from the local oscillator. The sampled data may be synchronized by the circuit board with other sensors of a navigation system via the trigger pulse.

Trigger design for a gamma ray detector of HIRFL-ETF

NASA Astrophysics Data System (ADS)

Du, Zhong-Wei; Su, Hong; Qian, Yi; Kong, Jie

2013-10-01

The Gamma Ray Array Detector (GRAD) is one subsystem of HIRFL-ETF (the External Target Facility (ETF) of the Heavy Ion Research Facility in Lanzhou (HIRFL)). It is capable of measuring the energy of gamma-rays with 1024 CsI scintillators in in-beam nuclear experiments. The GRAD trigger should select the valid events and reject the data from the scintillators which are not hit by the gamma-ray. The GRAD trigger has been developed based on the Field Programmable Gate Array (FPGAs) and PXI interface. It makes prompt trigger decisions to select valid events by processing the hit signals from the 1024 CsI scintillators. According to the physical requirements, the GRAD trigger module supplies 12-bit trigger information for the global trigger system of ETF and supplies a trigger signal for data acquisition (DAQ) system of GRAD. In addition, the GRAD trigger generates trigger data that are packed and transmitted to the host computer via PXI bus to be saved for off-line analysis. The trigger processing is implemented in the front-end electronics of GRAD and one FPGA of the GRAD trigger module. The logic of PXI transmission and reconfiguration is implemented in another FPGA of the GRAD trigger module. During the gamma-ray experiments, the GRAD trigger performs reliably and efficiently. The function of GRAD trigger is capable of satisfying the physical requirements.

The ITER disruption mitigation trigger: developing its preliminary design

NASA Astrophysics Data System (ADS)

Pautasso, G.; de Vries, P. C.; Humphreys, D.; Lehnen, M.; Rapson, C.; Raupp, G.; Snipes, J. A.; Treutterer, W.; Vergara-Fernandez, A.; Zabeo, L.

2018-03-01

A concept for the generation of the trigger for the ITER disruption mitigation system is described in this paper. The issuing of the trigger will be the result of a complex decision process, taken by the plasma control system, or by the central interlock system, determining that the plasma is unavoidably going to disrupt—or has disrupted—and that a fast mitigated shut-down is required. Given the redundancy of the mitigation system, the plasma control system must also formulate an injection scheme and specify when and how the injectors of the mitigation system should be activated. The parameters and the conceptual algorithms required for the configuration and generation of the trigger are discussed.

At Least I Tried: The Relationship between Regulatory Focus and Regret Following Action vs. Inaction

PubMed Central

Itzkin, Adi; Van Dijk, Dina; Azar, Ofer H.

2016-01-01

Regret is an unpleasant feeling that may arise following decisions that ended poorly, and may affect the decision-maker's well-being and future decision making. Some studies show that a decision to act leads to greater regret than a decision not to act when both resulted in failure, because the latter is usually the norm. In some cases, when the norm is to act, this pattern is reversed. We suggest that the decision maker's regulatory focus, affects regret after action or inaction. Specifically, promotion-focused individuals, who tend to be more proactive, view action as more normal than prevention-focused individuals, and therefore experience regulatory fit when an action decision is made. Hence, we hypothesized that promotion-focused individuals will feel less regret than prevention-focused individuals when a decision to act ended poorly. In addition, we hypothesized that a trigger for change implied in the situation, decreases the level of regret following action. We tested our hypotheses on a sample of 330 participants enrolled in an online survey. The participants received six decision scenarios, in which they were asked to evaluate the level of regret following action and inaction. Individual regulatory focus was measured by two different scales. Promotion-focused individuals attributed less regret than prevention-focused individuals to action decisions. Regret following inaction was not affected by regulatory focus. In addition, a trigger for change decreases regret following action. Orthodox people tend to attribute more regret than non-orthodox to a person who made an action decision. The results contribute to the literature by showing that not only the situation but also the decision maker's orientation affects the regret after action vs. inaction. PMID:27833581

Probabilistic Decision Making with Spikes: From ISI Distributions to Behaviour via Information Gain.

PubMed

Caballero, Javier A; Lepora, Nathan F; Gurney, Kevin N

2015-01-01

Computational theories of decision making in the brain usually assume that sensory 'evidence' is accumulated supporting a number of hypotheses, and that the first accumulator to reach threshold triggers a decision in favour of its associated hypothesis. However, the evidence is often assumed to occur as a continuous process whose origins are somewhat abstract, with no direct link to the neural signals - action potentials or 'spikes' - that must ultimately form the substrate for decision making in the brain. Here we introduce a new variant of the well-known multi-hypothesis sequential probability ratio test (MSPRT) for decision making whose evidence observations consist of the basic unit of neural signalling - the inter-spike interval (ISI) - and which is based on a new form of the likelihood function. We dub this mechanism s-MSPRT and show its precise form for a range of realistic ISI distributions with positive support. In this way we show that, at the level of spikes, the refractory period may actually facilitate shorter decision times, and that the mechanism is robust against poor choice of the hypothesized data distribution. We show that s-MSPRT performance is related to the Kullback-Leibler divergence (KLD) or information gain between ISI distributions, through which we are able to link neural signalling to psychophysical observation at the behavioural level. Thus, we find the mean information needed for a decision is constant, thereby offering an account of Hick's law (relating decision time to the number of choices). Further, the mean decision time of s-MSPRT shows a power law dependence on the KLD offering an account of Piéron's law (relating reaction time to stimulus intensity). These results show the foundations for a research programme in which spike train analysis can be made the basis for predictions about behavior in multi-alternative choice tasks.

Probabilistic Decision Making with Spikes: From ISI Distributions to Behaviour via Information Gain

PubMed Central

Caballero, Javier A.; Lepora, Nathan F.; Gurney, Kevin N.

2015-01-01

Computational theories of decision making in the brain usually assume that sensory 'evidence' is accumulated supporting a number of hypotheses, and that the first accumulator to reach threshold triggers a decision in favour of its associated hypothesis. However, the evidence is often assumed to occur as a continuous process whose origins are somewhat abstract, with no direct link to the neural signals - action potentials or 'spikes' - that must ultimately form the substrate for decision making in the brain. Here we introduce a new variant of the well-known multi-hypothesis sequential probability ratio test (MSPRT) for decision making whose evidence observations consist of the basic unit of neural signalling - the inter-spike interval (ISI) - and which is based on a new form of the likelihood function. We dub this mechanism s-MSPRT and show its precise form for a range of realistic ISI distributions with positive support. In this way we show that, at the level of spikes, the refractory period may actually facilitate shorter decision times, and that the mechanism is robust against poor choice of the hypothesized data distribution. We show that s-MSPRT performance is related to the Kullback-Leibler divergence (KLD) or information gain between ISI distributions, through which we are able to link neural signalling to psychophysical observation at the behavioural level. Thus, we find the mean information needed for a decision is constant, thereby offering an account of Hick's law (relating decision time to the number of choices). Further, the mean decision time of s-MSPRT shows a power law dependence on the KLD offering an account of Piéron's law (relating reaction time to stimulus intensity). These results show the foundations for a research programme in which spike train analysis can be made the basis for predictions about behavior in multi-alternative choice tasks. PMID:25923907

The quantal theory of how the immune system discriminates between "self and non-self"

PubMed

Smith, Kendall A

2004-12-17

In the past 50 years, immunologists have accumulated an amazing amount of information as to how the immune system functions. However, one of the most fundamental aspects of immunity, how the immune system discriminates between self vs. non-self, still remains an enigma. Any attempt to explain this most intriguing and fundamental characteristic must account for this decision at the level of the whole immune system, but as well, at the level of the individual cells making up the immune system. Moreover, it must provide for a molecular explanation as to how and why the cells behave as they do. The "Quantal Theory", proposed herein, is based upon the "Clonal Selection Theory", first proposed by Sir McFarland Burnet in 1955, in which he explained the remarkable specificity as well as diversity of recognition of everything foreign in the environment. The "Quantal Theory" is built upon Burnet's premise that after antigen selection of cell clones, a proliferative expansion of the selected cells ensues. Furthermore, it is derived from experiments which indicate that the proliferation of antigen-selected cell clones is determined by a quantal, "all-or-none", decision promulgated by a critical number of cellular receptors triggered by the T Cell Growth Factor (TCGF), interleukin 2 (IL2). An extraordinary number of experiments reported especially in the past 20 years, and detailed herein, indicate that the T cell Antigen Receptor (TCR) behaves similarly, and also that there are several critical numbers of triggered TCRs that determine different fates of the T cells. Moreover, the fates of the cells appear ultimately to be determined by the TCR triggering of the IL2 and IL2 receptor (IL2R) genes, which are also expressed in a very quantal fashion. The "Quantal Theory" states that the fundamental decisions of the T cell immune system are dependent upon the cells receiving a critical number of triggered TCRs and IL2Rs and that the cells respond in an all-or-none fashion. The "Quantal Theory" accounts fully for the development of T cells in the thymus, and such fundamental cellular fates as both "positive" and "negative" selection, as well as the decision to differentiate into a "Regulatory T cell" (T-Reg). In the periphery, the "Quantal Theory" accounts for the decision to proliferate or not in response to the presence of an antigen, either non-self or self, or to differentiate into a T-Reg. Since the immune system discriminates between self and non-self antigens by the accumulated number of triggered TCRs and IL2Rs, therapeutic manipulation of the determinants of these quantal decisions should permit new approaches to either enhance or dampen antigen-specific immune responses.

Intimate Partner Jealousy and Femicide Among Former Ethiopians in Israel.

PubMed

Edelstein, Arnon

2018-02-01

Ethiopian immigrant women in Israel are overrepresented as victims of femicide; they are killed at more than 16 times the rate of the general population. This article suggests integrating current theoretical and empirical models to explain Ethiopian femicide, and stresses that considering psychological or sociocultural explanations as risk factors alone is not enough to understand this phenomenon. We distinguish between risk factors and triggers for femicide against Ethiopian women. While sociocultural and even psychological changes are risk factors for femicide, one, two, or three main triggers may activate such potential risk factors, such as the woman's willingness (WW) to leave the intimate relationship, sexual jealousy (SJ), and formal complaints against the abusive partner. The first two triggers are jealousy oriented. To analyze this phenomenon in Israel, we examined all court decisions on intimate partner homicide (IPH) from 1990 to 2010. After reading former studies on IPH and identifying important variables that could explain the phenomenon, we first catalogued the data in every decision and verdict according to main independent variables mentioned in the literature. The study population consists of first-generation immigrants, N = 194: native Israelis (47%), new immigrants from the former Soviet Union (FSU; 31%), and Ethiopians (16%). Our analysis of court decisions reveals that triggers containing jealousy components are responsible for 83% of femicide cases committed by Ethiopian men, in comparison with native Israelis (77%) and immigrant Russian men (66%) who murdered their intimate partners. In addition, there is a significant correlation among motive (jealousy), method of killing (stabbing), and "overkilling" (excessive force).

Data-Driven Geospatial Visual Analytics for Real-Time Urban Flooding Decision Support

NASA Astrophysics Data System (ADS)

Liu, Y.; Hill, D.; Rodriguez, A.; Marini, L.; Kooper, R.; Myers, J.; Wu, X.; Minsker, B. S.

2009-12-01

Urban flooding is responsible for the loss of life and property as well as the release of pathogens and other pollutants into the environment. Previous studies have shown that spatial distribution of intense rainfall significantly impacts the triggering and behavior of urban flooding. However, no general purpose tools yet exist for deriving rainfall data and rendering them in real-time at the resolution of hydrologic units used for analyzing urban flooding. This paper presents a new visual analytics system that derives and renders rainfall data from the NEXRAD weather radar system at the sewershed (i.e. urban hydrologic unit) scale in real-time for a Chicago stormwater management project. We introduce a lightweight Web 2.0 approach which takes advantages of scientific workflow management and publishing capabilities developed at NCSA (National Center for Supercomputing Applications), streaming data-aware semantic content management repository, web-based Google Earth/Map and time-aware KML (Keyhole Markup Language). A collection of polygon-based virtual sensors is created from the NEXRAD Level II data using spatial, temporal and thematic transformations at the sewershed level in order to produce persistent virtual rainfall data sources for the animation. Animated color-coded rainfall map in the sewershed can be played in real-time as a movie using time-aware KML inside the web browser-based Google Earth for visually analyzing the spatiotemporal patterns of the rainfall intensity in the sewershed. Such system provides valuable information for situational awareness and improved decision support during extreme storm events in an urban area. Our further work includes incorporating additional data (such as basement flooding events data) or physics-based predictive models that can be used for more integrated data-driven decision support.

The Influence of Counterfactual Thinking and Regret on Ethical Decision Making

ERIC Educational Resources Information Center

Celuch, Kevin; Saxby, Carl; Oeding, Jill

2015-01-01

The authors explore the influence of counterfactual thoughts in triggering the emotions of regret and disappointment in ethical decision making. Counterfactual thinking involves examining possible outcomes to events and is often explored in what-if scenarios. Findings support that subjects were able to transfer regret (but not disappointment)…

Motivational Reasons for Biased Decisions: The Sunk-Cost Effect's Instrumental Rationality.

PubMed

Domeier, Markus; Sachse, Pierre; Schäfer, Bernd

2018-01-01

The present study describes the mechanism of need regulation, which accompanies the so-called "biased" decisions. We hypothesized an unconscious urge for psychological need satisfaction as the trigger for cognitive biases. In an experimental study ( N = 106), participants had the opportunity to win money in a functionality test. In the test, they could either use the solution they had developed (sunk cost) or an alternative solution that offered a higher probability of winning. The selection of the sunk-cost option (SCO) was the most chosen option, supporting the hypothesis of this study. The reason behind the majority of participants choosing the SCO seemed to be the satisfaction of psychological needs, despite a reduced chance of winning money. An intervention, which aimed at triggering self-reflection, had no impact on the decision. The findings of this study contribute to the discussion on the reasons for cognitive biases and their formation in the human mind. Moreover, it discusses the application of the label "irrational" for biased decisions and proposes reasons for instrumental rationality, which exist at an unconscious, need-regulative level.

Motivational Reasons for Biased Decisions: The Sunk-Cost Effect’s Instrumental Rationality

PubMed Central

Domeier, Markus; Sachse, Pierre; Schäfer, Bernd

2018-01-01

The present study describes the mechanism of need regulation, which accompanies the so-called “biased” decisions. We hypothesized an unconscious urge for psychological need satisfaction as the trigger for cognitive biases. In an experimental study (N = 106), participants had the opportunity to win money in a functionality test. In the test, they could either use the solution they had developed (sunk cost) or an alternative solution that offered a higher probability of winning. The selection of the sunk-cost option (SCO) was the most chosen option, supporting the hypothesis of this study. The reason behind the majority of participants choosing the SCO seemed to be the satisfaction of psychological needs, despite a reduced chance of winning money. An intervention, which aimed at triggering self-reflection, had no impact on the decision. The findings of this study contribute to the discussion on the reasons for cognitive biases and their formation in the human mind. Moreover, it discusses the application of the label “irrational” for biased decisions and proposes reasons for instrumental rationality, which exist at an unconscious, need-regulative level. PMID:29881366

ATLAS level-1 calorimeter trigger: Run-2 performance and Phase-1 upgrades

NASA Astrophysics Data System (ADS)

Carlson, Ben; Hong, Tae Min; Atlas Collaboration

2017-01-01

The Run-2 performance and Phase-1 upgrade are presented for the hardware-based level-1 calorimeter trigger (L1Calo) for the ATLAS Experiment. This trigger has a latency of about 2.2 microseconds to make a decision to help ATLAS select about 100 kHz of the most interesting collisions from the nominal LHC rate of 40 MHz. We summarize the upgrade after Run-1 (2009-2012) and discuss its performance in Run-2 (2015-current). We also outline the on-going Phase-1 upgrade for the next run (2021-2024) and its expected performance.

Method and system for redundancy management of distributed and recoverable digital control system

NASA Technical Reports Server (NTRS)

Stange, Kent (Inventor); Hess, Richard (Inventor); Kelley, Gerald B (Inventor); Rogers, Randy (Inventor)

2012-01-01

A method and system for redundancy management is provided for a distributed and recoverable digital control system. The method uses unique redundancy management techniques to achieve recovery and restoration of redundant elements to full operation in an asynchronous environment. The system includes a first computing unit comprising a pair of redundant computational lanes for generating redundant control commands. One or more internal monitors detect data errors in the control commands, and provide a recovery trigger to the first computing unit. A second redundant computing unit provides the same features as the first computing unit. A first actuator control unit is configured to provide blending and monitoring of the control commands from the first and second computing units, and to provide a recovery trigger to each of the first and second computing units. A second actuator control unit provides the same features as the first actuator control unit.

PHOTOSENSITIVE RELAY CONTROL CIRCUIT

DOEpatents

Martin, C.F.

1958-01-14

adapted for the measurement of the time required for an oscillating member to pass through a preselected number of oscillations, after being damped to a certain maximum amplitude of oscillation. A mirror is attached to the moving member and directs light successively to a photocell which is part of a trigger unit and to first and second photocells which are part of a starter unit, as the member swings to its maximum amplitude. The starter and trigger units comprise thyratrons and relays so interconnected that the trigger circuit, although generating a counter pulse, does not register a count in the counter when the light traverses both photocells of the starter unit. When the amplitude of oscillation of the member decreases to where the second photocell is not transversed, the triggei pulse is received by the counter. The counter taen operates to register the desired number of oscillations and initiates and terminates a timer for measuring the time irterval for the preselected number of oscillations.

Parental Trigger Laws and the Power of Framing in Educational Politics

ERIC Educational Resources Information Center

Feuerstein, Abe

2015-01-01

This paper examines the discursive strategies employed by advocates of Parent Trigger laws in the United States which allow parents of children in "failing" schools, in some states, to call for interventions in the operation of the schools via petition. The paper reviews the genesis of Parent Trigger laws, the network of conservative…

A compact, low jitter, nanosecond rise time, high voltage pulse generator with variable amplitude.

PubMed

Mao, Jiubing; Wang, Xin; Tang, Dan; Lv, Huayi; Li, Chengxin; Shao, Yanhua; Qin, Lan

2012-07-01

In this paper, a compact, low jitter, nanosecond rise time, command triggered, high peak power, gas-switch pulse generator system is developed for high energy physics experiment. The main components of the system are a high voltage capacitor, the spark gap switch and R = 50 Ω load resistance built into a structure to obtain a fast high power pulse. The pulse drive unit, comprised of a vacuum planar triode and a stack of avalanche transistors, is command triggered by a single or multiple TTL (transistor-transistor logic) level pulses generated by a trigger pulse control unit implemented using the 555 timer circuit. The control unit also accepts user input TTL trigger signal. The vacuum planar triode in the pulse driving unit that close the first stage switches is applied to drive the spark gap reducing jitter. By adjusting the charge voltage of a high voltage capacitor charging power supply, the pulse amplitude varies from 5 kV to 10 kV, with a rise time of <3 ns and the maximum peak current up to 200 A (into 50 Ω). The jitter of the pulse generator system is less than 1 ns. The maximum pulse repetition rate is set at 10 Hz that limited only by the gas-switch and available capacitor recovery time.

The Executive Process, Grade Eight. Resource Unit (Unit III).

ERIC Educational Resources Information Center

Minnesota Univ., Minneapolis. Project Social Studies Curriculum Center.

This resource unit, developed by the University of Minnesota's Project Social Studies, introduces eighth graders to the executive process. The unit uses case studies of presidential decision making such as the decision to drop the atomic bomb on Hiroshima, the Cuba Bay of Pigs and quarantine decisions, and the Little Rock decision. A case study of…

CISN ShakeAlert Earthquake Early Warning System Monitoring Tools

NASA Astrophysics Data System (ADS)

Henson, I. H.; Allen, R. M.; Neuhauser, D. S.

2015-12-01

CISN ShakeAlert is a prototype earthquake early warning system being developed and tested by the California Integrated Seismic Network. The system has recently been expanded to support redundant data processing and communications. It now runs on six machines at three locations with ten Apache ActiveMQ message brokers linking together 18 waveform processors, 12 event association processes and 4 Decision Module alert processes. The system ingests waveform data from about 500 stations and generates many thousands of triggers per day, from which a small portion produce earthquake alerts. We have developed interactive web browser system-monitoring tools that display near real time state-of-health and performance information. This includes station availability, trigger statistics, communication and alert latencies. Connections to regional earthquake catalogs provide a rapid assessment of the Decision Module hypocenter accuracy. Historical performance can be evaluated, including statistics for hypocenter and origin time accuracy and alert time latencies for different time periods, magnitude ranges and geographic regions. For the ElarmS event associator, individual earthquake processing histories can be examined, including details of the transmission and processing latencies associated with individual P-wave triggers. Individual station trigger and latency statistics are available. Detailed information about the ElarmS trigger association process for both alerted events and rejected events is also available. The Google Web Toolkit and Map API have been used to develop interactive web pages that link tabular and geographic information. Statistical analysis is provided by the R-Statistics System linked to a PostgreSQL database.

A novel trigger for pseudospark switch with high repetition rate, low jitter, and compact structure

NASA Astrophysics Data System (ADS)

Yan, Jiaqi; Shen, Saikang; Wang, Yanan; Zhang, Siyu; Cheng, Le; Ding, Weidong

2018-06-01

This paper presents the design and development of a trigger with a high repetition rate, low jitter, and compact structure for the pseudospark switch (PSS), which includes an improved Marx generator based on avalanche transistors and a corona-plasma trigger unit. The generator adopted a novel 3 × 12-stage Marx circuit based on avalanche transistors in which the failure rate of transistors in the first and second stages was significantly reduced by connecting the parallel capacitors compared to the previous similar generator. The reason for the improved performance was also discussed. The main parameters of output pulses were an amplitude of -7 kV, rise time of 6 ns, jitter of 0.2 ns, and repetition rate of 2 kHz. The corona-plasma trigger unit adopted BaTiO3 ceramics with high ɛr as the dielectric and was arranged in the hollow cathode of the PSS. The experiments of triggering a PSS prototype were conducted. The influence of anode voltage and pressure on the trigger delay and jitter was studied, and the minimum trigger jitter achieved <1 ns. This trigger worked for 107 shots at the repetition rate of 2 kHz continuously without obvious performance degradation and any failure of the generator. The main advantage of this trigger is the simultaneous combination of the high repetition rate, low jitter, long lifetime, and great simplicity in a compact structure.

Decision making and action implementation: evidence for an early visually triggered motor activation specific to potential actions.

PubMed

Tandonnet, Christophe; Garry, Michael I; Summers, Jeffery J

2013-07-01

To make a decision may rely on accumulating evidence in favor of one alternative until a threshold is reached. Sequential-sampling models differ by the way of accumulating evidence and the link with action implementation. Here, we tested a model's prediction of an early action implementation specific to potential actions. We assessed the dynamics of action implementation in go/no-go and between-hand choice tasks by transcranial magnetic stimulation of the motor cortex (single- or paired-pulse TMS; 3-ms interstimulus interval). Prior to implementation of the selected action, the amplitude of the motor evoked potential first increased whatever the visual stimulus but only for the hand potentially involved in the to-be-produced action. These findings suggest that visual stimuli can trigger an early motor activation specific to potential actions, consistent with race-like models with continuous transmission between decision making and action implementation. Copyright © 2013 Society for Psychophysiological Research.

The impact and determinants of the energy paradigm on economic growth in European Union.

PubMed

Andrei, Jean Vasile; Mieila, Mihai; Panait, Mirela

2017-01-01

Contemporary economies are strongly reliant on energy and analyzing the determining factors that trigger the changes in energy paradigm and their impact upon economic growth is a topical research subject. Our contention is that energy paradigm plays a major role in achieving the sustainable development of contemporary economies. In order to prove this the panel data methodology of research was employed, namely four panel unit root tests (LLC, IPS, F-ADF and F-PP) aiming to reveal the connections and relevance among 17 variables denoting energy influence on economic development. Moreover, it was introduced a specific indicator to express energy consumption per capita. Our findings extend the classical approach of the changes in energy paradigm and their impact upon economic growth and offer a comprehensive analysis which surpasses the practices and policy decisions in the field.

A field programmable gate array unit for the diagnosis and control of neoclassical tearing modes on MAST

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

O'Gorman, T.; Gibson, K. J.; Snape, J. A.

2012-10-15

A real-time system has been developed to trigger both the MAST Thomson scattering (TS) system and the plasma control system on the phase and amplitude of neoclassical tearing modes (NTMs), extending the capabilities of the original system. This triggering system determines the phase and amplitude of a given NTM using magnetic coils at different toroidal locations. Real-time processing of the raw magnetic data occurs on a low cost field programmable gate array (FPGA) based unit which permits triggering of the TS lasers on specific amplitudes and phases of NTM evolution. The MAST plasma control system can receive a separate triggermore » from the FPGA unit that initiates a vertical shift of the MAST magnetic axis. Such shifts have fully removed m/n= 2/1 NTMs instabilities on a number of MAST discharges.« less

The ATLAS Level-1 Calorimeter Trigger: PreProcessor implementation and performance

NASA Astrophysics Data System (ADS)

Åsman, B.; Achenbach, R.; Allbrooke, B. M. M.; Anders, G.; Andrei, V.; Büscher, V.; Bansil, H. S.; Barnett, B. M.; Bauss, B.; Bendtz, K.; Bohm, C.; Bracinik, J.; Brawn, I. P.; Brock, R.; Buttinger, W.; Caputo, R.; Caughron, S.; Cerrito, L.; Charlton, D. G.; Childers, J. T.; Curtis, C. J.; Daniells, A. C.; Davis, A. O.; Davygora, Y.; Dorn, M.; Eckweiler, S.; Edmunds, D.; Edwards, J. P.; Eisenhandler, E.; Ellis, K.; Ermoline, Y.; Föhlisch, F.; Faulkner, P. J. W.; Fedorko, W.; Fleckner, J.; French, S. T.; Gee, C. N. P.; Gillman, A. R.; Goeringer, C.; Hülsing, T.; Hadley, D. R.; Hanke, P.; Hauser, R.; Heim, S.; Hellman, S.; Hickling, R. S.; Hidvégi, A.; Hillier, S. J.; Hofmann, J. I.; Hristova, I.; Ji, W.; Johansen, M.; Keller, M.; Khomich, A.; Kluge, E.-E.; Koll, J.; Laier, H.; Landon, M. P. J.; Lang, V. S.; Laurens, P.; Lepold, F.; Lilley, J. N.; Linnemann, J. T.; Müller, F.; Müller, T.; Mahboubi, K.; Martin, T. A.; Mass, A.; Meier, K.; Meyer, C.; Middleton, R. P.; Moa, T.; Moritz, S.; Morris, J. D.; Mudd, R. D.; Narayan, R.; zur Nedden, M.; Neusiedl, A.; Newman, P. R.; Nikiforov, A.; Ohm, C. C.; Perera, V. J. O.; Pfeiffer, U.; Plucinski, P.; Poddar, S.; Prieur, D. P. F.; Qian, W.; Rieck, P.; Rizvi, E.; Sankey, D. P. C.; Schäfer, U.; Scharf, V.; Schmitt, K.; Schröder, C.; Schultz-Coulon, H.-C.; Schumacher, C.; Schwienhorst, R.; Silverstein, S. B.; Simioni, E.; Snidero, G.; Staley, R. J.; Stamen, R.; Stock, P.; Stockton, M. C.; Tan, C. L. A.; Tapprogge, S.; Thomas, J. P.; Thompson, P. D.; Thomson, M.; True, P.; Watkins, P. M.; Watson, A. T.; Watson, M. F.; Weber, P.; Wessels, M.; Wiglesworth, C.; Williams, S. L.

2012-12-01

The PreProcessor system of the ATLAS Level-1 Calorimeter Trigger (L1Calo) receives about 7200 analogue signals from the electromagnetic and hadronic components of the calorimetric detector system. Lateral division results in cells which are pre-summed to so-called Trigger Towers of size 0.1 × 0.1 along azimuth (phi) and pseudorapidity (η). The received calorimeter signals represent deposits of transverse energy. The system consists of 124 individual PreProcessor modules that digitise the input signals for each LHC collision, and provide energy and timing information to the digital processors of the L1Calo system, which identify physics objects forming much of the basis for the full ATLAS first level trigger decision. This paper describes the architecture of the PreProcessor, its hardware realisation, functionality, and performance.

The ATLAS Eventlndex: data flow and inclusion of other metadata

NASA Astrophysics Data System (ADS)

Barberis, D.; Cárdenas Zárate, S. E.; Favareto, A.; Fernandez Casani, A.; Gallas, E. J.; Garcia Montoro, C.; Gonzalez de la Hoz, S.; Hrivnac, J.; Malon, D.; Prokoshin, F.; Salt, J.; Sanchez, J.; Toebbicke, R.; Yuan, R.; ATLAS Collaboration

2016-10-01

The ATLAS EventIndex is the catalogue of the event-related metadata for the information collected from the ATLAS detector. The basic unit of this information is the event record, containing the event identification parameters, pointers to the files containing this event as well as trigger decision information. The main use case for the EventIndex is event picking, as well as data consistency checks for large production campaigns. The EventIndex employs the Hadoop platform for data storage and handling, as well as a messaging system for the collection of information. The information for the EventIndex is collected both at Tier-0, when the data are first produced, and from the Grid, when various types of derived data are produced. The EventIndex uses various types of auxiliary information from other ATLAS sources for data collection and processing: trigger tables from the condition metadata database (COMA), dataset information from the data catalogue AMI and the Rucio data management system and information on production jobs from the ATLAS production system. The ATLAS production system is also used for the collection of event information from the Grid jobs. EventIndex developments started in 2012 and in the middle of 2015 the system was commissioned and started collecting event metadata, as a part of ATLAS Distributed Computing operations.

The hierarchy of task decision and response selection: a task-switching event related potentials study.

PubMed

Braverman, Ami; Berger, Andrea; Meiran, Nachshon

2014-07-01

According to "hierarchical" multi-step theories, response selection is preceded by a decision regarding which task rule should be executed. Other theories assume a "flat" single-step architecture in which task information and stimulus information are simultaneously considered. Using task switching, the authors independently manipulated two kinds of conflict: task conflict (with information that potentially triggers the relevant or the competing task rule/identity) and response conflict (with information that potentially triggers the relevant or the competing response code/motor response). Event related potentials indicated that the task conflict effect began before the response conflict effect and carried on in parallel with it. These results are more in line with the hierarchical view. Copyright © 2014 Elsevier Inc. All rights reserved.

Triggered earthquakes and the 1811-1812 New Madrid, central United States, earthquake sequence

USGS Publications Warehouse

Hough, S.E.

2001-01-01

The 1811-1812 New Madrid, central United States, earthquake sequence included at least three events with magnitudes estimated at well above M 7.0. I discuss evidence that the sequence also produced at least three substantial triggered events well outside the New Madrid Seismic Zone, most likely in the vicinity of Cincinnati, Ohio. The largest of these events is estimated to have a magnitude in the low to mid M 5 range. Events of this size are large enough to cause damage, especially in regions with low levels of preparedness. Remotely triggered earthquakes have been observed in tectonically active regions in recent years, but not previously in stable continental regions. The results of this study suggest, however, that potentially damaging triggered earthquakes may be common following large mainshocks in stable continental regions. Thus, in areas of low seismic activity such as central/ eastern North America, the hazard associated with localized source zones might be more far reaching than previously recognized. The results also provide additional evidence that intraplate crust is critically stressed, such that small stress changes are especially effective at triggering earthquakes.

UV-crosslinkable and thermo-responsive chitosan hybrid hydrogel for NIR-triggered localized on-demand drug delivery.

PubMed

Wang, Lei; Li, Baoqiang; Xu, Feng; Xu, Zheheng; Wei, Daqing; Feng, Yujie; Wang, Yaming; Jia, Dechang; Zhou, Yu

2017-10-15

Innovative drug delivery technologies based on smart hydrogels for localized on-demand drug delivery had aroused great interest. To acquire smart UV-crosslinkable chitosan hydrogel for NIR-triggered localized on-demanded drug release, a novel UV-crosslinkable and thermo-responsive chitosan was first designed and synthesized by grafting with poly N-isopropylacrylamide, acetylation of methacryloyl groups and embedding with photothermal carbon. The UV-crosslinkable unit (methacryloyl groups) endowed chitosan with gelation via UV irradiation. The thermo-responsive unit (poly N-isopropylacrylamide) endowed chitosan hydrogel with temperature-triggered volume shrinkage and reversible swelling/de-swelling behavior. The chitosan hybrid hydrogel embedded with photothermal carbon exhibited distinct NIR-triggered volume shrinkage (∼42% shrinkage) in response to temperature elevation as induced by NIR laser irradiation. As a demonstration, doxorubicin release rate was accelerated and approximately 40 times higher than that from non-irradiated hydrogels. The UV-crosslinkable and thermal-responsive hybrid hydrogel served as in situ forming hydrogel-based drug depot is developed for NIR-triggered localized on-demand release. Copyright © 2017 Elsevier Ltd. All rights reserved.

The effects of stress and affiliation on social decision-making: Investigating the tend-and-befriend pattern.

PubMed

Steinbeis, Nikolaus; Engert, Veronika; Linz, Roman; Singer, Tania

2015-12-01

The prevalence of psychosocial stress in Western societies is constantly on the rise. Its influence on social decision-making, however, remains poorly understood. Whereas, it is known that stress triggers psychological and physiological defense mechanisms, indications of such patterns in social decisions are ambivalent. We sought to elucidate the underlying mechanisms of stress-induced social decisions. We recruited 145 men, who were individually exposed to either a psychosocial stressor or a control condition, while primed with affiliation by interacting either with members of an in- or an out-group. We found that stressed participants were less trusting and engaged in less costly punishment compared to the non-stressed control group. Interacting with out-group members led to less reciprocity and more spiteful punishment. There was no interaction between stress and the affiliation conditions in any of the used social-decision-making paradigms. Lastly, while stress-reactive cortisol levels had no effect on trust behavior, higher baseline cortisol was correlated with greater trust. Our findings suggest that previous ambiguities in data reported on the influence of stress on social decisions, namely tend-and-befriend behavior may have arisen through critical social confounds in the induction of stress. When controlling for potential social confounds, stress may trigger fight-or-flight behavior as indicated by increased social anxiety. These findings highlight the considerable context-dependence of psychosocial stress and its effects on social behavior. Copyright © 2015 Elsevier Ltd. All rights reserved.

If you want to save, focus on the forest rather than on trees. The effects of shifts in levels of construal on saving decisions.

PubMed

Rudzinska-Wojciechowska, Joanna

2017-01-01

Although financial decisions are expected to be rational, there is a growing body of experimental research indicating that small psychological changes in one's mind-set in the actual decision-making moment might affect saving ratios. In this article, another type of change in one's mind-set, which can influence saving decisions, is explored, namely the level of construal. Construal level is a key descriptor of people's cognitive representations of targets, and is a way of characterising the mental mind-sets people use. Building on recent advances in the link between construal levels and intertemporal choices, the present research evaluates the effect of shifts in levels of construal in the very moment of decision making on people's propensity to save money. It is suggested that triggering a high-level construal mind-set would influence individuals' financial decisions and result in greater willingness to save than triggering a low-level construal mind-set. This assumption is supported by the findings: across three experiments, those with an abstract mind-set showed an increased willingness to save when compared to those with a concrete mind-set. The first experiment demonstrated that people in an abstract mind-set are more willing to delay financial gratification than those in a concrete mind-set. In the second and third experiments, those with an abstract mind-set showed an increased willingness to save when compared to those with a concrete mind-set. The research provides further evidence that mental states, which can be evoked by previous, unrelated tasks, such as level of cognitive abstraction, can influence everyday financial decisions. It, thus, highlights the role of situational factors that consumers may be not aware of, which still affect their savings decisions.

Enhancing Fire Control Decision Making with the Patriot Cognitive Skills Trainer: Development and Validation

DTIC Science & Technology

2017-11-01

existing instruction. In addition, the methodology used to identify decision-triggers may be applied to other Army domains to develop instruction...ADDIE is an instructional design framework used as a descriptive guideline for building effective training and performance support tools. 3 In...and evaluate information, and create a solution—were Level Descriptive Terms Additional Examples Create Generating – hypothesizing Planning

76 FR 31225 - Procedures Governing Administrative Review of a United States Trustee's Decision To Deny a...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... Administrative Review of a United States Trustee's Decision To Deny a Chapter 12 or Chapter 13 Standing Trustee's... Trustee's decision to deny a trustee's claim that certain expenses are actual and necessary for the... (``Director'') will conduct a de novo review of the United States Trustee's decision to determine whether the...

Consideration of reference points for the management of renewable resources under an adaptive management paradigm

USGS Publications Warehouse

Irwin, Brian J.; Conroy, Michael J.

2013-01-01

The success of natural resource management depends on monitoring, assessment and enforcement. In support of these efforts, reference points (RPs) are often viewed as critical values of management-relevant indicators. This paper considers RPs from the standpoint of objective-driven decision making in dynamic resource systems, guided by principles of structured decision making (SDM) and adaptive resource management (AM). During the development of natural resource policy, RPs have been variously treated as either ‘targets’ or ‘triggers’. Under a SDM/AM paradigm, target RPs correspond approximately to value-based objectives, which may in turn be either of fundamental interest to stakeholders or intermediaries to other central objectives. By contrast, trigger RPs correspond to decision rules that are presumed to lead to desirable outcomes (such as the programme targets). Casting RPs as triggers or targets within a SDM framework is helpful towards clarifying why (or whether) a particular metric is appropriate. Further, the benefits of a SDM/AM process include elucidation of underlying untested assumptions that may reveal alternative metrics for use as RPs. Likewise, a structured decision-analytic framework may also reveal that failure to achieve management goals is not because the metrics are wrong, but because the decision-making process in which they are embedded is insufficiently robust to uncertainty, is not efficiently directed at producing a resource objective, or is incapable of adaptation to new knowledge.

Application of Fault Management Theory to the Quantitive Selection of a Launch Vehicle Abort Trigger Suite

NASA Technical Reports Server (NTRS)

Lo, Yunnhon; Johnson, Stephen B.; Breckenridge, Jonathan T.

2014-01-01

SHM/FM theory has been successfully applied to the selection of the baseline set Abort Triggers for the NASA SLS center dot Quantitative assessment played a useful role in the decision process ? M&FM, which is new within NASA MSFC, required the most "new" work, as this quantitative analysis had never been done before center dot Required development of the methodology and tool to mechanize the process center dot Established new relationships to the other groups ? The process is now an accepted part of the SLS design process, and will likely be applied to similar programs in the future at NASA MSFC ? Future improvements center dot Improve technical accuracy ?Differentiate crew survivability due to an abort, vs. survivability even no immediate abort occurs (small explosion with little debris) ?Account for contingent dependence of secondary triggers on primary triggers ?Allocate "? LOC Benefit" of each trigger when added to the previously selected triggers. center dot Reduce future costs through the development of a specialized tool ? Methodology can be applied to any manned/unmanned vehicle, in space or terrestrial

The impact and determinants of the energy paradigm on economic growth in European Union

PubMed Central

Mieila, Mihai; Panait, Mirela

2017-01-01

Contemporary economies are strongly reliant on energy and analyzing the determining factors that trigger the changes in energy paradigm and their impact upon economic growth is a topical research subject. Our contention is that energy paradigm plays a major role in achieving the sustainable development of contemporary economies. In order to prove this the panel data methodology of research was employed, namely four panel unit root tests (LLC, IPS, F-ADF and F-PP) aiming to reveal the connections and relevance among 17 variables denoting energy influence on economic development. Moreover, it was introduced a specific indicator to express energy consumption per capita. Our findings extend the classical approach of the changes in energy paradigm and their impact upon economic growth and offer a comprehensive analysis which surpasses the practices and policy decisions in the field. PMID:28301505

Real-time track-less Cherenkov ring fitting trigger system based on Graphics Processing Units

NASA Astrophysics Data System (ADS)

Ammendola, R.; Biagioni, A.; Chiozzi, S.; Cretaro, P.; Cotta Ramusino, A.; Di Lorenzo, S.; Fantechi, R.; Fiorini, M.; Frezza, O.; Gianoli, A.; Lamanna, G.; Lo Cicero, F.; Lonardo, A.; Martinelli, M.; Neri, I.; Paolucci, P. S.; Pastorelli, E.; Piandani, R.; Piccini, M.; Pontisso, L.; Rossetti, D.; Simula, F.; Sozzi, M.; Vicini, P.

2017-12-01

The parallel computing power of commercial Graphics Processing Units (GPUs) is exploited to perform real-time ring fitting at the lowest trigger level using information coming from the Ring Imaging Cherenkov (RICH) detector of the NA62 experiment at CERN. To this purpose, direct GPU communication with a custom FPGA-based board has been used to reduce the data transmission latency. The GPU-based trigger system is currently integrated in the experimental setup of the RICH detector of the NA62 experiment, in order to reconstruct ring-shaped hit patterns. The ring-fitting algorithm running on GPU is fed with raw RICH data only, with no information coming from other detectors, and is able to provide more complex trigger primitives with respect to the simple photodetector hit multiplicity, resulting in a higher selection efficiency. The performance of the system for multi-ring Cherenkov online reconstruction obtained during the NA62 physics run is presented.

The digital trigger system for the RED-100 detector

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

Naumov, P. P., E-mail: ddr727@yandex.ru; Akimov, D. Yu.; Belov, V. A.

The system for forming a trigger for the liquid xenon detector RED-100 is developed. The trigger can be generated for all types of events that the detector needs for calibration and data acquisition, including the events with a single electron of ionization. In the system, a mechanism of event detection is implemented according to which the timestamp and event type are assigned to each event. The trigger system is required in the systems searching for rare events to select and keep only the necessary information from the ADC array. The specifications and implementation of the trigger unit which provides amore » high efficiency of response even to low-energy events are considered.« less

Seismicity remotely triggered by the magnitude 7.3 landers, california, earthquake

USGS Publications Warehouse

Hill, D.P.; Reasenberg, P.A.; Michael, A.; Arabaz, W.J.; Beroza, G.; Brumbaugh, D.; Brune, J.N.; Castro, R.; Davis, S.; Depolo, D.; Ellsworth, W.L.; Gomberg, J.; Harmsen, S.; House, L.; Jackson, S.M.; Johnston, M.J.S.; Jones, L.; Keller, Rebecca Hylton; Malone, S.; Munguia, L.; Nava, S.; Pechmann, J.C.; Sanford, A.; Simpson, R.W.; Smith, R.B.; Stark, M.; Stickney, M.; Vidal, A.; Walter, S.; Wong, V.; Zollweg, J.

1993-01-01

The magnitude 7.3 Landers earthquake of 28 June 1992 triggered a remarkably sudden and widespread increase in earthquake activity across much of the western United States. The triggered earthquakes, which occurred at distances up to 1250 kilometers (17 source dimensions) from the Landers mainshock, were confined to areas of persistent seismicity and strike-slip to normal faulting. Many of the triggered areas also are sites of geothermal and recent volcanic activity. Static stress changes calculated for elastic models of the earthquake appear to be too small to have caused the triggering. The most promising explanations involve nonlinear interactions between large dynamic strains accompanying seismic waves from the mainshock and crustal fluids (perhaps including crustal magma).

Response inhibition and impulsive decision-making in sexual offenders against children.

PubMed

Turner, Daniel; Laier, Christian; Brand, Matthias; Bockshammer, Tamara; Welsch, Robin; Rettenberger, Martin

2018-05-31

Current theories view impulsivity as an important factor in the explanation of sexual offending. While impulsivity itself is a multidimensional construct, response inhibition and impulsive decision-making are frequently discussed subcomponents. Impulsivity in sexual offenders could be triggered by sexual cues with high emotional significance. The present study compared response inhibition abilities and the degree of impulsive decision-making between 63 child sexual abusers and 63 nonoffending controls. A Go/No-Go task was used to assess response inhibition, while the Iowa Gambling Task (IGT) and the Game of Dice Task (GDT) were used for the assessment of decision-making. In contrast to previous studies, modified versions of the Go/No-Go task and the IGT were used, including pictures of the Not Real People-Set depicting nude adults and children. Child sexual abusers showed more deficits in response inhibition in the Go/No-Go task. Furthermore, decision-making was especially impaired by the presence of child images in child sexual abusers with more intense pedophilic sexual interests. In contrast, in the nonoffending controls the presence of preferred sexual cues (pictures of women) improved decision-making performance. No differences in overall GDT performance were found between the groups; however, child sexual abusers chose the riskiest option more frequently than nonoffending controls. In line with theoretical assumptions about the processes underlying sexual offending, child sexual abusers show more deficits in neuropsychological functioning, which may be related to more impulsive behaviors. These impairments could be triggered by the presence of sexually relevant cues. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Intraplate triggered earthquakes: Observations and interpretation

USGS Publications Warehouse

Hough, S.E.; Seeber, L.; Armbruster, J.G.

2003-01-01

We present evidence that at least two of the three 1811-1812 New Madrid, central United States, mainshocks and the 1886 Charleston, South Carolina, earthquake triggered earthquakes at regional distances. In addition to previously published evidence for triggered earthquakes in the northern Kentucky/southern Ohio region in 1812, we present evidence suggesting that triggered events might have occurred in the Wabash Valley, to the south of the New Madrid Seismic Zone, and near Charleston, South Carolina. We also discuss evidence that earthquakes might have been triggered in northern Kentucky within seconds of the passage of surface waves from the 23 January 1812 New Madrid mainshock. After the 1886 Charleston earthquake, accounts suggest that triggered events occurred near Moodus, Connecticut, and in southern Indiana. Notwithstanding the uncertainty associated with analysis of historical accounts, there is evidence that at least three out of the four known Mw 7 earthquakes in the central and eastern United States seem to have triggered earthquakes at distances beyond the typically assumed aftershock zone of 1-2 mainshock fault lengths. We explore the possibility that remotely triggered earthquakes might be common in low-strain-rate regions. We suggest that in a low-strain-rate environment, permanent, nonelastic deformation might play a more important role in stress accumulation than it does in interplate crust. Using a simple model incorporating elastic and anelastic strain release, we show that, for realistic parameter values, faults in intraplate crust remain close to their failure stress for a longer part of the earthquake cycle than do faults in high-strain-rate regions. Our results further suggest that remotely triggered earthquakes occur preferentially in regions of recent and/or future seismic activity, which suggests that faults are at a critical stress state in only some areas. Remotely triggered earthquakes may thus serve as beacons that identify regions of long-lived stress concentration.

Common Readout Unit (CRU) - A new readout architecture for the ALICE experiment

NASA Astrophysics Data System (ADS)

Mitra, J.; Khan, S. A.; Mukherjee, S.; Paul, R.

2016-03-01

The ALICE experiment at the CERN Large Hadron Collider (LHC) is presently going for a major upgrade in order to fully exploit the scientific potential of the upcoming high luminosity run, scheduled to start in the year 2021. The high interaction rate and the large event size will result in an experimental data flow of about 1 TB/s from the detectors, which need to be processed before sending to the online computing system and data storage. This processing is done in a dedicated Common Readout Unit (CRU), proposed for data aggregation, trigger and timing distribution and control moderation. It act as common interface between sub-detector electronic systems, computing system and trigger processors. The interface links include GBT, TTC-PON and PCIe. GBT (Gigabit transceiver) is used for detector data payload transmission and fixed latency path for trigger distribution between CRU and detector readout electronics. TTC-PON (Timing, Trigger and Control via Passive Optical Network) is employed for time multiplex trigger distribution between CRU and Central Trigger Processor (CTP). PCIe (Peripheral Component Interconnect Express) is the high-speed serial computer expansion bus standard for bulk data transport between CRU boards and processors. In this article, we give an overview of CRU architecture in ALICE, discuss the different interfaces, along with the firmware design and implementation of CRU on the LHCb PCIe40 board.

75 FR 66188 - Sentencing Guidelines for United States Courts

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-27

...) by striking ``five kilograms of marihuana'' and inserting ``2 grams of cocaine base''; by inserting... required to trigger the 5-year mandatory minimum term of imprisonment was increased from 5 grams to 28 grams, and the quantity threshold required to trigger the 10-year mandatory minimum term of imprisonment...

IEEE 802.21 Assisted Seamless and Energy Efficient Handovers in Mixed Networks

NASA Astrophysics Data System (ADS)

Liu, Huaiyu; Maciocco, Christian; Kesavan, Vijay; Low, Andy L. Y.

Network selection is the decision process for a mobile terminal to handoff between homogeneous or heterogeneous networks. With multiple available networks, the selection process must evaluate factors like network services/conditions, monetary cost, system conditions, user preferences etc. In this paper, we investigate network selection using a cost function and information provided by IEEE 802.21. The cost function provides flexibility to balance different factors in decision making and our research is focused on improving both seamlessness and energy efficiency of handovers. Our solution is evaluated using real WiFi, WiMax, and 3G signal strength traces. The results show that appropriate networks were selected based on selection policies, handovers were triggered at optimal times to increase overall network connectivity as compared to traditional triggering schemes, while at the same time the energy consumption of multi-radio devices for both on-going operations as well as during handovers is optimized.

Nurse managers' decision-making in daily unit operation in peri-operative settings: a cross-sectional descriptive study.

PubMed

Siirala, Eriikka; Peltonen, Laura-Maria; Lundgrén-Laine, Heljä; Salanterä, Sanna; Junttila, Kristiina

2016-09-01

To describe the tactical and the operational decisions made by nurse managers when managing the daily unit operation in peri-operative settings. Management is challenging as situations change rapidly and decisions are constantly made. Understanding decision-making in this complex environment helps to develop decision support systems to support nurse managers' operative and tactical decision-making. Descriptive cross-sectional design. Data were collected from 20 nurse managers with the think-aloud method during the busiest working hours and analysed using thematic content analysis. Nurse managers made over 700 decisions; either ad hoc (n = 289), near future (n = 268) or long-term (n = 187) by nature. Decisions were often made simultaneously with many interruptions. Ad hoc decisions covered staff allocation, ensuring adequate staff, rescheduling surgical procedures, confirmation tangible resources and following-up the daily unit operation. Decisions in the near future were: planning of surgical procedures and tangible resources, and planning staff allocation. Long-term decisions were: human recourses, nursing development, supplies and equipment, and finances in the unit. Decision-making was vulnerable to interruptions, which sometimes complicated the managing tasks. The results can be used when planning decision support systems and when defining the nurse managers' tasks in peri-operative settings. © 2016 John Wiley & Sons Ltd.

Discussions about treatment restrictions in chronic neurologic diseases: a structured review.

PubMed

Seeber, Antje A; Hijdra, Albert; Vermeulen, Marinus; Willems, Dick L

2012-02-21

Many incurable neurologic diseases have predictable complications during their course or at their end stage. Timely discussions of potential treatment restrictions may improve the quality of treatment decisions toward the end of life. What is known about the actual practice of these discussions? We performed a literature search in MEDLINE, EMBASE, and CINAHL for empirical studies about discussions and decisions to restrict treatment in the course of 6 conditions: motor neuron disease (amyotrophic lateral sclerosis [ALS]), primary malignant brain tumors, multiple sclerosis, stroke, Parkinson disease, and dementia (Alzheimer disease). In 10 of 43 studies, the actual practice of decision-making was studied; in the remaining 33, caregivers were interviewed about this practice. Three scenarios were described: 1) acute devastating disease (severe stroke); 2) stable severe neurologic deficit with complications (poststroke brain damage); and 3) chronic progressive disease with complications (dementia and ALS). We found no studies concerning the other conditions. In all 3 scenarios, discussions and decisions seemed to be mostly triggered by the occurrence of life-threatening situations, either caused by the disease itself (1), or complications (2 and 3, including many patients with ALS). Some ALS studies showed that timely discussion of treatment options improved end-of-life decision-making. The actual practice of discussions about treatment restrictions in chronic neurologic disease has hardly been studied. The currently available empirical data suggest that discussions are mainly triggered by life-threatening situations, whereas anticipation of such situations may be beneficial for patients and their families.

Interpretation of 'Unnatural death' in coronial law: A review of the English legal process of decision making, statutory interpretation, and case law: The implications for medical cases and coronial consistency.

PubMed

Harris, Andrew; Walker, Andrew

2018-04-23

The article examines the decision-making process for medical reporting of deaths to a coroner and the statutory basis for coronial decisions whether to investigate. It analyses what is published about the consistency of decision making of coroners and discusses what should be the legal basis for determining whether a particular death is natural or unnatural in English law. There is a review of English case law, including the significance of Touche and Benton and the development of 'unnatural' as a term of art, which informs what the courts have held to be an unnatural death. What case law indicates about multiple causes and the significance of the wording in the Coroners & Justice Act 2009 that triggers an investigation are considered. It highlights the importance of considering the medical cause of death and to what extent information other than the initial death report is required, before making the decision that the coroner's duty to open an investigation is triggered. The article concludes that a two-stage test is required. Firstly, is the cause of death medically unnatural? Secondly, whether the circumstances themselves are unnatural or such as to make a medically natural cause of death unnatural. If the coroner has reason to suspect the medical cause of death is unnatural per se the statutory duty to investigate will be engaged, regardless of the circumstances.

A method for producing digital probabilistic seismic landslide hazard maps

USGS Publications Warehouse

Jibson, R.W.; Harp, E.L.; Michael, J.A.

2000-01-01

The 1994 Northridge, California, earthquake is the first earthquake for which we have all of the data sets needed to conduct a rigorous regional analysis of seismic slope instability. These data sets include: (1) a comprehensive inventory of triggered landslides, (2) about 200 strong-motion records of the mainshock, (3) 1:24 000-scale geologic mapping of the region, (4) extensive data on engineering properties of geologic units, and (5) high-resolution digital elevation models of the topography. All of these data sets have been digitized and rasterized at 10 m grid spacing using ARC/INFO GIS software on a UNIX computer. Combining these data sets in a dynamic model based on Newmark's permanent-deformation (sliding-block) analysis yields estimates of coseismic landslide displacement in each grid cell from the Northridge earthquake. The modeled displacements are then compared with the digital inventory of landslides triggered by the Northridge earthquake to construct a probability curve relating predicted displacement to probability of failure. This probability function can be applied to predict and map the spatial variability in failure probability in any ground-shaking conditions of interest. We anticipate that this mapping procedure will be used to construct seismic landslide hazard maps that will assist in emergency preparedness planning and in making rational decisions regarding development and construction in areas susceptible to seismic slope failure. ?? 2000 Elsevier Science B.V. All rights reserved.

A method for producing digital probabilistic seismic landslide hazard maps; an example from the Los Angeles, California, area

USGS Publications Warehouse

Jibson, Randall W.; Harp, Edwin L.; Michael, John A.

1998-01-01

The 1994 Northridge, California, earthquake is the first earthquake for which we have all of the data sets needed to conduct a rigorous regional analysis of seismic slope instability. These data sets include (1) a comprehensive inventory of triggered landslides, (2) about 200 strong-motion records of the mainshock, (3) 1:24,000-scale geologic mapping of the region, (4) extensive data on engineering properties of geologic units, and (5) high-resolution digital elevation models of the topography. All of these data sets have been digitized and rasterized at 10-m grid spacing in the ARC/INFO GIS platform. Combining these data sets in a dynamic model based on Newmark's permanent-deformation (sliding-block) analysis yields estimates of coseismic landslide displacement in each grid cell from the Northridge earthquake. The modeled displacements are then compared with the digital inventory of landslides triggered by the Northridge earthquake to construct a probability curve relating predicted displacement to probability of failure. This probability function can be applied to predict and map the spatial variability in failure probability in any ground-shaking conditions of interest. We anticipate that this mapping procedure will be used to construct seismic landslide hazard maps that will assist in emergency preparedness planning and in making rational decisions regarding development and construction in areas susceptible to seismic slope failure.

The LUX experiment - trigger and data acquisition systems

NASA Astrophysics Data System (ADS)

Druszkiewicz, Eryk

2013-04-01

The Large Underground Xenon (LUX) detector is a two-phase xenon time projection chamber designed to detect interactions of dark matter particles with the xenon nuclei. Signals from the detector PMTs are processed by custom-built analog electronics which provide properly shaped signals for the trigger and data acquisition (DAQ) systems. During calibrations, both systems must be able to handle high rates and have large dynamic ranges; during dark matter searches, maximum sensitivity requires low thresholds. The trigger system uses eight-channel 64-MHz digitizers (DDC-8) connected to a Trigger Builder (TB). The FPGA cores on the digitizers perform real-time pulse identification (discriminating between S1 and S2-like signals) and event localization. The TB uses hit patterns, hit maps, and maximum response detection to make trigger decisions, which are reached within few microseconds after the occurrence of an event of interest. The DAQ system is comprised of commercial digitizers with customized firmware. Its real-time baseline suppression allows for a maximum event acquisition rate in excess of 1.5 kHz, which results in virtually no deadtime. The performance of the trigger and DAQ systems during the commissioning runs of LUX will be discussed.

Severe Thunderstorm and Tornado Warnings at Raleigh, North Carolina.

NASA Astrophysics Data System (ADS)

Hoium, Debra K.; Riordan, Allen J.; Monahan, John; Keeter, Kermit K.

1997-11-01

The National Weather Service issues public warnings for severe thunderstorms and tornadoes when these storms appear imminent. A study of the warning process was conducted at the National Weather Service Forecast Office at Raleigh, North Carolina, from 1994 through 1996. The purpose of the study was to examine the decision process by documenting the types of information leading to decisions to warn or not to warn and by describing the sequence and timing of events in the development of warnings. It was found that the evolution of warnings followed a logical sequence beginning with storm monitoring and proceeding with increasingly focused activity. For simplicity, information input to the process was categorized as one of three types: ground truth, radar reflectivity, or radar velocity.Reflectivity, velocity, and ground truth were all equally likely to initiate the investigation process. This investigation took an average of 7 min, after which either a decision was made not to warn or new information triggered the warning. Decisions not to issue warnings were based more on ground truth and reflectivity than radar velocity products. Warnings with investigations of more than 2 min were more likely to be triggered by radar reflectivity, than by velocity or ground truth. Warnings with a shorter investigation time, defined here as "immediate trigger warnings," were less frequently based on velocity products and more on ground truth information. Once the decision was made to warn, it took an average of 2.1 min to prepare the warning text. In 85% of cases when warnings were issued, at least one contact was made to emergency management officials or storm spotters in the warned county. Reports of severe weather were usually received soon after the warning was transmitted-almost half of these within 30 min after issue. A total of 68% were received during the severe weather episode, but some of these storm reports later proved false according to Storm Data.Even though the WSR-88D is a sophisticated tool, ground truth information was found to be a vital part of the warning process. However, the data did not indicate that population density was statistically correlated either with the number of warnings issued or the verification rate.

Model-based decision making in early clinical development: minimizing the impact of a blood pressure adverse event.

PubMed

Stroh, Mark; Addy, Carol; Wu, Yunhui; Stoch, S Aubrey; Pourkavoos, Nazaneen; Groff, Michelle; Xu, Yang; Wagner, John; Gottesdiener, Keith; Shadle, Craig; Wang, Hong; Manser, Kimberly; Winchell, Gregory A; Stone, Julie A

2009-03-01

We describe how modeling and simulation guided program decisions following a randomized placebo-controlled single-rising oral dose first-in-man trial of compound A where an undesired transient blood pressure (BP) elevation occurred in fasted healthy young adult males. We proposed a lumped-parameter pharmacokinetic-pharmacodynamic (PK/PD) model that captured important aspects of the BP homeostasis mechanism. Four conceptual units characterized the feedback PD model: a sinusoidal BP set point, an effect compartment, a linear effect model, and a system response. To explore approaches for minimizing the BP increase, we coupled the PD model to a modified PK model to guide oral controlled-release (CR) development. The proposed PK/PD model captured the central tendency of the observed data. The simulated BP response obtained with theoretical release rate profiles suggested some amelioration of the peak BP response with CR. This triggered subsequent CR formulation development; we used actual dissolution data from these candidate CR formulations in the PK/PD model to confirm a potential benefit in the peak BP response. Though this paradigm has yet to be tested in the clinic, our model-based approach provided a common rational framework to more fully utilize the limited available information for advancing the program.

Applying value stream mapping techniques to eliminate non-value-added waste for the procurement of endovascular stents.

PubMed

Teichgräber, Ulf K; de Bucourt, Maximilian

2012-01-01

OJECTIVES: To eliminate non-value-adding (NVA) waste for the procurement of endovascular stents in interventional radiology services by applying value stream mapping (VSM). The Lean manufacturing technique was used to analyze the process of material and information flow currently required to direct endovascular stents from external suppliers to patients. Based on a decision point analysis for the procurement of stents in the hospital, a present state VSM was drawn. After assessment of the current status VSM and progressive elimination of unnecessary NVA waste, a future state VSM was drawn. The current state VSM demonstrated that out of 13 processes for the procurement of stents only 2 processes were value-adding. Out of the NVA processes 5 processes were unnecessary NVA activities, which could be eliminated. The decision point analysis demonstrated that the procurement of stents was mainly a forecast driven push system. The future state VSM applies a pull inventory control system to trigger the movement of a unit after withdrawal by using a consignment stock. VSM is a visualization tool for the supply chain and value stream, based on the Toyota Production System and greatly assists in successfully implementing a Lean system. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Hemoglobin levels triggering erythropoiesis-stimulating agent therapy in patients with cancer: the shift after United States Food and Drug Administration policy changes.

PubMed

Stroupe, Kevin T; Tarlov, Elizabeth; Lee, Todd A; Weichle, Thomas W; Zhang, Qiuying L; Michaelis, Laura C; Ozer, Howard; Durazo-Arvizu, Ramon; Browning, Margaret M; Hynes, Denise M

2012-11-01

To determine whether the hemoglobin level at which health care providers prescribed erythropoiesis-stimulating agent (ESA) therapy (trigger hemoglobin level) for their patients receiving chemotherapy was lower after the United States Food and Drug Administration (FDA) mandated a black-box warning in March 2007. Retrospective analysis. U.S. Department of Veterans Affairs Healthcare System (VA) national databases. A total of 7450 patients who were diagnosed with cancer between 2002 and 2009, were undergoing chemotherapy, and who received an ESA within 12 months after their cancer diagnosis. Data were collected on patients' demographic, clinical, environmental, and treatment-related factors. After controlling for these factors, multivariable regression analyses were used to compare the trigger hemoglobin level before and after the FDA-mandated labeling change. The average trigger hemoglobin level was 0.73 g/dl lower after the labeling change (95% confidence interval [CI] -0.84 to -0.63). Moreover, the decline in trigger hemoglobin levels began in mid-2006, when the average trigger hemoglobin level fell from 10.50 g/dl in early 2006 (95% CI 10.36-10.63) to 9.30 g/dl by late 2009 (95% CI 9.10-9.49). Even before the 2007 FDA-mandated changes in ESA product labeling, hemoglobin levels that triggered ESA treatment began declining for patients receiving cancer care within the VA. This highlights the critical importance of dissemination of postmarketing safety data to impact shifts in ESA use for anemia management. © 2012 Pharmacotherapy Publications, Inc.

Adaptive management of large aquatic ecosystem recovery programs in the United States.

PubMed

Thom, Ronald; St Clair, Tom; Burns, Rebecca; Anderson, Michael

2016-12-01

Adaptive management (AM) is being employed in a number of programs in the United States to guide actions to restore aquatic ecosystems because these programs are both expensive and are faced with significant uncertainties. Many of these uncertainties are associated with prioritizing when, where, and what kind of actions are needed to meet the objectives of enhancing ecosystem services and recovering threatened and endangered species. We interviewed nine large-scale aquatic ecosystem restoration programs across the United States to document the lessons learned from implementing AM. In addition, we recorded information on ecological drivers (e.g., endangered fish species) for the program, and inferred how these drivers reflected more generic ecosystem services. Ecosystem services (e.g., genetic diversity, cultural heritage), albeit not explicit drivers, were either important to the recovery or enhancement of the drivers, or were additional benefits associated with actions to recover or enhance the program drivers. Implementing programs using AM lessons learned has apparently helped achieve better results regarding enhancing ecosystem services and restoring target species populations. The interviews yielded several recommendations. The science and AM program must be integrated into how the overall restoration program operates in order to gain understanding and support, and effectively inform management decision-making. Governance and decision-making varied based on its particular circumstances. Open communication within and among agency and stakeholder groups and extensive vetting lead up to decisions. It was important to have an internal agency staff member to implement the AM plan, and a clear designation of roles and responsibilities, and long-term commitment of other involved parties. The most important management questions and information needs must be identified up front. It was imperative to clearly identify, link and continually reinforce the essential components of an AM plan, including objectives, constraints, uncertainties, hypotheses, management actions, decision criteria and triggers, monitoring, and research. Some employed predictive models and the results of research on uncertainties to vet options for actions. Many relied on best available science and professional judgment to decide if adjustments to actions were needed. All programs emphasized the need to be nimble enough to be responsive to new information and make necessary adjustments to management action implementation. We recommend that ecosystem services be explicit drivers of restoration programs to facilitate needed funding and communicate to the general public and with the global efforts on restoring and conserving ecosystems. Copyright © 2016 Elsevier Ltd. All rights reserved.

If you want to save, focus on the forest rather than on trees. The effects of shifts in levels of construal on saving decisions

PubMed Central

2017-01-01

Although financial decisions are expected to be rational, there is a growing body of experimental research indicating that small psychological changes in one’s mind-set in the actual decision-making moment might affect saving ratios. In this article, another type of change in one’s mind-set, which can influence saving decisions, is explored, namely the level of construal. Construal level is a key descriptor of people’s cognitive representations of targets, and is a way of characterising the mental mind-sets people use. Building on recent advances in the link between construal levels and intertemporal choices, the present research evaluates the effect of shifts in levels of construal in the very moment of decision making on people’s propensity to save money. It is suggested that triggering a high-level construal mind-set would influence individuals’ financial decisions and result in greater willingness to save than triggering a low-level construal mind-set. This assumption is supported by the findings: across three experiments, those with an abstract mind-set showed an increased willingness to save when compared to those with a concrete mind-set. The first experiment demonstrated that people in an abstract mind-set are more willing to delay financial gratification than those in a concrete mind-set. In the second and third experiments, those with an abstract mind-set showed an increased willingness to save when compared to those with a concrete mind-set. The research provides further evidence that mental states, which can be evoked by previous, unrelated tasks, such as level of cognitive abstraction, can influence everyday financial decisions. It, thus, highlights the role of situational factors that consumers may be not aware of, which still affect their savings decisions. PMID:28552943

Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.

PubMed

Richardson, Karen J; Sengstack, Patricia; Doucette, Jeffrey N; Hammond, William E; Schertz, Matthew; Thompson, Julie; Johnson, Constance

2016-02-01

The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.

Moral decision making in neonatal intensive care.

PubMed

Chally, P S

1992-01-01

To gain information about the perspective that neonatal intensive-care unit nurses use to make moral decisions. Descriptive. Neonatal intensive-care unit of a large teaching hospital in the midwestern United States. Convenience sample of 26 female nurses working in a neonatal intensive-care unit. Audiotaped, semistructured interviews and demographic questionnaires. The results indicated that most (65%) of the nurses used the care perspective to make moral decisions. A small number (12%) used the justice perspective, and the remaining nurses (23%) used a combined care and justice perspective. Both the care and justice perspectives were found to be important for understanding how nurses make moral decisions.

Old Business: From Brown to Now.

ERIC Educational Resources Information Center

Clark, Kenneth B.

1978-01-01

During the past ten years, subtle White northern liberal racism, White backlash, and Black separatism have seriously threatened the gains of the civil rights movement that were triggered by the "Brown" decision. Fortunately, this negative tide is now being reversed. (Author/IRT)

Nature of collective decision-making by simple yes/no decision units.

PubMed

Hasegawa, Eisuke; Mizumoto, Nobuaki; Kobayashi, Kazuya; Dobata, Shigeto; Yoshimura, Jin; Watanabe, Saori; Murakami, Yuuka; Matsuura, Kenji

2017-10-31

The study of collective decision-making spans various fields such as brain and behavioural sciences, economics, management sciences, and artificial intelligence. Despite these interdisciplinary applications, little is known regarding how a group of simple 'yes/no' units, such as neurons in the brain, can select the best option among multiple options. One prerequisite for achieving such correct choices by the brain is correct evaluation of relative option quality, which enables a collective decision maker to efficiently choose the best option. Here, we applied a sensory discrimination mechanism using yes/no units with differential thresholds to a model for making a collective choice among multiple options. The performance corresponding to the correct choice was shown to be affected by various parameters. High performance can be achieved by tuning the threshold distribution with the options' quality distribution. The number of yes/no units allocated to each option and its variability profoundly affects performance. When this variability is large, a quorum decision becomes superior to a majority decision under some conditions. The general features of this collective decision-making by a group of simple yes/no units revealed in this study suggest that this mechanism may be useful in applications across various fields.

A framework for designing and analyzing binary decision-making strategies in cellular systems†

PubMed Central

Porter, Joshua R.; Andrews, Burton W.; Iglesias, Pablo A.

2015-01-01

Cells make many binary (all-or-nothing) decisions based on noisy signals gathered from their environment and processed through noisy decision-making pathways. Reducing the effect of noise to improve the fidelity of decision-making comes at the expense of increased complexity, creating a tradeoff between performance and metabolic cost. We present a framework based on rate distortion theory, a branch of information theory, to quantify this tradeoff and design binary decision-making strategies that balance low cost and accuracy in optimal ways. With this framework, we show that several observed behaviors of binary decision-making systems, including random strategies, hysteresis, and irreversibility, are optimal in an information-theoretic sense for various situations. This framework can also be used to quantify the goals around which a decision-making system is optimized and to evaluate the optimality of cellular decision-making systems by a fundamental information-theoretic criterion. As proof of concept, we use the framework to quantify the goals of the externally triggered apoptosis pathway. PMID:22370552

Wzx flippases exhibiting complex O-unit preferences require a new model for Wzx-substrate interactions.

PubMed

Liu, Michael A; Morris, Paraskevi; Reeves, Peter R

2018-06-10

The Wzx flippase is a critical component of the O-antigen biosynthesis pathway, being responsible for the translocation of oligosaccharide O units across the inner membrane in Gram-negative bacteria. Recent studies have shown that Wzx has a strong preference for its cognate O unit, but the types of O-unit structural variance that a given Wzx can accommodate are poorly understood. In this study, we identified two Yersinia pseudotuberculosis Wzx that can distinguish between different terminal dideoxyhexose sugars on a common O-unit main-chain, despite both being able to translocate several other structurally-divergent O units. We also identified other Y. pseudotuberculosis Wzx that can translocate a structurally divergent foreign O unit with high efficiency, and thus exhibit an apparently relaxed substrate preference. It now appears that Wzx substrate preference is more complex than previously suggested, and that not all O-unit residues are equally important determinants of translocation efficiency. We propose a new "Structure-Specific Triggering" model in which Wzx translocation proceeds at a low level for a wide variety of substrates, with high-frequency translocation only being triggered by Wzx interacting with one or more preferred O-unit structural elements found on its cognate O unit(s). © 2018 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.

The ATLAS high level trigger steering

NASA Astrophysics Data System (ADS)

Berger, N.; Bold, T.; Eifert, T.; Fischer, G.; George, S.; Haller, J.; Hoecker, A.; Masik, J.; Nedden, M. Z.; Reale, V. P.; Risler, C.; Schiavi, C.; Stelzer, J.; Wu, X.

2008-07-01

The High Level Trigger (HLT) of the ATLAS experiment at the Large Hadron Collider receives events which pass the LVL1 trigger at ~75 kHz and has to reduce the rate to ~200 Hz while retaining the most interesting physics. It is a software trigger and performs the reduction in two stages: the LVL2 trigger and the Event Filter (EF). At the heart of the HLT is the Steering software. To minimise processing time and data transfers it implements the novel event selection strategies of seeded, step-wise reconstruction and early rejection. The HLT is seeded by regions of interest identified at LVL1. These and the static configuration determine which algorithms are run to reconstruct event data and test the validity of trigger signatures. The decision to reject the event or continue is based on the valid signatures, taking into account pre-scale and pass-through. After the EF, event classification tags are assigned for streaming purposes. Several new features for commissioning and operation have been added: comprehensive monitoring is now built in to the framework; for validation and debugging, reconstructed data can be written out; the steering is integrated with the new configuration (presented separately), and topological and global triggers have been added. This paper will present details of the final design and its implementation, the principles behind it, and the requirements and constraints it is subject to. The experience gained from technical runs with realistic trigger menus will be described.

A dynamic model of reasoning and memory.

PubMed

Hawkins, Guy E; Hayes, Brett K; Heit, Evan

2016-02-01

Previous models of category-based induction have neglected how the process of induction unfolds over time. We conceive of induction as a dynamic process and provide the first fine-grained examination of the distribution of response times observed in inductive reasoning. We used these data to develop and empirically test the first major quantitative modeling scheme that simultaneously accounts for inductive decisions and their time course. The model assumes that knowledge of similarity relations among novel test probes and items stored in memory drive an accumulation-to-bound sequential sampling process: Test probes with high similarity to studied exemplars are more likely to trigger a generalization response, and more rapidly, than items with low exemplar similarity. We contrast data and model predictions for inductive decisions with a recognition memory task using a common stimulus set. Hierarchical Bayesian analyses across 2 experiments demonstrated that inductive reasoning and recognition memory primarily differ in the threshold to trigger a decision: Observers required less evidence to make a property generalization judgment (induction) than an identity statement about a previously studied item (recognition). Experiment 1 and a condition emphasizing decision speed in Experiment 2 also found evidence that inductive decisions use lower quality similarity-based information than recognition. The findings suggest that induction might represent a less cautious form of recognition. We conclude that sequential sampling models grounded in exemplar-based similarity, combined with hierarchical Bayesian analysis, provide a more fine-grained and informative analysis of the processes involved in inductive reasoning than is possible solely through examination of choice data. PsycINFO Database Record (c) 2016 APA, all rights reserved.

Culture and medical decision making: Healthcare consumer perspectives in Japan and the United States.

PubMed

Alden, Dana L; Friend, John M; Lee, Angela Y; de Vries, Marieke; Osawa, Ryosuke; Chen, Qimei

2015-12-01

Two studies identified core value influences on medical decision-making processes across and within cultures. In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents (interdependence, independence, and power distance) were also measured. In Study 2, American adults reviewed a colorectal cancer screening decision aid. Decision preparedness was measured along with interdependence, independence, and desire for medical information. In Study 1, higher interdependence predicted stronger desire for decision-making information in both countries, but was significantly stronger in Japan. The path from information desire to decision-making influence desire was significant only in Japan. The independence path to desire for decision-making influence was significant only in the United States. Power distance effects negatively predicted desire for decision-making influence only in the United States. For Study 2, high (low) interdependents and women (men) in the United States felt that a colorectal cancer screening decision aid helped prepare them more (less) for a medical consultation. Low interdependent men were at significantly higher risk for low decision preparedness. Study 1 suggests that Japanese participants may tend to view medical decision-making influence as an interdependent, information sharing exchange, whereas American respondents may be more interested in power sharing that emphasizes greater independence. Study 2 demonstrates the need to assess value influences on medical decision-making processes within and across cultures and suggests that individually tailored versions of decision aids may optimize decision preparedness. (c) 2015 APA, all rights reserved).

Deriving empirical benchmarks from existing monitoring datasets for rangeland adaptive management

USDA-ARS?s Scientific Manuscript database

Under adaptive management, goals and decisions for managing rangeland resources are shaped by requirements like the Bureau of Land Management’s (BLM’s) Land Health Standards, which specify desired conditions. Without formalized, quantitative benchmarks for triggering management actions, adaptive man...

Deciding to institutionalize: caregiving crisis, intergenerational communication, and uncertainty management for elders and their children in Shanghai.

PubMed

Chen, Lin

2015-01-01

This phenomenological study integrated crisis theory, social identity theory, and uncertainty management theory to conceptualize the decision-making process around institutionalization among nursing home residents and their children in Shanghai. I conducted face-to-face, semistructured interviews with 12 dyads of matched elders and their children (N = 24). The findings suggest that caregiving crises triggered intergenerational communication about caregiving alternatives and new arrangements, although each generation had different stances and motivations. Children finalized the decision by helping their parents to manage the uncertainties pertaining to institutionalization. This study sheds light on caregiving decision-making dynamics for the increasing aging population across cultures.

Different dimensions of the prediction error as a decisive factor for the triggering of the reconsolidation process.

PubMed

Agustina López, M; Jimena Santos, M; Cortasa, Santiago; Fernández, Rodrigo S; Carbó Tano, Martin; Pedreira, María E

2016-12-01

The reconsolidation process is the mechanism by which strength and/or content of consolidated memories are updated. Prediction error (PE) is the difference between the prediction made and current events. It is proposed as a necessary condition to trigger the reconsolidation process. Here we analyzed deeply the role of the PE in the associative memory reconsolidation in the crab Neohelice granulata. An incongruence between the learned temporal relationship between conditioned and unconditioned stimuli (CS-US) was enough to trigger the reconsolidation process. Moreover, after a partial reinforced training, a PE of 50% opened the possibility to labilize the consolidated memory with a reminder which included or not the US. Further, during an extinction training a small PE in the first interval between CSs was enough to trigger reconsolidation. Overall, we highlighted the relation between training history and different reactivation possibilities to recruit the process responsible of memory updating. Copyright © 2016 Elsevier Inc. All rights reserved.

A study of 60 patients with percutaneous trigger finger releases: clinical and ultrasonographic findings.

PubMed

Gulabi, D; Cecen, G S; Bekler, H I; Saglam, F; Tanju, N

2014-09-01

We present the clinical results and ultrasonographic findings of 61 trigger digits treated with percutaneous A1 pulley release. An endoscopic carpal tunnel knife was used for the release in the outpatient department. The mean follow-up period was 3.5 months. A total of 55 digits (90%) had complete relief of their triggering postoperatively. Six digits (10%) had Grade 2 triggering clinically in the early postoperative period.The complications included six cases of insufficient release (10%), scar sensitivity in one patient, short-term hypoaesthesia in three digits (5%), and flexor tendon laceration noted on postoperative ultrasonography in eight digits (13%). No neurovascular damage was noted on the postoperative ultrasonography. Ultrasonograpy provides information about tendon laceration and changes in thickness of the pulleys and confirm A1 pulley release after surgery, but it does not alter clinical decision-making. We believe that pre- and postoperative ultrasonograpy does not need to be included as a routine examination. © The Author(s) 2014.

GPU real-time processing in NA62 trigger system

NASA Astrophysics Data System (ADS)

Ammendola, R.; Biagioni, A.; Chiozzi, S.; Cretaro, P.; Di Lorenzo, S.; Fantechi, R.; Fiorini, M.; Frezza, O.; Lamanna, G.; Lo Cicero, F.; Lonardo, A.; Martinelli, M.; Neri, I.; Paolucci, P. S.; Pastorelli, E.; Piandani, R.; Piccini, M.; Pontisso, L.; Rossetti, D.; Simula, F.; Sozzi, M.; Vicini, P.

2017-01-01

A commercial Graphics Processing Unit (GPU) is used to build a fast Level 0 (L0) trigger system tested parasitically with the TDAQ (Trigger and Data Acquisition systems) of the NA62 experiment at CERN. In particular, the parallel computing power of the GPU is exploited to perform real-time fitting in the Ring Imaging CHerenkov (RICH) detector. Direct GPU communication using a FPGA-based board has been used to reduce the data transmission latency. The performance of the system for multi-ring reconstrunction obtained during the NA62 physics run will be presented.

Prior Family Communication and Consent to Organ Donation: Using Intensive Care Physicians’ Perception to Model Decision Processes

PubMed Central

Schulz, Peter J.; van Ackere, Ann; Hartung, Uwe; Dunkel, Anke

2012-01-01

Generally, the Swiss hold favourable attitudes to organ donation, but only few carry a donor card. If no card is found on a potential donor, families have to be approached about donation. The aim of this paper is to model the role that some family communication factors play in the family decision to consent or not to organ donation by a brain dead relative. Information was gathered in face-to-face interviews, using a questionnaire and recording open answers and comments. Eight heads of intensive care units (ICU) of Swiss hospitals and one representative from Swisstransplant were interviewed. Questions asked respondents to estimate the prevalence and effect of communication factors in families facing a decision to consent to donation. Answers were averaged for modelling purposes. Modelling also relies on a previous representative population survey for cross-validation. The family of the deceased person is almost always approached about donation. Physicians perceive that prior thinking and favourable predisposition to donation are correlated and that the relatives’ predisposition is the most important factor for the consent to donation, up to the point that a negative predisposition may override an acknowledged wish of the deceased to donate. Donor cards may trigger family communication and ease the physicians’ approach to family about donation. Campaigns should encourage donate-willing people to talk to their families about it, make people think about organ donation and try to change unfavourable predispositions. Acknowledgement the authors wish to thank the interviewees whose collaboration has provided them an overview of today’s situation in Switzerland. PMID:25170455

Uncertainty and probability in wildfire management decision support: An example from the United States [Chapter 4

Treesearch

Matthew Thompson; David Calkin; Joe H. Scott; Michael Hand

2017-01-01

Wildfire risk assessment is increasingly being adopted to support federal wildfire management decisions in the United States. Existing decision support systems, specifically the Wildland Fire Decision Support System (WFDSS), provide a rich set of probabilistic and risk‐based information to support the management of active wildfire incidents. WFDSS offers a wide range...

A multi-purpose open-source triggering platform for magnetic resonance

NASA Astrophysics Data System (ADS)

Ruytenberg, T.; Webb, A. G.; Beenakker, J. W. M.

2014-10-01

Many MR scans need to be synchronised with external events such as the cardiac or respiratory cycles. For common physiological functions commercial trigger equipment exists, but for more experimental inputs these are not available. This paper describes the design of a multi-purpose open-source trigger platform for MR systems. The heart of the system is an open-source Arduino Due microcontroller. This microcontroller samples an analogue input and digitally processes these data to determine the trigger. The output of the microcontroller is programmed to mimic a physiological signal which is fed into the electrocardiogram (ECG) or pulse oximeter port of MR scanner. The microcontroller is connected to a Bluetooth dongle that allows wireless monitoring and control outside the scanner room. This device can be programmed to generate a trigger based on various types of input. As one example, this paper describes how it can be used as an acoustic cardiac triggering unit. For this, a plastic stethoscope is connected to a microphone which is used as an input for the system. This test setup was used to acquire retrospectively-triggered cardiac scans in ten volunteers. Analysis showed that this platform produces a reliable trigger (>99% triggers are correct) with a small average 8 ms variation between the exact trigger points.

A multi-purpose open-source triggering platform for magnetic resonance.

PubMed

Ruytenberg, T; Webb, A G; Beenakker, J W M

2014-10-01

Many MR scans need to be synchronised with external events such as the cardiac or respiratory cycles. For common physiological functions commercial trigger equipment exists, but for more experimental inputs these are not available. This paper describes the design of a multi-purpose open-source trigger platform for MR systems. The heart of the system is an open-source Arduino Due microcontroller. This microcontroller samples an analogue input and digitally processes these data to determine the trigger. The output of the microcontroller is programmed to mimic a physiological signal which is fed into the electrocardiogram (ECG) or pulse oximeter port of MR scanner. The microcontroller is connected to a Bluetooth dongle that allows wireless monitoring and control outside the scanner room. This device can be programmed to generate a trigger based on various types of input. As one example, this paper describes how it can be used as an acoustic cardiac triggering unit. For this, a plastic stethoscope is connected to a microphone which is used as an input for the system. This test setup was used to acquire retrospectively-triggered cardiac scans in ten volunteers. Analysis showed that this platform produces a reliable trigger (>99% triggers are correct) with a small average 8 ms variation between the exact trigger points. Copyright © 2014 Elsevier Inc. All rights reserved.

Individual and work-unit measures of psychological demands and decision latitude and the use of antihypertensive medication.

PubMed

Daugaard, S; Andersen, J H; Grynderup, M B; Stokholm, Z A; Rugulies, R; Hansen, Å M; Kærgaard, A; Mikkelsen, S; Bonde, J P; Thomsen, J F; Christensen, K L; Kolstad, H A

2015-04-01

To analyse whether psychological demands and decision latitude measured on individual and work-unit level were related to prescription of antihypertensive medication. A total of 3,421 women and 897 men within 388 small work units completed a questionnaire concerning psychological working conditions according to the job strain model. Mean levels of psychological demands and decision latitude were computed for each work unit to obtain exposure measures that were less influenced by reporting bias. Dispensed antihypertensive medication prescriptions were identified in The Danish National Prescription Registry. Odds ratios (OR) comparing the highest and lowest third of the population at individual and work-unit level, respectively, were estimated by multilevel logistic regression adjusted for confounders. Psychological demands and decision latitude were tested for interaction. Supplementary analyses of 21 months follow-up were conducted. Among women, increasing psychological demands at individual (adjusted OR 1.54; 95 % CI 1.02-2.33) and work-unit level (adjusted OR 1.41; 95 % CI 1.04-1.90) was significantly associated with purchase of antihypertensive medication. No significant association was found for decision latitude. Follow-up results supported an association with psychological demands but they were not significant. All results for men showed no association. Psychological demands and decision latitude did not interact. High psychological work demands were associated with the purchase of prescribed antihypertensive medication among women. This effect was present on both the work-unit and the individual level. Among men there were no associations. The lack of interaction between psychological demands and decision latitude did not support the job strain model.

Wireless clinical alerts and patient outcomes in the surgical intensive care unit.

PubMed

Major, Kevin; Shabot, M Michael; Cunneen, Scott

2002-12-01

Errors in medicine have gained public interest since the Institute of Medicine published its 1999 report on this subject. Although errors of commission are frequently cited, errors of omission can be equally serious. A computerized surgical intensive care unit (SICU) information system when coupled to an event-driven alerting engine has the potential to reduce errors of omission for critical intensive care unit events. Automated alerts and patient outcomes were prospectively collected for all patients admitted to a tertiary-care SICU for a 2-year period. During the study period 3,973 patients were admitted to the SICU and received 13,608 days of care. A total of 15,066 alert pages were sent including alerts for physiologic condition (6,163), laboratory data (4,951), blood gas (3,774), drug allergy (130), and toxic drug levels (48). Admission Simplified Acute Physiology Score and Acute Physiology and Chronic Health Evaluation II score, SICU lengths of stay, and overall mortality rates were significantly higher in patients who triggered the alerting system. Patients triggering the alert paging system were 49.4 times more likely to die in the SICU compared with patients who did not generate an alert. Even after transfer to floor care the patients who triggered the alerting system were 5.7 times more likely to die in the hospital. An alert page identifies patients who will stay in the SICU longer and have a significantly higher chance of death compared with patients who do not trigger the alerting system.

The News. Spring 2006

ERIC Educational Resources Information Center

Giles, Ray, Ed.

2006-01-01

This Spring issue of the quarterly newsletter of the Community College League of California contains the following articles: (1) Enrollment Drops; Fees to Blame?; (2) Senate's Grad Proposal Triggers Debate on Mission, Access; (3) Compton Decision has Affected Perceptions of Commission (discussion with Barbara Beno); (4) Dynamic New Architectural…

E-Estuary: Developing a Decision-support System for Coastal Management in the Conterminous United States

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The United States Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E...

Widespread Triggering of Earthquakes in the Central US by the 2011 M9.0 Tohoku-Oki Earthquake

NASA Astrophysics Data System (ADS)

Rubinstein, J. L.; Savage, H. M.

2011-12-01

The strong shaking of the 2011 M9.0 off-Tohoku earthquake triggered tectonic tremor and earthquakes in many locations around the world. We analyze broadband records from the USARRAY to identify triggered seismicity in more than 10 different locations in the Central United States. We identify triggered events in many states including: Kansas, Nebraska, Arkansas, Minnesota, and Iowa. The locally triggered earthquakes are obscured in broadband records by the Tohoku-Oki mainshock but can be revealed with high-pass filtering. With the exception of one location (central Arkansas), the triggered seismicity occurred in regions that are seismically quiet. The coincidence of this seismicity with the Tohoku-Oki event suggests that these earthquakes were triggered. The triggered seismicity in Arkansas occurred in a region where there has been an active swarm of seismicity since August 2010. There are two lines of evidence to indicate that the seismicity in Arkansas is triggered instead of part of the swarm: (1) we observe two earthquakes that initiate coincident with the arrival of shear wave and Love wave; (2) the seismicity rate increased dramatically following the Tohoku-Oki mainshock. Our observations of widespread earthquake triggering in regions thought to be seismically quiet remind us that earthquakes can occur in most any location. Studying additional teleseismic events has the potential to reveal regions with a propensity for earthquake triggering.

Accounting for the social triggers of sexual compulsivity.

PubMed

Parsons, Jeffrey T; Kelly, Brian C; Bimbi, David S; Muench, Frederick; Morgenstern, Jon

2007-01-01

To examine the social triggers of sexual compulsivity amongst a diverse sample of gay and bisexual men. Qualitative interviews were conducted with 180 gay and bisexual men in the United States who self-identified that their sex lives were spinning out of control. The data were analyzed using a grounded theory approach to explore the range of social triggers that were driving sexual compulsions. An open-ended interview and a structured clinical interview were conducted with each participant. The interviews examined their experiences with sexual compulsivity over time and the impact of their problematic sexual behaviors on their lives. Two types of social triggers emerged from the data: event-centered triggers and contextual triggers. Event-centered triggers arise from sudden, unforeseen events. Two major event-centered triggers were identified: relationship turmoil and catastrophes. Contextual triggers, on the other hand, have a certain element of predictability, and included such things as location, people, the use of drugs, and pornography. This framework of triggers has clinical implications for the prevention and treatment of sexual compulsivity. Clinicians can utilize the framework of social triggers in the therapeutic process to provide insight into ways to effectively work through symptoms of sexual compulsivity. Awareness of the contextual aspects of sexual compulsivity may be critical to understanding the behaviors of sexually compulsive clients. Thus, therapeutic assessments should focus upon the social context in addition to the psychological components of the disorder.

Cooperative Drought Adaptation: Integrating Infrastructure Development, Conservation, and Water Transfers into Adaptive Policy Pathways

NASA Astrophysics Data System (ADS)

Zeff, H. B.; Characklis, G. W.; Reed, P. M.; Herman, J. D.

2015-12-01

Water supply policies that integrate portfolios of short-term management decisions with long-term infrastructure development enable utilities to adapt to a range of future scenarios. An effective mix of short-term management actions can augment existing infrastructure, potentially forestalling new development. Likewise, coordinated expansion of infrastructure such as regional interconnections and shared treatment capacity can increase the effectiveness of some management actions like water transfers. Highly adaptable decision pathways that mix long-term infrastructure options and short-term management actions require decision triggers capable of incorporating the impact of these time-evolving decisions on growing water supply needs. Here, we adapt risk-based triggers to sequence a set of potential infrastructure options in combination with utility-specific conservation actions and inter-utility water transfers. Individual infrastructure pathways can be augmented with conservation or water transfers to reduce the cost of meeting utility objectives, but they can also include cooperatively developed, shared infrastructure that expands regional capacity to transfer water. This analysis explores the role of cooperation among four water utilities in the 'Research Triangle' region of North Carolina by formulating three distinct categories of adaptive policy pathways: independent action (utility-specific conservation and supply infrastructure only), weak cooperation (utility-specific conservation and infrastructure development with regional transfers), and strong cooperation (utility specific conservation and jointly developed of regional infrastructure that supports transfers). Results suggest that strong cooperation aids the utilities in meeting their individual objections at substantially lower costs and with fewer irreversible infrastructure options.

Factors potentially associated with the decision of admission to the intensive care unit in a middle-income country: a survey of Brazilian physicians.

PubMed

Ramos, João Gabriel Rosa; Passos, Rogerio da Hora; Baptista, Paulo Benigno Pena; Forte, Daniel Neves

2017-01-01

To evaluate the factors potentially associated with the decision of admission to the intensive care unit in Brazil. An electronic survey of Brazilian physicians working in intensive care units. Fourteen variables that were potentially associated with the decision of admission to the intensive care unit were rated as important (from 1 to 5) by the respondents and were later grouped as "patient-related," "scarcity-related" and "administrative-related" factors. The workplace and physician characteristics were evaluated for correlation with the factor ratings. During the study period, 125 physicians completed the survey. The scores on patient-related factors were rated higher on their potential to affect decisions than scarcity-related or administrative-related factors, with a mean ± SD of 3.42 ± 0.7, 2.75 ± 0.7 and 2.87 ± 0.7, respectively (p < 0.001). The patient's underlying illness prognosis was rated by 64.5% of the physicians as always or frequently affecting decisions, followed by acute illness prognosis (57%), number of intensive care unit beds available (56%) and patient's wishes (53%). After controlling for confounders, receiving specific training on intensive care unit triage was associated with higher ratings of the patient-related factors and scarcity-related factors, while working in a public intensive care unit (as opposed to a private intensive care unit) was associated with higher ratings of the scarcity-related factors. Patient-related factors were more frequently rated as potentially affecting intensive care unit admission decisions than scarcity-related or administrative-related factors. Physician and workplace characteristics were associated with different factor ratings.

Factors potentially associated with the decision of admission to the intensive care unit in a middle-income country: a survey of Brazilian physicians

PubMed Central

Ramos, João Gabriel Rosa; Passos, Rogerio da Hora; Baptista, Paulo Benigno Pena; Forte, Daniel Neves

2017-01-01

Objective To evaluate the factors potentially associated with the decision of admission to the intensive care unit in Brazil. Methods An electronic survey of Brazilian physicians working in intensive care units. Fourteen variables that were potentially associated with the decision of admission to the intensive care unit were rated as important (from 1 to 5) by the respondents and were later grouped as "patient-related," "scarcity-related" and "administrative-related" factors. The workplace and physician characteristics were evaluated for correlation with the factor ratings. Results During the study period, 125 physicians completed the survey. The scores on patient-related factors were rated higher on their potential to affect decisions than scarcity-related or administrative-related factors, with a mean ± SD of 3.42 ± 0.7, 2.75 ± 0.7 and 2.87 ± 0.7, respectively (p < 0.001). The patient's underlying illness prognosis was rated by 64.5% of the physicians as always or frequently affecting decisions, followed by acute illness prognosis (57%), number of intensive care unit beds available (56%) and patient's wishes (53%). After controlling for confounders, receiving specific training on intensive care unit triage was associated with higher ratings of the patient-related factors and scarcity-related factors, while working in a public intensive care unit (as opposed to a private intensive care unit) was associated with higher ratings of the scarcity-related factors. Conclusions Patient-related factors were more frequently rated as potentially affecting intensive care unit admission decisions than scarcity-related or administrative-related factors. Physician and workplace characteristics were associated with different factor ratings. PMID:28977256

19 CFR 152.16 - Judicial changes in classification.

Code of Federal Regulations, 2013 CFR

2013-04-01

... decision of either the United States Court of International Trade or the United States Court of Appeals for... Government. The principles of any court decision favorable to the Government shall be applied to all... consumption or warehouse. (b) Similar merchandise under decision favorable to Government. The principles of...

19 CFR 152.16 - Judicial changes in classification.

Code of Federal Regulations, 2012 CFR

2012-04-01

... decision of either the United States Court of International Trade or the United States Court of Appeals for... Government. The principles of any court decision favorable to the Government shall be applied to all... consumption or warehouse. (b) Similar merchandise under decision favorable to Government. The principles of...

19 CFR 152.16 - Judicial changes in classification.

Code of Federal Regulations, 2011 CFR

2011-04-01

... decision of either the United States Court of International Trade or the United States Court of Appeals for... Government. The principles of any court decision favorable to the Government shall be applied to all... consumption or warehouse. (b) Similar merchandise under decision favorable to Government. The principles of...

Adaptive self-organization of Bali's ancient rice terraces.

PubMed

Lansing, J Stephen; Thurner, Stefan; Chung, Ning Ning; Coudurier-Curveur, Aurélie; Karakaş, Çağil; Fesenmyer, Kurt A; Chew, Lock Yue

2017-06-20

Spatial patterning often occurs in ecosystems as a result of a self-organizing process caused by feedback between organisms and the physical environment. Here, we show that the spatial patterns observable in centuries-old Balinese rice terraces are also created by feedback between farmers' decisions and the ecology of the paddies, which triggers a transition from local to global-scale control of water shortages and rice pests. We propose an evolutionary game, based on local farmers' decisions that predicts specific power laws in spatial patterning that are also seen in a multispectral image analysis of Balinese rice terraces. The model shows how feedbacks between human decisions and ecosystem processes can evolve toward an optimal state in which total harvests are maximized and the system approaches Pareto optimality. It helps explain how multiscale cooperation from the community to the watershed scale could persist for centuries, and why the disruption of this self-organizing system by the Green Revolution caused chaos in irrigation and devastating losses from pests. The model shows that adaptation in a coupled human-natural system can trigger self-organized criticality (SOC). In previous exogenously driven SOC models, adaptation plays no role, and no optimization occurs. In contrast, adaptive SOC is a self-organizing process where local adaptations drive the system toward local and global optima.

Human exposure modeling in a life cycle framework for chemicals and products

EPA Science Inventory

A chemical enters into commerce to serve a specific function in a product or process. This decision triggers both the manufacture of the chemical and its potential release over the life cycle of the product. Efficiently evaluating chemical safety and sustainability requires combi...

Stimuli-Responsive DNA-Based Hydrogels: From Basic Principles to Applications.

PubMed

Kahn, Jason S; Hu, Yuwei; Willner, Itamar

2017-04-18

The base sequence of nucleic acids encodes structural and functional information into the DNA biopolymer. External stimuli such as metal ions, pH, light, or added nucleic acid fuel strands provide triggers to reversibly switch nucleic acid structures such as metal-ion-bridged duplexes, i-motifs, triplex nucleic acids, G-quadruplexes, or programmed double-stranded hybrids of oligonucleotides (DNA). The signal-triggered oligonucleotide structures have been broadly applied to develop switchable DNA nanostructures and DNA machines, and these stimuli-responsive assemblies provide functional scaffolds for the rapidly developing area of DNA nanotechnology. Stimuli-responsive hydrogels undergoing signal-triggered hydrogel-to-solution transitions or signal-controlled stiffness changes attract substantial interest as functional matrices for controlled drug delivery, materials exhibiting switchable mechanical properties, acting as valves or actuators, and "smart" materials for sensing and information processing. The integration of stimuli-responsive oligonucleotides with hydrogel-forming polymers provides versatile means to exploit the functional information encoded in the nucleic acid sequences to yield stimuli-responsive hydrogels exhibiting switchable physical, structural, and chemical properties. Stimuli-responsive DNA-based nucleic acid structures are integrated in acrylamide polymer chains and reversible, switchable hydrogel-to-solution transitions of the systems are demonstrated by applying external triggers, such as metal ions, pH-responsive strands, G-quadruplex, and appropriate counter triggers that bridge and dissociate the polymer chains. By combining stimuli-responsive nucleic acid bridges with thermosensitive poly(N-isopropylacrylamide) (pNIPAM) chains, systems undergoing reversible solution ↔ hydrogel ↔ solid transitions are demonstrated. Specifically, by bridging acrylamide polymer chains by two nucleic acid functionalities, where one type of bridging unit provides a stimuli-responsive element and the second unit acts as internal "bridging memory", shape-memory hydrogels undergoing reversible and switchable transitions between shaped hydrogels and shapeless quasi-liquid states are demonstrated. By using stimuli-responsive hydrogel cross-linking units that can assemble the bridging units by two different input signals, the orthogonally-triggered functions of the shape-memory were shown. Furthermore, a versatile approach to assemble stimuli-responsive DNA-based acrylamide hydrogel films on surfaces is presented. The method involves the activation of the hybridization chain-reaction (HCR) by a surface-confined promoter strand, in the presence of acrylamide chains modified with two DNA hairpin structures and appropriate stimuli-responsive tethers. The resulting hydrogel-modified surfaces revealed switchable stiffness properties and signal-triggered catalytic functions. By applying the method to assemble the hydrogel microparticles, substrate-loaded, stimuli-responsive microcapsules are prepared. The signal-triggered DNA-based hydrogel microcapsules are applied as drug carriers for controlled release. The different potential applications and future perspectives of stimuli responsive hydrogels are discussed. Specifically, the use of these smart materials and assemblies as carriers for controlled drug release and as shape-memory matrices for information storage and inscription and the use of surface-confined stimuli-responsive hydrogels, exhibiting switchable stiffness properties, for catalysis and controlled growth of cells are discussed.

Determinants of spring migration departure decision in a bat.

PubMed

Dechmann, Dina K N; Wikelski, M; Ellis-Soto, D; Safi, K; O'Mara, M Teague

2017-09-01

Migratory decisions in birds are closely tied to environmental cues and fat stores, but it remains unknown if the same variables trigger bat migration. To learn more about the rare phenomenon of bat migration, we studied departure decisions of female common noctules ( Nyctalus noctula ) in southern Germany. We did not find the fattening period that modulates departure decisions in birds. Female noctules departed after a regular evening foraging session, uniformly heading northeast. As the day of year increased, migratory decisions were based on the interactions among wind speed, wind direction and air pressure. As the migration season progressed, bats were likely to migrate on nights with higher air pressure and faster tail winds in the direction of travel, and also show high probability of migration on low-pressure nights with slow head winds. Common noctules thus monitor complex environmental conditions to find the optimal migration night. © 2017 The Authors.

A Distributed Synchronization and Timing System on the EAST Tokamak

NASA Astrophysics Data System (ADS)

Luo, Jiarong; Wu, Yichun; Shu, Yantai

2008-08-01

A key requirement for the EAST distributed control system (EASTDCS) is time synchronization to an accuracy of <1 mus. In 2006 a Distributed Synchronization and Timing System (DSTS) was set up, which is based on the ATmega128 AVR microcontroller and the Nut/OS embedded Real Time Operating System (RTOS). The DSTS provides the control and the data acquisition systems with reference clocks (0.01 Hz 10 MHz) and delayed trigger times ( 1 mus 4294 s). These are produced by a Core Module Unit (CMU) connected by optical fibres to many Local Synchronized Node Units (LSNU). The fibres provide immunity from electrical noise and are of equal length to match clock and trigger delays between systems. This paper describes the architecture of the DSTS on the EAST tokamak and provides an overview of the characteristics of the main and local units.

Are gains in decision-making autonomy during early adolescence beneficial for emotional functioning? The case of the United States and china.

PubMed

Qin, Lili; Pomerantz, Eva M; Wang, Qian

2009-01-01

This research examined the role of children's decision-making autonomy in their emotional functioning during early adolescence in the United States and China. Four times over the 7th and 8th grades, 825 American and Chinese children (M = 12.73 years) reported on the extent to which they versus their parents make decisions about issues children often deem as under their authority. Children also reported on their emotional functioning. American children made greater gains over time in decision-making autonomy than did Chinese children. Initial decision-making autonomy predicted enhanced emotional functioning similarly among American and Chinese children. However, gains over time in decision-making autonomy predicted enhanced emotional functioning more in the United States (vs. China) where such gains were normative.

Implementation hurdles of an interactive, integrated, point-of-care computerised decision support system for hospital antibiotic prescription.

PubMed

Chow, A L; Ang, A; Chow, C Z; Ng, T M; Teng, C; Ling, L M; Ang, B S; Lye, D C

2016-02-01

Antimicrobial stewardship is used to combat antimicrobial resistance. In Singapore, a tertiary hospital has integrated a computerised decision support system, called Antibiotic Resistance Utilisation and Surveillance-Control (ARUSC), into the electronic inpatient prescribing system. ARUSC is launched either by the physician to seek guidance for an infectious disease condition or via auto-trigger when restricted antibiotics are prescribed. This paper describes the implementation of ARUSC over three phases from 1 May 2011 to 30 April 2013, compared factors between ARUSC launches via auto-trigger and for guidance, examined factors associated with acceptance of ARUSC recommendations, and assessed user acceptability. During the study period, a monthly average of 9072 antibiotic prescriptions was made, of which 2370 (26.1%) involved ARUSC launches. Launches via auto-trigger comprised 48.1% of ARUSC launches. In phase 1, 23% of ARUSC launches were completed. This rose to 38% in phase 2, then 87% in phase 3, as escapes from the ARUSC programme were sequentially disabled. Amongst completed launches for guidance, 89% of ARUSC recommendations were accepted versus 40% amongst completed launches via auto-trigger. Amongst ARUSC launches for guidance, being from a medical department [adjusted odds ratio (aOR)=1.20, 95% confidence interval (CI) 1.04-1.37] and ARUSC launch during on-call (aOR=1.81, 95% CI 1.61-2.05) were independently associated with acceptance of ARUSC recommendations. Junior physicians found ARUSC useful. Senior physicians found ARUSC reliable but admitted to having preferences for antibiotics that may conflict with ARUSC. Hospital-wide implementation of ARUSC encountered hurdles from physicians. With modifications, the completion rate improved. Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Work-related psychosocial events as triggers of sick leave--results from a Swedish case-crossover study.

PubMed

Hultin, Hanna; Hallqvist, Johan; Alexanderson, Kristina; Johansson, Gun; Lindholm, Christina; Lundberg, Ingvar; Möller, Jette

2011-03-23

Although illness is an important cause of sick leave, it has also been suggested that non-medical risk factors may influence this association. If such factors impact on the period of decision making, they should be considered as triggers. Yet, there is no empirical support available.The aim was to investigate whether recent exposure to work-related psychosocial events can trigger the decision to report sick when ill. A case-crossover design was applied to 546 sick-leave spells, extracted from a Swedish cohort of 1430 employees with a 3-12 month follow-up of new sick-leave spells. Exposure in a case period corresponding to an induction period of one or two days was compared with exposure during control periods sampled from workdays during a two-week period prior to sick leave for the same individual. This was done according to the matched-pair interval and the usual frequency approaches. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). Most sick-leave spells happened in relation to acute, minor illnesses that substantially reduced work ability. The risk of taking sick leave was increased when individuals had recently been exposed to problems in their relationship with a superior (OR 3.63; CI 1.44-9.14) or colleagues (OR 4.68; CI 1.43-15.29). Individuals were also more inclined to report sick on days when they expected a very stressful work situation than on a day when they were not under such stress (OR 2.27; CI 1.40-3.70). Exposure to problems in workplace relationships or a stressful work situation seems to be able to trigger reporting sick. Psychosocial work-environmental factors appear to have a short-term effect on individuals when deciding to report sick.

Comparison of anticancer drug coverage decisions in the United States and United Kingdom: does the evidence support the rhetoric?

PubMed

Mason, Anne; Drummond, Michael; Ramsey, Scott; Campbell, Jonathan; Raisch, Dennis

2010-07-10

In contrast to the United States, several European countries have health technology assessment programs for drugs, many of which assess cost effectiveness. Coverage decisions that consider cost effectiveness may lead to restrictions in access. For a purposive sample of five decision-making bodies, we analyzed US and United Kingdom coverage decisions on all anticancer drugs approved by the US Food and Drug Administration (FDA) from 2004 to 2008. Data sources for the timing and outcome of licensing and coverage decisions included published and unpublished documentation, Web sites, and personal communication. The FDA approved 59 anticancer drugs over the study period, of which 46 were also approved by the European Medicines Agency. In the United States, 100% of drugs were covered, mostly without restriction. However, the United Kingdom bodies made positive coverage decisions for less than half of licensed drugs (National Institute for Health and Clinical Excellence [NICE]: 39%; Scottish Medicines Consortium [SMC]: 43%). Whereas the Centers for Medicare and Medicaid Services (CMS) and the Department of Veterans Affairs (VA) covered all 59 drugs from the FDA license date, delays were evident for some Regence Group decisions that were informed by cost effectiveness (median, 0 days; semi-interquartile range [SIQR], 122 days; n = 22). Relative to the European Medicines Agency license date, median time to coverage was 783 days (SIQR, 170 days) for NICE and 231 days (SIQR, 129 days) for the SMC. Anticancer drug coverage decisions that consider cost effectiveness are associated with greater restrictions and slower time to coverage. However, this approach may represent an explicit alternative to rationing achieved through the use of patient copayments.

Trace Water as Prominent Factor to Induce Peptide Self-Assembly: Dynamic Evolution and Governing Interactions in Ionic Liquids.

PubMed

Wang, Juan; Yuan, Chengqian; Han, Yuchun; Wang, Yilin; Liu, Xiaomin; Zhang, Suojiang; Yan, Xuehai

2017-11-01

The interaction between water and biomolecules including peptides is of critical importance for forming high-level architectures and triggering life's functions. However, the bulk aqueous environment has limitations in detecting the kinetics and mechanisms of peptide self-assembly, especially relating to interactions of trace water. With ionic liquids (ILs) as a nonconventional medium, herein, it is discovered that trace amounts of water play a decisive role in triggering self-assembly of a biologically derived dipeptide. ILs provide a suitable nonaqueous environment, enabling us to mediate water content and follow the dynamic evolution of peptide self-assembly. The trace water is found to be involved in the assembly process of dipeptide, especially leading to the formation of stable noncovalent dipeptide oligomers in the early stage of nucleation, as evident by both experimental studies and theoretical simulations. The thermodynamics of the growth process is mainly governed by a synergistic effect of hydrophobic interaction and hydrogen bonds. Each step of assembly presents a different trend in thermodynamic energy. The dynamic evolution of assembly process can be efficiently mediated by changing trace water content. The decisive role of trace water in triggering and mediating self-assembly of biomolecules provides a new perspective in understanding supramolecular chemistry and molecular self-organization in biology. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Act quickly, decide later: long-latency visual processing underlies perceptual decisions but not reflexive behavior.

PubMed

Jolij, Jacob; Scholte, H Steven; van Gaal, Simon; Hodgson, Timothy L; Lamme, Victor A F

2011-12-01

Humans largely guide their behavior by their visual representation of the world. Recent studies have shown that visual information can trigger behavior within 150 msec, suggesting that visually guided responses to external events, in fact, precede conscious awareness of those events. However, is such a view correct? By using a texture discrimination task, we show that the brain relies on long-latency visual processing in order to guide perceptual decisions. Decreasing stimulus saliency leads to selective changes in long-latency visually evoked potential components reflecting scene segmentation. These latency changes are accompanied by almost equal changes in simple RTs and points of subjective simultaneity. Furthermore, we find a strong correlation between individual RTs and the latencies of scene segmentation related components in the visually evoked potentials, showing that the processes underlying these late brain potentials are critical in triggering a response. However, using the same texture stimuli in an antisaccade task, we found that reflexive, but erroneous, prosaccades, but not antisaccades, can be triggered by earlier visual processes. In other words: The brain can act quickly, but decides late. Differences between our study and earlier findings suggesting that action precedes conscious awareness can be explained by assuming that task demands determine whether a fast and unconscious, or a slower and conscious, representation is used to initiate a visually guided response.

Earthquake nucleation by transient deformations caused by the M = 7.9 Denali, Alaska, earthquake

USGS Publications Warehouse

Gomberg, J.; Bodin, P.; Larson, K.; Dragert, H.

2004-01-01

The permanent and dynamic (transient) stress changes inferred to trigger earthquakes are usually orders of magnitude smaller than the stresses relaxed by the earthquakes themselves, implying that triggering occurs on critically stressed faults. Triggered seismicity rate increases may therefore be most likely to occur in areas where loading rates are highest and elevated pore pressures, perhaps facilitated by high-temperature fluids, reduce frictional stresses and promote failure. Here we show that the 2002 magnitude M = 7.9 Denali, Alaska, earthquake triggered wide-spread seismicity rate increases throughout British Columbia and into the western United States. Dynamic triggering by seismic waves should be enhanced in directions where rupture directivity focuses radiated energy, and we verify this using seismic and new high-sample GPS recordings of the Denali mainshock. These observations are comparable in scale only to the triggering caused by the 1992 M = 7.4 Landers, California, earthquake, and demonstrate that Landers triggering did not reflect some peculiarity of the region or the earthquake. However, the rate increases triggered by the Denali earthquake occurred in areas not obviously tectonically active, implying that even in areas of low ambient stressing rates, faults may still be critically stressed and that dynamic triggering may be ubiquitous and unpredictable.

Application of Fault Management Theory to the Quantitative Selection of a Launch Vehicle Abort Trigger Suite

NASA Technical Reports Server (NTRS)

Lo, Yunnhon; Johnson, Stephen B.; Breckenridge, Jonathan T.

2014-01-01

This paper describes the quantitative application of the theory of System Health Management and its operational subset, Fault Management, to the selection of abort triggers for a human-rated launch vehicle, the United States' National Aeronautics and Space Administration's (NASA) Space Launch System (SLS). The results demonstrate the efficacy of the theory to assess the effectiveness of candidate failure detection and response mechanisms to protect humans from time-critical and severe hazards. The quantitative method was successfully used on the SLS to aid selection of its suite of abort triggers.

Application of Fault Management Theory to the Quantitative Selection of a Launch Vehicle Abort Trigger Suite

NASA Technical Reports Server (NTRS)

Lo, Yunnhon; Johnson, Stephen B.; Breckenridge, Jonathan T.

2014-01-01

This paper describes the quantitative application of the theory of System Health Management and its operational subset, Fault Management, to the selection of Abort Triggers for a human-rated launch vehicle, the United States' National Aeronautics and Space Administration's (NASA) Space Launch System (SLS). The results demonstrate the efficacy of the theory to assess the effectiveness of candidate failure detection and response mechanisms to protect humans from time-critical and severe hazards. The quantitative method was successfully used on the SLS to aid selection of its suite of Abort Triggers.

End-of-life decisions in Dutch neonatal intensive care units.

PubMed

Verhagen, A A Eduard; Dorscheidt, Jozef H H M; Engels, Bernadette; Hubben, Joep H; Sauer, Pieter J

2009-10-01

To clarify the practice of end-of-life decision making in severely ill newborns. Retrospective descriptive study with face-to-face interviews. The 10 neonatal intensive care units in the Netherlands from October 2005 to September 2006. All 367 newborn infants who died in the first 2 months of life in Dutch neonatal intensive care units. Adequate documentation was available in 359 deaths. Presence of end-of-life decisions, classification of deaths in 3 groups, and physicians' considerations leading to end-of-life decisions. An end-of-life decision preceded death in 95% of cases, and in 5% treatment was continued until death. Of all of the deaths, 58% were classified as having no chance of survival and 42% were stabilized newborns with poor prognoses. Withdrawal of life-sustaining therapy was the main mode of death in both groups. One case of deliberate ending of life was found. In 92% of newborns with poor prognoses, end-of-life decisions were based on patients' future quality of life and mainly concerned future suffering. Considerations regarding the infant's present state were made in 44% of infants. Virtually all deaths in Dutch neonatal intensive care units are preceded by the decision to withdraw life-sustaining treatment and many decisions are based on future quality of life. The decision to deliberately end the life of a newborn may occur less frequently than was previously assumed.

Clinical Alarms in intensive care: implications of alarm fatigue for the safety of patients1

PubMed Central

Bridi, Adriana Carla; Louro, Thiago Quinellato; da Silva, Roberto Carlos Lyra

2014-01-01

OBJECTIVES: to identify the number of electro-medical pieces of equipment in a coronary care unit, characterize their types, and analyze implications for the safety of patients from the perspective of alarm fatigue. METHOD: this quantitative, observational, descriptive, non-participatory study was conducted in a coronary care unit of a cardiology hospital with 170 beds. RESULTS: a total of 426 alarms were recorded in 40 hours of observation: 227 were triggered by multi-parametric monitors and 199 were triggered by other equipment (infusion pumps, dialysis pumps, mechanical ventilators, and intra-aortic balloons); that is an average of 10.6 alarms per hour. CONCLUSION: the results reinforce the importance of properly configuring physiological variables, the volume and parameters of alarms of multi-parametric monitors within the routine of intensive care units. The alarms of equipment intended to protect patients have increased noise within the unit, the level of distraction and interruptions in the workflow, leading to a false sense of security. PMID:25591100

Development of a Model of Interprofessional Shared Clinical Decision Making in the ICU: A Mixed-Methods Study.

PubMed

DeKeyser Ganz, Freda; Engelberg, Ruth; Torres, Nicole; Curtis, Jared Randall

2016-04-01

To develop a model to describe ICU interprofessional shared clinical decision making and the factors associated with its implementation. Ethnographic (observations and interviews) and survey designs. Three ICUs (two in Israel and one in the United States). A convenience sample of nurses and physicians. None. Observations and interviews were analyzed using ethnographic and grounded theory methodologies. Questionnaires included a demographic information sheet and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration. From observations and interviews, we developed a conceptual model of the process of shared clinical decision making that involves four stepped levels, proceeding from the lowest to the highest levels of collaboration: individual decision, information exchange, deliberation, and shared decision. This process is influenced by individual, dyadic, and system factors. Most decisions were made at the lower two levels. Levels of perceived collaboration were moderate with no statistically significant differences between physicians and nurses or between units. Both qualitative and quantitative data corroborated that physicians and nurses from all units were similarly and moderately satisfied with their level of collaboration and shared decision making. However, most ICU clinical decision making continues to take place independently, where there is some sharing of information but rarely are decisions made collectively. System factors, such as interdisciplinary rounds and unit culture, seem to have a strong impact on this process. This study provides a model for further study and improvement of interprofessional shared decision making.

Superfund explanation of significant difference for the record of decision (EPA Region 9): San Fernando Valley, Burbank Operable Unit, Los Angeles County, CA, November 21, 1990

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

Not Available

1995-01-01

The decision document presents this Explanation of Significant Differences (ESD) to the interim remedial action selected in the San Fernando Valley, Burbank Operable Unit Record of Decision (ROD) signed June 1989 (PB90-114844).

Latin American Medical Graduates: I. Determinants of the Decision to Remain in the United States.

ERIC Educational Resources Information Center

Gaviria, Moises; Wintrob, Ronald

1982-01-01

Fifty Peruvian physicians who decided to remain in the United States after postgraduate training disclose professional, economic and familial reasons for their decision. Fears of being unable to obtain a position that is professionally stimulating and that pays enough to support the family dominate the decision. (LC)

Decision Modeling Framework to Minimize Arrival Delays from Ground Delay Programs

NASA Astrophysics Data System (ADS)

Mohleji, Nandita

Convective weather and other constraints create uncertainty in air transportation, leading to costly delays. A Ground Delay Program (GDP) is a strategy to mitigate these effects. Systematic decision support can increase GDP efficacy, reduce delays, and minimize direct operating costs. In this study, a decision analysis (DA) model is constructed by combining a decision tree and Bayesian belief network. Through a study of three New York region airports, the DA model demonstrates that larger GDP scopes that include more flights in the program, along with longer lead times that provide stakeholders greater notice of a pending program, trigger the fewest average arrival delays. These findings are demonstrated to result in a savings of up to $1,850 per flight. Furthermore, when convective weather is predicted, forecast weather confidences remain the same level or greater at least 70% of the time, supporting more strategic decision making. The DA model thus enables quantification of uncertainties and insights on causal relationships, providing support for future GDP decisions.

Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

PubMed

Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia

2017-07-01

Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.

Incentives for Reporting Infectious Disease Outbreaks

ERIC Educational Resources Information Center

Malani, Anup; Laxminarayan, Ramanan

2011-01-01

The global spread of diseases such as swine flu and SARS highlights the difficult decision governments face when presented with evidence of a local outbreak. Reporting the outbreak may bring medical assistance but is also likely to trigger trade sanctions by countries hoping to contain the disease. Suppressing the information may avoid trade…

Front-end electronics for PWO-based PHOS calorimeter of ALICE

NASA Astrophysics Data System (ADS)

Muller, Hans; Budnikov, Dmitry; Ippolitov, Mikhail; Li, Qingxia; Manko, Vladislav; Pimenta, Rui; Rohrich, Dieter; Sibiryak, Iouri; Skaali, Bernhard; Vinogradov, Alexandre

2006-11-01

The electromagnetic Photon Spectrometer (PHOS) of ALICE consists of five modules with 56×64 PWO crystals, operated at -25 °C. Glued to each crystal are APD diodes which amplify a lightyield of 4.4 photoelectrons/MeV, followed by charge-sensitive pre-amplifiers with a charge conversion gain of ca. 1 V/pC. We describe our new 32-channel shaper/digitizer and readout electronics for gain-programmable photodiodes. These Front-End Electronics (FEE) cards are installed below the crystals in an isolated warm volume in geometrical correspondence to 2×16 crystal rows per card. With a total detector capacitance of 100 pF and a noise level of 3 MeV, the FEEs cover a 14 bit dynamic range from 5 MeV to 80 GeV. The low noise level is achieved by operating the APDs and preamplifiers at low temperature and by applying a relatively long shaping time of 1 μs. The offline timing resolution, obtained via a Gamma-2 fit is less than 2 ns. The second-order, dual-gain shapers produce semi-Gaussian output for 10 bit ADCs with embedded multi-event buffers. A Readout Control Unit (RCU) masters data readout with address-mapped access to the event-buffers and controls registers via a custom bus which interconnects up to 14 FEE cards. Programmable bias voltage controllers on the FEE cards allow for very precise gain adjustment of each individual APD. Being co-designed with the TRU trigger cards, each FEE card generates eight fast signal sums (2×2 crystals) as input to the TRU. FPGA-based algorithms generate level-0 and level-1 trigger decisions at 40 MHz and allow PHOS also to operate in self-triggered mode. Inside each PHOS module there are 112 FEE and 8 TRU cards which dissipate ca. 1 kW heat which is extracted via a water cooling system.

The effect of accountability on loss aversion.

PubMed

Vieider, Ferdinand M

2009-09-01

This paper investigates the effect of accountability-the expectation on the side of the decision maker of having to justify his/her decisions to somebody else-on loss aversion. Loss aversion is commonly thought to be the strongest component of risk aversion. Accountability is found to reduce the bias of loss aversion. This effect is explained by the higher cognitive effort induced by accountability, which triggers a rational check on emotional reactions at the base of loss aversion, leading to a reduction of the latter. Connections to dual-processing models are discussed.

Is autophagy the key mechanism by which the sphingolipid rheostat controls the cell fate decision?

PubMed

Lavieu, Gregory; Scarlatti, Francesca; Sala, Giusy; Levade, Thierry; Ghidoni, Riccardo; Botti, Joëlle; Codogno, Patrice

2007-01-01

Sphingolipids are major constituents of biological membrane and some of them behave as second messengers involved in the cell fate decision. Ceramide and sphingosine 1-phosphate (S1P) constitute a rheostat system in which ceramide promotes cell death and S1P increases cell survival. We have shown that both sphingolipids are able to trigger autophagy with opposing outcomes on cell survival. Here we discuss and speculate on the diverging functions of the autophagic pathways induced by ceramide and S1P, respectively.

Basolateral Amygdala to Orbitofrontal Cortex Projections Enable Cue-Triggered Reward Expectations.

PubMed

Lichtenberg, Nina T; Pennington, Zachary T; Holley, Sandra M; Greenfield, Venuz Y; Cepeda, Carlos; Levine, Michael S; Wassum, Kate M

2017-08-30

To make an appropriate decision, one must anticipate potential future rewarding events, even when they are not readily observable. These expectations are generated by using observable information (e.g., stimuli or available actions) to retrieve often quite detailed memories of available rewards. The basolateral amygdala (BLA) and orbitofrontal cortex (OFC) are two reciprocally connected key nodes in the circuitry supporting such outcome-guided behaviors. But there is much unknown about the contribution of this circuit to decision making, and almost nothing known about the whether any contribution is via direct, monosynaptic projections, or the direction of information transfer. Therefore, here we used designer receptor-mediated inactivation of OFC→BLA or BLA→OFC projections to evaluate their respective contributions to outcome-guided behaviors in rats. Inactivation of BLA terminals in the OFC, but not OFC terminals in the BLA, disrupted the selective motivating influence of cue-triggered reward representations over reward-seeking decisions as assayed by Pavlovian-to-instrumental transfer. BLA→OFC projections were also required when a cued reward representation was used to modify Pavlovian conditional goal-approach responses according to the reward's current value. These projections were not necessary when actions were guided by reward expectations generated based on learned action-reward contingencies, or when rewards themselves, rather than stored memories, directed action. These data demonstrate that BLA→OFC projections enable the cue-triggered reward expectations that can motivate the execution of specific action plans and allow adaptive conditional responding. SIGNIFICANCE STATEMENT Deficits anticipating potential future rewarding events are associated with many psychiatric diseases. Presently, we know little about the neural circuits supporting such reward expectation. Here we show that basolateral amygdala to orbitofrontal cortex projections are required for expectations of specific available rewards to influence reward seeking and decision making. The necessity of these projections was limited to situations in which expectations were elicited by reward-predictive cues. These projections therefore facilitate adaptive behavior by enabling the orbitofrontal cortex to use environmental stimuli to generate expectations of potential future rewarding events. Copyright © 2017 the authors 0270-6474/17/378374-11$15.00/0.

Basolateral Amygdala to Orbitofrontal Cortex Projections Enable Cue-Triggered Reward Expectations

PubMed Central

Lichtenberg, Nina T.; Pennington, Zachary T.; Holley, Sandra M.; Greenfield, Venuz Y.; Levine, Michael S.

2017-01-01

To make an appropriate decision, one must anticipate potential future rewarding events, even when they are not readily observable. These expectations are generated by using observable information (e.g., stimuli or available actions) to retrieve often quite detailed memories of available rewards. The basolateral amygdala (BLA) and orbitofrontal cortex (OFC) are two reciprocally connected key nodes in the circuitry supporting such outcome-guided behaviors. But there is much unknown about the contribution of this circuit to decision making, and almost nothing known about the whether any contribution is via direct, monosynaptic projections, or the direction of information transfer. Therefore, here we used designer receptor-mediated inactivation of OFC→BLA or BLA→OFC projections to evaluate their respective contributions to outcome-guided behaviors in rats. Inactivation of BLA terminals in the OFC, but not OFC terminals in the BLA, disrupted the selective motivating influence of cue-triggered reward representations over reward-seeking decisions as assayed by Pavlovian-to-instrumental transfer. BLA→OFC projections were also required when a cued reward representation was used to modify Pavlovian conditional goal-approach responses according to the reward's current value. These projections were not necessary when actions were guided by reward expectations generated based on learned action-reward contingencies, or when rewards themselves, rather than stored memories, directed action. These data demonstrate that BLA→OFC projections enable the cue-triggered reward expectations that can motivate the execution of specific action plans and allow adaptive conditional responding. SIGNIFICANCE STATEMENT Deficits anticipating potential future rewarding events are associated with many psychiatric diseases. Presently, we know little about the neural circuits supporting such reward expectation. Here we show that basolateral amygdala to orbitofrontal cortex projections are required for expectations of specific available rewards to influence reward seeking and decision making. The necessity of these projections was limited to situations in which expectations were elicited by reward-predictive cues. These projections therefore facilitate adaptive behavior by enabling the orbitofrontal cortex to use environmental stimuli to generate expectations of potential future rewarding events. PMID:28743727

Great Decisions '86.

ERIC Educational Resources Information Center

Hoepli, Nancy L., Ed.

Designed to initiate discussion of foreign policy decisions, this book contains an analysis of eight foreign policy issues confronting the United States in 1986. Each unit provides the background and guidelines to provide perspective to assist in understanding foreign policy crises. The units included in this issue are: (1) "How Foreign Policy Is…

Sensitivity of super-efficient data envelopment analysis results to individual decision-making units: an example of surgical workload by specialty.

PubMed

Dexter, Franklin; O'Neill, Liam; Xin, Lei; Ledolter, Johannes

2008-12-01

We use resampling of data to explore the basic statistical properties of super-efficient data envelopment analysis (DEA) when used as a benchmarking tool by the manager of a single decision-making unit. Our focus is the gaps in the outputs (i.e., slacks adjusted for upward bias), as they reveal which outputs can be increased. The numerical experiments show that the estimates of the gaps fail to exhibit asymptotic consistency, a property expected for standard statistical inference. Specifically, increased sample sizes were not always associated with more accurate forecasts of the output gaps. The baseline DEA's gaps equaled the mode of the jackknife and the mode of resampling with/without replacement from any subset of the population; usually, the baseline DEA's gaps also equaled the median. The quartile deviations of gaps were close to zero when few decision-making units were excluded from the sample and the study unit happened to have few other units contributing to its benchmark. The results for the quartile deviations can be explained in terms of the effective combinations of decision-making units that contribute to the DEA solution. The jackknife can provide all the combinations contributing to the quartile deviation and only needs to be performed for those units that are part of the benchmark set. These results show that there is a strong rationale for examining DEA results with a sensitivity analysis that excludes one benchmark hospital at a time. This analysis enhances the quality of decision support using DEA estimates for the potential ofa decision-making unit to grow one or more of its outputs.

A Real-Time Phase Vector Display for EEG Monitoring

NASA Technical Reports Server (NTRS)

Finger, Herbert J.; Anliker, James E.; Rimmer, Tamara

1973-01-01

A real-time, computer-based, phase vector display system has been developed which will output a vector whose phase is equal to the delay between a trigger and the peak of a function which is quasi-coherent with respect to the trigger. The system also contains a sliding averager which enables the operator to average successive trials before calculating the phase vector. Data collection, averaging and display generation are performed on a LINC-8 computer. Output displays appear on several X-Y CRT display units and on a kymograph camera/oscilloscope unit which is used to generate photographs of time-varying phase vectors or contourograms of time-varying averages of input functions.

The Hispanicization of the United States.

ERIC Educational Resources Information Center

Nostrand, Richard L.

Two strikingly contrasting culture groups, Latin Americans and Anglo Americans, overlap in a Borderlands that straddles the international boundary between the United States and Mexico. This overlap began with the Aztec conquest by Cortes which triggered the intermixing and miscegenation between Spaniards and Indians that produced a mestizo people…

Event-triggered fault detection for a class of discrete-time linear systems using interval observers.

PubMed

Zhang, Zhi-Hui; Yang, Guang-Hong

2017-05-01

This paper provides a novel event-triggered fault detection (FD) scheme for discrete-time linear systems. First, an event-triggered interval observer is proposed to generate the upper and lower residuals by taking into account the influence of the disturbances and the event error. Second, the robustness of the residual interval against the disturbances and the fault sensitivity are improved by introducing l 1 and H ∞ performances. Third, dilated linear matrix inequalities are used to decouple the Lyapunov matrices from the system matrices. The nonnegative conditions for the estimation error variables are presented with the aid of the slack matrix variables. This technique allows considering a more general Lyapunov function. Furthermore, the FD decision scheme is proposed by monitoring whether the zero value belongs to the residual interval. It is shown that the information communication burden is reduced by designing the event-triggering mechanism, while the FD performance can still be guaranteed. Finally, simulation results demonstrate the effectiveness of the proposed method. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

A Mechanical Switch Couples T Cell Receptor Triggering to the Cytoplasmic Juxtamembrane Regions of CD3ζζ.

PubMed

Lee, Mark S; Glassman, Caleb R; Deshpande, Neha R; Badgandi, Hemant B; Parrish, Heather L; Uttamapinant, Chayasith; Stawski, Philipp S; Ting, Alice Y; Kuhns, Michael S

2015-08-18

The eight-subunit T cell receptor (TCR)-CD3 complex is the primary determinant for T cell fate decisions. Yet how it relays ligand-specific information across the cell membrane for conversion to chemical signals remains unresolved. We hypothesized that TCR engagement triggers a change in the spatial relationship between the associated CD3ζζ subunits at the junction where they emerge from the membrane into the cytoplasm. Using three in situ proximity assays based on ID-PRIME, FRET, and EPOR activity, we determined that the cytosolic juxtamembrane regions of the CD3ζζ subunits are spread apart upon assembly into the TCR-CD3 complex. TCR engagement then triggered their apposition. This mechanical switch resides upstream of the CD3ζζ intracellular motifs that initiate chemical signaling, as well as the polybasic stretches that regulate signal potentiation. These findings provide a framework from which to examine triggering events for activating immune receptors and other complex molecular machines. Copyright © 2015 Elsevier Inc. All rights reserved.

Testing of Triggers by Data Mining of Epilepsy Patients' Structured Nursing Records.

PubMed

Kinnunen, Ulla-Mari; Kivekäs, Eija; Paananen, Pekka; Kälviäinen, Reetta; Saranto, Kaija

2016-01-01

Epilepsies are neurological disorders with many different etiologies, symptoms and prognoses. Care for epilepsy patients should be uniform, homogeneous and optimized to avoid unnecessary hospitalizations or even worse outcomes. FinCC-based structured nursing documentation facilitates analyzing patient profiles and populations, developing care processes, nursing documentation, decision-making, and data reuse. This research aimed to determine the potential for finding possible risks for epilepsy patients' health and well-being from the structured nursing data with defined triggers for epilepsy patients. The research data included structured documentation of nursing diagnoses of and interventions for adult epilepsy patients (n = 100) at one neurological ward in a university hospital in 2009-2013. The results showed that nurses documented abundantly, and all triggers were mostly found. The study results will be reviewed by the neurological ward nurses to assess the FinCC and highlight the importance of documentation.

Neonatal Early Warning Tools for recognising and responding to clinical deterioration in neonates cared for in the maternity setting: A retrospective case-control study.

PubMed

Paliwoda, Michelle; New, Karen; Bogossian, Fiona

2016-09-01

All newborns are at risk of deterioration as a result of failing to make the transition to extra uterine life. Signs of deterioration can be subtle and easily missed. It has been postulated that the use of an Early Warning Tool may assist clinicians in recognising and responding to signs of deterioration earlier in neonates, thereby preventing a serious adverse event. To examine whether observations from a Standard Observation Tool, applied to three neonatal Early Warning Tools, would hypothetically trigger an escalation of care more frequently than actual escalation of care using the Standard Observation Tool. A retrospective case-control study. A maternity unit in a tertiary public hospital in Australia. Neonates born in 2013 of greater than or equal to 34(+0) weeks gestation, admitted directly to the maternity ward from their birthing location and whose subsequent deterioration required admission to the neonatal unit, were identified as cases from databases of the study hospital. Each case was matched with three controls, inborn during the same period and who did not experience deterioration and neonatal unit admission. Clinical and physiological data recorded on a Standard Observation Tool, from time of admission to the maternity ward, for cases and controls were charted onto each of three Early Warning Tools. The primary outcome was whether the tool 'triggered an escalation of care'. Descriptive statistics (n, %, Mean and SD) were employed. Cases (n=26) comprised late preterm, early term and post-term neonates and matched by gestational age group with 3 controls (n=78). Overall, the Standard Observation Tool triggered an escalation of care for 92.3% of cases compared to the Early Warning Tools; New South Wales Health 80.8%, United Kingdom Newborn Early Warning Chart 57.7% and The Australian Capital Territory Neonatal Early Warning Score 11.5%. Subgroup analysis by gestational age found differences between the tools in hypothetically triggering an escalation of care. The Standard Observation Tool triggered an escalation of care more frequently than the Early Warning Tools, which may be as a result of behavioural data captured on the Standard Observation Tool and escalated, which could not be on the Early Warning Tools. Findings demonstrate that a single tool applied to all gestational age ranges may not be effective in identifying early deterioration or may over trigger an escalation of care. Further research is required into the sensitivity and specificity of Early Warning Tools in neonatal sub-populations. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of Cosmic Ray Interactions with the Focal Surface of JEM-EUSO

NASA Astrophysics Data System (ADS)

Rowley, C.; Adams, J. H.; Bonemente, M.

2013-12-01

The JEM-EUSO mission promises an entirely new perspective on ultra high energy cosmic ray (UHECR) detection. Bound for the International Space Station, its field of view is far greater than that of ground based instruments. However, being space-based, it is itself subject to cosmic ray (CR) impacts (abet much lower energy ones). In this poster, we discuss the effects this may have on the triggering algorithms implemented on JEM-EUSO. We conclude that the mean photoelectron rate due to CRs is 6.73×10-3 s-1 and that the fractional number of triggers per Gate Timing Unit (GTU) is 4.34×10-10 GTU-1 at a trigger level of 1 photoelectron. This is small and will have little effect on the triggering of JEM-EUSO.

22 CFR 1101.14 - Appeal of agency decision not to correct or amend a record.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Appeal of agency decision not to correct or amend a record. 1101.14 Section 1101.14 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.14 Appeal of agency decision...

Claims Against a University: The Role of Administrative Review in Australia and the United Kingdom

ERIC Educational Resources Information Center

Rochford, Francine

2005-01-01

The recent decision of the High Court of Australia in "Griffith University v. Tang" denied judicial review to a student aggrieved by the decision of a university to exclude her. This article analyses the role of judicial review of university decision-making in the United Kingdom and Australia, analysing the justification for…

22 CFR 1101.14 - Appeal of agency decision not to correct or amend a record.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Appeal of agency decision not to correct or amend a record. 1101.14 Section 1101.14 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.14 Appeal of agency decision...

Sociodemographic differences in triggers to quit smoking: findings from a national survey.

PubMed

Vangeli, E; West, R

2008-12-01

Reasons for quitting smoking and triggers that finally precipitate a quit attempt are not necessarily the same thing. We sought to assess variation in reported triggers of attempts to stop smoking as a function of age, gender and socioeconomic status. Cross-sectional household survey in England. A total of 2441 smokers and ex-smokers aged 16 and over, who reported making at least one serious quit attempt in the last 12 months, were recruited. The main outcome measure was participants' responses to the question "What finally triggered your most recent quit attempt?". Respondents selected from a list of options or specified a trigger not on the list. In the event, smokers typically reported as triggers similar factors as have previously been reported as "reasons". "A concern about future health problems" (28.5%) was the most commonly cited trigger followed by "health problems I had at the time" (18%) and then "a decision that smoking was too expensive" (12.2%). The most common external trigger was advice from a health professional (5.6%). Future health concern was more common in smokers with higher socioeconomic status (SES), whereas cost and current health problems were more often cited by lower SES smokers. Younger smokers were more likely to report their quit attempt being triggered by a TV advertisement while older smokers were more likely to cite advice from a health professional. Concern about future health problems was cited less often by 16 to 24 year olds and those aged 65+ than those aged 25 to 64 years. There are significant differences in reported triggers for quit attempts as a function of sociodemographic factors. Most notably, smokers with higher SES are more likely to report concern about future health whereas those from lower SES are more likely to cite cost and current health problems.

Magnetically triggered dual functional nanoparticles for resistance-free apoptotic hyperthermia.

PubMed

Yoo, Dongwon; Jeong, Heeyeong; Noh, Seung-Hyun; Lee, Jae-Hyun; Cheon, Jinwoo

2013-12-02

Overcoming resistance: Heat-treated cancer cells possess a protective mechanism for resistance and survival. Resistance-free apoptosis-inducing magnetic nanoparticles (RAINs) successfully promote hyperthermic apoptosis, obstructing cell survival by triggering two functional units of heat generation and the release of geldanamycin (GM) for heat shock protein (Hsp) inhibition under an alternating magnetic field (AMF). Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Superfund Record of Decision (EPA Region 6): Texarkana Wood Preserving Company, Operable Unit 2, Texarkana, TX, September 1993

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

Not Available

This decision document presents the selected remedial action for Operable Unit Two for the Texarkana Wood Preserving Company (TWPC) Superfund Site (Site) in Texarkana, Texas. This operable unit is the second of two operable units planned for the Site. Operable Unit Two involves remediation of the deeper ground water contaminated above the action levels in a limited area of the Silty Sand Zone around Monitoring Well-16.

Decision Making. Level Two/Three. Career Guidance.

ERIC Educational Resources Information Center

Cooper, Irene; And Others

Materials contained in this career guidance unit are designed to provide the seven-, eight-, or nine-year-old student with a framework of logical steps for decision making and problem solving. The seventeen activities included in the unit vary in length from thirty to sixty minutes; the entire unit requires approximately ten hours of instructional…

Designing and assessing weather-based financial hedging contracts to mitigate water conflicts at the river basin scale. A case study in the Italian Alps

NASA Astrophysics Data System (ADS)

Bellagamba, Laura; Denaro, Simona; Kern, Jordan; Giuliani, Matteo; Castelletti, Andrea; Characklis, Gregory

2016-04-01

Growing water demands and more frequent and severe droughts are increasingly challenging water management in many regions worldwide, exacerbating water disputes and reducing the space for negotiated agreements at the catchment scale. In the lack of a centralized controller, the design and deployment of coordination and/or regulatory mechanisms is a way to improve system-wide efficiency while preserving the distributed nature of the decision making setting, and facilitating cooperation among institutionally independent decision-makers. Recent years have witnessed an increased interest in index-based insurance contracts as mechanisms for sharing hydro-meteorological risk in complex and heterogeneous decision making context (e.g. multiple stakeholders and institutionally independent decision makers). In this study, we explore the potential for index-based insurance contracts to mitigate the conflict in a water system characterized by (political) power asymmetry between hydropower companies upstream and farmers downstream. The Lake Como basin in the Italian Alps is considered as a case study. We generated alternative regulatory mechanisms in the form of minimum release constraints to the hydropower facilities, and designed an insurance contract for hedging against hydropower relative revenue losses. The fundamental step in designing this type of insurance contracts is the identification of a suitable index, which triggers the payouts as well as the payout function, defined by strike level and slope (e.g., euros/index unit). A portfolio of index-based contracts was designed for the case study and evaluated in terms of revenue floor, basis risk and revenue fluctuation around the mean, both with and without insurance. Over the long term, the insurance proved to be capable to keep the minimum revenue above a specified level while providing a greater certainty on the revenue trend. This result shows the possibility to augment farmer's supply with little loss for hydropower companies, thus helping in mitigating the conflict between the stakeholders.

Context-aware system for pre-triggering irreversible vehicle safety actuators.

PubMed

Böhmländer, Dennis; Dirndorfer, Tobias; Al-Bayatti, Ali H; Brandmeier, Thomas

2017-06-01

New vehicle safety systems have led to a steady improvement of road safety and a reduction in the risk of suffering a major injury in vehicle accidents. A huge leap forward in the development of new vehicle safety systems are actuators that have to be activated irreversibly shortly before a collision in order to mitigate accident consequences. The triggering decision has to be based on measurements of exteroceptive sensors currently used in driver assistance systems. This paper focuses on developing a novel context-aware system designed to detect potential collisions and to trigger safety actuators even before an accident occurs. In this context, the analysis examines the information that can be collected from exteroceptive sensors (pre-crash data) to predict a certain collision and its severity to decide whether a triggering is entitled or not. A five-layer context-aware architecture is presented, that is able to collect contextual information about the vehicle environment and the actual driving state using different sensors, to perform reasoning about potential collisions, and to trigger safety functions upon that information. Accident analysis is used in a data model to represent uncertain knowledge and to perform reasoning. A simulation concept based on real accident data is introduced to evaluate the presented system concept. Copyright © 2017 Elsevier Ltd. All rights reserved.

Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System

PubMed Central

Beccaro, M. A. Del; Villanueva, R.; Knudson, K. M.; Harvey, E. M.; Langle, J. M.; Paul, W.

2010-01-01

Objective We sought to determine the frequency and type of decision support alerts by location and ordering provider role during Computerized Provider Order Entry (CPOE) medication ordering. Using these data we adjusted the decision support tools to reduce the number of alerts. Design Retrospective analyses were performed of dose range checks (DRC), drug-drug interaction and drug-allergy alerts from our electronic medical record. During seven sampling periods (each two weeks long) between April 2006 and October 2008 all alerts in these categories were analyzed. Another audit was performed of all DRC alerts by ordering provider role from November 2008 through January 2009. Medication ordering error counts were obtained from a voluntary error reporting system. Measurement/Results Between April 2006 and October 2008 the percent of medication orders that triggered a dose range alert decreased from 23.9% to 7.4%. The relative risk (RR) for getting an alert was higher at the start of the interventions versus later (RR= 2.40, 95% CI 2.28-2.52; p< 0.0001). The percentage of medication orders that triggered alerts for drug-drug interactions also decreased from 13.5% to 4.8%. The RR for getting a drug interaction alert at the start was 1.63, 95% CI 1.60-1.66; p< 0.0001. Alerts decreased in all clinical areas without an increase in reported medication errors. Conclusion We reduced the quantity of decision support alerts in CPOE using a systematic approach without an increase in reported medication errors PMID:23616845

Compassion fatigue in nurses.

PubMed

Yoder, Elizabeth A

2010-11-01

Compassion fatigue, trigger situations, and coping strategies were investigated in hospital and home care nurses. The Professional Quality of Life Scale measured compassion fatigue, compassion satisfaction, and burnout. Narrative questions elicited trigger situations and coping strategies. Compassion fatigue scores were significantly different between nurses who worked 8- or 12-hour shifts. Fifteen percent of the participants had scores indicating risk of the compassion fatigue. There were significant differences in compassion satisfaction, depending on the unit worked and time as a nurse. The most common category of trigger situations was caring for the patient. Work-related and personal coping strategies were identified. Copyright © 2010 Elsevier Inc. All rights reserved.

Derivation of data-driven triggers for palliative care consultation in critically ill patients.

PubMed

Hua, May S; Ma, Xiaoyue; Li, Guohua; Wunsch, Hannah

2018-04-30

To examine the ability of existing triggers for intensive care unit (ICU) palliative care consultation to predict 6-month mortality, and derive new triggers for consultation based on risk factors for 6-month mortality. Retrospective cohort study of NY state residents who received intensive care, 2008-2013. We examined sensitivity and specificity of existing triggers for predicting 6-month mortality and used logistic regression to generate patient subgroups at high-risk for 6-month mortality as potential novel triggers for ICU palliative care consultation. Of 1,019,849 patients, 195,847 (19.2%) died within 6 months of admission. Existing triggers were specific but not sensitive for predicting 6-month mortality, (sensitivity 0.3%-11.1%, specificity 96.5-99.9% for individual triggers). Using logistic regression, patient subgroups with the highest predicted probability of 6-month mortality were older patients admitted with sepsis (age 70-79 probability 49.7%, [49.5-50.0]) or cancer (non-metastatic cancer, age 70-79 probability 51.5%, [51.1-51.9]; metastatic cancer, age 70-79 probability 60.3%, [59.9-60.6]). Sensitivity and specificity of novel triggers ranged from 0.05% to 9.2% and 98.6% to 99.9%, respectively. Existing triggers for palliative care consultation are specific, but insensitive for 6-month mortality. Using a data-driven approach to derive novel triggers may identify subgroups of patients at high-risk of 6-month mortality. Copyright © 2018 Elsevier Inc. All rights reserved.

A seismic landslide susceptibility rating of geologic units based on analysis of characterstics of landslides triggered by the 17 January, 1994 Northridge, California earthquake

USGS Publications Warehouse

Parise, M.; Jibson, R.W.

2000-01-01

One of the most significant effects of the 17 January, 1994 Northridge, California earthquake (M=6.7) was the triggering of thousands of landslides over a broad area. Some of these landslides damaged and destroyed homes and other tructures, blocked roads, disrupted pipelines, and caused other serious damage. Analysis of the distribution and characteristics of these landslides is important in understanding what areas may be susceptible to landsliding in future earthquakes. We analyzed the frequency, distribution, and geometries of triggered landslides in the Santa Susana 7.5??? quadrangle, an area of intense seismic landslide activity near the earthquake epicenter. Landslides occured primarily in young (Late Miocene through Pleistocene) uncemented or very weakly cemented sediment that has been repeatedly folded, faulted, and uplifted in the past 1.5 million years. The most common types of landslide triggered by the earthquake were highly disrupted, shallow falls and slides of rock and debris. Far less numerous were deeper, more coherent slumps and block slides, primarily occuring in more cohesive or competent materials. The landslides in the Santa Susana quadrangle were divided into two samples: single landslides (1502) and landslide complexes (60), which involved multiple coalescing failures of surficial material. We described landslide, morphologies by computing simple morphometric parameters (area, length, width, aspect ratio, slope angle). To quantify and rank the relative susceptibility of each geologic unit to seismic landsliding, we calculated two indices: (1) the susceptibility index, which is the ratio (given as a percentage) of the area covered by landslide sources within a geologic unit to the total outcrop area of that unit: and (2) the frequency index [given in landslides per square kilometer (ls/km2)], which is the total number of landslides within each geologic unit divided by the outcrop area of that unit. Susceptibility categories include very high (>2.5% landslide area or >30 1s/km2). high (1.0-2.5% landslide area or 10-30 1s/km2), moderate (0.5-1.0% landslide area or 3-10 1s/km2), and low (<0.5% landslide area and <3 1s/km2). ?? 2000 Elsevier Science B.V. All rights reserved.

A three-stage birandom program for unit commitment with wind power uncertainty.

PubMed

Zhang, Na; Li, Weidong; Liu, Rao; Lv, Quan; Sun, Liang

2014-01-01

The integration of large-scale wind power adds a significant uncertainty to power system planning and operating. The wind forecast error is decreased with the forecast horizon, particularly when it is from one day to several hours ahead. Integrating intraday unit commitment (UC) adjustment process based on updated ultra-short term wind forecast information is one way to improve the dispatching results. A novel three-stage UC decision method, in which the day-ahead UC decisions are determined in the first stage, the intraday UC adjustment decisions of subfast start units are determined in the second stage, and the UC decisions of fast-start units and dispatching decisions are determined in the third stage is presented. Accordingly, a three-stage birandom UC model is presented, in which the intraday hours-ahead forecasted wind power is formulated as a birandom variable, and the intraday UC adjustment event is formulated as a birandom event. The equilibrium chance constraint is employed to ensure the reliability requirement. A birandom simulation based hybrid genetic algorithm is designed to solve the proposed model. Some computational results indicate that the proposed model provides UC decisions with lower expected total costs.

Internationalisation of Higher Education: The Gap between National Policy-Making and Institutional Needs

ERIC Educational Resources Information Center

Stensaker, Bjorn; Frolich, Nicoline; Gornitzka, Ase; Maassen, Peter

2008-01-01

The article discusses the impact of the growing emphasis on internationalisation on higher education institutions. Based on case studies of 12 Scandinavian universities and colleges, it is shown how issues related to internationalisation trigger processes of trying to enhance the institutional capacity for strategic decision-making and…

Wyatt v Stickney: 10 Years in Review--Past, Present and Future.

ERIC Educational Resources Information Center

Marchetti, Allen

The paper recounts the background of Wyatt v Stickney, which resulted in a landmark decision establishing a constitutional right to treatment for mentally retarded persons. Events which triggered the Wyatt litigation include an employee action brought about by staff in an effort to obtain re-employment. The involvement of the American Association…

Percutaneous Trigger Finger Release: A Cost-effectiveness Analysis.

PubMed

Gancarczyk, Stephanie M; Jang, Eugene S; Swart, Eric P; Makhni, Eric C; Kadiyala, Rajendra Kumar

2016-07-01

Percutaneous trigger finger releases (TFRs) performed in the office setting are becoming more prevalent. This study compares the costs of in-hospital open TFRs, open TFRs performed in ambulatory surgical centers (ASCs), and in-office percutaneous releases. An expected-value decision-analysis model was constructed from the payer perspective to estimate total costs of the three competing treatment strategies for TFR. Model parameters were estimated based on the best available literature and were tested using multiway sensitivity analysis. Percutaneous TFR performed in the office and then, if needed, revised open TFR performed in the ASC, was the most cost-effective strategy, with an attributed cost of $603. The cost associated with an initial open TFR performed in the ASC was approximately 7% higher. Initial open TFR performed in the hospital was the least cost-effective, with an attributed cost nearly twice that of primary percutaneous TFR. An initial attempt at percutaneous TFR is more cost-effective than an open TFR. Currently, only about 5% of TFRs are performed in the office; therefore, a substantial opportunity exists for cost savings in the future. Decision model level II.

Simulating school closure policies for cost effective pandemic decision making

PubMed Central

2012-01-01

Background Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life. Methods Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP) and closure durations. Results Assuming a willingness to pay per quality adjusted life-year (QALY) threshold equal to the US per capita GDP ($46,000), we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP) with the longest duration closure (24 weeks) considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates). Conclusions These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic. PMID:22713694

Coastal flooding as a parameter in multi-criteria analysis for industrial site selection

NASA Astrophysics Data System (ADS)

Christina, C.; Memos, C.; Diakoulaki, D.

2014-12-01

Natural hazards can trigger major industrial accidents, which apart from affecting industrial installations may cause a series of accidents with serious impacts on human health and the environment far beyond the site boundary. Such accidents, also called Na-Tech (natural - technical) accidents, deserve particular attention since they can cause release of hazardous substances possibly resulting in severe environmental pollution, explosions and/or fires. There are different kinds of natural events or, in general terms, of natural causes of industrial accidents, such as landslides, hurricanes, high winds, tsunamis, lightning, cold/hot temperature, floods, heavy rains etc that have caused accidents. The scope of this paper is to examine the coastal flooding as a parameter in causing an industrial accident, such as the nuclear disaster in Fukushima, Japan, and the critical role of this parameter in industrial site selection. Land use planning is a complex procedure that requires multi-criteria decision analysis involving economic, environmental and social parameters. In this context the parameter of a natural hazard occurrence, such as coastal flooding, for industrial site selection should be set by the decision makers. In this paper it is evaluated the influence that has in the outcome of a multi-criteria decision analysis for industrial spatial planning the parameter of an accident risk triggered by coastal flooding. The latter is analyzed in the context of both sea-and-inland induced flooding.

Factors influencing a mother's choice of feeding after discharge of her baby from a neonatal unit.

PubMed

Hallbauer, U; Grobler, J M; Niemand, I

2002-08-01

To assess feeding methods chosen by mothers of babies who spent time in a neonatal unit. Factors influencing this decision were investigated. Descriptive study. Mothers were interviewed on the day they took their babies home. Basic demographic data on mother and baby were collected from the hospital records. The neonatal unit, Pelonomi Hospital, Bloemfontein from May 1996 to May 1998. Eighty-one mothers of babies admitted to the neonatal unit. At discharge 60% of mothers intended to breast-feed their babies exclusively the next day. The mother's decision to breast-feed her baby at home was significantly associated with her decision before delivery (P = 0.0050). Other factors positively associated with the decision to breast-feed exclusively at home were a significantly higher birth weight of the baby (P < 0.0008) and gestational age of the baby (P < 0.0005). The only hospital practice positively associated with this decision was the frequency with which mothers saw their babies during their stay in the unit (P = 0.0153). Mothers' knowledge of how to increase breast-milk supply was very poor. Infants with a lower weight and gestational age, who stayed in the unit longer, were less likely to be breast-fed after discharge from the neonatal unit. The mothers' experience in the unit did not seem to alter their choice of feeding method decided upon before delivery. This suggests that efforts to promote breast-feeding in the neonatal unit were either ineffectual or inadequate. In order to remedy this situation it is necessary to keep the mother-infant pair together (lodger mothers) and to promote breast-feeding before and after delivery. It would also be necessary to train staff in the management of lactation problems.

The Effect of Load Carriage on Trunk Coordination during Treadmill Walking at Increasing Walking Speed

DTIC Science & Technology

2001-05-01

Kinematic and Kinetic Data Collection Systems. Three-dimensional kinematic data were collected at 100 Hz through an Optotrak 3020 System (Northern...regardless of load. The Optotrak system unit provides an external trigger that was used to trigger the start of the force plate data collection, thereby...synchronizing the kinematic and kinetic data. Optotrak required the use of infrared light emitting diodes (IREDS), which were placed bilaterally on the

A Summary of Biases in the BATSE Burst Trigger

NASA Technical Reports Server (NTRS)

Meegan, Charles A; Pendleton, Geoffrey N.; Mallozzi, Robert S.

1999-01-01

The BATSE threshold for triggering on a gamma-ray burst is generally expressed in units of peak flux between 50 and 300 keV averaged over 1024 milliseconds. The completeness of the sample is affected by several systematic and statistical affects. A study is currently underway to characterize two of these that have not yet been Included Abstract: in the BATSE trigger efficiency calculation. They are: 1) the effects of statistical fluctuations on the measurement of peak flux and, 2) the effect on the trigger threshold of "slow risers", In which some of the burst flux is Identified as background. Some other biases that have been identified are in fact Malmquist-type biases which relate to a volume limited, rather than peak flux limited, burst source distribution and which cannot be determined without knowledge of the burst luminosity distribution.

Evaluation of accuracy of IHI Trigger Tool in identifying adverse drug events: a prospective observational study.

PubMed

das Dores Graciano Silva, Maria; Martins, Maria Auxiliadora Parreiras; de Gouvêa Viana, Luciana; Passaglia, Luiz Guilherme; de Menezes, Renata Rezende; de Queiroz Oliveira, João Antonio; da Silva, Jose Luiz Padilha; Ribeiro, Antonio Luiz Pinho

2018-06-06

Adverse drug events (ADEs) can seriously compromise the safety and quality of care provided to hospitalized patients, requiring the adoption of accurate methods to monitor them. We sought to prospectively evaluate the accuracy of the triggers proposed by the Institute for Healthcare Improvement (IHI) for identifying ADEs. A prospective study was conducted in a public university hospital, in 2015, with patients ≥18 years. Triggers proposed by IHI and clinical alterations suspected to be ADEs were searched daily. The number of days in which the patient was hospitalized was considered as unit of measure to evaluate the accuracy of each trigger. Three hundred patients were included in this study. Mean age was 56.3 years (standard deviation (SD) 16.0), and 154 (51.3%) were female. The frequency of patients with ADEs was 24.7% and with at least one trigger was 53.3%. From those patients who had at least one trigger, the most frequent triggers were antiemetics (57.5%) and "abrupt medication stop" (31.8%). Triggers' sensitivity ranged from 0.3 to11.8 % and the positive predictive value ranged from 1.2 to 27.3%. Specificity and negative predictive value were greater than 86%. Most patients identified by the presence of triggers did not have ADEs (64.4%). No triggers were identified in 40 (38.5%) ADEs. IHI Trigger Tool did not show good accuracy in detecting ADEs in this prospective study. The adoption of combined strategies could enhance effectiveness in identifying patient safety flaws. Further discussion might contribute to improve trigger usefulness in clinical practice. This article is protected by copyright. All rights reserved.

Conceptualizing Surrogate Decision-Making at End of Life in the Intensive Care Unit using Cognitive Task Analysis

PubMed Central

Dionne-Odom, J. Nicholas; Willis, Danny G.; Bakitas, Marie; Crandall, Beth; Grace, Pamela J.

2014-01-01

Background Surrogate decision-makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. Purpose Identify and describe the underlying psychological processes of surrogate decision-making for adults at EOL in the ICU. Method Qualitative case study design using a cognitive task analysis (CTA) interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center’s ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semi-structured CTA interviews. Discussion The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions: gist impressions, distressing emotions, and moral intuitions impact a SDM’s judgment about the acceptability of either the patient’s medical treatments or his or her condition. Conclusion The framework offers initial insights about the underlying psychological processes of surrogate decision-making and may facilitate enhanced decision support for SDMs. PMID:25982772

Conceptualizing surrogate decision making at end of life in the intensive care unit using cognitive task analysis.

PubMed

Dionne-Odom, J Nicholas; Willis, Danny G; Bakitas, Marie; Crandall, Beth; Grace, Pamela J

2015-01-01

Surrogate decision makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. To identify and describe the underlying psychological processes of surrogate decision making for adults at EOL in the ICU. Qualitative case study design using a cognitive task analysis interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center's ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semistructured cognitive task analysis interviews. The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions (gist impressions, distressing emotions, and moral intuitions) impact an SDM's judgment about the acceptability of either the patient's medical treatments or his or her condition. The framework offers initial insights about the underlying psychological processes of surrogate decision making and may facilitate enhanced decision support for SDMs. Copyright © 2015 Elsevier Inc. All rights reserved.

Red blood cell transfusion triggers in acute leukemia: a randomized pilot study.

PubMed

DeZern, Amy E; Williams, Katherine; Zahurak, Marianna; Hand, Wesley; Stephens, R Scott; King, Karen E; Frank, Steven M; Ness, Paul M

2016-07-01

Red blood cell (RBC) transfusion thresholds have yet to be examined in large randomized trials in hematologic malignancies. This pilot study in acute leukemia uses a restrictive compared to a liberal transfusion strategy. A randomized (2:1) study was conducted of restrictive (LOW) hemoglobin (Hb) trigger (7 g/dL) compared to higher (HIGH) Hb trigger (8 g/dL). The primary outcome was feasibility of conducting a larger trial. The four requirements for success required that more than 50% of the eligible patients could be consented, more than 75% of the patients randomized to the LOW arm tolerated the transfusion trigger, fewer than 15% of patients crossed over from the LOW arm to the HIGH arm, and no indication for the need to pause the study for safety concerns. Secondary outcomes included fatigue, bleeding, and RBCs and platelets transfused. Ninety patients were consented and randomly assigned to LOW to HIGH. The four criteria for the primary objective of feasibility were met. When the number of units transfused was compared, adjusting for baseline Hb, the LOW arm was transfused on average 8.0 (95% confidence interval [CI], 6.9-9.1) units/patient while the HIGH arm received 11.7 (95% CI, 10.1-13.2) units (p = 0.0003). There was no significant difference in bleeding events or neutropenic fevers between study arms. This study establishes feasibility for trial of Hb thresholds in leukemia through demonstration of success in all primary outcome metrics and a favorable safety profile. This population requires further study to evaluate the equivalence of liberal and restrictive transfusion thresholds in this unique clinical setting. © 2016 AABB.

Can the uncertainty appraisal associated with emotion cancel the effect of the hunch period in the Iowa Gambling Task?

PubMed

Bollon, Thierry; Bagneux, Virginie

2013-01-01

Research has given little attention to the influence of incidental emotions on the Iowa Gambling Task (IGT), in which processing of the emotional cues associated with each decision is necessary to make advantageous decisions. Drawing on cognitive theories of emotions, we tested whether uncertainty-associated emotion can cancel the positive effect of the hunch period, by preventing participants from developing a tendency towards advantageous decisions. Our explanation is that uncertainty appraisals initiate deliberative processing that is irrelevant to process emotional cues, contrary to intuitive processing (Kahneman, 2003; Tiedens & Linton, 2001). As expected, uncertainty-associated emotion cancelled the positive effect of the hunch period in the IGT compared to certainty-associated emotion: disgusted participants (certainty-associated emotion) and sad participants induced to feel certainty developed a stronger tendency towards advantageous decisions than sad participants induced to feel uncertainty. We discuss the importance of the core components that trigger incidental emotions to predict decision making.

Adaptive sampling of information in perceptual decision-making.

PubMed

Cassey, Thomas C; Evens, David R; Bogacz, Rafal; Marshall, James A R; Ludwig, Casimir J H

2013-01-01

In many perceptual and cognitive decision-making problems, humans sample multiple noisy information sources serially, and integrate the sampled information to make an overall decision. We derive the optimal decision procedure for two-alternative choice tasks in which the different options are sampled one at a time, sources vary in the quality of the information they provide, and the available time is fixed. To maximize accuracy, the optimal observer allocates time to sampling different information sources in proportion to their noise levels. We tested human observers in a corresponding perceptual decision-making task. Observers compared the direction of two random dot motion patterns that were triggered only when fixated. Observers allocated more time to the noisier pattern, in a manner that correlated with their sensory uncertainty about the direction of the patterns. There were several differences between the optimal observer predictions and human behaviour. These differences point to a number of other factors, beyond the quality of the currently available sources of information, that influences the sampling strategy.

Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review.

PubMed

Lin, Yanxia; Myall, Michelle; Jarrett, Nikki

2017-12-01

To understand how decisions are made to transfer dying patients home from critical care units. Many people prefer a home death, but a high proportion die in critical care units. Transferring dying patients home is recognized to be complex but transfer decision-making itself remains unclear. Integrative review. Seven bibliographic databases (origin-2015), grey literature and reference lists were searched. An integrative review method was used to synthesize data from diverse sources. Papers were selected through title and abstract screening and full-text reviewing, using inclusion and exclusion criteria derived from review questions. Following quality appraisal, data were extracted and synthesized using normalization process theory as a framework. The number of patients transferred home ranged from 1-346, with most papers reporting on the transfer of one or two patients. Four themes regarding transfer decision-making work were generated: divergent views and practice, multiple stakeholders' involvement in decision-making, collective work and limited understanding of individuals' experiences. The practice of transferring patients home to die and its decision-making varies internationally and is usually influenced by the care system, culture or religion. It is less common to transfer patients home to die from critical care units in western societies. A better understanding of the decision-making work was obtained but mainly from the perspective of hospital-based healthcare professionals. Further research is needed to develop decision-making practice guidance to facilitate patients' wishes to die at home. © 2017 John Wiley & Sons Ltd.

Productivity Assessment and Improvement Measurement of Decision Making Units--An Application for Ranking Cities in Israel

ERIC Educational Resources Information Center

Hadad, Yossi; Keren, Baruch; Ben-Yair, Avner

2010-01-01

In this paper we will demonstrate how productivity and improvement rate of urban organizational units (called also Decision Making Units--DMUs) may be assessed when measured along several time periods. The assessment and subsequent ranking of cities is achieved by means of the Data Envelopment Analysis (DEA) methodology to determine DMU's…

How do strategic decisions and operative practices affect operating room productivity?

PubMed

Peltokorpi, Antti

2011-12-01

Surgical operating rooms are cost-intensive parts of health service production. Managing operating units efficiently is essential when hospitals and healthcare systems aim to maximize health outcomes with limited resources. Previous research about operating room management has focused on studying the effect of management practices and decisions on efficiency by utilizing mainly modeling approach or before-after analysis in single hospital case. The purpose of this research is to analyze the synergic effect of strategic decisions and operative management practices on operating room productivity and to use a multiple case study method enabling statistical hypothesis testing with empirical data. 11 hypotheses that propose connections between the use of strategic and operative practices and productivity were tested in a multi-hospital study that included 26 units. The results indicate that operative practices, such as personnel management, case scheduling and performance measurement, affect productivity more remarkably than do strategic decisions that relate to, e.g., units' size, scope or academic status. Units with different strategic positions should apply different operative practices: Focused hospital units benefit most from sophisticated case scheduling and parallel processing whereas central and ambulatory units should apply flexible working hours, incentives and multi-skilled personnel. Operating units should be more active in applying management practices which are adequate for their strategic orientation.

The trigger system of the JEM-EUSO Project

NASA Astrophysics Data System (ADS)

Bertaina, M.; Ebisuzaki, T.; Hamada, T.; Ikeda, H.; Kawasai, Y.; Sawabe, T.; Takahashi, Y.; JEM-EUSO Collaboration

The trigger system of JEM-EUSO should face different major challenging points: a) cope with the limited down-link transmission rate from the ISS to Earth, by operating a severe on-board and on-time data reduction; b) use very fast, low power consuming and radiation hard electronics; c) have a high signal-over-noise performance and flexibility in order to lower as much as possible the energy threshold of the detector, adjust the system to a variable nightglow background, and trigger on different categories of events (images insisting on the same pixels or crossing huge portions of the entire focal surface). Based on the above stringent requirements, the main ingredients for the trigger logic are: the Gate Time Unit (GTU); the minimum number Nthresh of photo-electrons piling up in a GTU in a pixel to be fired; the persistency level Npers, in which fired pixels are over threshold; the localization and correlation in space and time of the fired pixels, that distinguish a real EAS from an accidental background enhancement. The core of the trigger logic is the Track Trigger Algorithm that has been specifically developed for this purpose. Its characteristics, preliminary performance and its possible implementation on FPGA or DSP will be discussed together with a general overview of the architecture of the triggering system of JEM-EUSO.

22 CFR 1101.14 - Appeal of agency decision not to correct or amend a record.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Appeal of agency decision not to correct or amend a record. 1101.14 Section 1101.14 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.14 Appeal of agency decision not to correct or amend a record. (a) An appea...

Are Gains in Decision-Making Autonomy during Early Adolescence Beneficial for Emotional Functioning? The Case of the United States and China

ERIC Educational Resources Information Center

Qin, Lili; Pomerantz, Eva M.; Wang, Qian

2009-01-01

This research examined the role of children's decision-making autonomy in their emotional functioning during early adolescence in the United States and China. Four times over the 7th and 8th grades, 825 American and Chinese children (M = 12.73 years) reported on the extent to which they versus their parents make decisions about issues children…

Dystonic storm: a practical clinical and video review.

PubMed

Termsarasab, Pichet; Frucht, Steven J

2017-01-01

Dystonic storm is a frightening hyperkinetic movement disorder emergency. Marked, rapid exacerbation of dystonia requires prompt intervention and admission to the intensive care unit. Clinical features of dystonic storm include fever, tachycardia, tachypnea, hypertension, sweating and autonomic instability, often progressing to bulbar dysfunction with dysarthria, dysphagia and respiratory failure. It is critical to recognize early and differentiate dystonic storm from other hyperkinetic movement disorder emergencies. Dystonic storm usually occurs in patients with known dystonia, such as DYT1 dystonia, Wilson's disease and dystonic cerebral palsy. Triggers such as infection or medication adjustment are present in about one-third of all events. Due to the significant morbidity and mortality of this disorder, we propose a management algorithm that divides decision making into two periods: the first 24 h, and the next 2-4 weeks. During the first 24 h, supportive therapy should be initiated, and appropriate patients should be identified early as candidates for pallidal deep brain stimulation or intrathecal baclofen. Management in the next 2-4 weeks aims at symptomatic dystonia control and supportive therapies.

Famines in Africa: is early warning early enough?

PubMed Central

Kim, Jeeyon Janet; Guha-Sapir, Debarati

2012-01-01

Following the second Sahelian famine in 1984–1985, major investments were made to establish Early Warning Systems. These systems help to ensure that timely warnings and vulnerability information are available to decision makers to anticipate and avert food crises. In the recent crisis in the Horn of Africa, alarming levels of acute malnutrition were documented from March 2010, and by August 2010, an impending food crisis was forecast. Despite these measures, the situation remained unrecognised, and further deteriorated causing malnutrition levels to grow in severity and scope. By the time the United Nations officially declared famine on 20 July 2011, and the humanitarian community sluggishly went into response mode, levels of malnutrition and mortality exceeded catastrophic levels. At this time, an estimated 11 million people were in desperate and immediate need for food. With warnings of food crises in the Sahel, South Sudan, and forecast of the drought returning to the Horn, there is an immediate need to institutionalize change in the health response during humanitarian emergencies. Early warning systems are only effective if they trigger an early response. PMID:22745628

Famines in Africa: is early warning early enough?

PubMed

Kim, Jeeyon Janet; Guha-Sapir, Debarati

2012-01-01

Following the second Sahelian famine in 1984-1985, major investments were made to establish Early Warning Systems. These systems help to ensure that timely warnings and vulnerability information are available to decision makers to anticipate and avert food crises. In the recent crisis in the Horn of Africa, alarming levels of acute malnutrition were documented from March 2010, and by August 2010, an impending food crisis was forecast. Despite these measures, the situation remained unrecognised, and further deteriorated causing malnutrition levels to grow in severity and scope. By the time the United Nations officially declared famine on 20 July 2011, and the humanitarian community sluggishly went into response mode, levels of malnutrition and mortality exceeded catastrophic levels. At this time, an estimated 11 million people were in desperate and immediate need for food. With warnings of food crises in the Sahel, South Sudan, and forecast of the drought returning to the Horn, there is an immediate need to institutionalize change in the health response during humanitarian emergencies. Early warning systems are only effective if they trigger an early response.

Dear Diary: Confessions of a Nice White Girl

ERIC Educational Resources Information Center

Bradley, Deborah

2005-01-01

"Music and the Racial Imagination" triggered the reminiscences from the author's teens described in the "diary presented in this article." These memories undoubtedly played a role in her decision to enter an undergraduate music education program at the age of 40. These and other memories have been called up in a variety of contexts more recently…

How to Represent Adaptation in e-Learning with IMS Learning Design

ERIC Educational Resources Information Center

Burgos, Daniel; Tattersall, Colin; Koper, Rob

2007-01-01

Adaptation in e-learning has been an important research topic for the last few decades in computer-based education. In adaptivity the behaviour of the user triggers some actions in the system that guides the learning process. In adaptability, the user makes changes and takes decisions. Progressing from computer-based training and adaptive…

Rhapsody in avian major: a concerto of songbirds, forest management, and the public.

Treesearch

Sally Duncan

2004-01-01

Controversy over timber harvesting continues, and public perception of timber harvest has become increasingly important in the debate over land management decisions. However, forest management alternatives are often framed in terms to which the public cannot easily relate, such as "millions of board feet", or terms that trigger a preconceived negative...

Linking Exploration and Exploitation: How a Think Tank Triggers a Managerial Innovation

ERIC Educational Resources Information Center

Frost, Jetta; Vogel, Rick

2008-01-01

In this article, we focus on think tanks as intermediaries between exploration and exploitation. To underpin our theoretical arguments on their linking function between both domains, we conducted a case study. The object of investigation is a think tank which has played a decisive role in the modernisation of the German public sector. The…

A Framework for Developing and Testing Financial Capability Education Programs Targeted to Elementary Schools

ERIC Educational Resources Information Center

Collins, J. Michael; Odders-White, Elizabeth

2015-01-01

Concerns about consumers' ability to manage their finances have triggered a range of proposals, including interventions aimed at elementary school students. The goal of these approaches is to improve lifelong economic decision making, but the evidence supporting their efficacy is thin. In this article, the authors discuss the trend toward…

Affect asymmetry and comfort food consumption.

PubMed

Dubé, Laurette; LeBel, Jordan L; Lu, Ji

2005-11-15

It is proposed that the emotional triggers of comfort food consumption can reliably be predicted by factors tied to affect asymmetry whereby negative affects dominate one's experience, decision making and behaviors in some instances while positive emotions prevail in others. Specifically, we relate three of these factors (age, gender, and culture) to differences in the emotional triggers of comfort food consumption and we further explore the possibility that the type of food eaten during comfort-seeking episodes can also be tied to affect asymmetry. Two hundred and seventy-seven participants completed a web-based survey conducted to assess the emotional antecedents and consequences of comfort food consumption. Consistent with expectations, results indicate that men's comfort food consumption was motivated by positive emotions whereas women's consumption was triggered by negative affects. Consumption of comfort foods alleviated women's negative emotions but also produced guilt. Positive affect was a particularly powerful trigger of comfort food consumption for older participants and for participants with French cultural background. Younger participants and participants with English background reported more intense negative emotions prior to consuming comfort foods. Foods high in sugar and fat content were more efficient in alleviating negative affects whereas low-calorie foods were more efficient in increasing positive emotions.

Nursing Homes Appeals of Deficiency Citations: The Informal Dispute Resolution Process

PubMed Central

Mukamel, Dana B.; Weimer, David L.; Li, Yue; Bailey, Lauren; Spector, William D.; Harrington, Charlene

2012-01-01

Objective Nursing homes found to be not meeting quality standards are cited for deficiencies. Before 1995, their only recourse was a formal appeal process, which is lengthy and costly. In 1995, the Centers for Medicare & Medicaid Services (CMS) instituted the Informal Dispute Resolution (IDR) process. This study presents for the first time national statistics about the IDR process and an analysis of the factors that influence nursing homes’ decisions to request an IDR. Design Retrospective study including descriptive statistics and multivariate logistic hierarchical models. Setting U.S. nursing homes in 2005 to 2008. Participant 15,916 Medicaid and Medicare certified nursing homes nationally, with 94,188 surveys and 9,388 IDRs. Measures The unit of observation was an annual survey or a complaint survey that generated at least one deficiency. The dependent variable was dichotomous and indicated whether the annual or a complaint survey triggered an IDR request. Independent variables included characteristics of the nursing home, the deficiency, the market, and the state regulatory environment. Results Ten percent of all annual surveys and complaint surveys resulted in IDRs. There was substantial variation across states, which persisted over time. Multivariate results suggest that nursing homes’ decisions to request an IDR depend on their assessment of the probability of success and assessment of the benefits of the submission. Conclusions Nursing homes avail themselves of the IDR process. Their propensity to do so depends on a number of factors, including the state regulatory system and the market environment in which they operate. PMID:22402171

The September 29, 2009 Earthquake and Tsunami in American Samoa: A Case Study of Household Evacuation Behavior and the Protective Action Decision Model

NASA Astrophysics Data System (ADS)

Apatu, E. J. I.; Gregg, C. E.; Lindell, M. K.; Sorensen, J.; Hillhouse, J.; Sorensen, B.

2012-04-01

In 2009, the islands of Samoa, American Samoa, and Tonga were struck by an 8.1 magnitude earthquake that triggered a tsunami. The latter claimed an estimated 149, 34, and nine lives, respectively. Preparing persons to take protective action during an earthquake and tsunami is important to help save lives, but evacuation behavior is a dynamic process, which involves many factors such as recognition and interpretation of environmental cues, characteristics of the receiver, characteristics of official and informal warnings and a person's social context during the event. Compared to individualistic cultures like that in the USA, little is known about what factors affect household evacuation behavior in collectivist cultures. The Protective Action Decision Model (PADM) of Lindell and Perry (2004) is a theoretical framework that purports to explain human response to natural hazards. This broad behavioral hazard model has been tested in several settings in the United States. However, to date, the PADM has never been tested in a collectivist culture. Thus, this study will summarize interview findings from 300 American Samoan survivors to understand household evacuation behavior in response to the 2009 tsunami and earthquake that hit American Samoa. In addition, an investigation of how well the PADM explains evacuation action behavior will be reported. Findings from this study will be useful for public health emergency professionals in planning efforts for local tsunamis in coastal communities in the Pacific and around the world.

Superfund record of decision amendment (EPA Region 5): Ninth Avenue Dump, Gary, IN, September 13, 1994

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

Not Available

The decision document, together with Records of Decision dated June 30, 1989 (PB90-114810) and September 20, 1988 (PB89-153837) and an Explanation of Significant Differences dated October 1991, present the selected remedial action for the Ninth Avenue Dump site. The remedial action for the site consists of two operable units. The first operable unit addressed an oil layer floating on the groundwater by means of oil and groundwater extraction, oil storage, reintroduction of the groundwater, containment with a slurry wall, and management of excess surface water. The extracted groundwater was treated prior to reintroduction. The second operable unit, which is beingmore » amended by this decision document, addresses the remaining threats at the site.« less

NeuroImaging Radiological Interpretation System (NIRIS) for Acute Traumatic Brain Injury (TBI).

PubMed

Wintermark, Max; Li, Ying; Ding, Victoria Y; Xu, Yingding; Jiang, Bin; Ball, Robyn L; Zeineh, Michael; Gean, Alisa; Sanelli, Pina

2018-04-18

To develop an outcome-based NeuroImaging Radiological Interpretation System (NIRIS) for acute traumatic brain injury (TBI) patients that would standardize the interpretation of non-contrast head CTs and consolidate imaging findings into ordinal severity categories that would inform specific patient management actions and that could be used as a clinical decision support tool. We retrospectively identified all patients transported to our emergency department by ambulance or helicopter, for whom a trauma alert was triggered per established criteria and who underwent a non-contrast head CT due to suspicion of TBI, between November 2015 and April 2016. Two neuroradiologists reviewed the non-contrast head CTs and assessed the TBI imaging common data elements (CDEs), as defined by the National Institutes of Health (NIH). Using descriptive statistics and receiver operating characteristic curve analyses to identify imaging characteristics and associated thresholds that best distinguished among outcomes, we classified patients into five mutually exclusive categories: 0-discharge from the emergency department; 1-follow-up brain imaging and/or admission; 2-admission to an advanced care unit; 3-neurosurgical procedure; 4-death up to 6 months after TBI. Sensitivity of NIRIS with respect to each patient's true outcome was then evaluated and compared to that of the Marshall and Rotterdam scoring systems for TBI. In our cohort of 542 TBI patients, NIRIS was developed to predict discharge (182 patients), follow-up brain imaging/admission (187 patients), need for advanced care unit (151 patients). neurosurgical procedures (10 patients) and death (12 patients). NIRIS performed similarly to the Marshall and Rotterdam scoring systems in terms of predicting mortality. We developed an interpretation system for neuroimaging using the CDEs that informs specific patient management actions and could be used as a clinical decision support tool for patients with TBI. Our NIRIS classification, with evidence-based grouping of the CDEs into actionable categories, will need to be validated in different TBI populations.

Discriminating External and Internal Causes for Heading Changes in Freely Flying Drosophila

PubMed Central

Sayaman, Rosalyn W.; Murray, Richard M.; Dickinson, Michael H.

2013-01-01

As animals move through the world in search of resources, they change course in reaction to both external sensory cues and internally-generated programs. Elucidating the functional logic of complex search algorithms is challenging because the observable actions of the animal cannot be unambiguously assigned to externally- or internally-triggered events. We present a technique that addresses this challenge by assessing quantitatively the contribution of external stimuli and internal processes. We apply this technique to the analysis of rapid turns (“saccades”) of freely flying Drosophila melanogaster. We show that a single scalar feature computed from the visual stimulus experienced by the animal is sufficient to explain a majority (93%) of the turning decisions. We automatically estimate this scalar value from the observable trajectory, without any assumption regarding the sensory processing. A posteriori, we show that the estimated feature field is consistent with previous results measured in other experimental conditions. The remaining turning decisions, not explained by this feature of the visual input, may be attributed to a combination of deterministic processes based on unobservable internal states and purely stochastic behavior. We cannot distinguish these contributions using external observations alone, but we are able to provide a quantitative bound of their relative importance with respect to stimulus-triggered decisions. Our results suggest that comparatively few saccades in free-flying conditions are a result of an intrinsic spontaneous process, contrary to previous suggestions. We discuss how this technique could be generalized for use in other systems and employed as a tool for classifying effects into sensory, decision, and motor categories when used to analyze data from genetic behavioral screens. PMID:23468601

Graphics Processors in HEP Low-Level Trigger Systems

NASA Astrophysics Data System (ADS)

Ammendola, Roberto; Biagioni, Andrea; Chiozzi, Stefano; Cotta Ramusino, Angelo; Cretaro, Paolo; Di Lorenzo, Stefano; Fantechi, Riccardo; Fiorini, Massimiliano; Frezza, Ottorino; Lamanna, Gianluca; Lo Cicero, Francesca; Lonardo, Alessandro; Martinelli, Michele; Neri, Ilaria; Paolucci, Pier Stanislao; Pastorelli, Elena; Piandani, Roberto; Pontisso, Luca; Rossetti, Davide; Simula, Francesco; Sozzi, Marco; Vicini, Piero

2016-11-01

Usage of Graphics Processing Units (GPUs) in the so called general-purpose computing is emerging as an effective approach in several fields of science, although so far applications have been employing GPUs typically for offline computations. Taking into account the steady performance increase of GPU architectures in terms of computing power and I/O capacity, the real-time applications of these devices can thrive in high-energy physics data acquisition and trigger systems. We will examine the use of online parallel computing on GPUs for the synchronous low-level trigger, focusing on tests performed on the trigger system of the CERN NA62 experiment. To successfully integrate GPUs in such an online environment, latencies of all components need analysing, networking being the most critical. To keep it under control, we envisioned NaNet, an FPGA-based PCIe Network Interface Card (NIC) enabling GPUDirect connection. Furthermore, it is assessed how specific trigger algorithms can be parallelized and thus benefit from a GPU implementation, in terms of increased execution speed. Such improvements are particularly relevant for the foreseen Large Hadron Collider (LHC) luminosity upgrade where highly selective algorithms will be essential to maintain sustainable trigger rates with very high pileup.

[Development, implementation, and analysis of a "collaborative decision-making for reasonable care" document in pediatric palliative care].

PubMed

Paoletti, M; Litnhouvongs, M-N; Tandonnet, J

2015-05-01

In France, a legal framework and guidelines state that decisions to limit treatments (DLT) require a collaborative decision meeting and a transcription of decisions in the patient's file. The do-not-attempt-resuscitation order involves the same decision-making process for children in palliative care. To fulfill the law's requirements and encourage communication within the teams, the Resource Team in Pediatric Palliative Care in Aquitaine created a document shared by all children's hospital units, tracing the decision-making process. This study analyzed the decision-making process, quality of information transmission, and most particularly the relevance of this new "collaborative decision-making for reasonable care" card. Retrospective study evaluating the implementation of a traceable document relating the DLT process. All the data sheets collected between January and December 2013 were analyzed. A total of 58 data sheets were completed between January and December 2013. We chose to collect the most relevant data to evaluate the relevance of the items to be completed and the transmission of the document, to draw up the patients' profile, and the contents of discussions with families. Of the 58 children for whom DLT was discussed, 41 data sheets were drawn up in the pediatric intensive care unit, seven in the oncology and hematology unit, five in the neonatology unit, four in the neurology unit, and one in the pneumology unit. For 30 children, one sheet was created, for 11 children, two sheets and for two children, three sheets were filled out. Thirty-nine decisions were made for withholding lifesaving treatment, 11 withdrawing treatment, and for five children, no limitation was set. Nine children survived after DLT. Of the 58 data sheets, only 31 discussions with families were related to the content of the data sheet. Of the 14 children transferred out of the unit with a completed data sheet, it was transmitted to the new unit for 11 children (79%). The number of data sheets collected in 1 year shows the value of this document. The participation of several pediatric specialities' referents in its creation, then its progressive presentation in the children's hospital units, were essential steps in introducing and establishing its use. Items describing the situation, management proposals, and adaptation of the children's supportive care were completed in the majority of cases. They correspond to a clinical description, the object of the discussion, and the daily caregiver's practices, respectively. On the other hand, discussions with families were related to the card's contents in only 53% of the cases. This can be explained by the time required to complete the DLT process. It is difficult for referring doctors to systematically, faithfully, and objectively transcribe discussions with parents. Although this process has been used for a long time in intensive care units, this document made possible an indispensable formalisation in the decision-making process. In other pediatric specialities, the sheet allowed introducing the palliative approach and was a starter and a tool for reflection on the do-not-attempt-resuscitation order, thus suggesting the need for anticipation in these situations. With the implementation of this new document, the DLT, data transmission, and continuity of care conditions were improved in the children's hospital units. Sharing this sheet with all professionals in charge of these children would support homogeneity and quality of management and care for children and their parents. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Work-related psychosocial events as triggers of sick leave - results from a Swedish case-crossover study

PubMed Central

2011-01-01

Background Although illness is an important cause of sick leave, it has also been suggested that non-medical risk factors may influence this association. If such factors impact on the period of decision making, they should be considered as triggers. Yet, there is no empirical support available. The aim was to investigate whether recent exposure to work-related psychosocial events can trigger the decision to report sick when ill. Methods A case-crossover design was applied to 546 sick-leave spells, extracted from a Swedish cohort of 1 430 employees with a 3-12 month follow-up of new sick-leave spells. Exposure in a case period corresponding to an induction period of one or two days was compared with exposure during control periods sampled from workdays during a two-week period prior to sick leave for the same individual. This was done according to the matched-pair interval and the usual frequency approaches. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). Results Most sick-leave spells happened in relation to acute, minor illnesses that substantially reduced work ability. The risk of taking sick leave was increased when individuals had recently been exposed to problems in their relationship with a superior (OR 3.63; CI 1.44-9.14) or colleagues (OR 4.68; CI 1.43-15.29). Individuals were also more inclined to report sick on days when they expected a very stressful work situation than on a day when they were not under such stress (OR 2.27; CI 1.40-3.70). Conclusions Exposure to problems in workplace relationships or a stressful work situation seems to be able to trigger reporting sick. Psychosocial work-environmental factors appear to have a short-term effect on individuals when deciding to report sick. PMID:21429193

Directional Slack-Based Measure for the Inverse Data Envelopment Analysis

PubMed Central

Abu Bakar, Mohd Rizam; Lee, Lai Soon; Jaafar, Azmi B.; Heydar, Maryam

2014-01-01

A novel technique has been introduced in this research which lends its basis to the Directional Slack-Based Measure for the inverse Data Envelopment Analysis. In practice, the current research endeavors to elucidate the inverse directional slack-based measure model within a new production possibility set. On one occasion, there is a modification imposed on the output (input) quantities of an efficient decision making unit. In detail, the efficient decision making unit in this method was omitted from the present production possibility set but substituted by the considered efficient decision making unit while its input and output quantities were subsequently modified. The efficiency score of the entire DMUs will be retained in this approach. Also, there would be an improvement in the efficiency score. The proposed approach was investigated in this study with reference to a resource allocation problem. It is possible to simultaneously consider any upsurges (declines) of certain outputs associated with the efficient decision making unit. The significance of the represented model is accentuated by presenting numerical examples. PMID:24883350

The Decision to Dismiss General MacArthur

DTIC Science & Technology

1966-04-22

this document can be found in the DTIC ® Technical Report Database. g DISTRIBUTION STATEMENT A. Approved for public release; distribution is... reporters pre- dicting a bloody stalemate unless major additions were made to his forces and new policies formulated by the United Nations. On 20 March...his decision to dismiss General MacArthur and return him to the United States. Due to a report of a leak of this decision to a newspaper, the

A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in Cardiac Surgery.

PubMed

Koch, Colleen G; Sessler, Daniel I; Mascha, Edward J; Sabik, Joseph F; Li, Liang; Duncan, Andra I; Zimmerman, Nicole M; Blackstone, Eugene H

2017-10-01

Class I evidence supporting a threshold for transfusion in the cardiac surgical setting is scarce. We randomly allocated patients to a transfusion hematocrit trigger of 24% versus 28% to compare morbidity, mortality, and resource use. From March 2007 to August 2014, two centers randomly assigned 722 adults undergoing coronary artery bypass graft surgery or valve procedures to a 24% hematocrit trigger (n = 363, low group) or 28% trigger (n = 354, high group). One unit of red blood cells was transfused if the hematocrit fell below the designated threshold. The primary endpoint was a composite of postoperative morbidities and mortality. Treatment effect was primarily assessed using an average relative effect generalized estimating equation model. At the second planned interim analysis, the a priori futility boundary was crossed, and the study was stopped. There was no detected treatment effect on the composite outcome (average relative effect odds ratio, low versus high, 0.86, 95% confidence interval: 0.29 to 2.54, p = 0.71). However, the low group received fewer red blood cell transfusions than the high group (54% versus 75%, p < 0.001), mostly administered in the operating room (low group, 112 [31%]; high group, 208 [59%]), followed by intensive care unit (low, 105 [31%]; high, 115 [34%]) and floor (low, 41 [12%]; high, 42 [13%]). The low group was exposed to lower hematocrits: median before transfusion, 22% (Q1 = 21%, Q3 = 23%) versus 24% (Q1 = 22%, Q3 = 25%). Negative exposures differed between treatment groups, with lower hematocrit in the 24% trigger group and more red blood cells used in the 28% group, but adverse outcomes did not differ. Because red blood cell use was less with a 24% trigger without adverse effects, our randomized trial results support aggressive blood conservation efforts in cardiac surgery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Article 31(b) Triggers - The COMA Misfires

DTIC Science & Technology

1994-03-01

under Article 31 to the effect that he need not be a witness against himself.31 9 The court’s final appeal to Miranda rationale came in the form of a...the suspect will be irrelevant.49’ Thus the test will avoid any appeal to emotion or false perception. What factors should the court examine? The...history of the UCMJ, the United States Court of Military Appeals (COMA) has struggled to develop and maintain a coherent analysis of the triggering

Evaluation of a 10 kV, 400 kA Si SGTO at High dI/dt

DTIC Science & Technology

2006-05-01

inspection and high-potting of each component module prior to pulsing. The complete unit was then switched in a low inductance RLC circuit to test...during triggering. A ring down RLC circuit (Fig. 3) was designed with minimum inductance to test for peak dI/dt of anode-cathode flowing current. A...single 860 µF capacitor was charged to a chosen high voltage, then the power supply was disconnected and the switch was triggered to rapidly

26 CFR 301.7701-7 - Trusts-domestic and foreign.

Code of Federal Regulations, 2010 CFR

2010-04-01

... more United States persons have the authority to control all substantial decisions of the trust... decisions. The term substantial decisions means those decisions that persons are authorized or required to make under the terms of the trust instrument and applicable law and that are not ministerial. Decisions...

Intraspinal microstimulation and diaphragm activation after cervical spinal cord injury

PubMed Central

Mercier, L. M.; Gonzalez-Rothi, E. J.; Streeter, K. A.; Posgai, S. S.; Poirier, A. S.; Fuller, D. D.; Reier, P. J.

2016-01-01

Intraspinal microstimulation (ISMS) using implanted electrodes can evoke locomotor movements after spinal cord injury (SCI) but has not been explored in the context of respiratory motor output. An advantage over epidural and direct muscle stimulation is the potential of ISMS to selectively stimulate components of the spinal respiratory network. The present study tested the hypothesis that medullary respiratory activity could be used to trigger midcervical ISMS and diaphragm motor unit activation in rats with cervical SCI. Studies were conducted after acute (hours) and subacute (5–21 days) C2 hemisection (C2Hx) injury in adult rats. Inspiratory bursting in the genioglossus (tongue) muscle was used to trigger a 250-ms train stimulus (100 Hz, 100–200 μA) to the ventral C4 spinal cord, targeting the phrenic motor nucleus. After both acute and subacute injury, genioglossus EMG activity effectively triggered ISMS and activated diaphragm motor units during the inspiratory phase. The ISMS paradigm also evoked short-term potentiation of spontaneous inspiratory activity in the previously paralyzed hemidiaphragm (i.e., bursting persisting beyond the stimulus period) in ∼70% of the C2Hx animals. We conclude that medullary inspiratory output can be used to trigger cervical ISMS and diaphragm activity after SCI. Further refinement of this method may enable “closed-loop-like” ISMS approaches to sustain ventilation after severe SCI. NEW & NOTEWORTHY We examined the feasibility of using intraspinal microstimulation (ISMS) of the cervical spinal cord to evoke diaphragm activity ipsilateral to acute and subacute hemisection of the upper cervical spinal cord of the rat. This proof-of-concept study demonstrated the efficacy of diaphragm activation, using an upper airway respiratory EMG signal to trigger ISMS at the level of the ipsilesional phrenic nucleus during acute and advanced postinjury intervals. PMID:27881723

Development of the new trigger for VANDLE neutron detector

NASA Astrophysics Data System (ADS)

Hasse, Adam; Taylor, Steven; Daugherty, Hadyn; Grzywacz, Robert

2014-09-01

Beta-delayed neutron emission (βn) is the dominant decay channel for the majority of very neutron-rich nuclei. In order to study these decays a new detector system called the Versatile Array of Neutron Detectors at Low Energy (VANDLE) was constructed. A critical part of this neutron time of flight detector is a trigger unit. This trigger is sensitive to electron from beta decay down to very low energies, insensitive to gamma rays and have a good timing performance, better than 1 ns. In order to satisfy these condition, we have developed a new system, which utilizes plastic scintillator but uses recently developed light readout technique, based on the so called Silicon Photomultiplier, manufactured by Sensl. New system has been developed and performance tested using digital data acquisition system at the University of Tennessee and will be utilized in future experiments involving VANDLE. Beta-delayed neutron emission (βn) is the dominant decay channel for the majority of very neutron-rich nuclei. In order to study these decays a new detector system called the Versatile Array of Neutron Detectors at Low Energy (VANDLE) was constructed. A critical part of this neutron time of flight detector is a trigger unit. This trigger is sensitive to electron from beta decay down to very low energies, insensitive to gamma rays and have a good timing performance, better than 1 ns. In order to satisfy these condition, we have developed a new system, which utilizes plastic scintillator but uses recently developed light readout technique, based on the so called Silicon Photomultiplier, manufactured by Sensl. New system has been developed and performance tested using digital data acquisition system at the University of Tennessee and will be utilized in future experiments involving VANDLE. Department of Physics and Astronomy, University of Tennessee, Knoxville, USA.

A bench study of intensive-care-unit ventilators: new versus old and turbine-based versus compressed gas-based ventilators

PubMed Central

Thille, Arnaud W.; Lyazidi, Aissam; Richard, Jean-Christophe M.; Galia, Fabrice; Brochard, Laurent

2009-01-01

Objective To compare 13 commercially available, new-generation, intensive-care-unit (ICU) ventilators regarding trigger function, pressurization capacity during pressure-support ventilation (PSV), accuracy of pressure measurements and expiratory resistance. Design and Setting Bench study at a research laboratory in a university hospital. Material Four turbine-based ventilators and nine conventional servo-valve compressed-gas ventilators were tested using a two-compartment lung model. Results Three levels of effort were simulated. Each ventilator was evaluated at four PSV levels (5, 10, 15, and 20 cm H2O), with and without positive end-expiratory pressure (5 cm H2O, Trigger function was assessed as the time from effort onset to detectable pressurization. Pressurization capacity was evaluated using the airway pressure-time product computed as the net area under the pressure-time curve over the first 0.3 s after inspiratory effort onset. Expiratory resistance was evaluated by measuring trapped volume in controlled ventilation. Significant differences were found across the ventilators, with a range of triggering-delay from 42 ms to 88 ms for all conditions averaged (P<.001). Under difficult conditions, the triggering delay was longer than 100 ms and the pressurization was poor with five ventilators at PSV5 and three at PSV10, suggesting an inability to unload patient’s effort. On average, turbine-based ventilators performed better than conventional ventilators, which showed no improvement compared to a 2000 bench comparison. Conclusion Technical performances of trigger function, pressurization capacity and expiratory resistance vary considerably across new-generation ICU ventilators. ICU ventilators seem to have reached a technical ceiling in recent years, and some ventilators still perform inadequately. PMID:19352622

A bench study of intensive-care-unit ventilators: new versus old and turbine-based versus compressed gas-based ventilators.

PubMed

Thille, Arnaud W; Lyazidi, Aissam; Richard, Jean-Christophe M; Galia, Fabrice; Brochard, Laurent

2009-08-01

To compare 13 commercially available, new-generation, intensive-care-unit (ICU) ventilators in terms of trigger function, pressurization capacity during pressure-support ventilation (PSV), accuracy of pressure measurements, and expiratory resistance. Bench study at a research laboratory in a university hospital. Four turbine-based ventilators and nine conventional servo-valve compressed-gas ventilators were tested using a two-compartment lung model. Three levels of effort were simulated. Each ventilator was evaluated at four PSV levels (5, 10, 15, and 20 cm H2O), with and without positive end-expiratory pressure (5 cm H2O). Trigger function was assessed as the time from effort onset to detectable pressurization. Pressurization capacity was evaluated using the airway pressure-time product computed as the net area under the pressure-time curve over the first 0.3 s after inspiratory effort onset. Expiratory resistance was evaluated by measuring trapped volume in controlled ventilation. Significant differences were found across the ventilators, with a range of triggering delays from 42 to 88 ms for all conditions averaged (P < 0.001). Under difficult conditions, the triggering delay was longer than 100 ms and the pressurization was poor for five ventilators at PSV5 and three at PSV10, suggesting an inability to unload patient's effort. On average, turbine-based ventilators performed better than conventional ventilators, which showed no improvement compared to a bench comparison in 2000. Technical performance of trigger function, pressurization capacity, and expiratory resistance differs considerably across new-generation ICU ventilators. ICU ventilators seem to have reached a technical ceiling in recent years, and some ventilators still perform inadequately.

A Panel Study on the Effects of Task Uncertainty, Interdependence , and Size on Unit Decision Making

ERIC Educational Resources Information Center

Van De Ven, Andrew H.

1977-01-01

This panel study examined the determinants of supervisory, employee, and group decision-making in departments or units within a complex organization. Available from: Comparative Administration Research Institute, Kent State University Press, Kent State University, Kent, OH 44242. (Author)

Decision Topology Assessment in Engineering Design Under Uncertainity

DTIC Science & Technology

2014-01-01

those of the United States Government or the DoA, and shall not be used for advertising or product endorsement purposes. REFERENCES 1. Clemen ...Raiffa, H., 1994, Decisions with Multiple Objectives, Cambridge University Press, Cambridge, United Kingdom. 6. Lewis, K., W. Chen, and L.C. Schmidt

Who has the D? How clear decision roles enhance organizational performance.

PubMed

Rogers, Paul; Blenko, Marcia

2006-01-01

Decisions are the coin of the realm in business. But even in highly respected companies, decisions can get stuck inside the organization like loose change. As a result, the entire decision-making process can stall, usually at one of four bottlenecks: global versus local, center versus business unit, function versus function, and inside versus outside partners. Decision-making bottlenecks can occur whenever there is ambiguity or tension over who gets to decide what. For example, do marketers or product developers get to decide the features of a new product? Should a major capital investment depend on the approval of the business unit that will own it, or should headquarters make the final call? Which decisions can be delegated to an outsourcing partner, and which must be made internally? Bain consultants Paul Rogers and Marcia Blenko use an approach called RAPID (recommend, agree, perform, input, and decide) to help companies unclog their decision-making bottlenecks by explicitly defining roles and responsibilities. For example, British American Tobacco struck a new balance between global and local decision making to take advantage of the company's scale while maintaining its agility in local markets. At Wyeth Pharmaceuticals, a growth opportunity revealed the need to push more decisions down to the business units. And at the UK department-store chain John Lewis, buyers and sales staff clarified their decision roles in order to implement a new strategy for selling its salt and pepper mills. When revamping its decision-making process, a company must take some practical steps: Align decision roles with the most important sources of value, make sure that decisions are made by the right people at the right levels of the organization, and let the people who will live with the new process help design it.

Return of the JITAI: Applying a Just-in-Time Adaptive Intervention Framework to the Development of m-Health Solutions for Addictive Behaviors

PubMed Central

Evans, Brittney C.; Flack, Daniel; Juarascio, Adrienne; Manasse, Stephanie; Zhang, Fengqing; Forman, Evan M.

2018-01-01

Purpose Lapses are strong indicators of later relapse among individuals with addictive disorders, and thus are an important intervention target. However, lapse behavior has proven resistant to change due to the complex interplay of lapse triggers that are present in everyday life. It could be possible to prevent lapses before they occur by using m-Health solutions to deliver interventions in real-time. Method Just-in-time adaptive intervention (JITAI) is an intervention design framework that could be delivered via mobile app to facilitate in-the-moment monitoring of triggers for lapsing, and deliver personalized coping strategies to the user to prevent lapses from occurring. An organized framework is key for successful development of a JITAI. Results Nahum-Shani and colleagues (2014) set forth six core elements of a JITAI and guidelines for designing each: distal outcomes, proximal outcomes, tailoring variables, decision points, decision rules, and intervention options. The primary aim of this paper is to illustrate the use of this framework as it pertains to developing a JITAI that targets lapse behavior among individuals following a weight control diet. Conclusion We will detail our approach to various decision points during the development phases, report on preliminary findings where applicable, identify problems that arose during development, and provide recommendations for researchers who are currently undertaking their own JITAI development efforts. Issues such as missing data, the rarity of lapses, advantages/disadvantages of machine learning, and user engagement are discussed. PMID:28083725

Monitoring for a specific management objective: protection of shorebird foraging habitat adjacent to a waste water treatment plant.

PubMed

Morris, Liz; Petch, David; May, David; Steele, William K

2017-05-01

Intertidal invertebrates are often used in environmental monitoring programs as they are good indicators of water quality and an important food source for many species of fish and birds. We present data from a monitoring program where the primary aim is to report on the condition of the potential invertebrate prey abundance, biomass and diversity for migrating shorebirds on mudflats adjacent to a waste water treatment plant in a Ramsar listed wetland in Victoria, Australia. A key threat to the foraging habitat at this site has been assessed as a reduction in potential prey items as a result of the changes to the waste water treatment processes. We use control charts, which summarise data from intertidal mudflats across the whole shoreline of the adjacent waste water treatment plant, to elicit a management response when trigger levels are reached. We then examine data from replicate discharge and control sites to determine the most appropriate management response. The monitoring program sits within an adaptive management framework where management decisions are reviewed and the data is examined at different scales to evaluate and modify our models of the likely outcomes of management actions. This study provides a demonstration of the process undertaken in a year when trigger levels were reached and a management decision was required. This highlights the importance of monitoring data from a range of scales in reducing uncertainty and improving decision making in complex systems.

The use of the truth and deception in dementia care amongst general hospital staff.

PubMed

Turner, Alex; Eccles, Fiona; Keady, John; Simpson, Jane; Elvish, Ruth

2017-08-01

Deceptive practice has been shown to be endemic in long-term care settings. However, little is known about the use of deception in dementia care within general hospitals and staff attitudes towards this practice. This study aimed to develop understanding of the experiences of general hospital staff and explore their decision-making processes when choosing whether to tell the truth or deceive a patient with dementia. This qualitative study drew upon a constructivist grounded theory approach to analyse data gathered from semi-structured interviews with a range of hospital staff. A model, grounded in participant experiences, was developed to describe their decision-making processes. Participants identified particular triggers that set in motion the need for a response. Various mediating factors influenced how staff chose to respond to these triggers. Overall, hospital staff were reluctant to either tell the truth or to lie to patients. Instead, 'distracting' or 'passing the buck' to another member of staff were preferred strategies. The issue of how truth and deception are defined was identified. The study adds to the growing research regarding the use of lies in dementia care by considering the decision-making processes for staff in general hospitals. Various factors influence how staff choose to respond to patients with dementia and whether deception is used. Similarities and differences with long-term dementia care settings are discussed. Clinical and research implications include: opening up the topic for further debate, implementing staff training about communication and evaluating the impact of these processes.

Return of the JITAI: Applying a Just-in-Time Adaptive Intervention Framework to the Development of m-Health Solutions for Addictive Behaviors.

PubMed

Goldstein, Stephanie P; Evans, Brittney C; Flack, Daniel; Juarascio, Adrienne; Manasse, Stephanie; Zhang, Fengqing; Forman, Evan M

2017-10-01

Lapses are strong indicators of later relapse among individuals with addictive disorders, and thus are an important intervention target. However, lapse behavior has proven resistant to change due to the complex interplay of lapse triggers that are present in everyday life. It could be possible to prevent lapses before they occur by using m-Health solutions to deliver interventions in real-time. Just-in-time adaptive intervention (JITAI) is an intervention design framework that could be delivered via mobile app to facilitate in-the-moment monitoring of triggers for lapsing, and deliver personalized coping strategies to the user to prevent lapses from occurring. An organized framework is key for successful development of a JITAI. Nahum-Shani and colleagues (2014) set forth six core elements of a JITAI and guidelines for designing each: distal outcomes, proximal outcomes, tailoring variables, decision points, decision rules, and intervention options. The primary aim of this paper is to illustrate the use of this framework as it pertains to developing a JITAI that targets lapse behavior among individuals following a weight control diet. We will detail our approach to various decision points during the development phases, report on preliminary findings where applicable, identify problems that arose during development, and provide recommendations for researchers who are currently undertaking their own JITAI development efforts. Issues such as missing data, the rarity of lapses, advantages/disadvantages of machine learning, and user engagement are discussed.

A decision modeling for phasor measurement unit location selection in smart grid systems

NASA Astrophysics Data System (ADS)

Lee, Seung Yup

As a key technology for enhancing the smart grid system, Phasor Measurement Unit (PMU) provides synchronized phasor measurements of voltages and currents of wide-area electric power grid. With various benefits from its application, one of the critical issues in utilizing PMUs is the optimal site selection of units. The main aim of this research is to develop a decision support system, which can be used in resource allocation task for smart grid system analysis. As an effort to suggest a robust decision model and standardize the decision modeling process, a harmonized modeling framework, which considers operational circumstances of component, is proposed in connection with a deterministic approach utilizing integer programming. With the results obtained from the optimal PMU placement problem, the advantages and potential that the harmonized modeling process possesses are assessed and discussed.

Recruitment of motor units in the medial gastrocnemius muscle during human quiet standing: is recruitment intermittent? What triggers recruitment?

PubMed Central

Loram, Ian D.; Muceli, Silvia; Merletti, Roberto; Farina, Dario

2012-01-01

The recruitment and the rate of discharge of motor units are determinants of muscle force. Within a motoneuron pool, recruitment and rate coding of individual motor units might be controlled independently, depending on the circumstances. In this study, we tested whether, during human quiet standing, the force of the medial gastrocnemius (MG) muscle is predominantly controlled by recruitment or rate coding. If MG control during standing was mainly due to recruitment, then we further asked what the trigger mechanism is. Is it determined internally, or is it related to body kinematics? While seven healthy subjects stood quietly, intramuscular electromyograms were recorded from the MG muscle with three pairs of wire electrodes. The number of active motor units and their mean discharge rate were compared for different sway velocities and positions. Motor unit discharges occurred more frequently when the body swayed faster and forward (Pearson R = 0.63; P < 0.0001). This higher likelihood of observing motor unit potentials was explained chiefly by the recruitment of additional units. During forward body shifts, the median number of units detected increased from 3 to 11 (P < 0.0001), whereas the discharge rate changed from 8 ± 1.1 (mean ± SD) to 10 ± 0.9 pulses/s (P = 0.001). Strikingly, motor units did not discharge continuously throughout standing. They were recruited within individual, forward sways and intermittently, with a modal rate of two recruitments per second. This modal rate is consistent with previous circumstantial evidence relating the control of standing to an intrinsic, higher level planning process. PMID:21994258

Recruitment of motor units in the medial gastrocnemius muscle during human quiet standing: is recruitment intermittent? What triggers recruitment?

PubMed

Vieira, Taian M M; Loram, Ian D; Muceli, Silvia; Merletti, Roberto; Farina, Dario

2012-01-01

The recruitment and the rate of discharge of motor units are determinants of muscle force. Within a motoneuron pool, recruitment and rate coding of individual motor units might be controlled independently, depending on the circumstances. In this study, we tested whether, during human quiet standing, the force of the medial gastrocnemius (MG) muscle is predominantly controlled by recruitment or rate coding. If MG control during standing was mainly due to recruitment, then we further asked what the trigger mechanism is. Is it determined internally, or is it related to body kinematics? While seven healthy subjects stood quietly, intramuscular electromyograms were recorded from the MG muscle with three pairs of wire electrodes. The number of active motor units and their mean discharge rate were compared for different sway velocities and positions. Motor unit discharges occurred more frequently when the body swayed faster and forward (Pearson R = 0.63; P < 0.0001). This higher likelihood of observing motor unit potentials was explained chiefly by the recruitment of additional units. During forward body shifts, the median number of units detected increased from 3 to 11 (P < 0.0001), whereas the discharge rate changed from 8 ± 1.1 (mean ± SD) to 10 ± 0.9 pulses/s (P = 0.001). Strikingly, motor units did not discharge continuously throughout standing. They were recruited within individual, forward sways and intermittently, with a modal rate of two recruitments per second. This modal rate is consistent with previous circumstantial evidence relating the control of standing to an intrinsic, higher level planning process.

Remotely Triggered Earthquakes Recorded by EarthScope's Transportable Array and Regional Seismic Networks: A Case Study Of Four Large Earthquakes

NASA Astrophysics Data System (ADS)

Velasco, A. A.; Cerda, I.; Linville, L.; Kilb, D. L.; Pankow, K. L.

2013-05-01

Changes in field stress required to trigger earthquakes have been classified in two basic ways: static and dynamic triggering. Static triggering occurs when an earthquake that releases accumulated strain along a fault stress loads a nearby fault. Dynamic triggering occurs when an earthquake is induced by the passing of seismic waves from a large mainshock located at least two or more fault lengths from the epicenter of the main shock. We investigate details of dynamic triggering using data collected from EarthScope's USArray and regional seismic networks located in the United States. Triggered events are identified using an optimized automated detector based on the ratio of short term to long term average (Antelope software). Following the automated processing, the flagged waveforms are individually analyzed, in both the time and frequency domains, to determine if the increased detection rates correspond to local earthquakes (i.e., potentially remotely triggered aftershocks). Here, we show results using this automated schema applied to data from four large, but characteristically different, earthquakes -- Chile (Mw 8.8 2010), Tokoku-Oki (Mw 9.0 2011), Baja California (Mw 7.2 2010) and Wells Nevada (Mw 6.0 2008). For each of our four mainshocks, the number of detections within the 10 hour time windows span a large range (1 to over 200) and statistically >20% of the waveforms show evidence of anomalous signals following the mainshock. The results will help provide for a better understanding of the physical mechanisms involved in dynamic earthquake triggering and will help identify zones in the continental U.S. that may be more susceptible to dynamic earthquake triggering.

A probabilistic strategy for parametric catastrophe insurance

NASA Astrophysics Data System (ADS)

Figueiredo, Rui; Martina, Mario; Stephenson, David; Youngman, Benjamin

2017-04-01

Economic losses due to natural hazards have shown an upward trend since 1980, which is expected to continue. Recent years have seen a growing worldwide commitment towards the reduction of disaster losses. This requires effective management of disaster risk at all levels, a part of which involves reducing financial vulnerability to disasters ex-ante, ensuring that necessary resources will be available following such events. One way to achieve this is through risk transfer instruments. These can be based on different types of triggers, which determine the conditions under which payouts are made after an event. This study focuses on parametric triggers, where payouts are determined by the occurrence of an event exceeding specified physical parameters at a given location, or at multiple locations, or over a region. This type of product offers a number of important advantages, and its adoption is increasing. The main drawback of parametric triggers is their susceptibility to basis risk, which arises when there is a mismatch between triggered payouts and the occurrence of loss events. This is unavoidable in said programmes, as their calibration is based on models containing a number of different sources of uncertainty. Thus, a deterministic definition of the loss event triggering parameters appears flawed. However, often for simplicity, this is the way in which most parametric models tend to be developed. This study therefore presents an innovative probabilistic strategy for parametric catastrophe insurance. It is advantageous as it recognizes uncertainties and minimizes basis risk while maintaining a simple and transparent procedure. A logistic regression model is constructed here to represent the occurrence of loss events based on certain loss index variables, obtained through the transformation of input environmental variables. Flood-related losses due to rainfall are studied. The resulting model is able, for any given day, to issue probabilities of occurrence of loss events. Due to the nature of parametric programmes, it is still necessary to clearly define when a payout is due or not, and so a decision threshold probability above which a loss event is considered to occur must be set, effectively converting the issued probabilities into deterministic binary outcomes. Model skill and value are evaluated over the range of possible threshold probabilities, with the objective of defining the optimal one. The predictive ability of the model is assessed. In terms of value assessment, a decision model is proposed, allowing users to quantify monetarily their expected expenses when different combinations of model event triggering and actual event occurrence take place, directly tackling the problem of basis risk.

Rational suicide among patients who are terminally ill.

PubMed

Valente, S M; Trainor, D

1998-08-01

Patients' end-of-life decisions challenge nurses. Often, aggressive, life prolonging strategies create ethical dilemmas for nurses when patients decide to stop treatment. In Oregon, assisted suicide is legal and will have a profound effect on nursing practice. When a patient considers suicide, nurses need to examine the patient's mental health, symptom management, and rational decision-making ability. Evaluation of suicide risk is a priority. Nurses need to recognize that medical land psychological symptoms often trigger thoughts of suicide, but prompt treatment of pain and symptoms also reduces suicide risk. Ethical issues and guidelines for management of patients considering suicide and evaluation of rationality are presented.

Mediated Debate, Historical Framing, and Public Art: The Juan de Onate Controversy in El Paso

ERIC Educational Resources Information Center

Perez, Frank G.; Ortega, Carlos F.

2008-01-01

In 1988, the El Paso, Texas, city council accepted a proposal to build twelve statues of historically important individuals as part of a downtown revitalization initiative. Juan de Onate was selected as the centerpiece statue of the XII Travelers Memorial of the Southwest. The decision to honor the Spanish colonizer triggered a local controversy…

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

Treesearch

David L. Peterson; Daniel L. Schmoldt

1999-01-01

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

Immersive, Interactive, Web-Enabled Computer Simulation as a Trigger for Learning: The next Generation of Problem-Based Learning in Educational Leadership

ERIC Educational Resources Information Center

Mann, Dale; Reardon, R. M.; Becker, J. D.; Shakeshaft, C.; Bacon, Nicholas

2011-01-01

This paper describes the use of advanced computer technology in an innovative educational leadership program. This program integrates full-motion video scenarios that simulate the leadership challenges typically faced by principals over the course of a full school year. These scenarios require decisions that are then coupled to consequences and…

Seeing Green: Mere Exposure to Money Triggers a Business Decision Frame and Unethical Outcomes

ERIC Educational Resources Information Center

Kouchaki, Maryam; Smith-Crowe, Kristin; Brief, Arthur P.; Sousa, Carlos

2013-01-01

Can mere exposure to money corrupt? In four studies, we examined the likelihood of unethical outcomes when the construct of money was activated through the use of priming techniques. The results of Study 1 demonstrated that individuals primed with money were more likely to demonstrate unethical intentions than those in the control group. In Study…

77 FR 40030 - Army Science Board Summer Study Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-06

...: Department of the Army, DoD. ACTION: Notice of open meeting. SUMMARY: Pursuant to the Federal Advisory... studies: Strategic Direction for Army Science and Technology and Small Unit Data to Decisions. Proposed... Technology and Small Unit Data to Decisions studies are presented to the ASB. The ASB will deliberate and...

20 CFR 655.75 - Decision and order of administrative law judge.

Code of Federal Regulations, 2010 CFR

2010-04-01

... LABOR TEMPORARY EMPLOYMENT OF FOREIGN WORKERS IN THE UNITED STATES Labor Certification Process and... Nursing in the United States (H-2B Workers) § 655.75 Decision and order of administrative law judge. (a... determination resulting from that process. Under no circumstances shall the administrative law judge determine...

Educational Adequacy Litigation in the American South: 1973-2009

ERIC Educational Resources Information Center

Dishman, Mike; Redish, Traci

2010-01-01

Prior to the United States Supreme Court's decision in "Brown v. Board of Education" (1954), educational finance litigation focused almost entirely on the equitable distribution of state educational financing, ending preferential disbursement of state funds. This ended in 1973, with the United States Supreme Court's decision in "San…

US Forest Service bark beetle research in the western United States: Looking toward the future

Treesearch

Jose F. Negron; Barbara J. Bentz; Christopher J. Fettig; Nancy Gillette; E. Matthew Hansen; Jane L. Hayes; Rick G. Kelsey; John E. Lundquist; Ann M. Lynch; Robert A. Progar; Steven J. Seybold

2008-01-01

Bark beetles cause extensive tree mortality in coniferous forests of western North America and play an important role in the disturbance ecology of these ecosystems. Recently, elevated populations of bark beetles have been observed in all conifer forest types across the western United States. This has heightened public awareness of the issue and triggered legislation...

18. SHEAR PIN, UNIT 24 GORGE POWERHOUSE. THE WICKET GATES ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

18. SHEAR PIN, UNIT 24 GORGE POWERHOUSE. THE WICKET GATES ON THE TURBINE ARE EACH EQUIPPED WITH A SHEAR PIN AND OIL PRESSURE GAUGE. IF A GATE JAMS, THE PIN SMEARS AND THE CHANGE IN OIL PRESSURE TRIGGERS AN ALARM, 1989. - Skagit Power Development, Gorge Powerhouse, On Skagit River, 0.4 mile upstream from Newhalem, Newhalem, Whatcom County, WA

The relationship between patient data and pooled clinical management decisions.

PubMed

Ludbrook, G I; O'Loughlin, E J; Corcoran, T B; Grant, C

2013-01-01

A strong relationship between patient data and preoperative clinical decisions could potentially be used to support clinical decisions in preoperative management. The aim of this exploratory study was to determine the relationship between key patient data and pooled clinical opinions on management. In a previous study, panels of anaesthetists compared the quality of computer-assisted patient health assessments with outpatient consultations and made decisions on the need for preoperative tests, no preoperative outpatient assessment, possible postoperative intensive care unit/high dependency unit requirements and aspiration prophylaxis. In the current study, the relationship between patient data and these decisions was examined using binomial logistic regression analysis. Backward stepwise regression was used to identify independent predictors of each decision (at P >0.15), which were then incorporated into a predictive model. The number of factors related to each decision varied: blood picture (four factors), biochemistry (six factors), coagulation studies (three factors), electrocardiography (eight factors), chest X-ray (seven factors), preoperative outpatient assessment (17 factors), intensive care unit requirement (eight factors) and aspiration prophylaxis (one factor). The factor types also varied, but included surgical complexity, age, gender, number of medications or comorbidities, body mass index, hypertension, central nervous system condition, heart disease, sleep apnoea, smoking, persistent pain and stroke. Models based on these relationships usually demonstrated good sensitivity and specificity, with receiver operating characteristics in the following areas under curve: blood picture (0.75), biochemistry (0.86), coagulation studies (0.71), electrocardiography (0.90), chest X-ray (0.85), outpatient assessment (0.85), postoperative intensive care unit requirement (0.88) and aspiration prophylaxis (0.85). These initial results suggest modelling of patient data may have utility supporting clinicians' preoperative decisions.

Rapanos v. United States & Carabell v. United States

EPA Pesticide Factsheets

Documents associated with guidance for implementing the definition of waters of the United States under the Clean Water Act following the Rapanos v. United States, and Carabell v. United States Supreme Court decision.

26 CFR 301.7481-1 - Date when Tax Court decision becomes final; decision modified or reversed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the Supreme Court directs that the decision of the Tax Court be modified or reversed, the decision of... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Date when Tax Court decision becomes final... Proceedings Civil Actions by the United States § 301.7481-1 Date when Tax Court decision becomes final...

Changes in muscle activity determine progression of clinical symptoms in patients with chronic spine-related muscle pain. A complex clinical and neurophysiological approach

PubMed Central

Wytra̦żek, Marcin; Huber, Juliusz; Lisiński, Przemysław

Summary Spine-related muscle pain can affect muscle strength and motor unit activity. This study was undertaken to investigate whether surface electromyographic (sEMG) recordings performed during relaxation and maximal contraction reveal differences in the activity of muscles with or without trigger points (TRPs). We also analyzed the possible coexistence of characteristic spontaneous activity in needle electromyographic (eEMG) recordings with the presence of TRPs. Thirty patients with non-specific cervical and back pain were evaluated using clinical, neuroimaging and electroneurographic examinations. Muscle pain was measured using a visual analog scale (VAS), and strength using Lovett’s scale; trigger points were detected by palpation. EMG was used to examine motor unit activity. Trigger points were found mainly in the trapezius muscles in thirteen patients. Their presence was accompanied by increased pain intensity, decreased muscle strength, increased resting sEMG amplitude, and decreased sEMG amplitude during muscle contraction. eEMG revealed characteristic asynchronous discharges in TRPs. The results of EMG examinations point to a complexity of muscle pain that depends on progression of the myofascial syndrome PMID:22152435

Zero-sum politics, the Herbert thesis, and the Ryan White CARE Act: lessons learned from the local side of AIDS.

PubMed

Slack, J

2001-01-01

This study examines the dynamics of grass-roots decision-making processes involved in the implementation of the Ryan White CARE Act. Providing social services to persons with HIV/AIDS, the CARE act requires participation of all relevant groups, including representatives of the HIV/AIDS and gay communities. Decision-making behavior is explored by applying a political (zero-sum) model and a bureaucratic (the Herbert Thesis) model. Using qualitative research techniques, the Kern County (California) Consortium is used as a case study. Findings shed light on the decision-making behavior of social service organizations characterized by intense advocacy and structured on the basis of volunteerism and non-hierarchical relationships. Findings affirm bureaucratic behavior predicted by the Herbert Thesis and also discern factors which seem to trigger more conflictual zero-sum behavior.

New Decision Support for Landslide and Other Disaster Events

NASA Astrophysics Data System (ADS)

Nair, U. S.; Keiser, K.; Wu, Y.; Kaulfus, A.; Srinivasan, K.; Anderson, E. R.; McEniry, M.

2013-12-01

An Event-Driven Data delivery (ED3) framework has been created that provides reusable services and configurations to support better data preparedness for decision support of disasters and other events by rapidly providing pre-planned access to data, special processing, modeling and other capabilities, all executed in response to criteria-based events. ED3 facilitates decision makers to plan in advance of disasters and other types of events for the data necessary for decisions and response activities. A layer of services provided in the ED3 framework allows systems to support user definition of subscriptions for data plans that will be triggered when events matching specified criteria occur. Pre-planning for data in response to events lessens the burden on decision makers in the aftermath of an event and allows planners to think through the desired processing for specialized data products. Additionally the ED3 framework provides support for listening for event alerts and support for multiple workflow managers that provide data and processing functionality in response to events. Landslides are often costly and, at times, deadly disaster events. Whereas intense and/or sustained rainfall is often the primary trigger for landslides, soil type and slope are also important factors in determining the location and timing of slope failure. Accounting for the substantial spatial variability of these factors is one of the major difficulties when predicting the timing and location of slope failures. A wireless sensor network (WSN), developed by NASA SERVIR and USRA, with peer-to-peer communication capability and low power consumption, is ideal for high spatial in situ monitoring in remote locations. In collaboration with the University of Huntsville at Alabama, WSN equipped with accelerometer, rainfall and soil moisture sensors is being integrated into an end-to-end landslide warning system. The WSN is being tested to ascertain communication capabilities and the density of nodes required depending upon the nature of terrain and land cover. The performance of a water table model, to be utilized in the end-to-end system, is being evaluated by comparing against landslides that occurred during the 6th and 7th of May, 2003 and 20th and 21st of April, 2011. The model provides a deterministic assessment of slope stability by evaluating horizontal and vertical transport of underground water and associated weight bearing capacity. In the proposed end-to-end system, the model will be coupled to the WSN, and the in situ data collected will be used to drive the model. The output from the model could be communicated back to the WSN providing the capability of generating warning of possible events to the ED3 framework to trigger additional data retrieval or the processing of additional models based on decision maker's ED3 preparedness plans. NASA's Applied Science Program has funded a feasibility study of the ED3 technology and as a result the capability is on track be integrated into existing decision support systems, with an initial reference implementation hosted at the Global Hydrology Resource Center, a NASA distributed active archive center (DAAC).

22 CFR 224.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... limited to any advantage, preference, privilege, license, permit, favorable decision, ruling, status, or... United States Government. Individual means a natural person. Initial decision means the written decision of the ALJ required by § 224.10 or § 224.37, and includes a revised initial decision issued following...

Enhancing Decision Topology Assessment in Engineering Design

DTIC Science & Technology

2014-04-10

in engineering design decision making. References 1. Clemen , R. T., 1997, Making Hard Decisions, Second Edition, Duxbury Press. 2. Hazelrigg, G. A...United Kingdom. 6. Lewis, K., Chen, W. and L. C. Schmidt , Editors, 2006, Decision Making in Engineering Design, ASME Press, New York. 7. Myers

The relationship between work complexity and nurses' participation in decision making in hospitals.

PubMed

Bacon, Cynthia Thornton; Lee, Shoou-Yih Daniel; Mark, Barbara

2015-04-01

The aim of this study is to examine the relationship between work complexity and nurses' participation in decision making in hospital nursing units. Increasing nurses' participation in decision making has been used as a way to manage work complexity; however, the work of nurses in acute care hospitals has become highly complex, and strategies used to manage this complexity have not been fully explored. The relationship between work complexity and nurse participation in decision making was examined using data from the Outcomes Research in Nursing Administration project. The sample included 3,718 RNs in 278 medical-surgical units in 143 hospitals. When work complexity increased, nurses' participation in decision making decreased. When nurses have limited input into decision making, the information available to the care team may be incomplete. Barriers to nurses' participation in decision making should be explored and interventions developed so that nurses may be full participants in decision making affecting both patients and the work environment.

Using a Context-aware Medical Application to Address Information Needs for Extubation Decisions

PubMed Central

Zhu, Xinxin; Lord, William

2005-01-01

Information overload has been one of the causes of preventable medical errors [1] and escalating costs [2]. A context-aware application with embedded clinical knowledge is proposed to provide practitioners with the appropriate amount of information and content. We developed a prototype of a context-aware medical application to address clinicians’ information needs that arise in a data-intensive unit, the Cardio-Thoracic Intensive Care Unit (CTICU). A major clinical decision supported by the prototype, the extubation decision, is illustrated. PMID:16779455

Decision conflict and regret among surrogate decision makers in the medical intensive care unit.

PubMed

Miller, Jesse J; Morris, Peter; Files, D Clark; Gower, Emily; Young, Michael

2016-04-01

Family members of critically ill patients in the intensive care unit face significant morbidity. It may be the decision-making process that plays a significant role in the psychological morbidity associated with being a surrogate in the ICU. We hypothesize that family members facing end-of-life decisions will have more decisional conflict and decisional regret than those facing non-end-of-life decisions. We enrolled a sample of adult patients and their surrogates in a tertiary care, academic medical intensive care unit. We queried the surrogates regarding decisions they had made on behalf of the patient and assessed decision conflict. We then contacted the family member again to assess decision regret. Forty (95%) of 42 surrogates were able to identify at least 1 decision they had made on behalf of the patient. End-of-life decisions (defined as do not resuscitate [DNR]/do not intubate [DNI] or continuation of life support) accounted for 19 of 40 decisions (47.5%). Overall, the average Decision Conflict Scale (DCS) score was 21.9 of 100 (range 0-100, with 0 being little decisional conflict and 100 being great decisional conflict). The average DCS score for families facing end-of-life decisions was 25.5 compared with 18.7 for all other decisions. Those facing end-of-life decisions scored higher on the uncertainty subscale (subset of DCS questions that indicates level of certainty regarding decision) with a mean score of 43.4 compared with all other decisions with a mean score of 27.0. Overall, very few surrogates experienced decisional regret with an average DRS score of 13.4 of 100. Nearly all surrogates enrolled were faced with decision-making responsibilities on behalf of his or her critically ill family member. In our small pilot study, we found more decisional conflict in those surrogates facing end-of-life decisions, specifically on the subset of questions dealing with uncertainty. Surrogates report low levels of decisional regret. Copyright © 2015 Elsevier Inc. All rights reserved.

Fusion of Heterogeneous Intrusion Detection Systems for Network Attack Detection

PubMed Central

Kaliappan, Jayakumar; Thiagarajan, Revathi; Sundararajan, Karpagam

2015-01-01

An intrusion detection system (IDS) helps to identify different types of attacks in general, and the detection rate will be higher for some specific category of attacks. This paper is designed on the idea that each IDS is efficient in detecting a specific type of attack. In proposed Multiple IDS Unit (MIU), there are five IDS units, and each IDS follows a unique algorithm to detect attacks. The feature selection is done with the help of genetic algorithm. The selected features of the input traffic are passed on to the MIU for processing. The decision from each IDS is termed as local decision. The fusion unit inside the MIU processes all the local decisions with the help of majority voting rule and makes the final decision. The proposed system shows a very good improvement in detection rate and reduces the false alarm rate. PMID:26295058

Fusion of Heterogeneous Intrusion Detection Systems for Network Attack Detection.

PubMed

Kaliappan, Jayakumar; Thiagarajan, Revathi; Sundararajan, Karpagam

2015-01-01

An intrusion detection system (IDS) helps to identify different types of attacks in general, and the detection rate will be higher for some specific category of attacks. This paper is designed on the idea that each IDS is efficient in detecting a specific type of attack. In proposed Multiple IDS Unit (MIU), there are five IDS units, and each IDS follows a unique algorithm to detect attacks. The feature selection is done with the help of genetic algorithm. The selected features of the input traffic are passed on to the MIU for processing. The decision from each IDS is termed as local decision. The fusion unit inside the MIU processes all the local decisions with the help of majority voting rule and makes the final decision. The proposed system shows a very good improvement in detection rate and reduces the false alarm rate.

Special article: Creation of a guide for the transfer of care of the malignant hyperthermia patient from ambulatory surgery centers to receiving hospital facilities.

PubMed

Larach, Marilyn Green; Dirksen, Sharon J Hirshey; Belani, Kumar G; Brandom, Barbara W; Metz, Keith M; Policastro, Michael A; Rosenberg, Henry; Valedon, Arnaldo; Watson, Charles B

2012-01-01

Volatile anesthetics and/or succinylcholine may trigger a potentially lethal malignant hyperthermia (MH) event requiring critical care crisis management. If the MH triggering anesthetic is given in an ambulatory surgical center (ASC), then the patient will need to be transferred to a receiving hospital. Before May 2010, there was no clinical guide regarding the development of a specific transfer plan for MH patients in an ASC. MECHANISM BY WHICH THE STATEMENT WAS GENERATED: A consensual process lasting 18 months among 13 representatives of the Malignant Hyperthermia Association of the United States, the Ambulatory Surgery Foundation, the Society for Ambulatory Anesthesia, the Society for Academic Emergency Medicine, and the National Association of Emergency Medical Technicians led to the creation of this guide. EVIDENCE FOR THE STATEMENT: Most of the guide is based on the clinical experience and scientific expertise of the 13 representatives. The list of representatives appears in Appendix 1. The recommendation that IV dantrolene should be initiated pending transfer is also supported by clinical research demonstrating that the likelihood of significant MH complications doubles for every 30-minute delay in dantrolene administration (Anesth Analg 2010;110:498-507). This guide includes a list of potential clinical problems and therapeutic interventions to assist each ASC in the development of its own unique MH transfer plan. Points to consider include receiving health care facility capabilities, indicators of patient stability and necessary report data, transport team considerations and capabilities, implementation of transfer decisions, and coordination of communication among the ASC, the receiving hospital, and the transport team. See Appendix 2 for the guide.

Landslides and vegetation cover in the 2005 North Pakistan earthquake: a GIS and statistical quantitative approach

NASA Astrophysics Data System (ADS)

Peduzzi, P.

2010-04-01

The growing concern for loss of services once provided by natural ecosystems is getting increasing attention. However, the accelerating rate of natural resources destruction calls for rapid and global action. With often very limited budgets, environmental agencies and NGOs need cost-efficient ways to quickly convince decision-makers that sound management of natural resources can help to protect human lives and their welfare. The methodology described in this paper, is based on geospatial and statistical analysis, involving simple Geographical Information System (GIS) and remote sensing algorithms. It is based on free or very low-cost data. It aims to scientifically assess the potential role of vegetation in mitigating landslides triggered by earthquakes by normalising for other factors such as slopes and distance from active fault. The methodology was applied to the 2005 North Pakistan/India earthquake which generated a large number of victims and hundreds of landslides. The study shows that if slopes and proximity from active fault are the main susceptibility factors for post landslides triggered by earthquakes in this area, the results clearly revealed that areas covered by denser vegetation suffered less and smaller landslides than areas with thinner (or devoid of) vegetation cover. Short distance from roads/trails and rivers also proved to be pertinent factors in increasing landslides susceptibility. This project is a component of a wider initiative involving the Global Resource Information Database Europe from the United Nations Environment Programme, the International Union for Conservation of Nature, the Institute of Geomatics and Risk Analysis from the University of Lausanne and the "institut universitaire d'études du développement" from the University of Geneva.

Combining heuristic and statistical techniques in landslide hazard assessments

NASA Astrophysics Data System (ADS)

Cepeda, Jose; Schwendtner, Barbara; Quan, Byron; Nadim, Farrokh; Diaz, Manuel; Molina, Giovanni

2014-05-01

As a contribution to the Global Assessment Report 2013 - GAR2013, coordinated by the United Nations International Strategy for Disaster Reduction - UNISDR, a drill-down exercise for landslide hazard assessment was carried out by entering the results of both heuristic and statistical techniques into a new but simple combination rule. The data available for this evaluation included landslide inventories, both historical and event-based. In addition to the application of a heuristic method used in the previous editions of GAR, the availability of inventories motivated the use of statistical methods. The heuristic technique is largely based on the Mora & Vahrson method, which estimates hazard as the product of susceptibility and triggering factors, where classes are weighted based on expert judgment and experience. Two statistical methods were also applied: the landslide index method, which estimates weights of the classes for the susceptibility and triggering factors based on the evidence provided by the density of landslides in each class of the factors; and the weights of evidence method, which extends the previous technique to include both positive and negative evidence of landslide occurrence in the estimation of weights for the classes. One key aspect during the hazard evaluation was the decision on the methodology to be chosen for the final assessment. Instead of opting for a single methodology, it was decided to combine the results of the three implemented techniques using a combination rule based on a normalization of the results of each method. The hazard evaluation was performed for both earthquake- and rainfall-induced landslides. The country chosen for the drill-down exercise was El Salvador. The results indicate that highest hazard levels are concentrated along the central volcanic chain and at the centre of the northern mountains.

Triggers for attempted suicide in Istanbul youth, with special reference to their socio-demographic background.

PubMed

Akkaya-Kalayci, Türkan; Kapusta, Nestor D; Winkler, Dietmar; Kothgassner, Oswald D; Popow, Christian; Özlü-Erkilic, Zeliha

2018-06-01

Suicidal behavior of young people is a topic of utmost importance because suicide is irreversible, and should be prevented. Knowing about the psychosocial background and the triggering events could help in preventing suicidal behavior. We therefore aimed at identifying psychosocial factors that may trigger suicidal behavior in youth. We analyzed retrospectively the standardized records of 2232 youths aged ≤25 years, who were treated after a suicide attempt at emergency units of public hospitals in Istanbul, Turkey during a period of 1 year. We describe this population according to sex and socio-economic conditions, like educational, occupational, relationship status and link them with their reported reasons for suicide attempts. The majority of patients were female (81.6%, N = 1822 females, 18.4%, N = 410 males). Independent of their educational and occupational background, patients indicated most frequently intra-familial problems (females 45.8%, males 30.5%), intrapersonal problems (females 19.9%, males 18.5%), and relationship problems (females 11.3%, males 23.9%) as triggering reasons. Because intra-familial problems were the most frequently reported triggers of suicide attempts, preventive measures should focus on handling intra-familial conflicts. As sex differences were observed for the second-most common trigger-reasons, prevention should also focus on differentially handling intrapersonal and relationship conflicts better.

78 FR 76317 - Llano Seco Riparian Sanctuary Unit Restoration and Pumping Plant/Fish Screen Facility Protection...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-17

...We, the U.S. Fish and Wildlife Service (Service) and the California Department of Fish and Wildlife (CDFW), announce that the record of decision (ROD) for the Llano Seco Riparian Sanctuary Unit Restoration and Princeton, Codora, Glenn & Provident Irrigation Districts (PCGID-PID) Pumping Plan/Fish Screen Facility Protection Project is now available. The ROD includes a statement of the decisions made, the basis for the decisions, a description of the alternative considered, a description of the environmentally preferable alternative, an overview of the measures to minimize environmental impacts, and a summary of public involvement in the decision-making process.

Superfund Record of Decision (EPA Region 9): San Fernando Valley Area 2, operable unit 2, Los Angeles County, CA, June 1993

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

Not Available

1993-06-01

This decision document presents the selected remedial action for the Glendale North Operable Unit, San Fernando Valley Area 2 Superfund site. The remedy involves groundwater extraction and treatment for the shallow aquifer system in the Glendale area of the San Fernando Valley.

Superfund Record of Decision (EPA Region 9): San Fernando Valley Area 2, operable unit 3, Los Angeles County, CA, June 1993

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

Not Available

1993-06-01

This decision document presents the selected remedial action for the Glendale South Operable Unit, San Fernando Valley Area 2 Superfund site. The remedy involves groundwater extraction and treatment for the shallow aquifer system in the Glendale area of the San Fernando Valley.

The Patentability of Living Organisms under 35 U.S.C. Section 101: In re Bergy.

ERIC Educational Resources Information Center

Harvard Law Review, 1978

1978-01-01

Examined is the In re Bergy decision in which a divided United States Court of Customs and Patent Appeals held that a living micro-organism was patentable under section 101 of the United States Code. Differing views and problems with the decision are also discussed. (JMD)

Systems identification and the adaptive management of waterfowl in the United States

USGS Publications Warehouse

Williams, B.K.; Nichols, J.D.

2001-01-01

Waterfowl management in the United States is one of the more visible conservation success stories in the United States. It is authorized and supported by appropriate legislative authorities, based on large-scale monitoring programs, and widely accepted by the public. The process is one of only a limited number of large-scale examples of effective collaboration between research and management, integrating scientific information with management in a coherent framework for regulatory decision-making. However, harvest management continues to face some serious technical problems, many of which focus on sequential identification of the resource system in a context of optimal decision-making. The objective of this paper is to provide a theoretical foundation of adaptive harvest management, the approach currently in use in the United States for regulatory decision-making. We lay out the legal and institutional framework for adaptive harvest management and provide a formal description of regulatory decision-making in terms of adaptive optimization. We discuss some technical and institutional challenges in applying adaptive harvest management and focus specifically on methods of estimating resource states for linear resource systems.

What triggers catch-up saccades during visual tracking?

PubMed

de Brouwer, Sophie; Yuksel, Demet; Blohm, Gunnar; Missal, Marcus; Lefèvre, Philippe

2002-03-01

When tracking moving visual stimuli, primates orient their visual axis by combining two kinds of eye movements, smooth pursuit and saccades, that have very different dynamics. Yet, the mechanisms that govern the decision to switch from one type of eye movement to the other are still poorly understood, even though they could bring a significant contribution to the understanding of how the CNS combines different kinds of control strategies to achieve a common motor and sensory goal. In this study, we investigated the oculomotor responses to a large range of different combinations of position error and velocity error during visual tracking of moving stimuli in humans. We found that the oculomotor system uses a prediction of the time at which the eye trajectory will cross the target, defined as the "eye crossing time" (T(XE)). The eye crossing time, which depends on both position error and velocity error, is the criterion used to switch between smooth and saccadic pursuit, i.e., to trigger catch-up saccades. On average, for T(XE) between 40 and 180 ms, no saccade is triggered and target tracking remains purely smooth. Conversely, when T(XE) becomes smaller than 40 ms or larger than 180 ms, a saccade is triggered after a short latency (around 125 ms).

Stress-induced changes in human decision-making are reversible.

PubMed

Soares, J M; Sampaio, A; Ferreira, L M; Santos, N C; Marques, F; Palha, J A; Cerqueira, J J; Sousa, N

2012-07-03

Appropriate decision-making relies on the ability to shift between different behavioral strategies according to the context in which decisions are made. A cohort of subjects exposed to prolonged stress, and respective gender- and age-matched controls, performed an instrumental behavioral task to assess their decision-making strategies. The stressed cohort was reevaluated after a 6-week stress-free period. The behavioral analysis was complemented by a functional magnetic resonance imaging (fMRI) study to detect the patterns of activation in corticostriatal networks ruling goal-directed and habitual actions. Using structural MRI, the volumes of the main cortical and subcortical regions implicated in instrumental behavior were determined. Here we show that chronic stress biases decision-making strategies in humans toward habits, as choices of stressed subjects become insensitive to changes in outcome value. Using functional imaging techniques, we demonstrate that prolonged exposure to stress in humans causes an imbalanced activation of the networks that govern decision processes, shifting activation from the associative to the sensorimotor circuits. These functional changes are paralleled by atrophy of the medial prefrontal cortex and the caudate, and by an increase in the volume of the putamina. Importantly, a longitudinal assessment of the stressed individuals showed that both the structural and functional changes triggered by stress are reversible and that decisions become again goal-directed.

Psychopharmacology decision-making among pregnant and postpartum women and health providers: informing compassionate and collaborative care women's health.

PubMed

Price, Sarah Kye; Bentley, Kia J

2013-01-01

Psychopharmaceutical use by pregnant and postpartum women is complicated by the complexity of prescribing as well as the sociocultural context in which medication-related decisions are made. This study sought to advance understanding of decision-making processes and communication experiences regarding use of psychopharmaceuticals during pregnancy by considering both provider and consumer perspectives. An electronic survey was conducted with health care providers (N = 88) and women consumers (N = 83) from July 2010 through October 2011 regarding the perceived costs and benefits of taking mental health medication during and around the time of pregnancy. Descriptive analysis compared and contrasted experiences between the two groups regarding consumer-provider communication, critical incidents and triggers in decision-making, and response to case scenarios crafted around hypothetical client experiences. Both similarities and differences were evident among health care provider and women consumer responses regarding costs, benefits, communication experiences, and case scenario responses. Both quantitative and qualitative survey results indicated the need for more accurate, unbiased, and complete information exchange around mental health and medication. Study results suggested the centrality of the client-provider milieu to guide decision-making and emphasized the expressed need within both groups to create a shared decision-making practice environment characterized by authenticity, non-judgmental decision-making, compassion, humaneness, and reciprocity.

Decisions reduce sensitivity to subsequent information.

PubMed

Bronfman, Zohar Z; Brezis, Noam; Moran, Rani; Tsetsos, Konstantinos; Donner, Tobias; Usher, Marius

2015-07-07

Behavioural studies over half a century indicate that making categorical choices alters beliefs about the state of the world. People seem biased to confirm previous choices, and to suppress contradicting information. These choice-dependent biases imply a fundamental bound of human rationality. However, it remains unclear whether these effects extend to lower level decisions, and only little is known about the computational mechanisms underlying them. Building on the framework of sequential-sampling models of decision-making, we developed novel psychophysical protocols that enable us to dissect quantitatively how choices affect the way decision-makers accumulate additional noisy evidence. We find robust choice-induced biases in the accumulation of abstract numerical (experiment 1) and low-level perceptual (experiment 2) evidence. These biases deteriorate estimations of the mean value of the numerical sequence (experiment 1) and reduce the likelihood to revise decisions (experiment 2). Computational modelling reveals that choices trigger a reduction of sensitivity to subsequent evidence via multiplicative gain modulation, rather than shifting the decision variable towards the chosen alternative in an additive fashion. Our results thus show that categorical choices alter the evidence accumulation mechanism itself, rather than just its outcome, rendering the decision-maker less sensitive to new information. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Roles, processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study.

PubMed

Dunn, Sandra I; Cragg, Betty; Graham, Ian D; Medves, Jennifer; Gaboury, Isabelle

2018-05-01

Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members' perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.

20 CFR 655.75 - Decision and order of administrative law judge.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Decision and order of administrative law... Nursing in the United States (H-2B Workers) § 655.75 Decision and order of administrative law judge. (a) The administrative law judge shall issue a decision. If any party desires review of the decision...

Rapid Deployment of International Tele-Intensive Care Unit Services in War-Torn Syria.

PubMed

Moughrabieh, Anas; Weinert, Craig

2016-02-01

The conflict in Syria has created the largest humanitarian emergency of the twenty-first century. The 4-year Syrian conflict has destroyed hospitals and severely reduced the capacity of intensive care units (ICUs) and on-site intensivists. The crisis has triggered attempts from abroad to support the medical care of severely injured and acutely ill civilians inside Syria, including application of telemedicine. Within the United States, tele-ICU programs have been operating for more than a decade, albeit with high start-up costs and generally long development times. With the benefit of lessons drawn from those domestic models, the Syria Tele-ICU program was launched in December 2012 to manage the care of ICU patients in parts of Syria by using inexpensive, off-the-shelf video cameras, free social media applications, and a volunteer network of Arabic-speaking intensivists in North America and Europe. Within 1 year, 90 patients per month in three ICUs were receiving tele-ICU services. At the end of 2015, a network of approximately 20 participating intensivists was providing clinical decision support 24 hours per day to five civilian ICUs in Syria. The volunteer clinicians manage patients at a distance of more than 6,000 miles, separated by seven or eight time zones between North America and Syria. The program is implementing a cloud-based electronic medical record for physician documentation and a medication administration record for nurses. There are virtual chat rooms for patient rounds, radiology review, and trainee teaching. The early success of the program shows how a small number of committed physicians can use inexpensive equipment spawned by the Internet revolution to support from afar civilian health care delivery in a high-conflict country.

Rapid Deployment of International Tele–Intensive Care Unit Services in War-Torn Syria

PubMed Central

Moughrabieh, Anas

2016-01-01

The conflict in Syria has created the largest humanitarian emergency of the twenty-first century. The 4-year Syrian conflict has destroyed hospitals and severely reduced the capacity of intensive care units (ICUs) and on-site intensivists. The crisis has triggered attempts from abroad to support the medical care of severely injured and acutely ill civilians inside Syria, including application of telemedicine. Within the United States, tele-ICU programs have been operating for more than a decade, albeit with high start-up costs and generally long development times. With the benefit of lessons drawn from those domestic models, the Syria Tele-ICU program was launched in December 2012 to manage the care of ICU patients in parts of Syria by using inexpensive, off-the-shelf video cameras, free social media applications, and a volunteer network of Arabic-speaking intensivists in North America and Europe. Within 1 year, 90 patients per month in three ICUs were receiving tele-ICU services. At the end of 2015, a network of approximately 20 participating intensivists was providing clinical decision support 24 hours per day to five civilian ICUs in Syria. The volunteer clinicians manage patients at a distance of more than 6,000 miles, separated by seven or eight time zones between North America and Syria. The program is implementing a cloud-based electronic medical record for physician documentation and a medication administration record for nurses. There are virtual chat rooms for patient rounds, radiology review, and trainee teaching. The early success of the program shows how a small number of committed physicians can use inexpensive equipment spawned by the Internet revolution to support from afar civilian health care delivery in a high-conflict country. PMID:26788827

Bar Code Medication Administration Technology: Characterization of High-Alert Medication Triggers and Clinician Workarounds.

PubMed

Miller, Daniel F; Fortier, Christopher R; Garrison, Kelli L

2011-02-01

Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors. To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR). Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted. Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time. BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes must be continually analyzed and restructured to yield the intended full benefits of BCMA technology. © 2011 SAGE Publications.

Technology diffusion and environmental regulation: Evidence from electric power plants under the Clean Air Act

NASA Astrophysics Data System (ADS)

Frey, Elaine F.

Even though environmental policy can greatly affect the path of technology diffusion, the economics literature contains limited empirical evidence of this relationship. My research will contribute to the available evidence by providing insight into the technology adoption decisions of electric generating firms. Since policies are often evaluated based on the incentives they provide to promote adoption of new technologies, it is important that policy makers understand the relationship between technological diffusion and regulation structure to make informed decisions. Lessons learned from this study can be used to guide future policies such as those directed to mitigate climate change. I first explore the diffusion of scrubbers, a sulfur dioxide (SO 2) abatement technology, in response to federal market-based regulations and state command-and-control regulations. I develop a simple theoretical model to describe the adoption decisions of scrubbers and use a survival model to empirically test the theoretical model. I find that power plants with strict command-and-control regulations have a high probability of installing a scrubber. These findings suggest that although market-based regulations have encouraged diffusion, many scrubbers have been installed because of state regulatory pressure. Although tradable permit systems are thought to give firms more flexibility in choosing abatement technologies, I show that interactions between a permit system and pre-existing command-and-control regulations can limit that flexibility. In a separate analysis, I explore the diffusion of combined cycle (CC) generating units, which are natural gas-fired generating units that are cleaner and more efficient than alternative generating units. I model the decision to consider adoption of a CC generating unit and the extent to which the technology is adopted in response to environmental regulations imposed on new sources of pollutants. To accomplish this, I use a zero-inflated Poisson model and focus on both the decision to adopt a CC unit at an existing power plant as well as the firm-level decision to adopt a CC unit in either a new or an existing power plant. Evidence from this empirical investigation shows that environmental regulation has a significant effect on both the decision to consider adoption as well as the extent of adoption.

"I Don't Want to Die like that...": The Impact of Significant Others' Death Quality on Advance Care Planning

ERIC Educational Resources Information Center

Carr, Deborah

2012-01-01

Purpose of the Study: I examine whether 5 aspects of a significant other's death quality (pain, decision-making capacity, location, problems with end-of life care, and preparation) affect whether one does advance care planning (ACP). I also identify specific aspects of others' deaths that respondents say triggered their own planning. Design and…

Triggers of self-conscious emotions in the sexually transmitted infection testing process

PubMed Central

2010-01-01

Background Self-conscious emotions (shame, guilt and embarrassment) are part of many individuals' experiences of seeking STI testing. These emotions can have negative impacts on individuals' interpretations of the STI testing process, their willingness to seek treatment and their willingness to inform sexual partners in light of positive STI diagnoses. Because of these impacts, researchers have called for more work to be completed on the connections between shame, guilt, embarrassment and STI testing. We examine the specific events in the STI testing process that trigger self-conscious emotions in young adults who seek STI testing; and to understand what it is about these events that triggers these emotions. Semi-structured interviews with 30 adults (21 women, 9 men) in the Republic of Ireland. Findings Seven specific triggers of self-conscious emotions were identified. These were: having unprotected sex, associated with the initial reason for seeking STI testing; talking to partners and peers about the intention to seek STI testing; the experience of accessing STI testing facilities and sitting in clinic waiting rooms; negative interactions with healthcare professionals; receiving a positive diagnosis of an STI; having to notify sexual partners in light of a positive STI diagnosis; and accessing healthcare settings for treatment for an STI. Self-conscious emotions were triggered in each case by a perceived threat to respondents' social identities. Conclusion There are multiple triggers of self-conscious emotions in the STI testing process, ranging from the initial decision to seek testing, right through to the experience of accessing treatment. The role of self-conscious emotions needs to be considered in each component of service design from health promotion approaches, through facility layout to the training of all professionals involved in the STI testing process. PMID:20716339

A Review of Factors Influencing the Banking of Collected Umbilical Cord Blood Units

PubMed Central

Allan, David; Petraszko, Tanya; Elmoazzen, Heidi; Smith, Susan

2013-01-01

Umbilical cord blood banking efforts have increased dramatically in the past two decades in response to increasing demand for alternative sources of blood stem cells to support patients requiring hematopoietic stem cell transplantation. Transplant centres have accumulated increasing expertise in their understanding of umbilical cord blood characteristics that are associated with improved outcome following transplantation. These characteristics and factors can assist transplant centres in selecting cord blood units from the worldwide inventory of banked units. Umbilical cord blood banks, therefore, need to remain agile in adjusting the inventory of the banks to address shifts or changes in the needs of transplant centres. Public umbilical cord blood banks face the challenge of building inventory while managing limited resources and are faced with decisions regarding which units can be stored and which units that have been collected should be discarded or used for other endeavours such as research. To this end, we sought to review parameters influencing the decision to bank a collected cord blood unit. In this paper, we will address parameters associated with graft potency and address other factors that guide the decision to bank collected units. PMID:23533442

Remotely triggered seismicity on the United States west coast following the Mw 7.9 Denali fault earthquake

USGS Publications Warehouse

Prejean, S.G.; Hill, D.P.; Brodsky, E.E.; Hough, S.E.; Johnston, M.J.S.; Malone, S.D.; Oppenheimer, D.H.; Pitt, A.M.; Richards-Dinger, K. B.

2004-01-01

The Mw 7.9 Denali fault earthquake in central Alaska of 3 November 2002 triggered earthquakes across western North America at epicentral distances of up to at least 3660 km. We describe the spatial and temporal development of triggered activity in California and the Pacific Northwest, focusing on Mount Rainier, the Geysers geothermal field, the Long Valley caldera, and the Coso geothermal field.The onset of triggered seismicity at each of these areas began during the Love and Raleigh waves of the Mw 7.9 wave train, which had dominant periods of 15 to 40 sec, indicating that earthquakes were triggered locally by dynamic stress changes due to low-frequency surface wave arrivals. Swarms during the wave train continued for ∼4 min (Mount Rainier) to ∼40 min (the Geysers) after the surface wave arrivals and were characterized by spasmodic bursts of small (M ≤ 2.5) earthquakes. Dynamic stresses within the surface wave train at the time of the first triggered earthquakes ranged from 0.01 MPa (Coso) to 0.09 MPa (Mount Rainier). In addition to the swarms that began during the surface wave arrivals, Long Valley caldera and Mount Rainier experienced unusually large seismic swarms hours to days after the Denali fault earthquake. These swarms seem to represent a delayed response to the Denali fault earthquake. The occurrence of spatially and temporally distinct swarms of triggered seismicity at the same site suggests that earthquakes may be triggered by more than one physical process.

Application of Fault Management Theory to the Quantitative Selection of a Launch Vehicle Abort Trigger Suite

NASA Technical Reports Server (NTRS)

Lo, Yunnhon; Johnson, Stephen B.; Breckenridge, Jonathan T.

2014-01-01

The theory of System Health Management (SHM) and of its operational subset Fault Management (FM) states that FM is implemented as a "meta" control loop, known as an FM Control Loop (FMCL). The FMCL detects that all or part of a system is now failed, or in the future will fail (that is, cannot be controlled within acceptable limits to achieve its objectives), and takes a control action (a response) to return the system to a controllable state. In terms of control theory, the effectiveness of each FMCL is estimated based on its ability to correctly estimate the system state, and on the speed of its response to the current or impending failure effects. This paper describes how this theory has been successfully applied on the National Aeronautics and Space Administration's (NASA) Space Launch System (SLS) Program to quantitatively estimate the effectiveness of proposed abort triggers so as to select the most effective suite to protect the astronauts from catastrophic failure of the SLS. The premise behind this process is to be able to quantitatively provide the value versus risk trade-off for any given abort trigger, allowing decision makers to make more informed decisions. All current and planned crewed launch vehicles have some form of vehicle health management system integrated with an emergency launch abort system to ensure crew safety. While the design can vary, the underlying principle is the same: detect imminent catastrophic vehicle failure, initiate launch abort, and extract the crew to safety. Abort triggers are the detection mechanisms that identify that a catastrophic launch vehicle failure is occurring or is imminent and cause the initiation of a notification to the crew vehicle that the escape system must be activated. While ensuring that the abort triggers provide this function, designers must also ensure that the abort triggers do not signal that a catastrophic failure is imminent when in fact the launch vehicle can successfully achieve orbit. That is, the abort triggers must have low false negative rates to be sure that real crew-threatening failures are detected, and also low false positive rates to ensure that the crew does not abort from non-crew-threatening launch vehicle behaviors. The analysis process described in this paper is a compilation of over six years of lessons learned and refinements from experiences developing abort triggers for NASA's Constellation Program (Ares I Project) and the SLS Program, as well as the simultaneous development of SHM/FM theory. The paper will describe the abort analysis concepts and process, developed in conjunction with SLS Safety and Mission Assurance (S&MA) to define a common set of mission phase, failure scenario, and Loss of Mission Environment (LOME) combinations upon which the SLS Loss of Mission (LOM) Probabilistic Risk Assessment (PRA) models are built. This abort analysis also requires strong coordination with the Multi-Purpose Crew Vehicle (MPCV) and SLS Structures and Environments (STE) to formulate a series of abortability tables that encapsulate explosion dynamics over the ascent mission phase. The design and assessment of abort conditions and triggers to estimate their Loss of Crew (LOC) Benefits also requires in-depth integration with other groups, including Avionics, Guidance, Navigation and Control(GN&C), the Crew Office, Mission Operations, and Ground Systems. The outputs of this analysis are a critical input to SLS S&MA's LOC PRA models. The process described here may well be the first full quantitative application of SHM/FM theory to the selection of a sensor suite for any aerospace system.

[Track and trigger systems in Denmark - small country, great variations].

PubMed

Lønnee, Mads; Bukan, Ramin Brandt; Waldau, Tina; Møller, Ann Merete; Bukan, Katrine Brandt

2018-05-07

A track and trigger (TAT) system and mobile emergency team (MET) can aid observation and care for admitted patients in the hospital ward. We have examined the literature and find evidence, though not strong, that the introduction of TAT and MET systems reduce hospital mortality. However, in Denmark, many different TAT systems are used, and several hospitals do not have MET. We believe, that a standardised national TAT system could encourage interregional research and the investigation of system compliance, cost-benefit and impact on intensive care unit admissions.

Superfund record of decision (EPA Region 3): US Defense General Supply Center, Operable Unit 9, Chesterfield County, VA, September 1993

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

Not Available

1993-09-01

The decision document presents the selected interim remedial action for Operable Unit 9 (OU9) at the Defense General Supply Center (DGSC) in Chesterfield County, Virginia near Richmond. OU9 pertains to groundwater beneath Area 50, the Open Storage Area (OSA), and the Naitonal Guard Area (NGA). This operable unit is the third of nine operable units that are currently being addressed at the DGSC. OU9 addresses interim treatment and containment of groundwater in the upper and lower aquifers beneath Area 50, the OSA, and the NGA.

Integrating concerns about wood production and sustainable forest management in the United States.

Treesearch

R.W. Haynes

2007-01-01

The implementation of Sustainable Forest Management (SFM) in the United States is strongly influenced by U.S. forest products markets and the numerous management decisions made by individual landowners and managers. These decisions are influenced by a mix of market incentives and regulatory actions reducing predictability in assessing progress towards SFM and causing...

Superfund record of decision (EPA Region 3): Langley AFB/NASA Langley Center, Tabbs Creek Operable Unit, Hampton, VA, September 30, 1998

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

NONE

1998-10-01

This Record of Decision (ROD) presents remedial action for the Tabbs Creek Operable Unit (OU) at the NASA Langley Research Center (LaRC) in Hampton, Virginia (the Site). This action addresses the principle threat at the OU by dredging and disposing contaminated sediment.

Supporting End of Life Decision Making: Case Studies of Relational Closeness in Supported Decision Making for People with Severe or Profound Intellectual Disability

ERIC Educational Resources Information Center

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-01-01

Background: The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions.…

Patient Preferences and Surrogate Decision Making in Neuroscience Intensive Care Units

PubMed Central

Cai, Xuemei; Robinson, Jennifer; Muehlschlegel, Susanne; White, Douglas B.; Holloway, Robert G.; Sheth, Kevin N.; Fraenkel, Liana; Hwang, David Y.

2016-01-01

In the neuroscience intensive care unit (NICU), most patients lack the capacity to make their own preferences known. This fact leads to situations where surrogate decision makers must fill the role of the patient in terms of making preference-based treatment decisions, oftentimes in challenging situations where prognosis is uncertain. The neurointensivist has a large responsibility and role to play in this shared decision making process. This review covers how NICU patient preferences are determined through existing advance care documentation or surrogate decision makers and how the optimum roles of the physician and surrogate decision maker are addressed. We outline the process of reaching a shared decision between family and care team and describe a practice for conducting optimum family meetings based on studies of ICU families in crisis. We review challenges in the decision making process between surrogate decision makers and medical teams in neurocritical care settings, as well as methods to ameliorate conflicts. Ultimately, the goal of shared decision making is to increase knowledge amongst surrogates and care providers, decrease decisional conflict, promote realistic expectations and preference-centered treatment strategies, and lift the emotional burden on families of neurocritical care patients. PMID:25990137

From Narratives to Numbers: Data Work and Patient-Generated Health Data in Consultations.

PubMed

Lindroth, Tomas; Islind, Anna Sigridur; Steineck, Gunnar; Lundin, Johan

2018-01-01

This article presents preliminary findings on how the introduction of patient-generated health data (PGHD) triggers changes during patient-nurse consultations. This article builds on a two-year case study, examining the work practice at a cancer rehabilitation clinic at a Swedish Hospital using PGHD. The study focuses on how nurses' use data, gathered by patients with a mobile phone app, during consultations. The use of PGHD introduce a change in the translation work, the work of turning rich patient descriptions and transform them into data, during the consultation for documentation and clinical decision-making. This change affects precision, questions asked and the use of visualizations as well as the patient-nurse decision making.

Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit.

PubMed

Ehrenfeld, Jesse M; Dexter, Franklin; Rothman, Brian S; Minton, Betty Sue; Johnson, Diane; Sandberg, Warren S; Epstein, Richard H

2013-12-01

When the phase I postanesthesia care unit (PACU) is at capacity, completed cases need to be held in the operating room (OR), causing a "PACU delay." Statistical methods based on historical data can optimize PACU staffing to achieve the least possible labor cost at a given service level. A decision support process to alert PACU charge nurses that the PACU is at or near maximum census might be effective in lessening the incidence of delays and reducing over-utilized OR time, but only if alerts are timely (i.e., neither too late nor too early to act upon) and the PACU slot can be cleared quickly. We evaluated the maximum potential benefit of such a system, using assumptions deliberately biased toward showing utility. We extracted 3 years of electronic PACU data from a tertiary care medical center. At this hospital, PACU admissions were limited by neither inadequate PACU staffing nor insufficient PACU beds. We developed a model decision support system that simulated alerts to the PACU charge nurse. PACU census levels were reconstructed from the data at a 1-minute level of resolution and used to evaluate if subsequent delays would have been prevented by such alerts. The model assumed there was always a patient ready for discharge and an available hospital bed. The time from each alert until the maximum census was exceeded ("alert lead time") was determined. Alerts were judged to have utility if the alert lead time fell between various intervals from 15 or 30 minutes to 60, 75, or 90 minutes after triggering. In addition, utility for reducing over-utilized OR time was assessed using the model by determining if 2 patients arrived from 5 to 15 minutes of each other when the PACU census was at 1 patient less than the maximum census. At most, 23% of alerts arrived 30 to 60 minutes prior to the admission that resulted in the PACU exceeding the specified maximum capacity. When the notification window was extended to 15 to 90 minutes, the maximum utility was <50%. At most, 45% of alerts potentially would have resulted in reassigning the last available PACU slot to 1 OR versus another within 15 minutes of the original assignment. Despite multiple biases that favored effectiveness, the maximum potential benefit of a decision support system to mitigate PACU delays on the day on the surgery was below the 70% minimum threshold for utility of automated decision support messages, previously established via meta-analysis. Neither reduction in PACU delays nor reassigning promised PACU slots based on reducing over-utilized OR time were realized sufficiently to warrant further development of the system. Based on these results, the only evidence-based method of reducing PACU delays is to adjust PACU staffing and staff scheduling using computational algorithms to match the historical workload (e.g., as developed in 2001).

Stop making plans; start making decisions.

PubMed

Mankins, Michael C; Steele, Richard

2006-01-01

Many executives have grown skeptical of strategic planning. Is it any wonder? Despite all the time and energy that go into it, strategic planning most often acts as a barrier to good decision making and does little to influence strategy. Strategic planning fails because of two factors: It typically occurs annually, and it focuses on individual business units. As such, the process is completely at odds with the way executives actually make important strategy decisions, which are neither constrained by the calendar nor defined by unit boundaries. Thus, according to a survey of 156 large companies, senior executives often make strategic decisions outside the planning process, in an ad hoc fashion and without rigorous analysis or productive debate. But companies can fix the process if they attack its root problems. A few forward-looking firms have thrown out their calendar-driven, business-unit-focused planning procedures and replaced them with continuous, issues-focused decision making. In doing so, they rely on several basic principles: They separate, but integrate, decision making and plan making. They focus on a few key themes. And they structure strategy reviews to produce real decisions. When companies change the timing and focus of strategic planning, they also change the nature of senior management's discussions about strategy--from "review and approve" to "debate and decide," in which top executives actively think through every major decision and its implications for the company's performance and value. The authors have found that these companies make more than twice as many important strategic decisions per year as companies that follow the traditional planning model.

Community organizing network for environmental health: using a community health development approach to increase community capacity around reduction of environmental triggers.

PubMed

Parker, Edith A; Chung, Lynna K; Israel, Barbara A; Reyes, Angela; Wilkins, Donele

2010-04-01

The Community Organizing Network for Environmental Health (CONEH), a project of Community Action Against Asthma, used a community health development approach to improve children's asthma-related health through increasing the community's capacity to reduce physical and social environmental triggers for asthma. Three community organizers were hired to work with community groups and residents in neighborhoods in Detroit on the priority areas of air quality, housing, and citizen involvement in the environmental project and policy decision-making. As part of the evaluation of the CONEH project, 20 one-on-one semi-structured, in-depth interviews were conducted between August and November 2005 involving steering committee members, staff members, and key community organization staff and/or community members. Using data from the evaluation of the CONEH project, this article identifies the dimensions of community capacity that were enhanced as part of a CBPR community health development approach to reducing physical and social environmental triggers associated with childhood asthma and the factors that facilitated or inhibited the enhancement of community capacity.

Community Organizing Network for Environmental Health: Using a Community Health Development Approach to Increase Community Capacity around Reduction of Environmental Triggers

PubMed Central

Chung, Lynna K.; Israel, Barbara A.; Reyes, Angela; Wilkins, Donele

2010-01-01

The Community Organizing Network for Environmental Health (CONEH), a project of Community Action Against Asthma, used a community health development approach to improve children’s asthma-related health through increasing the community’s capacity to reduce physical and social environmental triggers for asthma. Three community organizers were hired to work with community groups and residents in neighborhoods in Detroit on the priority areas of air quality, housing, and citizen involvement in the environmental project and policy decision-making. As part of the evaluation of the CONEH project, 20 one-on-one semi-structured, in-depth interviews were conducted between August and November 2005 involving steering committee members, staff members, and key community organization staff and/or community members. Using data from the evaluation of the CONEH project, this article identifies the dimensions of community capacity that were enhanced as part of a CBPR community health development approach to reducing physical and social environmental triggers associated with childhood asthma and the factors that facilitated or inhibited the enhancement of community capacity. PMID:20306137

The structure, logic of operation and distinctive features of the system of triggers and counting signals formation for gamma-telescope GAMMA-400

NASA Astrophysics Data System (ADS)

Topchiev, N. P.; Galper, A. M.; Arkhangelskiy, A. I.; Arkhangelskaja, I. V.; Kheymits, M. D.; Suchkov, S. I.; Yurkin, Y. T.

2017-01-01

Scientific project GAMMA-400 (Gamma Astronomical Multifunctional Modular Apparatus) relates to the new generation of space observatories intended to perform an indirect search for signatures of dark matter in the cosmic-ray fluxes, measurements of characteristics of diffuse gamma-ray emission and gamma-rays from the Sun during periods of solar activity, gamma-ray bursts, extended and point gamma-ray sources, electron/positron and cosmic-ray nuclei fluxes up to TeV energy region by means of the GAMMA-400 gamma-ray telescope represents the core of the scientific complex. The system of triggers and counting signals formation of the GAMMA-400 gamma-ray telescope constitutes the pipelined processor structure which collects data from the gamma-ray telescope subsystems and produces summary information used in forming the trigger decision for each event. The system design is based on the use of state-of-the-art reconfigurable logic devices and fast data links. The basic structure, logic of operation and distinctive features of the system are presented.

Superfund record of decision (EPA Region 2): Hercules Incorporated (Gibbstown Plant), Solid Waste Disposal Area, Operable Unit 3, Greenwich Township, Gloucester County, NJ, January 22, 1966

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

NONE

1996-10-01

This decision document presents the selected remedial action for the Solid Waste Disposal Area (SWDA) - Operable Unit 3, Hercules Incorporated, Higgins Plant (hereinafter Hercules site or site), in Greenwhich Township, Gloucester County, New Jersey. The Record of Decision (ROD) addresses all contaminated media at the SWDA portion of the site including soil and ground water. The selected remedy is a modified version of the `In-Place Containment` remedy of the Porposed Plan.

“The problem often is that we do not have a family spokesperson but a spokesgroup”: Family Member Informal Roles in End-of-Life Decision-Making in Adult ICUs

PubMed Central

Quinn, Jill R.; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A.; Dombeck, Mary T.; Sellers, Craig R.

2013-01-01

Background To support the process of effective family decision-making, it is important to recognize and understand informal roles various family members may play in the end-of-life decision-making process. Objective The purpose of this study was to describe some informal roles consistently enacted by family members involved in the process of end-of-life decision-making in intensive care units (ICUs). Methods Ethnographic study. Data were collected via participant observation with field notes and semi-structured interviews on four ICUs in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical ICU, a surgical ICU, a burn and trauma ICU, and a cardiovascular ICU. Participants Participants included health care clinicians, patients, and family members. Results Informal roles for family members consistently observed were:, Primary Caregiver, Primary Decision Maker, Family Spokesperson, Out-of-Towner, Patient Wishes Expert, Protector, Vulnerable Member, and Health Care Expert. The identified informal roles were part of family decision making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision-making within the family system, and between the family and health care domains. Conclusions These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these family member informal roles can assist clinicians to recognize and understand the functions of these roles in family decision making at the end-of-life, and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes. PMID:22210699

Virtual Mission Operations of Remote Sensors With Rapid Access To and From Space

NASA Technical Reports Server (NTRS)

Ivancic, William D.; Stewart, Dave; Walke, Jon; Dikeman, Larry; Sage, Steven; Miller, Eric; Northam, James; Jackson, Chris; Taylor, John; Lynch, Scott;

Patient and physician predictors of patient receipt of therapies recommended by a computerized decision support system when initially prescribed broad-spectrum antibiotics: a cohort study

PubMed Central

Lye, David C.; Arah, Onyebuchi A

2016-01-01

Objective Antibiotic computerized decision support systems (CDSSs) were developed to guide antibiotic decisions, yet prescriptions of CDSS-recommended antibiotics have remained low. Our aim was to identify predictors of patients' receipt of empiric antibiotic therapies recommended by a CDSS when the prescribing physician had an initial preference for using broad-spectrum antibiotics. Methods We conducted a prospective cohort study in a 1 500-bed tertiary-care hospital in Singapore. We included all patients admitted from October 1, 2011 through September 30, 2012, who were prescribed piperacillin-tazobactam or carbapenem for empiric therapy and auto-triggered to receive antibiotic recommendations by the in-house antibiotic CDSS. Relevant data on the patient, prescribing and attending physicians were collected via electronic linkages of medical records and administrative databases. To account for clustering, we used multilevel logistic regression models to explore factors associated with receipt of CDSS-recommended antibiotic therapy. Results One-quarter of the 1 886 patients received CDSS-recommended antibiotics. More patients treated for pneumonia (33.2%) than sepsis (12.1%) and urinary tract infections (7.1%) received CDSS-recommended antibiotic therapies. The prescribing physician – but not the attending physician or clinical specialty – accounted for some (13.3%) of the variation. Prior hospitalization (odds ratio [OR] 1.32, 95% CI, 1.01-1.71), presumed pneumonia (OR 6.77, 95% CI, 3.28-13.99), intensive care unit (ICU) admission (OR 0.38, 95% CI, 0.21-0.66), and renal impairment (OR 0.70, 95% CI, 0.52-0.93) were factors associated with patients’ receipt of CDSS-recommended antibiotic therapies. Conclusions We observed that ICU admission and renal impairment were negative predictors of patients’ receipt of CDSS-recommended antibiotic therapies. Patients admitted to ICU and those with renal impairment might have more complex clinical conditions that require a physician's assessment in addition to antibiotic CDSS. PMID:26342216

Memory and modularity in cell-fate decision making

NASA Astrophysics Data System (ADS)

Norman, Thomas M.; Lord, Nathan D.; Paulsson, Johan; Losick, Richard

2013-11-01

Genetically identical cells sharing an environment can display markedly different phenotypes. It is often unclear how much of this variation derives from chance, external signals, or attempts by individual cells to exert autonomous phenotypic programs. By observing thousands of cells for hundreds of consecutive generations under constant conditions, we dissect the stochastic decision between a solitary, motile state and a chained, sessile state in Bacillus subtilis. We show that the motile state is `memoryless', exhibiting no autonomous control over the time spent in the state. In contrast, the time spent as connected chains of cells is tightly controlled, enforcing coordination among related cells in the multicellular state. We show that the three-protein regulatory circuit governing the decision is modular, as initiation and maintenance of chaining are genetically separable functions. As stimulation of the same initiating pathway triggers biofilm formation, we argue that autonomous timing allows a trial commitment to multicellularity that external signals could extend.

20 CFR 655.75 - Decision and order of administrative law judge.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 3 2012-04-01 2012-04-01 false Decision and order of administrative law... administrative law judge shall be inoperative unless and until the Board issues an order affirming the decision... Nursing in the United States (H-2B Workers) Integrity Measures § 655.75 Decision and order of...

UK: AIDS treatment main factor in decision to grant permission to appeal immigration decision.

PubMed

Gold, Jennifer

2003-12-01

On 26 June 2003, the England and Wales Court of Appeal (Civil Division) granted an application for leave to appeal a decision of the Immigration Appeal Tribunal, which had overturned an adjudicator's decision to allow an HIV-positive citizen of Uganda to immigrate to the United Kingdom (UK).

Understanding social influences on wilderness fire stewardship decisions

Treesearch

Katie Knotek

2006-01-01

Federal land managers and the public engage in many decisions about stewardship of wilderness in the United States, including decisions about stewardship of fire. To date, social science research lacks a holistic examination of the decision-making context of managers and the public about stewardship of fire inside wilderness and across its boundaries. A conceptual...

12 CFR 408.5 - Ensuring environmental documents are actually considered in Agency decision-making.

Code of Federal Regulations, 2010 CFR

2010-01-01

... considered in Agency decision-making. 408.5 Section 408.5 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED... Procedures § 408.5 Ensuring environmental documents are actually considered in Agency decision-making... environmental documents in agency decision-making. To implement these requirements, Eximbank officials will: (a...

Developing the U.S. Wildland Fire Decision Support System

Treesearch

Erin Noonan-Wright; Tonja S. Opperman; Mark A. Finney; Tom Zimmerman; Robert C. Seli; Lisa M. Elenz; David E. Calkin; John R. Fiedler

2011-01-01

A new decision support tool, the Wildland Fire Decision Support System (WFDSS) has been developed to support risk-informed decision-making for individual fires in the United States. WFDSS accesses national weather data and forecasts, fire behavior prediction, economic assessment, smoke management assessment, and landscape databases to efficiently formulate and apply...

Towards ethical decision support and knowledge management in neonatal intensive care.

PubMed

Yang, L; Frize, M; Eng, P; Walker, R; Catley, C

2004-01-01

Recent studies in neonatal medicine, clinical nursing, and cognitive psychology have indicated the need to augment current decision-making practice in neonatal intensive care units with computerized, intelligent decision support systems. Rapid progress in artificial intelligence and knowledge management facilitates the design of collaborative ethical decision-support tools that allow clinicians to provide better support for parents facing inherently difficult choices, such as when to withdraw aggressive treatment. The appropriateness of using computers to support ethical decision-making is critically analyzed through research and literature review. In ethical dilemmas, multiple diverse participants need to communicate and function as a team to select the best treatment plan. In order to do this, physicians require reliable estimations of prognosis, while parents need a highly useable tool to help them assimilate complex medical issues and address their own value system. Our goal is to improve and structuralize the ethical decision-making that has become an inevitable part of modern neonatal care units. The paper contributes to clinical decision support by outlining the needs and basis for ethical decision support and justifying the proposed development efforts.

Distributed and recoverable digital control system

NASA Technical Reports Server (NTRS)

Stange, Kent (Inventor); Hess, Richard (Inventor); Kelley, Gerald B (Inventor); Rogers, Randy (Inventor)

2010-01-01

A real-time multi-tasking digital control system with rapid recovery capability is disclosed. The control system includes a plurality of computing units comprising a plurality of redundant processing units, with each of the processing units configured to generate one or more redundant control commands. One or more internal monitors are employed for detecting data errors in the control commands. One or more recovery triggers are provided for initiating rapid recovery of a processing unit if data errors are detected. The control system also includes a plurality of actuator control units each in operative communication with the computing units. The actuator control units are configured to initiate a rapid recovery if data errors are detected in one or more of the processing units. A plurality of smart actuators communicates with the actuator control units, and a plurality of redundant sensors communicates with the computing units.

The value of artefacts in stimulated-recall interviews.

PubMed

Burden, Sarah; Topping, Annie; O'Halloran, Catherine

2015-09-01

To assess the use of artefacts in semi-structured, stimulated-recall interviews in a study exploring mentors' decisions regarding students' competence in practice. Few empirical studies have examined how mentors reach a decision when assessing students' performance in practice. Concerns have repeatedly been voiced that students may lack essential skills at the point of registration or that mentors may have failed or been reticent to judge students' performance as unsatisfactory. Student practice assessment documents (PADs) were used in stimulated-recall (SR) interviews with mentors to explore decision making. A review of the literature identified that artefacts can play a role in triggering a more comprehensive retrospective examination of decision making, thus helping to capture the essence of a mentor's decision over time and in context. Use of an artefact to stimulate recall can elicit evidence of thought processes, which may be difficult to obtain in a normal, semi-structured interview. PADs proved to be a valuable way to generate naturalistic decision making. In addition, discussion of artefacts created by participants can promote participant-driven enquiry, thereby reducing researcher bias. Identifying an approach that captures post hoc decision making based on sustained engagement and interaction between students and their mentors was a challenge. Artefacts can be used to address the difficulties associated with retrospective introspection about a unique decision. There is the potential to increase the use of artefacts in healthcare research. SR can also help novice mentors develop their skills in making decisions regarding assessments of students.

The Role of Psychological Adjustment in the Decision-making Process for Voluntary Termination of Pregnancy.

PubMed

Sereno, Sara; Leal, Isabel; Maroco, João

2013-07-01

This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions.

Decision Processes and Determinants of Hospital Evacuation and Shelter-in-Place During Hurricane Sandy.

PubMed

McGinty, Meghan D; Burke, Thomas A; Resnick, Beth; Barnett, Daniel J; Smith, Katherine C; Rutkow, Lainie

Evacuation and shelter-in-place decision making for hospitals is complex, and existing literature contains little information about how these decisions are made in practice. To describe decision-making processes and identify determinants of acute care hospital evacuation and shelter-in-place during Hurricane Sandy. Semistructured interviews were conducted from March 2014 to February 2015 with key informants who had authority and responsibility for evacuation and shelter-in-place decisions for hospitals during Hurricane Sandy in 2012. Interviews were recorded, transcribed, and thematically analyzed. Interviewees included hospital executives and state and local public health, emergency management, and emergency medical service officials from Delaware, Maryland, New Jersey, and New York. Interviewees identified decision processes and determinants of acute care hospital evacuation and shelter-in-place during Hurricane Sandy. We interviewed 42 individuals from 32 organizations. Decisions makers reported relying on their instincts rather than employing guides or tools to make evacuation and shelter-in-place decisions during Hurricane Sandy. Risk to patient health from evacuation, prior experience, cost, and ability to maintain continuity of operations were the most influential factors in decision making. Flooding and utility outages, which were predicted to or actually impacted continuity of operations, were the primary determinants of evacuation. Evacuation and shelter-in-place decision making for hospitals can be improved by ensuring hospital emergency plans address flooding and include explicit thresholds that, if exceeded, would trigger evacuation. Comparative risk assessments that inform decision making would be enhanced by improved collection, analysis, and communication of data on morbidity and mortality associated with evacuation versus sheltering-in-place of hospitals. In addition, administrators and public officials can improve their preparedness to make evacuation and shelter-in-place decisions by practicing the use of decision-making tools during training and exercises.

KLEPSUDRA: How the Rio Grande Treaty Increased Instability in Mexico

DTIC Science & Technology

2008-05-09

Projected changes in trade patterns, population growth, consumer preferences and climate change will require a reassessment of American policies towards...land (which increased by 44%) shifted towards water intensive crops to accommodate market demands in the United States, Canada and shifts in consumer ... preferences in Mexico.20 NAFTA triggered explosive growth in fruit and produce exports to the United States and represents a sizeable “virtual” water

Optimization of replacement and inspection decisions for multiple components on a power system

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

Mauney, D.A.

1994-12-31

The use of optimization on the rescheduling of replacement dates provided a very proactive approach to deciding when components on individual units need to be addressed with a run/repair/replace decision. Including the effects of time value of money and taxes and unit need inside the spreadsheet model allowed the decision maker to concentrate on the effects of engineering input and replacement date decisions on the final net present value (NPV). The personal computer (PC)-based model was applied to a group of 140 forced outage critical fossil plant tube components across a power system. The estimated resulting NPV of the optimizationmore » was in the tens of millions of dollars. This PC spreadsheet model allows the interaction of inputs from structural reliability risk assessment models, plant foreman interviews, and actual failure history on a by component by unit basis across a complete power production system. This model includes not only the forced outage performance of these components caused by tube failures but, in addition, the forecasted need of the individual units on the power system and the expected cost of their replacement power if forced off line. The use of cash flow analysis techniques in the spreadsheet model results in the calculation of an NPV for a whole combination of replacement dates. This allows rapid assessments of {open_quotes}what if{close_quotes} scenarios of major maintenance projects on a systemwide basis and not just on a unit-by-unit basis.« less

Generalizing Automated Assessment of Small Unit Tactical Decision Making

DTIC Science & Technology

2013-12-01

stottlerhenke.com, presnell@stottlerhenke.com James Lunsford Decisive-Point, LLC Kansas City, MO jim@decisive-point.com Marshell G. Cobb US Army...engineer for Electronic Arts and Stormfront Studios. Dr. Marshell G. Cobb. In his current position with the US Army Research Institute (ARI), Dr...Lunsford Decisive-Point, LLC Kansas City, MO jim@decisive-point.com Marshell G. Cobb US Army Research Institute Ft. Benning, GA

Making Financial Decisions. Financial Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

ERIC Educational Resources Information Center

Adamson, Jan; And Others

One of a series of three self-instructional units, these materials are aimed at helping British hotel and catering managers improve profits and/or reduce costs in their areas of responsibility. Following a paragraph on how to use the unit and an introduction, section 1 covers control levels as the framework for making decisions. The section…

Stuck in the Middle: Examining the Intersection of Middle School Science Teachers' PCK and Classroom Practice

ERIC Educational Resources Information Center

Allen, Jared R.

2017-01-01

The purpose of this study was to explain middle school teachers' decisions for planning a science unit of instruction (reflection on action) and their decisions when enacting this planned unit (reflection in action) using the new teacher professional knowledge and skill (TPK&S) model as a guiding framework. In addition, this study specifically…

Classification, Social Contracts, Obligations, Civil Rights, and the Supreme Court: Sutton v. United Air Lines.

ERIC Educational Resources Information Center

Turnbull, H. Rutherford, III; Stowe, Matthew J.

2001-01-01

This article analyzes the 1999 decision of the U.S. Supreme Court, Sutton v. United Air Lines, as it pertains to people with disabilities, especially students covered by federal education and civil rights legislation. It sets out implications of the decision for special and general educators as they engage in Individualized Education Program…

Superfund record of decision (EPA Region 6): Southern Shipbuilding Corp., Slidell, LA, July 20, 1995

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

NONE

1996-03-01

This decision document presents the selected remedial action for the source control operable unit of the Southern Shipbuilding Corporation (SSC) site in Slidell, Louisiana. This remedy represents the source control operable unit which addresses remediation of highly contaminated sludge and soil, the marginally contaminated soil, and the graving dock sediments at the Southern Shipbuilding Corporation site.

Fateful Decisions 1945-1972: The United States' Vietnam Policies in Five Presidential Administrations. A Curriculum Guide.

ERIC Educational Resources Information Center

Oliveira, Louise A.; Robinson, Natalie

This curriculum unit for the study of Vietnam policy has the following goals: (1) student awareness and examination of alternatives to war; (2) student understanding of the process and elements involved in governmental decision making, including that of public opinion; (3) student understanding of their responsibilities and rights as citizens in a…

The relative meaning of absolute numbers: the case of pain intensity scores as decision support systems for pain management of patients with dementia.

PubMed

Lichtner, Valentina; Dowding, Dawn; Closs, S José

2015-12-24

Assessment and management of pain in patients with dementia is known to be challenging, due to patients' cognitive and/or communication difficulties. In the UK, pain in hospital is managed through regular assessments, with the use of pain intensity scores as triggers for action. The aim of this study was to understand current pain assessment practices, in order to later inform the development of a decision support tool designed to improve the management of pain for people with dementia in hospital. An exploratory study was conducted in four hospitals in the UK (11 wards), with observations of patients with dementia (n = 31), interviews of staff (n = 52) and patients' family members (n = 4) and documentary analysis. A thematic analysis was carried out, structured along dimensions of decision making. This paper focuses on the emergent themes related to the use of assessment tools and pain intensity scores. A variety of tools were used to record pain intensity, usually with numerical scales. None of the tools in actual use had been specifically designed for patients with cognitive impairment. With patients with more severe dementia, the patient's body language and other cues were studied to infer pain intensity and then a score entered on behalf of the patient. Information regarding the temporality of pain and changes in pain experience (rather than a score at a single point in time) seemed to be most useful to the assessment of pain. Given the inherent uncertainty of the meaning of pain scores for patients with dementia, numerical scales were used with caution. Numerical scores triggered action but their meaning was relative - to the patient, to the clinician, to the time of recording and to the purpose of documenting. There are implications for use of data and computerized decision support systems design. Decision support interventions should include personalized alerting cut-off scores for individual patients, display pain scores over time and integrate professional narratives, mitigating uncertainties around single pain scores for patients with dementia.

Evaluation of a decision support system for pressure ulcer prevention and management: preliminary findings.

PubMed

Zielstorff, R D; Estey, G; Vickery, A; Hamilton, G; Fitzmaurice, J B; Barnett, G O

1997-01-01

A decision support system for prevention and management of pressure ulcers was developed based on AHCPR guidelines and other sources. The system was implemented for 21 weeks on a 20-bed clinical care unit. Fifteen nurses on that unit volunteered as subjects of the intervention to see whether use of the system would have a positive effect on their knowledge about pressure ulcers and on their decision-making skills related to this topic. A similar care unit was used as a control. In addition, the system was evaluated by experts for its instructional adequacy, and by end users for their satisfaction with the system. Preliminary results show no effect on knowledge about pressure ulcers and no effect on clinical decision making skills. The system was rated positively for instructional adequacy, and positively for user satisfaction. User interviews related to satisfaction supplemented the quantitative findings. A discussion of the issues of conducting experiments like this in today's clinical environment is included.

Economic aspects of intraoperative coagulation management targeting higher fibrinogen concentrations during major craniosynostosis surgery.

PubMed

Haas, Thorsten; Spielmann, Nelly; Restin, Tanja; Schmidt, Alexander R; Schmugge, Markus; Cushing, Melissa M

2016-01-01

Results of a previously published study demonstrated a significant decrease in transfusion requirements and calculated blood loss for pediatric major craniosynostosis surgery, if a ROTEM(®) FIBTEM trigger of <13 mm (early substitution group) was applied as compared to a trigger of <8 mm (conventional group). The aim of this study was a posthoc analysis of the costs for this coagulation management. The total volume as well as the number of units or bags for all transfused blood products and coagulation factors were recorded for each case. The number of laboratory and point-of-care coagulation tests was also analyzed. Total blood product costs were calculated according to the local prices per unit. The total cost for all transfused/administered blood products/coagulation factors per patient was a median of 1023EUR (IQR 850EUR-1058EUR) in the early substitution group as compared to a median of 910EUR (IQR 719EUR-1351EUR) in the conventional group (P = 0.81). No difference in the number of coagulation tests performed was observed. In this study, the use of a higher fibrinogen trigger was not linked to a significant increase in total costs for transfused blood products and coagulation factors, and may offer an economically equivalent approach to coagulation management. © 2015 John Wiley & Sons Ltd.

Controlled release of free-falling test models

NASA Technical Reports Server (NTRS)

Fife, W. J.; Holway, H. P.

1970-01-01

Releasing device, powered by a drill motor through an adjustable speed reducer, has a spinning release head with three retractable spring-loaded fingers. The fingers are retracted by manual triggering of a cable at the motor end of the unit.

Psychopharmacology Decision-Making Among Pregnant and Postpartum Women and Health Providers: Informing Compassionate and Collaborative Care Women's Health

PubMed Central

Price, Sarah Kye; Bentley, Kia J.

2013-01-01

Psychopharmaceutical use by pregnant and postpartum women is complicated by the complexity of prescribing as well as the sociocultural context in which medication-related decisions are made. This study sought to advance understanding of decision–making processes and communication experiences regarding use of psychopharmaceuticals during pregnancy by considering both provider and consumer perspectives. An electronic survey was conducted with health care providers (N = 88) and women consumers (N = 3) from July 2010 through October 2011 regarding the perceived costs and benefits of taking mental health medication during and around the time of pregnancy. Descriptive analysis compared and contrasted experiences between the two groups regarding consumer-provider communication, critical incidents and triggers in decision-making, and response to case scenarios crafted around hypothetical client experiences. Both similarities and differences were evident among health care provider and women consumer responses regarding costs, benefits, communication experiences, and case scenario responses. Both quantitative and qualitative survey results indicated the need for more accurate, unbiased, and complete information exchange around mental health and medication. Study results suggested the centrality of the client-provider milieu to guide decision-making and emphasized the expressed need within both groups to create a shared decision-making practice environment characterized by authenticity, non-judgmental decision-making, compassion, humaneness, and reciprocity. PMID:23517513

Seasonality in communication and collective decision-making in ants.

PubMed

Stroeymeyt, N; Jordan, C; Mayer, G; Hovsepian, S; Giurfa, M; Franks, N R

2014-04-07

The ability of animals to adjust their behaviour according to seasonal changes in their ecology is crucial for their fitness. Eusocial insects display strong collective behavioural seasonality, yet the mechanisms underlying such changes are poorly understood. We show that nest preference by emigrating Temnothorax albipennis ant colonies is influenced by a season-specific modulatory pheromone that may help tune decision-making according to seasonal constraints. The modulatory pheromone triggers aversion towards low-quality nests and enhances colony cohesion in summer and autumn, but not after overwintering-in agreement with reports that field colonies split in spring and reunite in summer. Interestingly, we show that the pheromone acts by downgrading the perceived value of marked nests by informed and naive individuals. This contrasts with theories of collective intelligence, stating that accurate collective decision-making requires independent evaluation of options by individuals. The violation of independence highlighted here was accordingly shown to increase error rate during emigrations. However, this is counterbalanced by enhanced cohesion and the transmission of valuable information through the colony. Our results support recent claims that optimal decisions are not necessarily those that maximize accuracy. Other criteria-such as cohesion or reward rate-may be more relevant in animal decision-making.

Observing earthquakes triggered in the near field by dynamic deformations

USGS Publications Warehouse

Gomberg, J.; Bodin, P.; Reasenberg, P.A.

2003-01-01

We examine the hypothesis that dynamic deformations associated with seismic waves trigger earthquakes in many tectonic environments. Our analysis focuses on seismicity at close range (within the aftershock zone), complementing published studies of long-range triggering. Our results suggest that dynamic triggering is not confined to remote distances or to geothermal and volcanic regions. Long unilaterally propagating ruptures may focus radiated dynamic deformations in the propagation direction. Therefore, we expect seismicity triggered dynamically by a directive rupture to occur asymmetrically, with a majority of triggered earthquakes in the direction of rupture propagation. Bilaterally propagating ruptures also may be directive, and we propose simple criteria for assessing their directivity. We compare the inferred rupture direction and observed seismicity rate change following 15 earthquakes (M 5.7 to M 8.1) that occured in California and Idaho in the United States, the Gulf of Aqaba, Syria, Guatemala, China, New Guinea, Turkey, Japan, Mexico, and Antarctica. Nine of these mainshocks had clearly directive, unilateral ruptures. Of these nine, seven apparently induced an asymmetric increase in seismicity rate that correlates with the rupture direction. The two exceptions include an earthquake preceded by a comparable-magnitude event on a conjugate fault and another for which data limitations prohibited conclusive results. Similar (but weaker) correlations were found for the bilaterally rupturing earthquakes we studied. Although the static stress change also may trigger seismicity, it and the seismicity it triggers are expected to be similarly asymmetric only if the final slip is skewed toward the rupture terminus. For several of the directive earthquakes, we suggest that the seismicity rate change correlates better with the dynamic stress field than the static stress change.

Photofrin binds to procaspase-3 and mediates photodynamic treatment-triggered methionine oxidation and inactivation of procaspase-3

PubMed Central

Hsieh, Y-J; Chien, K-Y; Lin, S-Y; Sabu, S; Hsu, R-M; Chi, L-M; Lyu, P-C; Yu, J-S

2012-01-01

Diverse death phenotypes of cancer cells can be induced by Photofrin-mediated photodynamic therapy (PDT), which has a decisive role in eliciting a tumor-specific immunity for long-term tumor control. However, the mechanism(s) underlying this diversity remain elusive. Caspase-3 is a critical factor in determining cell death phenotypes in many physiological settings. Here, we report that Photofrin-PDT can modify and inactivate procaspase-3 in cancer cells. In cells exposed to an external apoptotic trigger, high-dose Photofrin-PDT pretreatment blocked the proteolytic activation of procaspase-3 by its upstream caspase. We generated and purified recombinant procaspase-3-D3A (a mutant without autolysis/autoactivation activity) to explore the underlying mechanism(s). Photofrin could bind directly to procaspase-3-D3A, and Photofrin-PDT-triggered inactivation and modification of procaspase-3-D3A was seen in vitro. Mass spectrometry-based quantitative analysis for post-translational modifications using both 16O/18O- and 14N/15N-labeling strategies revealed that Photofrin-PDT triggered a significant oxidation of procaspase-3-D3A (mainly on Met-27, -39 and -44) in a Photofrin dose-dependent manner, whereas the active site Cys-163 remained largely unmodified. Site-directed mutagenesis experiments further showed that Met-44 has an important role in procaspase-3 activation. Collectively, our results reveal that Met oxidation is a novel mechanism for the Photofrin-PDT-mediated inactivation of procaspase-3, potentially explaining at least some of the complicated cell death phenotypes triggered by PDT. PMID:22785533

The Nazaré Wave: a trigger for learning

NASA Astrophysics Data System (ADS)

Carapuço, M. M.; Cunha, A.; Taborda, R.; Andrade, C.; Maurício, C.

2016-02-01

Ocean management faces relevant sustainability challenges. It is consensual that a wiser governance of the oceans can only be achieved by the involvement of all key-players. In this scope scientists, as knowledge generators, have a vital role in ocean governance. Scientists are therefore called to share their knowledge outside the scientific community. This effort, framed under the Responsible Research and Innovation approach, will contribute to a more informed society, which in turn will be able to make better decisions. However, communicating science is a challenging task as is often necessary to inspire the audience and assure their receptivity, which may not be tuned to scientific contents. The present work focuses on the importance of the use of communication triggers in scientific knowledge transfer in ocean sciences. In this work the Nazaré wave - the highest wave ever surfed - was used as the communication trigger as it is a very popular subject with the media and is given great media coverage. Results show that the use of this subject can be an excellent trigger for the transfer of scientific knowledge on basic wave dynamics to the students. Additionally to the theme itself, it was found that short scientific animation videos voiced-over by students performed very well as the communication channel. The scripts used were written by scientists and commented by the students, previously to recording, assuring that the adequate language was used, and that the essential principles and fundamental concepts of waves reach the audience. Results of using the Nazaré´ wave as a communication trigger have been extremely positive and resulted in a well-succeeded engagement platform.

School Law.

ERIC Educational Resources Information Center

Splitt, David A.

1986-01-01

Reviews four recent court decisions affecting school law. A Circuit Court of Appeals ruling upheld Norfolk Schools' decision to abolish busing and reinstate neighborhood schools. The United States Supreme Court dismissed appeals to lower court decisions involving a minimum grade prerequisite, a teacher's privacy rights, and an "adult"…

Voluntary Race-Conscious Affirmative Action Plans: The Significance of Two Recent Supreme Court Decisions.

ERIC Educational Resources Information Center

Fischer, Louis

1987-01-01

Presents the United States Supreme Court's decisions in Wygant v. the Jackson Board of Education and in International Association of Firefighters v. City of Cleveland. Explores the decisions' more general applications to voluntary affirmative action plans. (PS)

Public Affairs Decision Making in the U.S. Air Force: An Application of Multiattribute Utility Theory.

ERIC Educational Resources Information Center

David, Prabu; Pierson, Michael M.

1998-01-01

Contributes to scholarship on public relations decision making and public relations theory. Examines decision making by United States Air Force public affairs personnel. Finds that only 48% of the decisions fit the public relations excellence criteria of accommodation and long-term relationship building. Finds also a negative correlation between…

Forecasting resource-allocation decisions under climate uncertainty: fire suppression with assessment of net benefits of research

Treesearch

Jeffrey P. Prestemon; Geoffrey H. Donovan

2008-01-01

Making input decisions under climate uncertainty often involves two-stage methods that use expensive and opaque transfer functions. This article describes an alternative, single-stage approach to such decisions using forecasting methods. The example shown is for preseason fire suppression resource contracting decisions faced by the United States Forest Service. Two-...

Using simulation to isolate physician variation in intensive care unit admission decision making for critically ill elders with end-stage cancer: a pilot feasibility study.

PubMed

Barnato, Amber E; Hsu, Heather E; Bryce, Cindy L; Lave, Judith R; Emlet, Lillian L; Angus, Derek C; Arnold, Robert M

2008-12-01

To determine the feasibility of high-fidelity simulation for studying variation in intensive care unit admission decision making for critically ill elders with end-stage cancer. Mixed qualitative and quantitative analysis of physician subjects participating in a simulation scenario using hospital set, actors, medical chart, and vital signs tracings. The simulation depicted a 78-yr-old man with metastatic gastric cancer, life-threatening hypoxia most likely attributable to cancer progression, and stable preferences to avoid intensive care unit admission and intubation. Two independent raters assessed the simulations and subjects completed a postsimulation web-based survey and debriefing interview. Peter M. Winter Institute for Simulation Education and Research at the University of Pittsburgh. Twenty-seven hospital-based attending physicians, including 6 emergency physicians, 13 hospitalists, and 8 intensivists. Outcomes included qualitative report of clinical verisimilitude during the debriefing interview, survey-reported diagnosis and prognosis, and observed treatment decisions. Independent variables included physician demographics, risk attitude, and reactions to uncertainty. All (100%) reported that the case and simulation were highly realistic, and their diagnostic and prognostic assessments were consistent with our intent. Eight physicians (29.6%) admitted the patient to the intensive care unit. Among the eight physicians who admitted the patient to the intensive care unit, three (37%) initiated palliation, two (25%) documented the patient's code status (do not intubate/do not resuscitate), and one intubated the patient. Among the 19 physicians who did not admit the patient to the intensive care unit, 13 (68%) initiated palliation and 5 (42%) documented code status. Intensivists and emergency physicians (p = 0.048) were more likely to admit the patient to the intensive care unit. Years since medical school graduation were inversely associated with the initiation of palliative care (p = 0.043). Simulation can reproduce the decision context of intensive care unit triage for a critically ill patient with terminal illness. When faced with an identical patient, hospital-based physicians from the same institution vary significantly in their treatment decisions.

Acquisition of linguistic procedures for printed words: neuropsychological implications for learning.

PubMed

Berninger, V W

1988-10-01

A microcomputerized experiment, administered to 45 children in the 2nd, 5th, and 8th month of first grade, manipulated three variables: (a) stimulus unit (whole word or letter-by-letter presentation), (b) nature of stimulus information (phonically regular words, phonically irregular words, nonsense words, and letter strings, which differ in whether phonemic, orthographic, semantic, and/or name codes are available), and (c) linguistic task (lexical decision, naming, and written reproduction). Letter-by-letter presentation resulted in more accurate lexical decision and naming but not more accurate written reproduction. Interactions between nature of stimulus information and linguistic task occurred. Throughout the year, accuracy was greater for lexical decision than for naming or written reproduction. The superiority of lexical decision cannot be attributed to the higher probability of correct responses on a binary choice task because only consistently correct responses on repeated trials were analyzed. The earlier development of lexical decision, a receptive task, than of naming or written reproduction, production tasks, suggests that hidden units (Hinton & Sejnowski, 1986) in tertiary cortical areas may abstract visual-linguistic associations in printed words before production units in primary cortical areas can produce printed words orally or graphically.

Superfund record of decision (EPA Region 3): US Defense General Supply Center (DLA), operable unit 3, Chesterfield County, Richmond, VA, September 29, 1995

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

NONE

This decision document presents the selected remedial action for the National Guard Source Area (NGA), Operable Unit (OU3) at the Defense General Supply Center (DGSC) in Richmond, Virginia. Operable Unit 3 addresses the contaminated soils at the National Guard . The selected alternative requires that institutional controls, including access restriction, property transfer restriction, and preconstruction assessment, be implemented or continued at the site. Also, contaminated soils posing human health risks will be excavated and disposed of.

Implementation of the ATLAS trigger within the multi-threaded software framework AthenaMT

NASA Astrophysics Data System (ADS)

Wynne, Ben; ATLAS Collaboration

2017-10-01

We present an implementation of the ATLAS High Level Trigger, HLT, that provides parallel execution of trigger algorithms within the ATLAS multithreaded software framework, AthenaMT. This development will enable the ATLAS HLT to meet future challenges due to the evolution of computing hardware and upgrades of the Large Hadron Collider, LHC, and ATLAS Detector. During the LHC data-taking period starting in 2021, luminosity will reach up to three times the original design value. Luminosity will increase further, to up to 7.5 times the design value, in 2026 following LHC and ATLAS upgrades. This includes an upgrade of the ATLAS trigger architecture that will result in an increase in the HLT input rate by a factor of 4 to 10 compared to the current maximum rate of 100 kHz. The current ATLAS multiprocess framework, AthenaMP, manages a number of processes that each execute algorithms sequentially for different events. AthenaMT will provide a fully multi-threaded environment that will additionally enable concurrent execution of algorithms within an event. This has the potential to significantly reduce the memory footprint on future manycore devices. An additional benefit of the HLT implementation within AthenaMT is that it facilitates the integration of offline code into the HLT. The trigger must retain high rejection in the face of increasing numbers of pileup collisions. This will be achieved by greater use of offline algorithms that are designed to maximize the discrimination of signal from background. Therefore a unification of the HLT and offline reconstruction software environment is required. This has been achieved while at the same time retaining important HLT-specific optimisations that minimize the computation performed to reach a trigger decision. Such optimizations include early event rejection and reconstruction within restricted geometrical regions. We report on an HLT prototype in which the need for HLT-specific components has been reduced to a minimum. Promising results have been obtained with a prototype that includes the key elements of trigger functionality including regional reconstruction and early event rejection. We report on the first experience of migrating trigger selections to this new framework and present the next steps towards a full implementation of the ATLAS trigger.

A Survey of Laws and Court Decisions in the United States as Related to Teacher Responsibility and Liability During Field Trips.

ERIC Educational Resources Information Center

DuVall, Charles R.; Krepel, Wayne J.

The purpose of this study was to investigate existing state laws and court decisions in the United States related to teacher responsibility and liability while on field trips. Literature reviewed in the report deals with both teacher responsibility and the instructional aspect of field trips. During July and August, 1971 a three-item questionnaire…

The Effect of Defense R&D Expenditures on Military Capability and Technological Spillover

DTIC Science & Technology

2013-03-01

ix List of Figures Page Figure 1. Decision Tree for Sectoring R&D Units...approach, often called sectoring , categorizes R&D activities by funding source, and the functional approach categorizes R&D activities by their objective...economic objectives (defense, and control and care of environment) (OECD, 2002). Figure 1 shows the decision tree for sectoring R&D units and

Science information for informing forest fuel management in dry forests of the western United States

Treesearch

Sarah McCaffrey; Russell Graham

2007-01-01

Land managers need timely and straightforward access to the best scientific information available for informing decisions on how to treat forest fuels in the dry forests of the western United States. However, although there is a tremendous amount of information available for informing fuels management decisions, often, it is in a form that is difficult to use or of...

The Importance of Ethical Training for the Improvement of Ethical Decision-Making: Evidence from Germany and the United States

ERIC Educational Resources Information Center

Rottig, Daniel; Heischmidt, Kenneth A.

2007-01-01

Based on three independent samples from Germany and the United States, this exploratory, cross-cultural study examines empirically the importance of ethical training for the improvement of ethical decision-making. The results of the study reveal a significant difference in the use of corporate codes of conduct and ethical training, as well as…

Rhetoric vs. Reality: The Fundraising Messages of the United Negro College Fund in the Immediate Aftermath of the "Brown" Decision

ERIC Educational Resources Information Center

Gasman, Marybeth

2004-01-01

In spite of the euphoria of the "Brown v. Board of Education of Topeka, Kansas" decision outlawing segregation, Black leaders and presidents of the member colleges of the United Negro College Fund (UNCF) understood that this critical point in history brought both opportunities and challenges to Black higher education. The "Brown" decision…

A Comparison of Coverage of Speech and Press Verdicts of Supreme Court.

ERIC Educational Resources Information Center

Hale, F. Dennis

1979-01-01

An analysis of the coverage by ten newspapers of 20 United States Supreme Court decisions concerning freedom of the press and 20 decisions concerning freedom of speech revealed that the newspapers gave significantly greater coverage to the press decisions. (GT)

Finance.

ERIC Educational Resources Information Center

MacPhail-Wilcox, Bettye; Beezer, Bruce

In 1988, there were two United States Supreme Court decisions regarding school finance. One decision upheld the constitutionality of a North Dakota statute regarding transportation fees, and the other decision ruled that interest from state and local government bearer bonds was subject to federal income taxation. Cases discussed in this chapter…

Weather to Make a Decision

ERIC Educational Resources Information Center

Hoyle, Julie E.; Mjelde, James W.; Litzenberg, Kerry K.

2006-01-01

DECIDE is a teacher-friendly, integrated approach designed to stimulate learning by allowing students to make decisions about situations they face in their lives while using scientific weather principles. This learning unit integrates weather science, decision theory, mathematics, statistics, geography, and reading in a context of decision…

Decision strategies to reduce teenage and young adult deaths in the United States.

PubMed

Keeney, Ralph L; Palley, Asa B

2013-09-01

This article uses decision analysis concepts and techniques to address an extremely important problem to any family with children, namely, how to avoid the tragic death of a child during the high-risk ages of 15-24. Descriptively, our analysis indicates that of the 35,000 annual deaths among this age group in the United States, approximately 20,000 could be avoided if individuals chose readily available alternatives for decisions relating to these deaths. Prescriptively, we develop a decision framework for parents and a child to both identify and proactively pursue decisions that can lower that child's exposure to life-threatening risks and positively alter decisions when facing such risks. Applying this framework for parents and the youth themselves, we illustrate the logic and process of generating proactive alternatives with numerous examples that each could pursue to lower these life-threatening risks and possibly avoid a tragic premature death, and discuss some public policy implications of our findings. © 2013 Society for Risk Analysis.

Skier triggering of backcountry avalanches with skilled route selection

NASA Astrophysics Data System (ADS)

Sinickas, Alexandra; Haegeli, Pascal; Jamieson, Bruce

2015-04-01

Jamieson (2009) provided numerical estimates for the baseline probabilities of triggering an avalanche by a backcountry skier making fresh tracks without skilled route selection as a function of the North American avalanche danger scale (i.e., hazard levels Low, Moderate, Considerable, High and Extreme). Using the results of an expert survey, he showed that triggering probabilities while skiing directly up, down or across a trigger zone without skilled route selection increase roughly by a factor of 10 with each step of the North American avalanche danger scale (i.e. hazard level). The objective of the present study is to examine the effect of skilled route selection on the relationship between triggering probability and hazard level. To assess the effect of skilled route selection on triggering probability by hazard level, we analysed avalanche hazard assessments as well as reports of skiing activity and triggering of avalanches from 11 Canadian helicopter and snowcat operations during two winters (2012-13 and 2013-14). These reports were submitted to the daily information exchange among Canadian avalanche safety operations, and reflect professional decision-making and route selection practices of guides leading groups of skiers. We selected all skier-controlled or accidentally triggered avalanches with a destructive size greater than size 1 according to the Canadian avalanche size classification, triggered by any member of a guided group (guide or guest). These operations forecast the avalanche hazard daily for each of three elevation bands: alpine, treeline and below treeline. In contrast to the 2009 study, an exposure was defined as a group skiing within any one of the three elevation bands, and consequently within a hazard rating, for the day (~4,300 ratings over two winters). For example, a group that skied below treeline (rated Moderate) and treeline (rated Considerable) in one day, would receive one count for exposure to Moderate hazard, and one count for exposure to Considerable hazard. While the absolute values for triggering probability cannot be compared to the 2009 study because of different definitions of exposure, our preliminary results suggest that with skilled route selection the triggering probability is similar all hazard levels, except for extreme for which there are few exposures. This means that the guiding teams of backcountry skiing operations effectively control the hazard from triggering avalanches with skilled route selection. Groups were exposed relatively evenly to Low hazard (1275 times or 29% of total exposure), Moderate hazard (1450 times or 33 %) and Considerable hazard (1215 times or 28 %). At higher levels, the exposure reduced to roughly 380 times (9 % of total exposure) to High hazard, and only 13 times (0.3 %) to Extreme hazard. We assess the sensitivity of the results to some of our key assumptions.

US Plans for the JEM-EUSO

NASA Technical Reports Server (NTRS)

Adams, James H.

2007-01-01

This viewgraph presentation reviews the planned United States work on the Extreme Universe Space Observatory (EUSO.) The EUSO is to be mounted to the JEM (Japanese Experiment Module). The plans areas for US participation are the Optics Investigations, Trigger Design and Event Reconstruction.

Real-Time System Verification by Kappa-Induction

NASA Technical Reports Server (NTRS)

Pike, Lee S.

2005-01-01

We report the first formal verification of a reintegration protocol for a safety-critical, fault-tolerant, real-time distributed embedded system. A reintegration protocol increases system survivability by allowing a node that has suffered a fault to regain state consistent with the operational nodes. The protocol is verified in the Symbolic Analysis Laboratory (SAL), where bounded model checking and decision procedures are used to verify infinite-state systems by k-induction. The protocol and its environment are modeled as synchronizing timeout automata. Because k-induction is exponential with respect to k, we optimize the formal model to reduce the size of k. Also, the reintegrator's event-triggered behavior is conservatively modeled as time-triggered behavior to further reduce the size of k and to make it invariant to the number of nodes modeled. A corollary is that a clique avoidance property is satisfied.

Mitochondrial Dynamics Impacts Stem Cell Identity and Fate Decisions by Regulating a Nuclear Transcriptional Program.

PubMed

Khacho, Mireille; Clark, Alysen; Svoboda, Devon S; Azzi, Joelle; MacLaurin, Jason G; Meghaizel, Cynthia; Sesaki, Hiromi; Lagace, Diane C; Germain, Marc; Harper, Mary-Ellen; Park, David S; Slack, Ruth S

2016-08-04

Regulated mechanisms of stem cell maintenance are key to preventing stem cell depletion and aging. While mitochondrial morphology plays a fundamental role in tissue development and homeostasis, its role in stem cells remains unknown. Here, we uncover that mitochondrial dynamics regulates stem cell identity, self-renewal, and fate decisions by orchestrating a transcriptional program. Manipulation of mitochondrial structure, through OPA1 or MFN1/2 deletion, impaired neural stem cell (NSC) self-renewal, with consequent age-dependent depletion, neurogenesis defects, and cognitive impairments. Gene expression profiling revealed ectopic expression of the Notch self-renewal inhibitor Botch and premature induction of transcription factors that promote differentiation. Changes in mitochondrial dynamics regulate stem cell fate decisions by driving a physiological reactive oxygen species (ROS)-mediated process, which triggers a dual program to suppress self-renewal and promote differentiation via NRF2-mediated retrograde signaling. These findings reveal mitochondrial dynamics as an upstream regulator of essential mechanisms governing stem cell self-renewal and fate decisions through transcriptional programming. Copyright © 2016 Elsevier Inc. All rights reserved.

When do business units benefit more from collective citizenship behavior of management teams? An upper echelons perspective.

PubMed

Liu, Wu; Gong, Yaping; Liu, Jun

2014-05-01

Drawing upon the notion of managerial discretion from upper echelons theory, we theorize which external contingencies moderate the relationship between collective organizational citizenship behavior (COCB) and unit performance. Focusing on business unit (BU) management teams, we hypothesize that COCB of BU management teams enhances BU performance and that this impact depends on environmental uncertainty and BU management-team decision latitude, 2 determinants of managerial discretion. In particular, the positive effect of COCB is stronger when environmental uncertainty or the BU management-team decision latitude is greater. Time-lagged data from 109 BUs of a telecommunications company support the hypotheses. Additional exploratory analysis shows that the positive moderating effect of environmental uncertainty is further amplified at higher levels of BU management-team decision latitude. Overall, this study extends the internally focused view in the micro OCB literature by introducing external contingencies for the COCB-unit-performance relationship. (c) 2014 APA, all rights reserved.

Disaster Preparedness: Anticipating the Worst Case Scenario Issue Paper Volume 05-05, March 2005

DTIC Science & Technology

2005-03-01

PROFESSOR B.E GRIFFARD, COL (RET.) ART BRAD4sAW; AND DR. KENT HUGnES BUTTs "Volcanic arcs and oceanic trenches partly encircling the Pacific Basin ...2004 Tsunami, triggered by a magnitude 9.0 earth- assists international organizations and other northern Sumatra . countries in sizing appropriate...Kathmandu, the United States Central Command, and the United States Army War College Center for Strategic Leadership. The conference focused on

Reviewing model application to support animal health decision making.

PubMed

Singer, Alexander; Salman, Mo; Thulke, Hans-Hermann

2011-04-01

Animal health is of societal importance as it affects human welfare, and anthropogenic interests shape decision making to assure animal health. Scientific advice to support decision making is manifold. Modelling, as one piece of the scientific toolbox, is appreciated for its ability to describe and structure data, to give insight in complex processes and to predict future outcome. In this paper we study the application of scientific modelling to support practical animal health decisions. We reviewed the 35 animal health related scientific opinions adopted by the Animal Health and Animal Welfare Panel of the European Food Safety Authority (EFSA). Thirteen of these documents were based on the application of models. The review took two viewpoints, the decision maker's need and the modeller's approach. In the reviewed material three types of modelling questions were addressed by four specific model types. The correspondence between tasks and models underpinned the importance of the modelling question in triggering the modelling approach. End point quantifications were the dominating request from decision makers, implying that prediction of risk is a major need. However, due to knowledge gaps corresponding modelling studies often shed away from providing exact numbers. Instead, comparative scenario analyses were performed, furthering the understanding of the decision problem and effects of alternative management options. In conclusion, the most adequate scientific support for decision making - including available modelling capacity - might be expected if the required advice is clearly stated. Copyright © 2011 Elsevier B.V. All rights reserved.

Increasing Access to Palliative Care Services in the Intensive Care Unit.

PubMed

McCarroll, Caitlin Marie

The Institute of Medicine's report, Dying in America, highlights the critical need for the widespread implementation of palliative care to improve end-of-life care. Approximately 20% of all deaths in America occur during or shortly after an intensive care unit (ICU) admission; therefore, it is important for critical care units to have systems in place to facilitate patient access to palliative care services. The aim of this quality improvement (QI) project was to develop and implement a palliative care screening tool using evidence-based triggers to help increase the proportion of palliative care consultations in the ICU setting. A QI project was designed and implemented in a 14-bed medical-surgical ICU in the southeastern United States using the Plan-Do-Study-Act cycle. A palliative care screening tool was developed by an interdisciplinary team of key stakeholders in the ICU using evidence-based triggers, and staff were educated on the intervention. The proportion of ICU patients who received a palliative care consultation was compared preintervention and postintervention to determine whether the QI project contributed to an increased proportion of palliative care consultations. The proportion of palliative care consultations among patients admitted to the ICU by the pulmonary critical care team increased from 1 of 10 preintervention to 3 of 10 postintervention, resulting in a promising increase in patients receiving palliative care services consistent with evidence-based recommendations. The use of an evidence-based screening tool to trigger palliative care consultation in the ICU setting can aid in increasing the proportion of critical care patients who receive a palliative care referral. The increase in the proportion of palliative care referrals by the pulmonary critical care service warrants expansion of the intervention to include additional medical subspecialists who frequently admit patients in this ICU setting. Further assessment of the intervention is warranted to determine whether the screening tool can aid in increasing palliative care consultations for more patients admitted to the hospital's ICU.

The Trigger and Data Acquisition System for the KM3NeT neutrino telescope

NASA Astrophysics Data System (ADS)

Pellegrino, Carmelo; Chiarusi, Tommaso

2016-04-01

KM3NeT is a large research infrastructure in the Mediterranean Sea that includes a network of deep-sea neutrino telescopes. The telescopes consist of vertical detection units carrying optical modules, whose separation is optimised according to the different ranges of neutrino energy that shall be explored. Two building blocks, each one made of 115 detection units, will be deployed at the KM3NeT-IT site, about 80 km from Capo Passero, Italy, to search for high-energy neutrino sources (ARCA); another building block will be installed at the KM3NeT-Fr site, about 40 km from Toulon, France, to study the hierarchy of neutrino masses (ORCA). The modular design of the KM3NeT allows for a progressive implementation and data taking even with an incomplete detector. The same scalable design is used for the Trigger and Data Acquisition Systems (TriDAS). In order to reduce the complexity of the hardware inside the optical modules, the "all data to shore" concept is adopted. This implies that the throughput is dominated by the optical background due to the decay of 40K dissolved in the sea water and to the bursts of bioluminescence, about 3 orders of magnitude larger than the physics signal, ranging from 20 Gbps to several hundreds Gbps, according to the number of detection units. In addition, information from the acoustic positioning system of the detection units must be transmitted. As a consequence of the detector construction, the on-shore DAQ infrastructure must be expanded to handle an increasing data-rate and implement an efficient fast data filtering for both the optical and acoustic channels. In this contribution, the Trigger and Data Acquisition System designed for the Phase 1 of KM3NeT and its future expansion are presented. The network infrastructure, the shore computing resources and the developed applications for handling, filtering and monitoring the optical and acoustic data-streams are described.

The Heat Is On: Decision-Maker Perspectives on When and How to Issue a Heat Warning

NASA Astrophysics Data System (ADS)

O'Neill, M.; Sampson, N.; McCormick, S.; Rood, R. B.; Buxton, M.; Ebi, K. L.; Gronlund, C. J.; Zhang, K.; Catalano, L.; White-Newsome, J. L.; Conlon, K. C.; Parker, E. A.

2011-12-01

To better understand how to prevent illness and deaths during hot weather, particularly among at-risk populations, we conducted a study in Detroit, Michigan; Phoenix, Arizona; New York, New York, and Philadelphia, Pennsylvania. Our aims were to characterize and better understand how heatwave and health early warning systems (HHWS) and related prevention and sustainability programs can be more widely and effectively implemented. Specifically, we here report on the scientific evidence, expert judgments and the process used in deciding to trigger a HHWS and activate public health and social services interventions. We conducted interviews with public officials who decide if and when heat advisories/warnings are issued. After transcribing the interviews, we used a qualitative analysis software, QSR NVivo 9.0, to assign codes to portions of text from each transcript and allow analysis of information with common themes across the data. For example, several sentences in a transcript discussing a heat index might be coded as 'definition of heat wave'. A common theme across cities was that deciding what type of weather is dangerous to health is not straightforward. The time in season that heat occurs; the duration of the heat; the level of humidity and other meteorological factors; the extent to which temperatures drop at night, allowing people to cool off; and prevailing weather conditions all play a role. A single 'safe' threshold is unrealistic because people's individual sensitivity, housing, surrounding environments, behaviors, and access to air conditioning can differ greatly. However, choices must be made as to the trigger for the HHWS. Although quantitative analysis with health data (mortality, hospital admissions) can inform the design of the triggers, historical analysis has limitations, and decisions to issue heat warnings are sometimes related to planned activities, such as parades or fairs, that may expose large numbers of people to heat. The HHWS approach designed by Lawrence Kalkstein and colleagues using synoptic air mass forecasts and mortality data has been used by some cities. Other cities use National Weather Service products that are built on a variety of data inputs and approaches, including calculation of season-specific thresholds. More than one respondent mentioned distaste for 'black box' approaches that were not easily communicated to end-users. The decision to issue a heat warning can save lives, through such activities as opening cooling centers, distributing water to the homeless, and assisting elderly residents. A relatively simple triggering system that is easily understood by the media and public may facilitate more widespread adoption of HHWS. Funding: U.S. Centers for Disease Control and Prevention Grant R18-EH000348

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study.

PubMed

Aladangady, Narendra; Shaw, Chloe; Gallagher, Katie; Stokoe, Elizabeth; Marlow, Neil

2017-03-01

To determine the short-term outcomes of babies for whom clinicians or parents discussed the limitation of life-sustaining treatment (LST). Prospective multicentre observational study. Two level 3, six level 2 and one level 1 neonatal units in the North-East London Neonatal Network. A total of 87 babies including 68 for whom limiting LST was discussed with parents and 19 babies died without discussion of limiting LST in the labour ward or neonatal unit. Final decision reached after discussions about limiting LST and neonatal unit outcomes (death or survived to discharge) for babies. Withdrawing LST, withholding LST and do not resuscitate (DNR) order was discussed with 48, 16 and 4 parents, respectively. In 49/68 (72%) cases decisions occurred in level 3 and 19 cases in level 2 units. Following the initial discussions, 34/68 parents made the decision to continue LST. In 33/68 cases, a second opinion was obtained. The parents of 14/48 and 2/16 babies did not agree to withdraw and withhold LST, respectively. Forty-seven out of 87 babies (54%) died following limitation of LST, 28/87 (32%) died receiving full intensive care support, 5/87 (6%) survived following a decision to limit LST and 7/87 (8%) babies survived following decision to continue LST. A significant proportion of parents chose to continue treatment following discussions regarding limiting LST for their babies, and a proportion of these babies survived to neonatal unit discharge. The long-term outcomes of babies who survive following limiting LST discussion need to be investigated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A meta-ethnography and theory of parental ethical decision making in the neonatal intensive care unit.

PubMed

Rosenthal, Sara A; Nolan, Marie T

2013-07-01

To synthesize the existing qualitative literature about parent ethical decision making in the neonatal intensive care unit (NICU) and to investigate the potential impact of culture on parents' decision making experiences. PubMed, CINAHL plus, and PsychInfo using the search terms parental decision making, culture, race, decision making, and parental decisions. Qualitative research studies investigating decision making for infants in the NICU from the parents' perspective were included. Studies involving older pediatric populations were excluded. Ten primary qualitative research articles were included. The primary author read all manuscripts and tabulated themes related to parents' ethical decision making. Study findings were synthesized using meta-ethnography involving translating concepts of separate studies into one another, exploring contradictions, and organizing these concepts into new theories. Key themes included parent involvement in decision making, parental role, necessity of good information, need for communication, desire for hope and compassion conveyed by providers, decision making satisfaction, and trust in caregiving team. A preliminary theoretical framework of ethical parent decision making was modeled based on the proposed relationships between the themes. Parent preferences for their involvement in decision making, their perceptions of communication with providers, and their relationships with providers are all important factors in the experience of making decisions for their infants. Needs of parents were the same regardless the ethnic or racial diversity of study participants. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

77 FR 5780 - Record of Decision for the White Elk Military Operations Area White Pine and Elko Counties...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-06

... DEPARTMENT OF DEFENSE Department of the Air Force Record of Decision for the White Elk Military... Availability (NOA) of a Record of Decision (ROD). SUMMARY: On November 4, 2011, the United States Air Force... states the Air Force decision to select the Proposed Action to establish the White Elk MOA airspace...

Command Decision-Making: Experience Counts

DTIC Science & Technology

2005-03-18

USAWC STRATEGY RESEARCH PROJECT COMMAND DECISION - MAKING : EXPERIENCE COUNTS by Lieutenant Colonel Kelly A. Wolgast United States Army Colonel Charles...1. REPORT DATE 18 MAR 2005 2. REPORT TYPE 3. DATES COVERED - 4. TITLE AND SUBTITLE Command Decision Making Experience Counts 5a. CONTRACT...Colonel Kelly A. Wolgast TITLE: Command Decision - making : Experience Counts FORMAT: Strategy Research Project DATE: 18 March 2005 PAGES: 30 CLASSIFICATION

Hot Topics: Cities, Energy Use, and Local Energy Decision Making | State,

Science.gov Websites

Making Hot Topics: Cities, Energy Use, and Local Energy Decision Making August 08, 2015 by Alexandra United States, read Alexandra's paper titled City-Level Energy Decision Making: Data Use in Energy Local, and Tribal Governments | NREL Hot Topics: Cities, Energy Use, and Local Energy Decision

Hierarchical analysis of bridge decision makers : the role of new technology adoption in the timber bridge market : special project fiscal year 1992

DOT National Transportation Integrated Search

1995-08-01

Bridge design engineers and local highway officials make bridge replacement decisions across the : United States. The Analytical Hierarchy Process was used to characterize the bridge material selection : decision of these individuals. State Departmen...

An exploration of influences on women’s birthplace decision-making in New Zealand: a mixed methods prospective cohort within the Evaluating Maternity Units study

PubMed Central

2014-01-01

Background There is worldwide debate surrounding the safety and appropriateness of different birthplaces for well women. One of the primary objectives of the Evaluating Maternity Units prospective cohort study was to compare the clinical outcomes for well women, intending to give birth in either an obstetric-led tertiary hospital or a free-standing midwifery-led primary maternity unit. This paper addresses a secondary aim of the study – to describe and explore the influences on women’s birthplace decision-making in New Zealand, which has a publicly funded, midwifery-led continuity of care maternity system. Methods This mixed method study utilised data from the six week postpartum survey and focus groups undertaken in the Christchurch area in New Zealand (2010–2012). Christchurch has a tertiary hospital and four primary maternity units. The survey was completed by 82% of the 702 study participants, who were well, pregnant women booked to give birth in one of these places. All women received midwifery-led continuity of care, regardless of their intended or actual birthplace. Results Almost all the respondents perceived themselves as the main birthplace decision-makers. Accessing a ‘specialist facility’ was the most important factor for the tertiary hospital group. The primary unit group identified several factors, including ‘closeness to home’, ‘ease of access’, the ‘atmosphere’ of the unit and avoidance of ‘unnecessary intervention’ as important. Both groups believed their chosen birthplace was the right and ‘safe’ place for them. The concept of ‘safety’ was integral and based on the participants’ differing perception of safety in childbirth. Conclusions Birthplace is a profoundly important aspect of women’s experience of childbirth. This is the first published study reporting New Zealand women’s perspectives on their birthplace decision-making. The groups’ responses expressed different ideologies about childbirth. The tertiary hospital group identified with the ‘medical model’ of birth, and the primary unit group identified with the ‘midwifery model’ of birth. Research evidence affirming the ‘clinical safety’ of primary units addresses only one aspect of the beliefs influencing women’s birthplace decision-making. In order for more women to give birth at a primary unit other aspects of women’s beliefs need addressing, and much wider socio-political change is required. PMID:24951093

Observing the economy

NASA Astrophysics Data System (ADS)

Rosenbaum, Stan

2009-07-01

In "The (unfortunate) complexity of the economy" (April pp28-32) Jean-Philippe Bouchaud presents clear evidence that traditional assumptions of rational markets have to be abandoned. The old investor slogan "buy on promise, sell on rumour" quickly magnifies a downturn into a crisis, which triggers two questions. If physics-based models are applied (beyond understanding and prediction) to actual market decisions, does this make the economy more or less stable? And, is this cause for stronger regulation?

Knowledge Representation for Decision Making Agents

DTIC Science & Technology

2013-07-15

knowledge map. This knowledge map is a dictionary data structure called tmap in the code. It represents a network of locations with a number [0,1...fillRandom(): Informed initial tmap distribution (randomly generated per node) with belief one. • initialBelief = 3 uses fillCenter(): normal...triggered on AllMyFMsHaveBeenInitialized. 2. Executes main.py • Initializes knowledge map labeled tmap . • Calls initialize search() – resets distanceTot and

Superfund record of decision (EPA Region 3): William Dick Lagoons, West Caln Township, Chester County, PA, March 1993

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

Not Available

1993-03-31

This decision document presents the selected remedial action for Operable Unit 3 of the William Dick Lagoons Site (Site), in West Caln Township, Pennsylvania. The remedy described in this Record of Decision is for Operable Unit 3 at the Site. The remedy selected for Operable Unit 3 will reduce the concentrations of hazardous substances in the Site soils so that leaching of contaminants into the groundwater will be minimized. Reduction of the volatile organic compounds and semi-volatile organic compounds in the soils is necessary in order the groundwater will not continue to be impacted above acceptable levels. In addition, themore » installation of a vegetative soil cover or multi-layer cap will prevent the surrounding community from exposure to Site-related contaminants through inhalation, ingestion, and dermal contact.« less

Exploring the decision-making process in the delivery of physiotherapy in a stroke unit.

PubMed

McGlinchey, Mark P; Davenport, Sally

2015-01-01

The aim of this study was to explore the decision-making process in the delivery of physiotherapy in a stroke unit. A focused ethnographical approach involving semi-structured interviews and observations of clinical practice was used. A purposive sample of seven neurophysiotherapists and four patients participated in semi-structured interviews. From this group, three neurophysiotherapists and four patients were involved in observation of practice. Data from interviews and observations were analysed to generate themes. Three themes were identified: planning the ideal physiotherapy delivery, the reality of physiotherapy delivery and involvement in the decision-making process. Physiotherapists used a variety of clinical reasoning strategies and considered many factors to influence their decision-making in the planning and delivery of physiotherapy post-stroke. These factors included the therapist's clinical experience, patient's presentation and response to therapy, prioritisation, organisational constraints and compliance with organisational practice. All physiotherapists highlighted the importance to involve patients in planning and delivering their physiotherapy. However, there were varying levels of patient involvement observed in this process. The study has generated insight into the reality of decision-making in the planning and delivery of physiotherapy post-stroke. Further research involving other stroke units is required to gain a greater understanding of this aspect of physiotherapy. Implications for Rehabilitation Physiotherapists need to consider multiple patient, therapist and organisational factors when planning and delivering physiotherapy in a stroke unit. Physiotherapists should continually reflect upon how they provide physiotherapy, with respect to the duration, frequency and time of day sessions are delivered, in order to guide current and future physiotherapy delivery. As patients may demonstrate varying levels of participation in deciding and understanding how physiotherapy is delivered, physiotherapists need to adjust how they engage patients in the decision-making process and manage patient expectations accordingly.

Nurses' autonomy in end-of-life situations in intensive care units.

PubMed

Paganini, Maria Cristina; Bousso, Regina Szylit

2015-11-01

The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude that inserts them into the decision-making process. © The Author(s) 2014.

Provision of healthy toilet for low income community based on community empowerment in Kelurahan Kebonsari, Surabaya City, towards Indonesia open defecation free (ODF) in 2019

NASA Astrophysics Data System (ADS)

Soedjono, Eddy Setiadi; Fitriani, Nurina; Yuniarto, Adhi; Wijaya, I. Made Wahyu

2017-11-01

One of the causes of open defecation (OD) is low awareness of local community towards open defecation free behavior. This community does not have a healthy toilet and usually defecate in the river. This poor environment is coupled with poverty and small footprint. Therefore, the tr.iggering methods should be modified by including the finance concept in form of stimulant funds to accelerate ODF targets by using appropriate technology for land limitations. The construction of healthy toilet in Kelurahan Kebonsari, Jambangan sub-district, was conducted in RW2 which consisted of RT 6 (4 units) and RT 7 (1 unit) and 2 units in RT 2 of RW 3. Construction was initiated with focus group discussion and indepth interview to locate the proper location to be triggered. Healthy toilet construction was conducted in cooperation among self-help community, Institut Teknologi Sepuluh Nopember (ITS), and the community itself. Every month the users had to pay the toilet construction (capacity of 0.75 m3) of IDR 100,000 for 10 months. Therefore, with this healthy toilet construction, KelurahanKebonsari becomes one of ODF village in Surabaya City.

Mapping plant invadedness in watersheds across the continental United States

EPA Science Inventory

Exotic aquatic plant invasions trigger a cascade of negative effects, resulting in altered structure and function of freshwater ecosystems, loss of native biodiversity, and reduction of valuable ecosystem services such as recreation and water quality. The problem of biological in...

The Role of Psychological Adjustment in the Decision-making Process for Voluntary Termination of Pregnancy

PubMed Central

Sereno, Sara; Leal, Isabel; Maroco, João

2013-01-01

Background This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. Methods In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. Results The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. Conclusion Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions. PMID:24163799

Modeling Operations Other Than War: Non-Combatants in Combat Modeling

DTIC Science & Technology

1994-09-01

supposition that non-combatants are an essential feature in OOTW. The model proposal includes a methodology for civilian unit decision making . The model...combatants are an essential feature in OOTW. The model proposal includes a methodology for civilian unit decision making . Thi- model also includes...numerical example demonstrated that the model appeared to perform in an acceptable manner, in that it produced output within a reasonable range. During the

Choosing a Field: How Graduate Student Choices of Field Sites Reflect Different Ideas of "Real" Anthropology in Colombia and the United States

ERIC Educational Resources Information Center

Macia, Laura

2012-01-01

This paper examines the decisions and motivations of graduate students in cultural anthropology when defining the field sites and topics of their final projects. The decisions among students at the Universidad de los Andes in Colombia are contrasted with those at the University of Pittsburgh in the United States. A review of recent final projects…

What Predicts Whether Foreign Doctorate Recipients from U.S. Institutions Stay in the United States: Foreign Doctorate Recipients in Science and Engineering Fields from 2000 to 2010

ERIC Educational Resources Information Center

Roh, Jin-Young

2015-01-01

Using data from the Survey of Earned Doctorates by the National Science Foundation, this study examines factors influencing foreign doctorate recipients' decisions to stay in the United States after they complete their degrees. This study expands the existing literature on human capital theory on migration decision by exploring the variables that…

Narrowing the Achievement Gap in a (Re) Segregated Urban School District: Research, Policy and Practice. The Achievement Gap, Research, Practice, and Policy

ERIC Educational Resources Information Center

Ikpa, Vivian W.; McGuire, C. Kent

2009-01-01

The interplay between sociopolitical forces and economic agendas becomes apparent when one examines the June 28, 2007 United States Supreme Court Decision, Parents Involved In Community Schools v. Seattle School District . In a reversal of the 1954 Brown Decision, the United States Supreme Court ruled that public schools could not use race as a…

The Impact of a Hybrid Sport Education-Invasion Games Competence Model Soccer Unit on Students' Decision Making, Skill Execution and Overall Game Performance

ERIC Educational Resources Information Center

Mesquita, Isabel; Farias, Claudio; Hastie, Peter

2012-01-01

The purpose of this study was to examine the impact of a hybrid Sport Education-Invasion Games Competence Model (SE-IGCM) unit application on students' improvements in decision making, skill execution and overall game performance, during a soccer season. Twenty-six fifth-grade students from a Portuguese public elementary school participated in a…

Basic concepts and architectural details of the Delphi trigger system

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

Bocci, V.; Booth, P.S.L.; Bozzo, M.

1995-08-01

Delphi (DEtector with Lepton, Photon and Hadron Identification) is one of the four experiments of the LEP (Large Electron Positron) collider at CERN. The detector is laid out to provide a nearly 4 {pi} coverage for charged particle tracking, electromagnetic, hadronic calorimetry and extended particle identification. The trigger system consists of four levels. The first two are synchronous with the BCO (Beam Cross Over) and rely on hardwired control units, while the last two are performed asynchronously with respect to the BCO and are driven by the Delphi host computers. The aim of this paper is to give a comprehensivemore » global view of the trigger system architecture, presenting in detail the first two levels, their various hardware components and the latest modifications introduced in order to improve their performance and make more user friendly the whole software user interface.« less

Design of a ``Digital Atlas Vme Electronics'' (DAVE) module

NASA Astrophysics Data System (ADS)

Goodrick, M.; Robinson, D.; Shaw, R.; Postranecky, M.; Warren, M.

2012-01-01

ATLAS-SCT has developed a new ATLAS trigger card, 'Digital Atlas Vme Electronics' (``DAVE''). The unit is designed to provide a versatile array of interface and logic resources, including a large FPGA. It interfaces to both VME bus and USB hosts. DAVE aims to provide exact ATLAS CTP (ATLAS Central Trigger Processor) functionality, with random trigger, simple and complex deadtime, ECR (Event Counter Reset), BCR (Bunch Counter Reset) etc. being generated to give exactly the same conditions in standalone running as experienced in combined runs. DAVE provides additional hardware and a large amount of free firmware resource to allow users to add or change functionality. The combination of the large number of individually programmable inputs and outputs in various formats, with very large external RAM and other components all connected to the FPGA, also makes DAVE a powerful and versatile FPGA utility card.

The buck stops here: midwives and maternity care in rural Scotland.

PubMed

Harris, Fiona M; van Teijlingen, Edwin; Hundley, Vanora; Farmer, Jane; Bryers, Helen; Caldow, Jan; Ireland, Jillian; Kiger, Alice; Tucker, Janet

2011-06-01

To explore and understand what it means to provide midwifery care in remote and rural Scotland. Qualitative interviews with 72 staff from 10 maternity units, analysed via a case study approach. Remote and rural areas of Scotland. Predominantly midwives, with some additional interviews with paramedics, general surgeons, anaesthetists and GPs. Remote and rural maternity care includes a range of settings and models of care. However, the impact of rural geographies on decision-making and risk assessment is common to all settings. Making decisions and dealing with the implications of these decisions is, in many cases, done without onsite specialist support. This has implications for the skills and competencies that are needed to practice midwifery in remote and rural settings. Whereas most rural midwives reported that their skills in risk assessment and decisions to transfer were well developed and appropriate to practising in their particular settings, they perceived these decisions to be under scrutiny by urban-based colleagues and felt the need to stress their competence in the face of what they imagined to be stereotypes of rural incompetence. This study shows that skills in risk assessment and decision-making are central to high quality remote and rural midwifery care. However, linked to different perspectives on care, there is a risk that these skills can be undermined by contact with colleagues in large urban units, particularly when staff do not know each other well. There is a need to develop a professional understanding between midwives in different locations. It is important for the good working relationships between urban and rural maternity units that all midwives understand the importance of contextual knowledge in both decisions to transfer from rural locations and the position of midwives in receiving units. Multiprofessional CPD courses have been effective in bringing together teams around obstetric emergencies; we suggest that a similar format may be required in considering issues of transfer. Copyright © 2010 Elsevier Ltd. All rights reserved.

E-Estuary: Developing a Decision Support System for Coastal Management in the Conterminous United States (IAHR)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

The More We Change....

ERIC Educational Resources Information Center

Sewall, Angela M.; Witcher, Ann E.

This report provides an overview of the struggle to desegregate schools in the United States. It describes the two phases of desegregation, focusing on court decisions that influenced desegregation and how these decisions changed the composition of the schools. It opens with the 1849 decision that asserted that desegregation was for the good of…

Recent Church-State Litigation.

ERIC Educational Resources Information Center

Bryson, Joseph E.

After a brief synopsis of the 1974 legal activity centering on the church-state relationship, the speaker examines three particular cases: the United States Supreme Court decision in Wheeler v. Barrera, a Missouri district court decision in Luetkemeyer v. Kaufmann, and the Supreme Court decision in Franchise Tax Board of California v. United…

39 CFR 963.20 - Final agency decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Final agency decision. 963.20 Section 963.20 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF PRACTICE IN PROCEEDINGS RELATIVE TO VIOLATIONS OF THE PANDERING ADVERTISEMENTS STATUTE, 39 U.S.C. 3008 § 963.20 Final agency decision. The...

39 CFR 963.18 - Initial decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Initial decision. 963.18 Section 963.18 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF PRACTICE IN PROCEEDINGS RELATIVE TO VIOLATIONS OF THE PANDERING ADVERTISEMENTS STATUTE, 39 U.S.C. 3008 § 963.18 Initial decision. Unless given orally at...

20 CFR 361.7 - Written decision following a hearing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... RECOVERY OF DEBTS OWED TO THE UNITED STATES GOVERNMENT BY GOVERNMENT EMPLOYEES § 361.7 Written decision... shall issue a written decision stating the facts evidencing the nature and origin of the alleged debt; the amount and validity of the alleged debt; and the judge or hearing official's analysis, findings...

78 FR 74225 - Decision That Certain Nonconforming Motor Vehicles Are Eligible for Importation

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-10

...-0136] Decision That Certain Nonconforming Motor Vehicles Are Eligible for Importation AGENCY: National... decisions by NHTSA that certain motor vehicles not originally manufactured to comply with all applicable Federal Motor Vehicle Safety Standards (FMVSS) are eligible for importation into the United States because...

Hazelwood Decision: The Complete Text of the Jan. 13 U.S. Supreme Court 5-3 Decision.

ERIC Educational Resources Information Center

Quill and Scroll, 1988

1988-01-01

Reprints the complete text of the January 13, 1988 United States Supreme Court decision on Hazelwood School District versus Kuhlmeier, which concerns educators' editorial control over the content of a high school newspaper produced as part of a school's journalism curriculum. (MS)

31 CFR 560.510 - Transactions related to the resolution of disputes between the United States or United States...

Code of Federal Regulations, 2012 CFR

2012-07-01

... of disputes between the United States or United States nationals and the Government of Iran. 560.510... between the United States or United States nationals and the Government of Iran. (a) Except as otherwise... with awards, decisions or orders of the Iran-United States Claims Tribunal in The Hague, the...

31 CFR 560.510 - Transactions related to the resolution of disputes between the United States or United States...

Code of Federal Regulations, 2010 CFR

2010-07-01

... resolution of disputes between the United States or United States nationals and the Government of Iran. 560... between the United States or United States nationals and the Government of Iran. (a) Except as otherwise... with awards, decisions or orders of the Iran-United States Claims Tribunal in The Hague, the...

Paediatric cerebrovascular CT angiography-towards better image quality.

PubMed

Thust, Stefanie C; Chong, Wui Khean Kling; Gunny, Roxana; Mazumder, Asif; Poitelea, Marius; Welsh, Anna; Ederies, Ash; Mankad, Kshitij

2014-12-01

Paediatric cerebrovascular CT angiography (CTA) can be challenging to perform due to variable cardiovascular physiology between different age groups and the risk of movement artefact. This analysis aimed to determine what proportion of CTA at our institution was of diagnostic quality and identify technical factors which could be improved. a retrospective analysis of 20 cases was performed at a national paediatric neurovascular centre assessing image quality with a subjective scoring system and Hounsfield Unit (HU) measurements. Demographic data, contrast dose, flow rate and triggering times were recorded for each patient. Using a qualitative scoring system, 75% of studies were found to be of diagnostic quality (n=9 'good', n=6 'satisfactory') and 25% (n=5) were 'poor'. Those judged subjectively to be poor had arterial contrast density measured at less than 250 HU. Increased arterial opacification was achieved for cases performed with an increased flow rate (2.5-4 mL/s) and higher intravenous contrast dose (2 mL/kg). Triggering was found to be well timed in nine cases, early in four cases and late in seven cases. Of the scans triggered early, 75% were poor. Of the scans triggered late, less (29%) were poor. High flow rates (>2.5 mL/s) were a key factor for achieving high quality paediatric cerebrovascular CTA imaging. However, appropriate triggering by starting the scan immediately on contrast opacification of the monitoring vessel plays an important role and could maintain image quality when flow rates were lower. Early triggering appeared more detrimental than late.

Magnesium-based photocathodes for triggering back-lighted thyratrons

NASA Astrophysics Data System (ADS)

Sozer, Esin B.

This dissertation presents experimental studies of application of magnesium-based photocathodes to optically triggered pseudospark switches, called back-lighted thyratrons (BLTs). Magnesium was chosen as a low work function metal photocathode for its potential to increase triggering performance of the switch with a higher photoemission performance than traditional BLT cathodes. Improvement in triggering performance of plasma switches is of interest for device development of compact pulsed power systems where the size of switching units can limit the overall size and the mobility of the system. Experiments were conducted on photoemission performance of photocathode candidates under BLT-relevant conditions; and delay and jitter performance of a BLT with photocathode candidates with changing helium pressure and switch voltages. A review of photocathode literature showed that Mg and Cu are the most promising candidates for increasing the photoemission during the triggering of BLTs. As a commonly used BLT cathode in the switch literature, Mo was chosen together with Mg and Cu to be tested under BLT-relevant pressure and field conditions. Quantum efficiency measurements of high-purity foils of Mg, Cu and Mo showed a superior performance of Mg and Cu over Mo. Mg had the highest quantum efficiency of 1.5 x 10-5 among all three materials. After photoemission measurements in a test bed were concluded, testing of these cathodes for their switching performance was done in two stages. First, an unfocused UV laser beam (8.5 x 106 W/cm 2) with a wavelength of 266 nm was used for delay measurements of a BLT with Mg, Cu and Mo-based cathodes. Mg-based cathodes showed at least a thirty-fold reduction in delay and jitter compared to Cu-based and at least an eighty-fold reduction in delay and jitter compared to Mo-based cathodes at any given helium pressure and switch voltage pair. Subsequently, a partial focusing of the same light source was utilized (7.4 x 107W/cm 2) for delay measurements of a BLT with copper electrodes at constant switch voltage and changing helium pressure before and after integration of a Mg foil. These measurements showed an order of magnitude shorter delay and jitter throughout the pressure range when the high-purity Mg-foil was present at the switch cathode. Theoretical estimations of electron emission from the cathode during the triggering suggested that the main mechanism responsible for the observed change in delay and jitter was the increased photoemission due to the lower work function of the Mg cathode and that the effect of temperature on triggering is negligible. SEM images of the high-purity Mg foil integrated at the BLT cathode for 106 shots showed signs of melting around the bore hole. No degradation of the switch performance was observed for the duration of 10 6 shots. In conclusion, magnesium-based cathodes for BLTs showed an important potential for small triggering units for optical triggering, especially when the intensity of the optical source is limited. A future work involving plasma simulations is suggested for assessing potential of different cathode/optical source pairs for triggering BLTs.

Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios

PubMed Central

2010-01-01

Introduction Evidence suggests that dying patients' physical and emotional suffering is inadequately treated in intensive care units. Although there are recommendations regarding decisions to forgo life-sustaining therapy, deciding on withdrawal of life support is difficult, and it is also difficult to decide who should participate in this decision. Methods We distributed a self-administered questionnaire in 13 adult intensive care units (ICUs) assessing the attitudes of physicians and nurses regarding end-of-life decisions. Family members from a medical-surgical ICU in a tertiary cancer hospital were also invited to participate. Questions were related to two hypothetical clinical scenarios, one with a competent patient and the other with an incompetent patient, asking whether the ventilator treatment should be withdrawn and about who should make this decision. Results Physicians (155) and nurses (204) of 12 ICUs agreed to take part in this study, along with 300 family members. The vast majority of families (78.6%), physicians (74.8%) and nurses (75%) want to discuss end-of-life decisions with competent patients. Most of the physicians and nurses desire family involvement in end-of-life decisions. Physicians are more likely to propose withdrawal of the ventilator with competent patients than with incompetent patients (74.8% × 60.7%, P = 0.028). When the patient was incompetent, physicians (34.8%) were significantly less prone than nurses (23.0%) and families (14.7%) to propose decisions regarding withdrawal of the ventilator support (P < 0.001). Conclusions Physicians, nurses and families recommended limiting life-support therapy with terminally ill patients and favored family participation. In decisions concerning an incompetent patient, physicians were more likely to maintain the therapy. PMID:21190560

Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios.

PubMed

Fumis, Renata R L; Deheinzelin, Daniel

2010-01-01

Evidence suggests that dying patients' physical and emotional suffering is inadequately treated in intensive care units. Although there are recommendations regarding decisions to forgo life-sustaining therapy, deciding on withdrawal of life support is difficult, and it is also difficult to decide who should participate in this decision. We distributed a self-administered questionnaire in 13 adult intensive care units (ICUs) assessing the attitudes of physicians and nurses regarding end-of-life decisions. Family members from a medical-surgical ICU in a tertiary cancer hospital were also invited to participate. Questions were related to two hypothetical clinical scenarios, one with a competent patient and the other with an incompetent patient, asking whether the ventilator treatment should be withdrawn and about who should make this decision. Physicians (155) and nurses (204) of 12 ICUs agreed to take part in this study, along with 300 family members. The vast majority of families (78.6%), physicians (74.8%) and nurses (75%) want to discuss end-of-life decisions with competent patients. Most of the physicians and nurses desire family involvement in end-of-life decisions. Physicians are more likely to propose withdrawal of the ventilator with competent patients than with incompetent patients (74.8% × 60.7%, P = 0.028). When the patient was incompetent, physicians (34.8%) were significantly less prone than nurses (23.0%) and families (14.7%) to propose decisions regarding withdrawal of the ventilator support (P < 0.001). Physicians, nurses and families recommended limiting life-support therapy with terminally ill patients and favored family participation. In decisions concerning an incompetent patient, physicians were more likely to maintain the therapy.

Effects of reflection on clinical decision-making of intensive care unit nurses.

PubMed

Razieh, Shahrokhi; Somayeh, Ghafari; Fariba, Haghani

2018-07-01

Nurses are one of the most influential factors in overcoming the main challenges faced by health systems throughout the world. Every health system should, hence, empower nurses in clinical judgment and decision-making skills. This study evaluated the effects of implementing Tanner's reflection method on clinical decision-making of nurses working in an intensive care unit (ICU). This study used an experimental, pretest, posttest design. The setting was the intensive care unit of Amin Hospital Isfahan, Iran. The convenience sample included 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). This clinical trial was performed on 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). The nurses were selected by census sampling and randomly allocated to either the case or the control group. Data were collected using a questionnaire containing demographic characteristics and the clinical decision-making scale developed by Laurie and Salantera (NDMI-14). The questionnaire was completed before and one week after the intervention. The data were analyzed using SPSS 21.0. The two groups were not significantly different in terms of the level and mean scores of clinical decision-making before the intervention (P = 0.786). Based on the results of independent t-test, the mean score of clinical decision-making one week after the intervention was significantly higher in the case group than in the control group (P = 0.009; t = -2.69). The results of Mann Whitney test showed that one week after the intervention, the nurses' level of clinical decision-making in the case group rose to the next level (P = 0.001). Reflection could improve the clinical decision-making of ICU nurses. It is, thus, recommended to incorporate this method into the nursing curriculum and care practices. Copyright © 2018. Published by Elsevier Ltd.

Superfund record of decision (EPA Region 5): Skinner Landfill, West Chester, OH, June 1993

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

Not Available

1993-06-04

The decision document presents the selected final remedial action for the Skinner Landfill site in West Chester, Ohio. The remedy is the second and final of two operable units for this site. The first operable unit addressed immediate site concerns, through the construction of a fence around the contaminated area, and by offering an alternate supply of drinking water to the potentially affected users of groundwater. This final operable unit addresses potential future migration of site contaminants into the groundwater and will limit the potential for direct exposure of site contaminants to humans through source control measures.

An information system to improve financial management, resource allocation and activity planning: evaluation results.

PubMed

Ruland, C M; Ravn, I H

2001-01-01

An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals. To evaluate CLASSICA, a Decision Support System (DSS), that assists nurse managers in financial management, resource allocation, staffing, and activity planning. Using a pre-post test design with control units, CLASSICA was evaluated in four test units. Baseline data and simultaneous parallel measures were collected prior to system implementation at test sites and control units. Using expense reports, staffing and financial statistics, surveys, interviews with nurse managers, and logs as data sources, CLASSICA was evaluated on: cost reduction, quality of management information; usefulness as decision support for improved financial management and decision-making; user satisfaction; and ease of use. Evaluation results showed a 41% reduction in expenditures for overtime and extra hours as compared to a 1.8% reduction in control units during the same time period. Users reported a significant improvement in management information; nurse managers stated that they had gained control over costs. The system helped them analyze the relationships between patient activity staffing, and cost of care. Users reported high satisfaction with the system, the information and decision support it provided, and its ease of use. These results suggest that CLASSICA is a DSS that successfully assists nurse managers in cost effective management of their units.

Corrective Action Decision Document for Corrective Action Unit 340: Pesticide Release sites, Nevada Test Site, Nevada

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

DOE /NV

This Corrective Action Decision Document has been prepared for Corrective Action Unit 340, the NTS Pesticide Release Sites, in accordance with the Federal Facility Agreement and Consent Order of 1996 (FFACO, 1996). Corrective Action Unit 340 is located at the Nevada Test Site, Nevada, and is comprised of the following Corrective Action Sites: 23-21-01, Area 23 Quonset Hut 800 Pesticide Release Ditch; 23-18-03, Area 23 Skid Huts Pesticide Storage; and 15-18-02, Area 15 Quonset Hut 15-11 Pesticide Storage. The purpose of this Corrective Action Decision Document is to identify and provide a rationale for the selection of a recommended correctivemore » action alternative for each Corrective Action Site. The scope of this Corrective Action Decision Document consists of the following tasks: Develop corrective action objectives; Identify corrective action alternative screening criteria; Develop corrective action alternatives; Perform detailed and comparative evaluations of the corrective action alternatives in relation to the corrective action objectives and screening criteria; and Recommend and justify a preferred corrective action alternative for each Corrective Action Site.« less

Life-sustaining treatment decisions in Portuguese intensive care units: a national survey of intensive care physicians.

PubMed

Cardoso, Teresa; Fonseca, Teresa; Pereira, Sofia; Lencastre, Luís

2003-12-01

The objective of the present study was to evaluate the opinion of Portuguese intensive care physicians regarding 'do-not-resuscitate' (DNR) orders and decisions to withhold/withdraw treatment. A questionnaire was sent to all physicians working on a full-time basis in all intensive care units (ICUs) registered with the Portuguese Intensive Care Society. A total of 266 questionnaires were sent and 175 (66%) were returned. Physicians from 79% of the ICUs participated. All participants stated that DNR orders are applied in their units, and 98.3% stated that decisions to withhold treatment and 95.4% stated that decisions to withdraw treatment are also applied. About three quarters indicated that only the medical group makes these decisions. Fewer than 15% of the responders stated that they involve nurses, 9% involve patients and fewer than 11% involve patients' relatives in end-of-life decisions. Physicians with more than 10 years of clinical experience more frequently indicated that they involve nurses in these decisions (P < 0.05), and agnostic/atheist doctors more frequently involve patients' relatives in decisions to withhold/withdraw treatment (P < 0.05). When asked about who they thought should be involved, more than 26% indicated nurses, more than 35% indicated the patient and more than 25% indicated patients' relatives. More experienced doctors more frequently felt that nurses should be involved (P < 0.05), and male doctors more frequently stated that patients' relatives should be involved in DNR orders (P < 0.05). When a decision to withdraw treatment is made, 76.8% of 151 respondents indicated that they would initiate palliative care; no respondent indicated that they would administer drugs to accelerate the expected outcome. The probability of survival from the acute episode and patients' wishes were the most important criteria influencing end-of-life decisions. These decisions are made only by the medical group in most of the responding ICUs, with little input from nursing staff, patients, or patients' relatives, although many respondents expressed a wish to involve them more in this process. Sex, experience and religious beliefs of the respondents influences the way in which these decisions are made.

Intraoperative transfusion practices in Europe

PubMed Central

Meier, J.; Filipescu, D.; Kozek-Langenecker, S.; Llau Pitarch, J.; Mallett, S.; Martus, P.; Matot, I.

2016-01-01

Background. Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl−1 and increased to 9.8 (1.8) g dl−1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusion. Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7–9 g dl−1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. Clinical trial registration. NCT 01604083. PMID:26787795

Intraoperative transfusion practices in Europe.

PubMed

Meier, J; Filipescu, D; Kozek-Langenecker, S; Llau Pitarch, J; Mallett, S; Martus, P; Matot, I

2016-02-01

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. NCT 01604083. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

Vulnerability of waterborne diseases to climate change in Canada: a review.

PubMed

Charron, Dominique; Thomas, M; Waltner-Toews, David; Aramini, Jeffery; Edge, Tom; Kent, Robert; Maarouf, Abdel; Wilson, Jeff

This project addresses two important issues relevant to the health of Canadians: the risk of waterborne illness and the health impacts of global climate change. The Canadian health burden from waterborne illness is unknown, although it presumably accounts for a significant proportion of enteric illness. Recently, large outbreaks with severe consequences produced by E. coli O157:H7 and Cryptosporidium have alarmed Canadians and brought demands for political action. A concurrent need to understand the health impacts of global climate changes and to develop strategies to prevent or prepare for these has also been recognized. There is mounting evidence that weather is often a factor in triggering waterborne disease outbreaks. A recent study of precipitation and waterborne illness in the United States found that more than half the waterborne disease outbreaks in the United States during the last half century followed a period of extreme rainfall. Projections of international global climate change scenarios suggest that, under conditions of global warming most of Canada may expect longer summers, milder winters, increased summer drought, and more extreme precipitation. Excess precipitation, floods, high temperatures, and drought could affect the risk of waterborne illness in Canada. The existing scientific information regarding most weather-related adverse health impacts and on the impacts of global climate change on health in Canada is insufficient for informed decision making. The results of this project address this need through the investigation of the complex systemic interrelationships between disease incidence, weather parameters, and water quality and quantity, and by projecting the potential impact of global climate change on those relationships.

Validation of the Intensive Care Unit Early Warning Dashboard: Quality Improvement Utilizing a Retrospective Case-Control Evaluation.

PubMed

Kavanaugh, Michael J; So, Joanne D; Park, Peter J; Davis, Konrad L

2017-02-01

Risk stratification with the Modified Early Warning System (MEWS) or electronic cardiac arrest trigger (eCART) has been utilized with ward patients to preemptively identify high-risk patients who might benefit from enhanced monitoring, including early intensive care unit (ICU) transfer. In-hospital mortality from cardiac arrest is ∼80%, making preventative interventions an important focus area. ICUs have lower patient to nurse ratios than wards, resulting in less emphasis on the development of ICU early warning systems. Our institution developed an early warning dashboard (EWD) identifying patients who may benefit from earlier interventions. Using the adverse outcomes of cardiac arrest, ICU mortality, and ICU readmissions, a retrospective case-control study was performed using three demographic items (age, diabetes, and morbid obesity) and 24 EWD measured items, including vital signs, laboratory values, ventilator information, and other clinical information, to validate the EWD. Ten statistically significant areas were identified for cardiac arrest and 13 for ICU death. Identified items included heart rate, dialysis, leukocytosis, and lactate. The ICU readmission outcome was compared to controls from both ICU patients and ward patients, and statistical significance was identified for respiratory rate >30. With several statistically significant data elements, the EWD parameters have been incorporated into advanced clinical decision algorithms to identify at-risk ICU patients. Earlier identification and treatment of organ failure in the ICU improve outcomes and the EWD can serve as a safety measure for both at-risk in-house patients and also extend critical care expertise through telemedicine to smaller hospitals.

C-A4-01: Computerized Clinical Decision Support During Drug Ordering for Long-term Care Residents With Renal Insufficiency

PubMed Central

Field, Terry S; Rochon, Paula; Lee, Monica; Gavendo, Linda; Baril, Joann L; Gurwitz, Jerry H

2010-01-01

Objective: To determine whether a computerized clinical decision support system (CDSS) providing patient specific recommendations in real- time improves the quality of prescribing for long-term care residents with renal insufficiency. Design: A randomized trial within the long-stay units of a large long-term care facility. Randomization was within blocks by unit type. Alerts related to medication prescribing for residents with renal insufficiency were displayed to prescribers in the intervention units and hidden but tracked in control units. Measurement: The proportions of final drug orders that were appropriate were compared between intervention and control units within alert categories: recommended medication doses; recommended administration frequencies; recommendations to avoid the drug; 4) warnings of missing information. Results: The rates of alerts were nearly equal in the intervention and control units: 2.5 per 1000 resident days in the intervention units and 2.4 in the control units. The proportions of dose alerts for which the final drug orders were appropriate were similar between the intervention and control units (relative risk 0.95, 95% confidence interval 0.83, 1.1). For the remaining alert categories significantly higher proportions of final drug orders were appropriate in the intervention units: relative risk 2.4 for maximum frequency (1.4, 4.4); 2.6 for drugs that should be avoided (1.4, 5.0); and 1.8 for alerts to acquire missing information (1.1, 3.4). Overall, final drug orders were appropriate significantly more often than a relative risk 1.2 (1.0, 1.4). By tracking personnel time and expenditures, we estimated the cost of developing the CDSS as $48,668.57. Drug costs saved during the 12 months of the trial are estimated at $2,137. Conclusion: Clinical decision support for physicians prescribing medications for long-term care residents with renal insufficiency can improve the quality of prescribing decisions. However, patient well-being and quality of care rather than the business case related to cost savings are likely to be the key drivers for adoption of this HIT application.

Improved representation of situational awareness within a dismounted small combat unit constructive simulation

NASA Astrophysics Data System (ADS)

Lee, K. David; Colony, Mike

2011-06-01

Modeling and simulation has been established as a cost-effective means of supporting the development of requirements, exploring doctrinal alternatives, assessing system performance, and performing design trade-off analysis. The Army's constructive simulation for the evaluation of equipment effectiveness in small combat unit operations is currently limited to representation of situation awareness without inclusion of the many uncertainties associated with real world combat environments. The goal of this research is to provide an ability to model situation awareness and decision process uncertainties in order to improve evaluation of the impact of battlefield equipment on ground soldier and small combat unit decision processes. Our Army Probabilistic Inference and Decision Engine (Army-PRIDE) system provides this required uncertainty modeling through the application of two critical techniques that allow Bayesian network technology to be applied to real-time applications. (Object-Oriented Bayesian Network methodology and Object-Oriented Inference technique). In this research, we implement decision process and situation awareness models for a reference scenario using Army-PRIDE and demonstrate its ability to model a variety of uncertainty elements, including: confidence of source, information completeness, and information loss. We also demonstrate that Army-PRIDE improves the realism of the current constructive simulation's decision processes through Monte Carlo simulation.

Airport metal detector activation is rare after posterior spinal fusion in children with scoliosis.

PubMed

Fabricant, Peter D; Robles, Alex; Blanco, John S

2013-12-01

Since the September 11, 2001 terrorist attacks on the World Trade Center in New York City, travel security has become an ever-increasing priority in the United States. Frequent parent and patient inquiry and recent literature reports have generated interest in the impact of heightened security measures on patients with orthopaedic implants, and have indicated increasing rates of metal detector triggering. There are no reports to date, however, evaluating children and adolescents who have undergone posterior spinal fusion for scoliosis, so responses to patient and parent inquiries are not data-driven. The purpose of this study is to determine the frequency of airport metal detector triggering by patients who have had posterior-only spinal fusion and to characterise any potential predictors of metal detector activation. A cross-sectional study was performed by interviewing 90 patients who underwent posterior-only spinal fusion for a diagnosis of juvenile or adolescent idiopathic scoliosis and have travelled by air in the past year. Demographic, clinical and surgical instrumentation data were collected and evaluated, along with patients' reports of airport metal detector triggering and subsequent screening procedures. Five patients with stainless steel instrumentation (5.6 % of the cohort) triggered an airport walkthrough metal detector, and an additional five patients who did not trigger an airport detector triggered a handheld detector at a different venue. All patients who triggered an airport metal detector had stainless steel instrumentation implanted prior to 2008, and no patient with titanium instrumentation triggered any detector in any venue. All trigger events required subsequent screening procedures, even when an implant card was presented. In this cohort of children and adolescents with posterior spinal instrumentation, airport walkthrough metal detector triggering was a rare event. Therefore, we advise patients and families with planned posterior scoliosis fusions using titanium instrumentation that airport detection risk is essentially non-existent, and only rare for those with planned stainless steel instrumentation. We no longer issue implant cards postoperatively, as these did not prevent further screening procedures in this cohort. Prognostic level 2. cross-sectional.

Survival and Death Strategies in Glioma Cells: Autophagy, Senescence and Apoptosis Triggered by a Single Type of Temozolomide-Induced DNA Damage

PubMed Central

Knizhnik, Anna V.; Roos, Wynand P.; Nikolova, Teodora; Quiros, Steve; Tomaszowski, Karl-Heinz; Christmann, Markus; Kaina, Bernd

2013-01-01

Apoptosis, autophagy, necrosis and cellular senescence are key responses of cells that were exposed to genotoxicants. The types of DNA damage triggering these responses and their interrelationship are largely unknown. Here we studied these responses in glioma cells treated with the methylating agent temozolomide (TMZ), which is a first-line chemotherapeutic for this malignancy. We show that upon TMZ treatment cells undergo autophagy, senescence and apoptosis in a specific time-dependent manner. Necrosis was only marginally induced. All these effects were completely abrogated in isogenic glioma cells expressing O6-methylguanine-DNA methyltransferase (MGMT), indicating that a single type of DNA lesion, O6-methylguanine (O6MeG), is able to trigger all these responses. Studies with mismatch repair mutants and MSH6, Rad51 and ATM knockdowns revealed that autophagy induced by O6MeG requires mismatch repair and ATM, and is counteracted by homologous recombination. We further show that autophagy, which precedes apoptosis, is a survival mechanism as its inhibition greatly ameliorated the level of apoptosis following TMZ at therapeutically relevant doses (<100 µM). Cellular senescence increases with post-exposure time and, similar to autophagy, precedes apoptosis. If autophagy was abrogated, TMZ-induced senescence was reduced. Therefore, we propose that autophagy triggered by O6MeG adducts is a survival mechanism that stimulates cells to undergo senescence rather than apoptosis. Overall, the data revealed that a specific DNA adduct, O6MeG, has the capability of triggering autophagy, senescence and apoptosis and that the decision between survival and death is determined by the balance of players involved. The data also suggests that inhibition of autophagy may ameliorate the therapeutic outcome of TMZ-based cancer therapy. PMID:23383259

Beyond the central pattern generator: amine modulation of decision-making neural pathways descending from the brain of the medicinal leech.

PubMed

Crisp, Kevin M; Mesce, Karen A

2006-05-01

The biological mechanisms of behavioral selection, as it relates to locomotion, are far from understood, even in relatively simple invertebrate animals. In the medicinal leech, Hirudo medicinalis, the decision to swim is distributed across populations of swim-activating and swim-inactivating neurons descending from the subesophageal ganglion of the compound cephalic ganglion, i.e. the brain. In the present study, we demonstrate that the serotonergic LL and Retzius cells in the brain are excited by swim-initiating stimuli and during spontaneous swim episodes. This activity likely influences or resets the neuromodulatory state of neural circuits involved in the activation or subsequent termination of locomotion. When serotonin (5-HT) was perfused over the brain, multi-unit recordings from descending brain neurons revealed rapid and substantial alterations. Subsequent intracellular recordings from identified command-like brain interneurons demonstrated that 5-HT, especially in combination with octopamine, inhibited swim-triggering neuron Tr1, as well as swim-inactivating neurons Tr2 and SIN1. Although 5-HT inhibited elements of the swim-inactivation pathway, rather than promoting them, the indirect and net effect of the amine was a reliable and sustained reduction in the firing of the segmental swim-gating neuron 204. This modulation caused cell 204 to relinquish its excitatory drive to the swim central pattern generator. The activation pattern of serotonergic brain neurons that we observed during swimming and the 5-HT-immunoreactive staining pattern obtained, suggest that within the head brain 5-HT secretion is massive. Over time, 5-HT secretion may provide a homeostatic feedback mechanism to limit swimming activity at the level of the head brain.

Establishing Final Cleanup Decisions for the Hanford Site River Corridor

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

Lerch, J.A.; Sands, J.P.

2007-07-01

A major challenge in the River Corridor Closure Contract is establishing final cleanup decisions for the source operable units in the Hanford Site river corridor. Cleanup actions in the river corridor began in 1994 and have been performed in accordance with a 'bias for action' approach adopted by the Tri-Parties - the U.S. Department of Energy, U.S. Environmental Protection Agency, and Washington State Department of Ecology. This approach enabled early application of cleanup dollars on actual remediation of contaminated waste sites. Consequently, the regulatory framework authorizing cleanup actions at source operable units in the river corridor consists largely of interimmore » action records of decision, which were supported by qualitative risk assessments. Obtaining final cleanup decisions for the source operable units is necessary to determine whether past cleanup actions in the river corridor are protective of human health and the environment and to identify any course corrections that may be needed to ensure that ongoing and future cleanup actions are protective. Because the cleanup actions are ongoing, it is desirable to establish the final cleanup decisions as early as possible to minimize the impacts of any identified course corrections to the present cleanup approach. Development of a strategy to obtain final cleanup decisions for the source operable units in a manner that is responsive to desires for an integrated approach with the groundwater and Columbia River components while maintaining the ability to evaluate each component on its own merit represents a significant challenge. There are many different options for grouping final cleanup decisions, and each involved party or stakeholder brings slightly different interests that shape the approach. Regardless of the selected approach, there are several specific challenges and issues to be addressed before making final cleanup decisions. A multi-agency and contractor working group has been established to address these issues and develop an endorsed strategy. Ultimately, it is anticipated that the Tri-Parties will establish a set of milestones to document pathway selection and define schedule requirements. (authors)« less

Red blood cell transfusion in infants and children - Current perspectives.

PubMed

Ali, Natasha

2018-06-01

Children routinely receive packed red blood transfusion when they are admitted in the intensive care unit or undergoing cardiac surgeries. These guidelines aim to summarize literature and provide transfusion triggers exclusively in infants and children. Copyright © 2017. Published by Elsevier B.V.

Attracting New Learners: International Evidence and Practice.

ERIC Educational Resources Information Center

Taylor, Sue, Ed.; Cameron, Helen, Ed.

This document explores the question of how the United Kingdom can attract more people into education and training. The introduction discusses the international seminar on which the document is based. "What Triggers Participation?" offers a conceptual framework for the seminar's findings. "A Comparative Perspective" examines…

An Examination of Selected Historical Rainfall-Induced Debris-Flow Events within the Central and Southern Appalachian Mountains of the Eastern United States

USGS Publications Warehouse

Wieczorek, Gerald F.; Eaton, L. Scott; Morgan, Benjamin A.; Wooten, R.M.; Morrissey, M.

2009-01-01

Generally, every several years, heavy amounts of rainfall trigger a large number of debris flows within the central and southern Appalachian Mountains of the Eastern United States. These types of landslides damage buildings, disrupt infrastructure, and occasionally injure and kill people. One of the first large debris flows was described in Pennsylvania in August 1779. The most destructive event occurred during August 19-20, 1969, in Nelson County, Va. During a period of 8 hours, 710 to 800 milimeters of rain triggered more than 3,000 landslides, killing more than 150 people. As the population increases in this region, future storms will likely increase the risks of property damage and loss of life. We provide a general overview of debris flows in the Appalachians, using a compilation of 19 storm events for which rainfall, duration of the storm, and descriptions of the resulting landslides have been substantially documented.

Computer Decision Support Software Safely Improves Glycemic Control in the Burn Intensive Care Unit: A Randomized Controlled Clinical Study

DTIC Science & Technology

2011-01-01

Program Jointly Managed by the USA MRMC, NIH, NASA, and the Juvenile Diabetes Research Foundation and Combat Casualty Care Division, United States Army...were performed in the CP group (p = 0.0003), and nursing staff compliance with CP recommendations was greater (p < 0.0001). Conclusions—Glycemic...enhanced consistency in practice, providing standardization among nursing staff. Keywords Glycemic control; hypoglycemia; computer decision support

Demonstration/Validation of Incremental Sampling at Two Diverse Military Ranges and Development of an Incremental Sampling Tool

DTIC Science & Technology

2010-06-01

Sampling (MIS)? • Technique of combining many increments of soil from a number of points within exposure area • Developed by Enviro Stat (Trademarked...Demonstrating a reliable soil sampling strategy to accurately characterize contaminant concentrations in spatially extreme and heterogeneous...into a set of decision (exposure) units • One or several discrete or small- scale composite soil samples collected to represent each decision unit

Superfund record of decision (EPA Region 3): Langley AFB/NASA Langley Center, Area E Warehouse Operable Unit, Hampton, VA, September 28, 1998

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

NONE

1998-10-01

This Record of Decision (ROD) presents the selected remedial action for the Area E Warehouse Operable Unit (OU) at the NASA Langley Research Center (LaRC) in Hampton, Virginia (the Site). This actions addresses the principle threat at the OU by imposing land use restrictions that will prevent any non-industrial activities to take place on the OU.

New constraints on mechanisms of remotely triggered seismicity at Long Valley Caldera

USGS Publications Warehouse

Brodsky, E.E.; Prejean, S.G.

2005-01-01

Regional-scale triggering of local earthquakes in the crust by seismic waves from distant main shocks has now been robustly documented for over a decade. Some of the most thoroughly recorded examples of repeated triggering of a single site from multiple, large earthquakes are measured in geothermal fields of the western United States like Long Valley Caldera. As one of the few natural cases where the causality of an earthquake sequence is apparent, triggering provides fundamental constraints on the failure processes in earthquakes. We show here that the observed triggering by seismic waves is inconsistent with any mechanism that depends on cumulative shaking as measured by integrated energy density. We also present evidence for a frequency-dependent triggering threshold. On the basis of the seismic records of 12 regional and teleseismic events recorded at Long Valley Caldera, long-period waves (>30 s) are more effective at generating local seismicity than short-period waves of comparable amplitude. If the properties of the system are stationary over time, the failure threshold for long-period waves is ~0.05 cm/s vertical shaking. Assuming a phase velocity of 3.5 km/s and an elastic modulus of 3.5 x 1010Pa, the threshold in terms of stress is 5 kPa. The frequency dependence is due in part to the attenuation of the surface waves with depth. Fluid flow through a porous medium can produce the rest of the observed frequency dependence of the threshold. If the threshold is not stationary with time, pore pressures that are >99.5% of lithostatic and vary over time by a factor of 4 could explain the observations with no frequency dependence of the triggering threshold. Copyright 2005 by the American Geophysical Union.

Spontaneous mental associations with the words "side effect": Implications for informed and shared decision making.

PubMed

Izadi, Sonya; Pachur, Thorsten; Wheeler, Courtney; McGuire, Jaclyn; Waters, Erika A

2017-10-01

To gain insight into patients' medical decisions by exploring the content of laypeople's spontaneous mental associations with the term "side effect." An online cross-sectional survey asked 144 women aged 40-74, "What are the first three things you think of when you hear the words 'side effect?"' Data were analyzed using content analysis, chi-square, and Fisher's exact tests. 17 codes emerged and were grouped into 4 themes and a Miscellaneous category: Health Problems (70.8% of participants), Decision-Relevant Evaluations (52.8%), Negative Affect (30.6%), Practical Considerations (18.1%) and Miscellaneous (9.7%). The 4 most frequently identified codes were: Risk (36.1%), Health Problems-Specific Symptoms (35.4%), Health Problems-General Terms (32.6%), and Negative Affect-Strong (19.4%). Code and theme frequencies were generally similar across demographic groups (ps>0.05). The term "side effect" spontaneously elicited comments related to identifying health problems and expressing negative emotions. This might explain why the mere possibility of side effects triggers negative affect for people making medical decisions. Some respondents also mentioned decision-relevant evaluations and practical considerations in response to side effects. Addressing commonly-held associations and acknowledging negative affects provoked by side effects are first steps healthcare providers can take towards improving informed and shared patient decision making. Copyright © 2017 Elsevier B.V. All rights reserved.

Racial Conflict in the United States: What Should Be Done? Grade Twelve. [Resource Unit V.] Project Social Studies.

ERIC Educational Resources Information Center

Minnesota Univ., Minneapolis. Project Social Studies Curriculum Center.

This is the fifth of seven resource units for a twelfth grade course on value conflicts and policy decisions. The topic for this unit is racial conflict in the United States. The introduction explains how this unit coincides with other units of the K-12 series which have treated intergroup relations. The objectives are listed as to…

The politics of obesity: seven steps to government action.

PubMed

Kersh, Rogan; Morone, James

2002-01-01

Concern is rapidly growing about obesity rates in the United States. This paper analyzes the political consequences. Despite myths about individualism and self-reliance, the U.S. government has a long tradition of regulating ostensibly private behavior. We draw on the historical experience in four other private realms (alcohol, illegal drugs, tobacco, and sexuality) to identify seven "triggers" that prompt government to intervene in citizens' private habits. We suggest which of those triggers have been tripped--or are in play--in the case of obesity and food consumption. Finally, we review what government now does in this field and what it might do in the future.

A hard-to-read font reduces the framing effect in a large sample.

PubMed

Korn, Christoph W; Ries, Juliane; Schalk, Lennart; Oganian, Yulia; Saalbach, Henrik

2018-04-01

How can apparent decision biases, such as the framing effect, be reduced? Intriguing findings within recent years indicate that foreign language settings reduce framing effects, which has been explained in terms of deeper cognitive processing. Because hard-to-read fonts have been argued to trigger deeper cognitive processing, so-called cognitive disfluency, we tested whether hard-to-read fonts reduce framing effects. We found no reliable evidence for an effect of hard-to-read fonts on four framing scenarios in a laboratory (final N = 158) and an online study (N = 271). However, in a preregistered online study with a rather large sample (N = 732), a hard-to-read font reduced the framing effect in the classic "Asian disease" scenario (in a one-sided test). This suggests that hard-read-fonts can modulate decision biases-albeit with rather small effect sizes. Overall, our findings stress the importance of large samples for the reliability and replicability of modulations of decision biases.

Mandatory and Location-Aware Access Control for Relational Databases

NASA Astrophysics Data System (ADS)

Decker, Michael

Access control is concerned with determining which operations a particular user is allowed to perform on a particular electronic resource. For example, an access control decision could say that user Alice is allowed to perform the operation read (but not write) on the resource research report. With conventional access control this decision is based on the user's identity whereas the basic idea of Location-Aware Access Control (LAAC) is to evaluate also a user's current location when making the decision if a particular request should be granted or denied. LAAC is an interesting approach for mobile information systems because these systems are exposed to specific security threads like the loss of a device. Some data models for LAAC can be found in literature, but almost all of them are based on RBAC and none of them is designed especially for Database Management Systems (DBMS). In this paper we therefore propose a LAAC-approach for DMBS and describe a prototypical implementation of that approach that is based on database triggers.

Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions.

PubMed

Ferris, Rosie; Blaum, Caroline; Kiwak, Eliza; Austin, Janet; Esterson, Jessica; Harkless, Gene; Oftedahl, Gary; Parchman, Michael; Van Ness, Peter H; Tinetti, Mary E

2018-06-01

To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.

Choice-specific sequences in parietal cortex during a virtual-navigation decision task

PubMed Central

Harvey, Christopher D.; Coen, Philip; Tank, David W.

2012-01-01

The posterior parietal cortex (PPC) plays an important role in many cognitive behaviors; however, the neural circuit dynamics underlying PPC function are not well understood. Here we optically imaged the spatial and temporal activity patterns of neuronal populations in mice performing a PPC-dependent task that combined a perceptual decision and memory-guided navigation in a virtual environment. Individual neurons had transient activation staggered relative to one another in time, forming a sequence of neuronal activation spanning the entire length of a task trial. Distinct sequences of neurons were triggered on trials with opposite behavioral choices and defined divergent, choice-specific trajectories through a state space of neuronal population activity. Cells participating in the different sequences and at distinct time points in the task were anatomically intermixed over microcircuit length scales (< 100 micrometers). During working memory decision tasks the PPC may therefore perform computations through sequence-based circuit dynamics, rather than long-lived stable states, implemented using anatomically intermingled microcircuits. PMID:22419153

Environmental Trigger(s) of Type 1 Diabetes: Why So Difficult to Identify?

PubMed Central

2015-01-01

Type 1 diabetes (T1D) is one of the most common chronic diseases with childhood onset, and the disease has increased two- to fivefold over the past half century by as yet unknown means. T1D occurs when the body's immune system turns against itself so that, in a very specific and targeted way, it destroys the pancreatic β-cells. T1D results from poorly defined interactions between susceptibility genes and environmental determinants. In contrast to the rapid progress in finding T1D genes, identification and confirmation of environmental determinants remain a formidable challenge. This review article will focus on factors which have to be evaluated and decision to take before starting a new prospective cohort study. Considering all the large ongoing prospective studies, new and more conclusive data than that obtained so far should instead come from international collaboration on the ongoing cohort studies. PMID:25883954

Evidence for spontaneous retrieval of suspended but not finished prospective memories.

PubMed

Scullin, Michael K; Einstein, Gilles O; McDaniel, Mark A

2009-06-01

McDaniel and Einstein (2007) argued that prospective memories can be retrieved through spontaneous retrieval processes stimulated by the presence of a target cue. To test this claim, we investigated whether presenting a prospective memory cue during a task that did not require an intention to be performed spontaneously triggered remembering of that intention. In two experiments, participants performed an image-rating task in which a prospective memory task (to press the "Q" key when a target word appeared) was embedded. Then, participants were told that their intention was finished or suspended. Finally, participants performed a lexical decision task in which each target (and a matched control) word appeared. RTs were slower to target words than to control words when the intention was suspended but not when it was finished. These results suggest that target cues associated with suspended intentions can spontaneously trigger remembering but that finished intentions are quickly deactivated.

Small Leucine-Rich Proteoglycans in Renal Inflammation: Two Sides of the Coin.

PubMed

Nastase, Madalina V; Janicova, Andrea; Roedig, Heiko; Hsieh, Louise Tzung-Harn; Wygrecka, Malgorzata; Schaefer, Liliana

2018-04-01

It is now well-established that members of the small leucine-rich proteoglycan (SLRP) family act in their soluble form, released proteolytically from the extracellular matrix (ECM), as danger-associated molecular patterns (DAMPs). By interacting with Toll-like receptors (TLRs) and the inflammasome, the two SLRPs, biglycan and decorin, autonomously trigger sterile inflammation. Recent data indicate that these SLRPs, besides their conventional role as pro-inflammatory DAMPs, additionally trigger anti-inflammatory signaling pathways to tightly control inflammation. This is brought about by selective employment of TLRs, their co-receptors, various adaptor molecules, and through crosstalk between SLRP-, reactive oxygen species (ROS)-, and sphingolipid-signaling. In this review, the complexity of SLRP signaling in immune and kidney resident cells and its relevance for renal inflammation is discussed. We propose that the dichotomy in SLRP signaling (pro- and anti-inflammatory) allows for fine-tuning the inflammatory response, which is decisive for the outcome of inflammatory kidney diseases.

L1 track triggers for ATLAS in the HL-LHC

DOE PAGES

Lipeles, E.

2012-01-01

The HL-LHC, the planned high luminosity upgrade for the LHC, will increase the collision rate in the ATLAS detector approximately a factor of 5 beyond the luminosity for which the detectors were designed, while also increasing the number of pile-up collisions in each event by a similar factor. This means that the level-1 trigger must achieve a higher rejection factor in a more difficult environment. This presentation discusses the challenges that arise in this environment and strategies being considered by ATLAS to include information from the tracking systems in the level-1 decision. The main challenges involve reducing the data volumemore » exported from the tracking system for which two options are under consideration: a region of interest based system and an intelligent sensor method which filters on hits likely to come from higher transverse momentum tracks.« less

Shared decision making in the United States: policy and implementation activity on multiple fronts.

PubMed

Frosch, Dominick L; Moulton, Benjamin W; Wexler, Richard M; Holmes-Rovner, Margaret; Volk, Robert J; Levin, Carrie A

2011-01-01

Shared decision making in the United States has become an important element in health policy debates. The recently passed federal health care reform legislation includes several key provisions related to shared decision making (SDM) and patient decision support. Several states have passed or are considering legislation that incorporates SDM as a key component of improved health care provision. Research on SDM is funded by a range of public and private organizations. Non-profit, for-profit, academic and government organizations are developing decision support interventions for numerous conditions. Some interventions are publicly available; others are distributed to patients through health insurance and healthcare providers. A significant number of clinical implementation projects are underway to test and evaluate different ways of incorporating SDM and patient decision support into routine clinical care. Numerous professional organizations are advocating for SDM and social networking efforts are increasing their advocacy as well. Policy makers are intrigued by the potential of SDM to improve health care provision and potentially lower costs. The role of shared decision making in policy and practice will be part of the larger health care reform debate. 2011. Published by Elsevier GmbH.

Information Dominance: Informations Role in Influencing Decision Making

DTIC Science & Technology

2014-03-01

AND DATES COVERED Master’s Thesis 4. TITLE AND SUBTITLE INFORMATION DOMINANCE : INFORMATION’S ROLE IN INFLUENCING DECISION MAKING 5. FUNDING...unlimited INFORMATION DOMINANCE : INFORMATION’S ROLE IN INFLUENCING DECISION MAKING Geoffrey C. Gaines Lieutenant, United States Navy B.S...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release; distribution is unlimited INFORMATION

The Quest for Mastery

ERIC Educational Resources Information Center

Johnson, Joseph F.; Uline, Cynthia L.; Perez, Lynne G.

2014-01-01

What drives decisions about what gets taught, how, and to whom? In some districts, teachers base these decisions on the organization of textbooks, the timing of pacing charts, or lesson plans from prior years. Often, they base curricular decisions on content that needs to be "covered." In contrast, in many of the United States'…

Free-Choice Learning Suited to Women's Participation Needs in Environmental Decision-Making Processes

ERIC Educational Resources Information Center

Skanavis, Constantina; Sakellari, Maria

2012-01-01

United Nations mandates recognize the need to promote the full participation of women in environmental decision-making processes on the basis of gender equality. But, there remains a profound lack of effective women's participation in some sectors of environmental decision-making. Free-choice environmental learning offers an effective educational…

34 CFR 31.9 - Decision of the hearing official.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Decision of the hearing official. 31.9 Section 31.9 Education Office of the Secretary, Department of Education SALARY OFFSET FOR FEDERAL EMPLOYEES WHO ARE INDEBTED TO THE UNITED STATES UNDER PROGRAMS ADMINISTERED BY THE SECRETARY OF EDUCATION § 31.9 Decision of...

Asian and Pacific Islander Cultural Values: Considerations for Health Care Decision Making.

ERIC Educational Resources Information Center

McLaughlin, Linda A.; Braun, Kathryn L.

1998-01-01

Some history on health-care decision making is reviewed. The current "individualist" model in the United States is contrasted with "collectivist" models of Asian and Pacific Islander cultures. Decision making styles are discussed in relationship to Western medicine. Six groups' cultural norms are presented. Conflicts with U.S.…

Every Child a Reader: What One Teacher Can Do

ERIC Educational Resources Information Center

Pinnell, Gay Su

2006-01-01

In today's educational climate, many teachers find themselves in situations where they have little say in the overarching decisions that influence their teaching lives. Still, there are daily decisions that teachers can make to benefit students, and by uniting their decision-making efforts, teachers can make a difference. The author of this column…

Assumptions Underlying Curriculum Decisions in Australia: An American Perspective.

ERIC Educational Resources Information Center

Willis, George

An analysis of the cultural and historical context in which curriculum decisions are made in Australia and a comparison with educational assumptions in the United States is the purpose of this paper. Methodology is based on personal teaching experience and observation in Australia. Seven factors are identified upon which curricular decisions in…

Perceptions of Health Impact Assessments in Influencing, Policy Decisions through Health Communications

ERIC Educational Resources Information Center

Ford, Cheryl

2016-01-01

Over the past 30 years, public health Practitioners worldwide have increasingly relied on Health Impact Assessments (HIAs) as a tool for informing decision makers of the potential health impacts of proposed policies, programs, and planning decisions. Adoption of the HIA is significantly less common in the United States than in international…

Educational Trends and U.S. Commitments Since the Brown Decision.

ERIC Educational Resources Information Center

Clark, Kenneth

The Supreme Court's landmark Brown decision changed the total pattern of race relations in the United States and helped to solidify the foundations of American democracy for the benefit of all Americans. Ironically, although the specific issue which resulted in the Brown decision was concerned with the constitutionality of racially segregated…

Regional Landslide Hazard Assessment Considering Potential Climate Change

NASA Astrophysics Data System (ADS)

Almeida, S.; Holcombe, E.; Pianosi, F.; Wagener, T.

2016-12-01

Landslides have many negative economic and societal impacts, including the potential for significant loss of life and damage to infrastructure. These risks are likely to be exacerbated in the future by a combination of climatic and socio-economic factors. Climate change, for example, is expected to increase the occurrence of rainfall-triggered landslides, because a warmer atmosphere tends to produce more high intensity rainfall events. Prediction of future changes in rainfall, however, is subject to high levels of uncertainty, making it challenging for decision-makers to identify the areas and populations that are most vulnerable to landslide hazards. In this study, we demonstrate how a physically-based model - the Combined Hydrology and Stability Model (CHASM) - can be used together with Global Sensitivity Analysis (GSA) to explore the underlying factors controlling the spatial distribution of landslide risks across a regional landscape, while also accounting for deep uncertainty around potential future rainfall triggers. We demonstrate how GSA can be used to analyse CHASM which in turn represents the spatial variability of hillslope characteristics in the study region, while accounting for other uncertainties. Results are presented in the form of landslide hazard maps, utilising high-resolution digital elevation datasets for a case study in St Lucia in the Caribbean. Our findings about spatial landslide hazard drivers have important implications for data collection approaches and for long-term decision-making about land management practices.

UnitedHealth Group

Cancer.gov

UnitedHealth Group provides accessible and affordable services, improved quality of care, coordinated health care efforts, and a supportive environment for shared decision making between patients and their physicians.

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

Sherrett, R.R.

This study investigates the relationship between NATO's decision to approach the problem created by the intermediate-range nuclear force superiority of the Soviets and the eventual signing of the INF Treaty by the United States and the Soviet Union. The concept presented is that by adopting the dual track decision, (a track for negotiations and a simultaneous track for fielding U.S. INF missiles), the United States was eventually able to conduct arms negotiations from a position of strength. In this way a significant contribution to the INF Treaty negotiation process was made. The study examines the position of each principal priormore » to the dual track decision, examines the role each played in that decision, and looks at the actions taken following the implementation of the dual track decision. The study also presents the nuclear background of NATO, and also examines the INF negotiations in some detail. The conclusions provide the current status of the INF Treaty implementation and outlines some lessons which could be applied to future negotiations of this type. Intermediate-range Nuclear Forces, INF Treaty, GLCM, PIT, Pershing II missiles, Ground Launched Cruise Missiles, Dual Track Decision, Nuclear arms negotiations.« less

Enrollment Management in Academic Units

ERIC Educational Resources Information Center

DeBiaso, Nick

2012-01-01

This study provides an understanding of how administrative leaders make decisions regarding enrollment management within academic units at a major research university in the southwestern United States. Key enrollment management functions of recruiting, admissions, marketing, orientation, financial aid/scholarships, academic advising, student…

Collaborative Visual Analytics: A Health Analytics Approach to Injury Prevention

PubMed Central

Fisher, Brian; Smith, Jennifer; Pike, Ian

2017-01-01

Background: Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods: Inspired by the Delphi method, we introduced a novel methodology—group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders’ observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results: The GA methodology triggered the emergence of ‘common ground’ among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders’ verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusions: Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ‘common ground’ among diverse stakeholders about health data and their implications. PMID:28895928

Collaborative Visual Analytics: A Health Analytics Approach to Injury Prevention.

PubMed

Al-Hajj, Samar; Fisher, Brian; Smith, Jennifer; Pike, Ian

2017-09-12

Background : Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods : Inspired by the Delphi method, we introduced a novel methodology-group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders' observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results : The GA methodology triggered the emergence of ' common g round ' among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders' verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusion s : Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ' common ground' among diverse stakeholders about health data and their implications.

Transient triggering of near and distant earthquakes

USGS Publications Warehouse

Gomberg, J.; Blanpied, M.L.; Beeler, N.M.

1997-01-01

We demonstrate qualitatively that frictional instability theory provides a context for understanding how earthquakes may be triggered by transient loads associated with seismic waves from near and distance earthquakes. We assume that earthquake triggering is a stick-slip process and test two hypotheses about the effect of transients on the timing of instabilities using a simple spring-slider model and a rate- and state-dependent friction constitutive law. A critical triggering threshold is implicit in such a model formulation. Our first hypothesis is that transient loads lead to clock advances; i.e., transients hasten the time of earthquakes that would have happened eventually due to constant background loading alone. Modeling results demonstrate that transient loads do lead to clock advances and that the triggered instabilities may occur after the transient has ceased (i.e., triggering may be delayed). These simple "clock-advance" models predict complex relationships between the triggering delay, the clock advance, and the transient characteristics. The triggering delay and the degree of clock advance both depend nonlinearly on when in the earthquake cycle the transient load is applied. This implies that the stress required to bring about failure does not depend linearly on loading time, even when the fault is loaded at a constant rate. The timing of instability also depends nonlinearly on the transient loading rate, faster rates more rapidly hastening instability. This implies that higher-frequency and/or longer-duration seismic waves should increase the amount of clock advance. These modeling results and simple calculations suggest that near (tens of kilometers) small/moderate earthquakes and remote (thousands of kilometers) earthquakes with magnitudes 2 to 3 units larger may be equally effective at triggering seismicity. Our second hypothesis is that some triggered seismicity represents earthquakes that would not have happened without the transient load (i.e., accumulated strain energy would have been relieved via other mechanisms). We test this using two "new-seismicity" models that (1) are inherently unstable but slide at steady-state conditions under the background load and (2) are conditionally stable such that instability occurs only for sufficiently large perturbations. For the new-seismicity models, very small-amplitude transients trigger instability relative to the clock-advance models. The unstable steady-state models predict that the triggering delay depends inversely and nonlinearly on the transient amplitude (as in the clock-advance models). We were unable to generate delayed triggering with conditionally stable models. For both new-seismicity models, the potential for triggering is independent of when the transient load is applied or, equivalently, of the prestress (unlike in the clock-advance models). In these models, a critical triggering threshold appears to be inversely proportional to frequency. Further advancement of our understanding will require more sophisticated, quantitative models and observations that distinguish between our qualitative, yet distinctly different, model predictions.

15 CFR 971.427 - Processing outside the United States.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 15 Commerce and Foreign Trade 3 2014-01-01 2014-01-01 false Processing outside the United States... outside the United States. If appropriate TCRs will incorporate provisions to implement the decision of the Administrator regarding the return of resources processed outside the United States, in accordance...

The Mental Capacity Act 1: advance decisions.

PubMed

Lynch, Teresa

This is the first of a two-part unit on the Mental Capacity Act 2005. Part 1 outlines the act's key principles and implications. Healthcare professionals' responsibilities are examined in relation to advance decisions.

Characteristics of Organizational Environments and Perceived Environmental Uncertainty

ERIC Educational Resources Information Center

Duncan, Robert B.

1972-01-01

Twenty-two decision groups in three manufacturing and three research and development organizations are studied to identify the characteristics of the environment that contribute to decision unit members experiencing uncertainty in decisionmaking. (Author)

28 CFR 541.64 - Decision of the Hearing Administrator.

Code of Federal Regulations, 2014 CFR

2014-07-01

... MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Procedures for Handling of HIV Positive Inmates Who... decision is based, along with evidence of the inmate's HIV positive status. (b) The Hearing Administrator...

28 CFR 541.64 - Decision of the Hearing Administrator.

Code of Federal Regulations, 2011 CFR

2011-07-01

... MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Procedures for Handling of HIV Positive Inmates Who... decision is based, along with evidence of the inmate's HIV positive status. (b) The Hearing Administrator...

28 CFR 541.64 - Decision of the Hearing Administrator.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Procedures for Handling of HIV Positive Inmates Who... decision is based, along with evidence of the inmate's HIV positive status. (b) The Hearing Administrator...

28 CFR 541.64 - Decision of the Hearing Administrator.

Code of Federal Regulations, 2012 CFR

2012-07-01

... MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Procedures for Handling of HIV Positive Inmates Who... decision is based, along with evidence of the inmate's HIV positive status. (b) The Hearing Administrator...

28 CFR 541.64 - Decision of the Hearing Administrator.

Code of Federal Regulations, 2013 CFR

2013-07-01

... MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Procedures for Handling of HIV Positive Inmates Who... decision is based, along with evidence of the inmate's HIV positive status. (b) The Hearing Administrator...

20 CFR 655.655 - Secretary's review of administrative law judge's decision.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF LABOR TEMPORARY EMPLOYMENT OF FOREIGN WORKERS IN THE UNITED STATES Enforcement of the... Secretary's review of administrative law judge's decision. (a) The Administrator or any interested party...

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

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

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

DOE PAGES

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu; ...

2017-10-11

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

A Descriptive Study of Decision-Making Conversations during Pediatric Intensive Care Unit Family Conferences.

PubMed

Smith, Michael A; Clayman, Marla L; Frader, Joel; Arenson, Melanie; Haber-Barker, Natalie; Ryan, Claire; Emanuel, Linda; Michelson, Kelly

2018-06-19

Little is known about how decision-making conversations occur during pediatric intensive care unit (PICU) family conferences (FCs). Describe the decision-making process and implementation of shared decision making (SDM) during PICU FCs. Observational study. University-based tertiary care PICU, including 31 parents and 94 PICU healthcare professionals involved in FCs. We recorded, transcribed, and analyzed 14 PICU FCs involving decision-making discussions. We used a modified grounded theory and content analysis approach to explore the use of traditionally described stages of decision making (DM) (information exchange, deliberation, and determining a plan). We also identified the presence or absence of predefined SDM elements. DM involved the following modified stages: information exchange; information-oriented deliberation; plan-oriented deliberation; and determining a plan. Conversations progressed through stages in a nonlinear manner. For the main decision discussed, all conferences included a presentation of the clinical issues, treatment alternatives, and uncertainty. A minority of FCs included assessing the family's understanding (21%), assessing the family's need for input from others (28%), exploring the family's desired decision-making role (35%), and eliciting the family's opinion (42%). In the FCs studied, we found that DM is a nonlinear process. We also found that several SDM elements that could provide information about parents' perspectives and needs did not always occur, identifying areas for process improvement.

A steroid-controlled global switch in sensitivity to apoptosis during Drosophila development.

PubMed

Kang, Yunsik; Bashirullah, Arash

2014-02-01

Precise control over activation of the apoptotic machinery is critical for development, tissue homeostasis and disease. In Drosophila, the decision to trigger apoptosis--whether in response to developmental cues or to DNA damage--converges on transcription of inhibitor of apoptosis protein (IAP) antagonists reaper, hid and grim. Here we describe a parallel process that regulates the sensitivity to, rather than the execution of, apoptosis. This process establishes developmental windows that are permissive or restrictive for triggering apoptosis, where the status of cells determines their capacity to die. We characterize one switch in the sensitivity to apoptotic triggers, from restrictive to permissive, that occurs during third-instar larval (L3) development. Early L3 animals are highly resistant to induction of apoptosis by expression of IAP-antagonists, DNA-damaging agents and even knockdown of the IAP diap1. This resistance to apoptosis, however, is lost in wandering L3 animals after acquiring a heightened sensitivity to apoptotic triggers. This switch in sensitivity to death activators is mediated by a change in mechanisms available for activating endogenous caspases, from an apoptosome-independent to an apoptosome-dependent pathway. This switch in apoptotic pathways is regulated in a cell-autonomous manner by the steroid hormone ecdysone, through changes in expression of critical pro-, but not anti-, apoptotic genes. This steroid-controlled switch defines a novel, physiologically-regulated, mechanism for controlling sensitivity to apoptosis and provides new insights into the control of apoptosis during development. © 2013 Published by Elsevier Inc.

Test beam demonstration of silicon microstrip modules with transverse momentum discrimination for the future CMS tracking detector

NASA Astrophysics Data System (ADS)

Adam, W.; Bergauer, T.; Brondolin, E.; Dragicevic, M.; Friedl, M.; Frühwirth, R.; Hoch, M.; Hrubec, J.; König, A.; Steininger, H.; Treberspurg, W.; Waltenberger, W.; Alderweireldt, S.; Beaumont, W.; Janssen, X.; Lauwers, J.; Van Mechelen, P.; Van Remortel, N.; Van Spilbeeck, A.; Beghin, D.; Brun, H.; Clerbaux, B.; De Lentdecker, G.; Delannoy, H.; Fasanella, G.; Favart, L.; Goldouzian, R.; Grebenyuk, A.; Karapostoli, G.; Lenzi, T.; Léonard, A.; Luetic, J.; Maerschalk, T.; Marinov, A.; Postiau, N.; Randle-Conde, A.; Seva, T.; Vanlaer, P.; Vannerom, D.; Yonamine, R.; Wang, Q.; Yang, Y.; Zenoni, F.; Zhang, F.; Abu Zeid, S.; Blekman, F.; De Bruyn, I.; De Clercq, J.; D'Hondt, J.; Deroover, K.; Lowette, S.; Moortgat, S.; Moreels, L.; Python, Q.; Skovpen, K.; Van Mulders, P.; Van Parijs, I.; Bakhshiansohi, H.; Bondu, O.; Brochet, S.; Bruno, G.; Caudron, A.; Delaere, C.; Delcourt, M.; De Visscher, S.; Francois, B.; Giammanco, A.; Jafari, A.; Cabrera Jamoulle, J.; De Favereau De Jeneret, J.; Komm, M.; Krintiras, G.; Lemaitre, V.; Magitteri, A.; Mertens, A.; Michotte, D.; Musich, M.; Piotrzkowski, K.; Quertenmont, L.; Szilasi, N.; Vidal Marono, M.; Wertz, S.; Beliy, N.; Caebergs, T.; Daubie, E.; Hammad, G. H.; Härkönen, J.; Lampén, T.; Luukka, P.; Peltola, T.; Tuominen, E.; Tuovinen, E.; Eerola, P.; Baulieu, G.; Boudoul, G.; Caponetto, L.; Combaret, C.; Contardo, D.; Dupasquier, T.; Gallbit, G.; Lumb, N.; Mirabito, L.; Perries, S.; Vander Donckt, M.; Viret, S.; Agram, J.-L.; Andrea, J.; Bloch, D.; Bonnin, C.; Brom, J.-M.; Chabert, E.; Chanon, N.; Charles, L.; Conte, E.; Fontaine, J.-Ch.; Gross, L.; Hosselet, J.; Jansova, M.; Tromson, D.; Autermann, C.; Feld, L.; Karpinski, W.; Kiesel, K. M.; Klein, K.; Lipinski, M.; Ostapchuk, A.; Pierschel, G.; Preuten, M.; Rauch, M.; Schael, S.; Schomakers, C.; Schulz, J.; Schwering, G.; Wlochal, M.; Zhukov, V.; Pistone, C.; Fluegge, G.; Kuensken, A.; Pooth, O.; Stahl, A.; Aldaya, M.; Asawatangtrakuldee, C.; Beernaert, K.; Bertsche, D.; Contreras-Campana, C.; Eckerlin, G.; Eckstein, D.; Eichhorn, T.; Gallo, E.; Garay Garcia, J.; Hansen, K.; Haranko, M.; Harb, A.; Hauk, J.; Keaveney, J.; Kalogeropoulos, A.; Kleinwort, C.; Lohmann, W.; Mankel, R.; Maser, H.; Mittag, G.; Muhl, C.; Mussgiller, A.; Pitzl, D.; Reichelt, O.; Savitskyi, M.; Schuetze, P.; Walsh, R.; Zuber, A.; Biskop, H.; Buhmann, P.; Centis-Vignali, M.; Garutti, E.; Haller, J.; Hoffmann, M.; Klanner, R.; Matysek, M.; Perieanu, A.; Scharf, Ch.; Schleper, P.; Schmidt, A.; Schwandt, J.; Sonneveld, J.; Steinbrück, G.; Vormwald, B.; Wellhausen, J.; Abbas, M.; Amstutz, C.; Barvich, T.; Barth, Ch.; Boegelspacher, F.; De Boer, W.; Butz, E.; Casele, M.; Colombo, F.; Dierlamm, A.; Freund, B.; Hartmann, F.; Heindl, S.; Husemann, U.; Kornmeyer, A.; Kudella, S.; Muller, Th.; Printz, M.; Simonis, H. J.; Steck, P.; Weber, M.; Weiler, Th.; Anagnostou, G.; Asenov, P.; Assiouras, P.; Daskalakis, G.; Kyriakis, A.; Loukas, D.; Paspalaki, L.; Siklér, F.; Veszprémi, V.; Bhardwaj, A.; Dalal, R.; Jain, G.; Ranjan, K.; Dutta, S.; Chowdhury, S. Roy; Bakhshiansohl, H.; Behnamian, H.; Khakzad, M.; Naseri, M.; Cariola, P.; Creanza, D.; De Palma, M.; De Robertis, G.; Fiore, L.; Franco, M.; Loddo, F.; Sala, G.; Silvestris, L.; Maggi, G.; My, S.; Selvaggi, G.; Albergo, S.; Costa, S.; Di Mattia, A.; Giordano, F.; Potenza, R.; Saizu, M. A.; Tricomi, A.; Tuve, C.; Barbagli, G.; Brianzi, M.; Ciaranfi, R.; Ciulli, V.; Civinini, C.; D'Alessandro, R.; Focardi, E.; Latino, G.; Lenzi, P.; Meschini, M.; Paoletti, S.; Russo, L.; Scarlini, E.; Sguazzoni, G.; Strom, D.; Viliani, L.; Ferro, F.; Lo Vetere, M.; Robutti, E.; Dinardo, M. E.; Fiorendi, S.; Gennai, S.; Malvezzi, S.; Manzoni, R. A.; Menasce, D.; Moroni, L.; Pedrini, D.; Azzi, P.; Bacchetta, N.; Bisello, D.; Dall'Osso, M.; Pozzobon, N.; Tosi, M.; De Canio, F.; Gaioni, L.; Manghisoni, M.; Nodari, B.; Riceputi, E.; Re, V.; Traversi, G.; Comotti, D.; Ratti, L.; Alunni Solestizi, L.; Biasini, M.; Bilei, G. M.; Cecchi, C.; Checcucci, B.; Ciangottini, D.; Fanò, L.; Gentsos, C.; Ionica, M.; Leonardi, R.; Manoni, E.; Mantovani, G.; Marconi, S.; Mariani, V.; Menichelli, M.; Modak, A.; Morozzi, A.; Moscatelli, F.; Passeri, D.; Placidi, P.; Postolache, V.; Rossi, A.; Saha, A.; Santocchia, A.; Storchi, L.; Spiga, D.; Androsov, K.; Azzurri, P.; Arezzini, S.; Bagliesi, G.; Basti, A.; Boccali, T.; Borrello, L.; Bosi, F.; Castaldi, R.; Ciampa, A.; Ciocci, M. A.; Dell'Orso, R.; Donato, S.; Fedi, G.; Giassi, A.; Grippo, M. T.; Ligabue, F.; Lomtadze, T.; Magazzu, G.; Martini, L.; Mazzoni, E.; Messineo, A.; Moggi, A.; Morsani, F.; Palla, F.; Palmonari, F.; Raffaelli, F.; Rizzi, A.; Savoy-Navarro, A.; Spagnolo, P.; Tenchini, R.; Tonelli, G.; Venturi, A.; Verdini, P. G.; Bellan, R.; Costa, M.; Covarelli, R.; Da Rocha Rolo, M.; Demaria, N.; Rivetti, A.; Dellacasa, G.; Mazza, G.; Migliore, E.; Monteil, E.; Pacher, L.; Ravera, F.; Solano, A.; Fernandez, M.; Gomez, G.; Jaramillo Echeverria, R.; Moya, D.; Gonzalez Sanchez, F. J.; Vila, I.; Virto, A. L.; Abbaneo, D.; Ahmed, I.; Albert, E.; Auzinger, G.; Berruti, G.; Bianchi, G.; Blanchot, G.; Bonnaud, J.; Caratelli, A.; Ceresa, D.; Christiansen, J.; Cichy, K.; Daguin, J.; D'Auria, A.; Detraz, S.; Deyrail, D.; Dondelewski, O.; Faccio, F.; Frank, N.; Gadek, T.; Gill, K.; Honma, A.; Hugo, G.; Jara Casas, L. M.; Kaplon, J.; Kornmayer, A.; Kottelat, L.; Kovacs, M.; Krammer, M.; Lenoir, P.; Mannelli, M.; Marchioro, A.; Marconi, S.; Mersi, S.; Martina, S.; Michelis, S.; Moll, M.; Onnela, A.; Orfanelli, S.; Pavis, S.; Peisert, A.; Pernot, J.-F.; Petagna, P.; Petrucciani, G.; Postema, H.; Rose, P.; Tropea, P.; Troska, J.; Tsirou, A.; Vasey, F.; Vichoudis, P.; Verlaat, B.; Zwalinski, L.; Bachmair, F.; Becker, R.; di Calafiori, D.; Casal, B.; Berger, P.; Djambazov, L.; Donega, M.; Grab, C.; Hits, D.; Hoss, J.; Kasieczka, G.; Lustermann, W.; Mangano, B.; Marionneau, M.; Martinez Ruiz del Arbol, P.; Masciovecchio, M.; Meinhard, M.; Perozzi, L.; Roeser, U.; Starodumov, A.; Tavolaro, V.; Wallny, R.; Zhu, D.; Amsler, C.; Bösiger, K.; Caminada, L.; Canelli, F.; Chiochia, V.; de Cosa, A.; Galloni, C.; Hreus, T.; Kilminster, B.; Lange, C.; Maier, R.; Ngadiuba, J.; Pinna, D.; Robmann, P.; Taroni, S.; Yang, Y.; Bertl, W.; Deiters, K.; Erdmann, W.; Horisberger, R.; Kaestli, H.-C.; Kotlinski, D.; Langenegger, U.; Meier, B.; Rohe, T.; Streuli, S.; Chen, P.-H.; Dietz, C.; Grundler, U.; Hou, W.-S.; Lu, R.-S.; Moya, M.; Cussans, D.; Flacher, H.; Goldstein, J.; Grimes, M.; Jacob, J.; Seif El Nasr-Storey, S.; Cole, J.; Hoad, C.; Hobson, P.; Morton, A.; Reid, I. D.; Auzinger, G.; Bainbridge, R.; Dauncey, P.; Fulcher, J.; Hall, G.; James, T.; Magnan, A.-M.; Pesaresi, M.; Raymond, D. M.; Uchida, K.; Braga, D.; Coughlan, J. A.; Harder, K.; Jones, L.; Ilic, J.; Murray, P.; Prydderch, M.; Tomalin, I. R.; Garabedian, A.; Heintz, U.; Narain, M.; Nelson, J.; Sagir, S.; Speer, T.; Swanson, J.; Tersegno, D.; Watson-Daniels, J.; Chertok, M.; Conway, J.; Conway, R.; Flores, C.; Lander, R.; Pellett, D.; Ricci-Tam, F.; Squires, M.; Thomson, J.; Yohay, R.; Burt, K.; Ellison, J.; Hanson, G.; Olmedo, M.; Si, W.; Yates, B. R.; Gerosa, R.; Sharma, V.; Vartak, A.; Yagil, A.; Zevi Della Porta, G.; Dutta, V.; Gouskos, L.; Incandela, J.; Kyre, S.; Mullin, S.; Qu, H.; White, D.; Dominguez, A.; Bartek, R.; Cumalat, J. P.; Ford, W. T.; Jensen, F.; Johnson, A.; Krohn, M.; Leontsinis, S.; Mulholland, T.; Stenson, K.; Wagner, S. R.; Apresyan, A.; Bolla, G.; Burkett, K.; Butler, J. N.; Cheung, H. W. K.; Chramowicz, J.; Christian, D.; Cooper, W. E.; Deptuch, G.; Derylo, G.; Gingu, C.; Grünendahl, S.; Hasegawa, S.; Hoff, J.; Howell, J.; Hrycyk, M.; Jindariani, S.; Johnson, M.; Kahlid, F.; Lei, C. M.; Lipton, R.; Lopes De Sá, R.; Liu, T.; Los, S.; Matulik, M.; Merkel, P.; Nahn, S.; Prosser, A.; Rivera, R.; Schneider, B.; Sellberg, G.; Shenai, A.; Spiegel, L.; Tran, N.; Uplegger, L.; Voirin, E.; Berry, D. R.; Chen, X.; Ennesser, L.; Evdokimov, A.; Evdokimov, O.; Gerber, C. E.; Hofman, D. J.; Makauda, S.; Mills, C.; Sandoval Gonzalez, I. D.; Alimena, J.; Antonelli, L. J.; Francis, B.; Hart, A.; Hill, C. S.; Parashar, N.; Stupak, J.; Bortoletto, D.; Bubna, M.; Hinton, N.; Jones, M.; Miller, D. H.; Shi, X.; Tan, P.; Baringer, P.; Bean, A.; Khalil, S.; Kropivnitskaya, A.; Majumder, D.; Wilson, G.; Ivanov, A.; Mendis, R.; Mitchell, T.; Skhirtladze, N.; Taylor, R.; Anderson, I.; Fehling, D.; Gritsan, A.; Maksimovic, P.; Martin, C.; Nash, K.; Osherson, M.; Swartz, M.; Xiao, M.; Acosta, J. G.; Cremaldi, L. M.; Oliveros, S.; Perera, L.; Summers, D.; Bloom, K.; Claes, D. R.; Fangmeier, C.; Gonzalez Suarez, R.; Monroy, J.; Siado, J.; Hahn, K.; Sevova, S.; Sung, K.; Trovato, M.; Bartz, E.; Gershtein, Y.; Halkiadakis, E.; Kyriacou, S.; Lath, A.; Nash, K.; Osherson, M.; Schnetzer, S.; Stone, R.; Walker, M.; Malik, S.; Norberg, S.; Ramirez Vargas, J. E.; Alyari, M.; Dolen, J.; Godshalk, A.; Harrington, C.; Iashvili, I.; Kharchilava, A.; Nguyen, D.; Parker, A.; Rappoccio, S.; Roozbahani, B.; Alexander, J.; Chaves, J.; Chu, J.; Dittmer, S.; McDermott, K.; Mirman, N.; Rinkevicius, A.; Ryd, A.; Salvati, E.; Skinnari, L.; Soffi, L.; Tao, Z.; Thom, J.; Tucker, J.; Zientek, M.; Akgün, B.; Ecklund, K. M.; Kilpatrick, M.; Nussbaum, T.; Zabel, J.; Betchart, B.; Covarelli, R.; Demina, R.; Hindrichs, O.; Petrillo, G.; Eusebi, R.; Patel, R.; Perloff, A.; Ulmer, K. A.; Delannoy, A. G.; D'Angelo, P.; Johns, W.

2018-03-01

A new CMS Tracker is under development for operation at the High Luminosity LHC from 2026 onwards. It includes an outer tracker based on dedicated modules that will reconstruct short track segments, called stubs, using spatially coincident clusters in two closely spaced silicon sensor layers. These modules allow the rejection of low transverse momentum track hits and reduce the data volume before transmission to the first level trigger. The inclusion of tracking information in the trigger decision is essential to limit the first level trigger accept rate. A customized front-end readout chip, the CMS Binary Chip (CBC), containing stub finding logic has been designed for this purpose. A prototype module, equipped with the CBC chip, has been constructed and operated for the first time in a 4 GeemVem/emc positron beam at DESY. The behaviour of the stub finding was studied for different angles of beam incidence on a module, which allows an estimate of the sensitivity to transverse momentum within the future CMS detector. A sharp transverse momentum threshold around 2 emVem/emc was demonstrated, which meets the requirement to reject a large fraction of low momentum tracks present in the LHC environment on-detector. This is the first realistic demonstration of a silicon tracking module that is able to select data, based on the particle's transverse momentum, for use in a first level trigger at the LHC . The results from this test are described here.

Balancing habitat delivery for breeding marsh birds and nonbreeding waterfowl: An integrated waterbird management and monitoring approach at Clarence Cannon National Wildlife Refuge, Missouri

USGS Publications Warehouse

Loges, Brian W.; Lyons, James E.; Tavernia, Brian G.

2017-08-23

The Clarence Cannon National Wildlife Refuge (CCNWR) in the Mississippi River flood plain of eastern Missouri provides high quality emergent marsh and moist-soil habitat benefitting both nesting marsh birds and migrating waterfowl. Staff of CCNWR manipulate water levels and vegetation in the 17 units of the CCNWR to provide conditions favorable to these two important guilds. Although both guilds include focal species at multiple planning levels and complement objectives to provide a diversity of wetland community types and water regimes, additional decision support is needed for choosing how much emergent marsh and moist-soil habitat should be provided through annual management actions.To develop decision guidance for balanced delivery of high-energy waterfowl habitat and breeding marsh bird habitat, two measureable management objectives were identified: nonbreeding Anas Linnaeus (dabbling duck) use-days and Rallus elegans (king rail) occupancy of managed units. Three different composite management actions were identified to achieve these objectives. Each composite management action is a unique combination of growing season water regime and soil disturbance. The three composite management actions are intense moist-soil management (moist-soil), intermediate moist-soil (intermediate), and perennial management, which idles soils disturbance (perennial). The two management objectives and three management options were used in a multi-criteria decision analysis to indicate resource allocations and inform annual decision making. Outcomes of the composite management actions were predicted in two ways and multi-criteria decision analysis was used with each set of predictions. First, outcomes were predicted using expert-elicitation techniques and a panel of subject matter experts. Second, empirical data from the Integrated Waterbird Management and Monitoring Initiative collected between 2010 and 2013 were used; where data were lacking, expert judgment was used. Also, a Bayesian decision model was developed that can be updated with monitoring data in an adaptive management framework.Optimal resource allocations were identified in the form of portfolios of composite management actions for the 17 units in the framework. A constrained optimization (linear programming) was used to maximize an objective function that was based on the sum of dabbling duck and king rail utility. The constraints, which included management costs and a minimum energetic carrying capacity (total moist-soil acres), were applied to balance habitat delivery for dabbling ducks and king rails. Also, the framework was constrained in some cases to apply certain management actions of interest to certain management units; these constraints allowed for a variety of hypothetical Habitat Management Plans, including one based on output from a hydrogeomorphic study of the refuge. The decision analysis thus created numerous refuge-wide scenarios, each representing a unique mix of options (one for each of 17 units) and associated benefits (i.e., outcomes with respect to two management objectives).Prepared in collaboration with the U.S. Fish and Wildlife Service, the decision framework presented here is designed as a decision-aiding tool for CCNWR managers who ultimately make difficult decisions each year with multiple objectives, multiple management units, and the complexity of natural systems. The framework also provides a way to document hypotheses about how the managed system functions. Furthermore, the framework identifies specific monitoring needs and illustrates precisely how monitoring data will be used for decision-aiding and adaptive management.

Neonatal Intensive Care Unit Census Influences Discharge of Moderately Preterm Infants

PubMed Central

Profit, Jochen; McCormick, Marie C.; Escobar, Gabriel J.; Richardson, Douglas K.; Zheng, Zheng; Coleman-Phox, Kim; Roberts, Rebecca; Zupancic, John A. F.

2011-01-01

Objective The timely discharge of moderately premature infants has important economic implications. The decision to discharge should occur independent of unit census. We evaluated the impact of unit census on the decision to discharge moderately preterm infants. Design/Methods In a prospective multicenter cohort study, we enrolled 850 infants born between 30 and 34 weeks' gestation at 10 NICUs in Massachusetts and California. We divided the daily census from each hospital into quintiles and tested whether discharges were evenly distributed among them. Using logistic regression, we analyzed predictors of discharge within census quintiles associated with a greater- or less-than-expected likelihood of discharge. We then explored parental satisfaction and postdischarge resource consumption in relation to discharge during census periods that were associated with high proportions of discharge. Results There was a significant correlation between unit census and likelihood of discharge. When unit census was in the lowest quintile, patients were 20% less likely to be discharged when compared with all of the other quintiles of unit census. In the lowest quintile of unit census, patient/nurse ratio was the only variable associated with discharge. When census was in the highest quintile, patients were 32% more likely to be discharged when compared with all of the other quintiles of unit census. For patients in this quintile, a higher patient/nurse ratio increased the likelihood of discharge. Conversely, infants with prolonged lengths of stay, an increasing Score for Neonatal Acute Physiology II, and minor congenital anomalies were less likely to be discharged. Infants discharged at high unit census did not differ from their peers in terms of parental satisfaction, emergency department visits, home nurse visits, or rehospitalization rates. Conclusions Discharges are closely correlated with unit census. Providers incorporate demand and case mix into their discharge decisions. PMID:17272621

ZBB--a new skill for the financial manager.

PubMed

Thompson, G B; Pyhrr, P A

1979-03-01

Zero-based budgeting (ZBB) is a management decision-making tool currently gaining wide acceptance. ZBB is a budgeting approach which is useful for planning, controlling and coordinating financial and human resources. It involves the re-evaluation of all budgeted activities in terms of priorities established by the management. The traditional process of incremental budgeting differs from ZBB in that only the planned changes are evaluated in the former. In incremental budgeting, the base budget is considered authorized and required little attention. The ZBB process focuses on the whol budget. This is accomplished by: (1) identifying decision units; (2) evaluating each decision unit in terms of performance, costs, benefits, and alternate means of accomplishiing the objectives; (3) ranking the decision packages; and (4) preparing a budget for the highest priority decision packages. The effect of the ZBB approach is that new high priority programs may be funded by eliminating or reducing existing lower-priority programs. ZBB is viewed as a logical process which can combine many of the elements of good management.

Toward sensor-based context aware systems.

PubMed

Sakurai, Yoshitaka; Takada, Kouhei; Anisetti, Marco; Bellandi, Valerio; Ceravolo, Paolo; Damiani, Ernesto; Tsuruta, Setsuo

2012-01-01

This paper proposes a methodology for sensor data interpretation that can combine sensor outputs with contexts represented as sets of annotated business rules. Sensor readings are interpreted to generate events labeled with the appropriate type and level of uncertainty. Then, the appropriate context is selected. Reconciliation of different uncertainty types is achieved by a simple technique that moves uncertainty from events to business rules by generating combs of standard Boolean predicates. Finally, context rules are evaluated together with the events to take a decision. The feasibility of our idea is demonstrated via a case study where a context-reasoning engine has been connected to simulated heartbeat sensors using prerecorded experimental data. We use sensor outputs to identify the proper context of operation of a system and trigger decision-making based on context information.

The Tangled Circuitry of Metabolism and Apoptosis

PubMed Central

Andersen, Joshua L.; Kornbluth, Sally

2013-01-01

For single cell organisms, nutrient uptake and metabolism are at the crux of their most basic decision of whether to grow or divide. In metazoans, cell fate decisions are more complex: organismal homeostasis must be strictly maintained by balancing cell proliferation and death. Despite this increased complexity, cell fate within multicellular organisms is also influenced by metabolism; recent studies, triggered in part be an interest tumor metabolism, are beginning to illuminate the mechanisms through which proliferation, death, and metabolism are intertwined. In particular, work on Bcl-2 family proteins suggests that the signaling pathways governing metabolism and apoptosis are inextricably linked. Here, we review the crosstalk between these pathways, emphasizing recent work that illustrates the emerging dual nature of several core apoptotic proteins in regulating both metabolism and cell death. PMID:23395270

The tangled circuitry of metabolism and apoptosis.

PubMed

Andersen, Joshua L; Kornbluth, Sally

2013-02-07

For single-cell organisms, nutrient uptake and metabolism are central to the fundamental decision of whether to grow or divide. In metazoans, cell fate decisions are more complex: organismal homeostasis must be strictly maintained by balancing cell proliferation and death. Despite this increased complexity, cell fate within multicellular organisms is also influenced by metabolism; recent studies, triggered in part by an interest in tumor metabolism, are beginning to illuminate the mechanisms through which proliferation, death, and metabolism are intertwined. In particular, work on Bcl-2 family proteins suggests that the signaling pathways governing metabolism and apoptosis are inextricably linked. Here we review the crosstalk between these pathways, emphasizing recent work that illustrates the emerging dual nature of several core apoptotic proteins in regulating both metabolism and cell death. Copyright © 2013 Elsevier Inc. All rights reserved.

Positive consequences of conflict on decision making: when a conflict mindset facilitates choice.

PubMed

Savary, Jennifer; Kleiman, Tali; Hassin, Ran R; Dhar, Ravi

2015-02-01

Much research has shown that conflict is aversive and leads to increased choice deferral. In contrast, we have proposed that conflict can be beneficial. Specifically, exposure to nonconscious goal conflict can activate a mindset (a set of cognitive procedures) that facilitates the systematic processing of information without triggering the associated costs, such as negative affect and stress. In a conflict mindset, people should be better able to make tradeoffs and resolve choice conflict. We tested this proposition in 4 experiments, and demonstrated that priming conflicting goals before a decision increases choice in domains unrelated to the primed conflict. We further demonstrated that increased choice occurs because people in a conflict mindset process choice information more systematically, and we rule out several alternative explanations for the results.

Simple Multiplexing Hand-Held Control Unit

NASA Technical Reports Server (NTRS)

Hannaford, Blake

1989-01-01

Multiplexer consists of series of resistors, each shunted by single-pole, single-throw switch. User operates switches by pressing buttons or squeezing triggers. Prototype includes three switches operated successfully in over 200 hours of system operations. Number of switches accommodated determined by signal-to-noise ratio of current source, noise induced in control unit and cable, and number of bits in output of analog-to-digital converter. Because many computer-contolled robots have extra analog-to-digital channels, such multiplexer added at little extra cost.

Climate Impacts Already Affect Every Region of the United States, Report Warns

NASA Astrophysics Data System (ADS)

Showstack, Randy

2014-05-01

"Climate change, once considered an issue for a distant future, has moved firmly into the present," according to the third iteration of the U.S. National Climate Assessment (NCA), issued by the White House on 6 May. "The observed warming and other climatic changes are triggering wide-ranging impacts in every region of our country and throughout our economy," states the report, titled Climate Change Impacts in the United States, issued through the federal interagency U.S. Global Change Research Program.

Multi-Threaded Algorithms for GPGPU in the ATLAS High Level Trigger

NASA Astrophysics Data System (ADS)

Conde Muíño, P.; ATLAS Collaboration

2017-10-01

General purpose Graphics Processor Units (GPGPU) are being evaluated for possible future inclusion in an upgraded ATLAS High Level Trigger farm. We have developed a demonstrator including GPGPU implementations of Inner Detector and Muon tracking and Calorimeter clustering within the ATLAS software framework. ATLAS is a general purpose particle physics experiment located on the LHC collider at CERN. The ATLAS Trigger system consists of two levels, with Level-1 implemented in hardware and the High Level Trigger implemented in software running on a farm of commodity CPU. The High Level Trigger reduces the trigger rate from the 100 kHz Level-1 acceptance rate to 1.5 kHz for recording, requiring an average per-event processing time of ∼ 250 ms for this task. The selection in the high level trigger is based on reconstructing tracks in the Inner Detector and Muon Spectrometer and clusters of energy deposited in the Calorimeter. Performing this reconstruction within the available farm resources presents a significant challenge that will increase significantly with future LHC upgrades. During the LHC data taking period starting in 2021, luminosity will reach up to three times the original design value. Luminosity will increase further to 7.5 times the design value in 2026 following LHC and ATLAS upgrades. Corresponding improvements in the speed of the reconstruction code will be needed to provide the required trigger selection power within affordable computing resources. Key factors determining the potential benefit of including GPGPU as part of the HLT processor farm are: the relative speed of the CPU and GPGPU algorithm implementations; the relative execution times of the GPGPU algorithms and serial code remaining on the CPU; the number of GPGPU required, and the relative financial cost of the selected GPGPU. We give a brief overview of the algorithms implemented and present new measurements that compare the performance of various configurations exploiting GPGPU cards.

A Framework for Achieving Situational Awareness during Crisis based on Twitter Analysis

NASA Astrophysics Data System (ADS)

Zielinski, Andrea; Tokarchuk, Laurissa; Middleton, Stuart; Chaves, Fernando

2013-04-01

Decision Support Systems for Natural Crisis Management increasingly employ Web 2.0 and 3.0 technologies for future collaborative decision making, including the use of social networks like Twitter. However, human sensor data is not readily accessible and interpretable, since the texts are unstructured, noisy and available in various languages. The present work focusses on the detection of crisis events in a multilingual setting as part of the FP7-funded EU project TRIDEC and is motivated by the goal to establish a Tsunami warning system for the Mediterranean. It is integrated into a dynamic spatial-temporal decision making component with a command and control unit's graphical user interface that presents all relevant information to the human operator to support critical decision-support. To this end, a tool for the interactive visualization of geospatial data is implemented: All tweets with an exact timestamp or geo-location are monitored on the map in real-time so that the operator on duty can get an overall picture of the situation. Apart from the human sensor data, the seismic sensor data will appear also on the same screen. Signs of abnormal activity from twitter usage in social networks as well as in sensor networks devices can then be used to trigger official warning alerts according to the CAP message standard. Whenever a certain threshold of relevant tweets in a HASC region (Hierarchical Administrative Subdivision Code) is exceeded, the twitter activity in this administrative region will be shown on a map. We believe that the following functionalities are crucial for monitoring crisis, making use of text mining and network analysis techniques: Focussed crawling, trustworthyness analysis geo-parsing, and multilingual tweet classification. In the first step, the Twitter Streaming API accesses the social data, using an adaptive keyword list (focussed crawling). Then, tweets are filtered and aggregated to form counts for a certain time-span (e.g., an interval of 1-2 minutes). Particularly, we investigate the following novel techniques that help to fulfill this task: trustworthyness analysis (linkage analysis and user network analysis), geo-parsing (locating the event in space), and multilingual tweet classification (filtering out of noisy tweets for various Mediterranean languages). Lastly, an aberration algorithm looks for spikes in the temporal stream of twitter data.

Awareness and use of the Ottawa ankle and knee rules in 5 countries: can publication alone be enough to change practice?

PubMed

Graham, I D; Stiell, I G; Laupacis, A; McAuley, L; Howell, M; Clancy, M; Durieux, P; Simon, N; Emparanza, J I; Aginaga, J R; O'connor, A; Wells, G

2001-03-01

We evaluate the international diffusion of the Ottawa Ankle and Knee Rules and determine emergency physicians' attitudes toward clinical decision rules in general. We conducted a cross-sectional, self-administered mail survey of random samples of 500 members each of the American College of Emergency Physicians, Canadian Association of Emergency Physicians, British Association for Accident and Emergency Medicine, Spanish Society for Emergency Medicine, and all members (n=1,350) of the French Speaking Society of Emergency Physicians, France. Main outcome measures were awareness of the Ottawa Ankle and Knee Rules, reported use of these rules, and attitudes toward clinical decision rules in general. A total of 1,769 (57%) emergency physicians responded, with country-specific response rates between 49% (United States and France) and 79% (Canada). More than 69% of physicians in all countries, except Spain, were aware of the Ottawa Ankle Rules. Use of the Ottawa Ankle Rules differed by country with more than 70% of all responding Canadian and United Kingdom physicians reporting frequent use of the rules compared with fewer than one third of US, French, and Spanish physicians. The Ottawa Knee Rule was less well known and less used by physicians in all countries. Most physicians in all countries viewed decision rules as intended to improve the quality of health care (>78%), a convenient source of advice (>67%), and good educational tools (>61%). Of all physicians, those from the United States held the least positive attitudes toward decision rules. This constitutes the largest international survey of emergency physicians' attitudes toward and use of clinical decision rules. Striking differences were apparent among countries with regard to knowledge and use of decision rules. Despite similar awareness in the United States, Canada, and the United Kingdom, US physicians appeared much less likely to use the Ottawa Ankle Rules. Future research should investigate factors leading to differences in rates of diffusion among countries and address strategies to enhance dissemination and implementation of such rules in the emergency department.

Superfund Record of Decision (EPA Region 4): Agriculture and Nutrition (Montgomery), Operable Unit 2, Montgomery, AL, September 28, 1998

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

NONE

This decision document presents the selected remedial action for the T.H. Agriculture and Nutrition (THAN) Site, Montgomery, Alabama. Operable Unit Two (OU2) encompasses the remediation of the contaminated soils and sediments on the Site, and also establishes the performance standards for the groundwater remedy. Upon reaching the cleanup standards for groundwater at an established point(s) of compliance, the groundwater pumping system will be shut down.

Implementing Article 12 of the United Nations Convention on the Rights of the Child in Child Protection Decision-Making: A Critical Analysis of the Challenges and Opportunities for Social Work

ERIC Educational Resources Information Center

McCafferty, Paul

2017-01-01

One of the most frequently cited principles in the 1989 United Nations Convention on the Rights of the Child is Article 12. This article provides a critical analysis of the challenges that child protection social work faces when implementing Article 12 in social work decision-making whilst simultaneously keeping children safe. The article begins…

Politics of Decision Making in Relation to Education in Comparative Perspective, Unity and Diversity as a Problem. Centralization and Decentralization in Decision Making: The Lay Board of Control.

ERIC Educational Resources Information Center

Pfnister, Allan O.

The evolution and role of the lay board of control (trustees, directors) of higher educational institutions and the part the board has played or may play in maintaining diversity in the American system are examined. The evolution of the lay board in the United States and in the United Kingdom is described. The lay board has become "the…

DoD Can Save Millions by Using Energy Efficient Centralized Aircraft Support Systems.

DTIC Science & Technology

1982-05-07

recommends that the Secretary of the Air Force: -- Reevaluate the decision not to install centralized systems at tactical bases. If the systems can be...discontinue using the aircraft’s onboard auxillary power units. These units consume tremendous amounts of jet fuel in providing cabin air-conditioning...requirements. Each command has been asked to analyze its bases to determine if centralized systems should be installed. Although a final decision has not

The Ethics of Rationing of Critical Care Services: Should Technology Assessment Play a Role?

PubMed Central

Bloomfield, Eric L.

2009-01-01

The costs of health care continue to increase rapidly and steeply in the United States. One area of great expense is that of intensive care units (ICUs). The causes of inflation have not been addressed effectively. ICU resources could become stretched such that they may no longer be available. This paper discusses some of the ethics and concerns behind decision making when providing ICU services in the United States. In particular, the use of electronic records with decision making tools, risk-analysis methods, and documentation of patient wishes for extraordinary care may help with better utilization of resources in the future. PMID:20798878

Proposed RCRA Permit Decision for CNMI Remedial Action Plan

EPA Pesticide Factsheets

EPA requesting public comment on its proposed Remedial Action Plan permit decision for the detonation unit and storage cave located at Marpi Point, Saipan, approximately 1 mile north of the new Marpi Landfill.

Midwives

MedlinePlus

... español Comadronas Congratulations, You're Pregnant! Let the decision-making begin. Choosing a health care provider to care for you and your baby during your pregnancy is one of the biggest decisions you'll make. In the United States, women's ...

"Usability of data integration and visualization software for multidisciplinary pediatric intensive care: a human factors approach to assessing technology".

PubMed

Lin, Ying Ling; Guerguerian, Anne-Marie; Tomasi, Jessica; Laussen, Peter; Trbovich, Patricia

2017-08-14

Intensive care clinicians use several sources of data in order to inform decision-making. We set out to evaluate a new interactive data integration platform called T3™ made available for pediatric intensive care. Three primary functions are supported: tracking of physiologic signals, displaying trajectory, and triggering decisions, by highlighting data or estimating risk of patient instability. We designed a human factors study to identify interface usability issues, to measure ease of use, and to describe interface features that may enable or hinder clinical tasks. Twenty-two participants, consisting of bedside intensive care physicians, nurses, and respiratory therapists, tested the T3™ interface in a simulation laboratory setting. Twenty tasks were performed with a true-to-setting, fully functional, prototype, populated with physiological and therapeutic intervention patient data. Primary data visualization was time series and secondary visualizations were: 1) shading out-of-target values, 2) mini-trends with exaggerated maxima and minima (sparklines), and 3) bar graph of a 16-parameter indicator. Task completion was video recorded and assessed using a use error rating scale. Usability issues were classified in the context of task and type of clinician. A severity rating scale was used to rate potential clinical impact of usability issues. Time series supported tracking a single parameter but partially supported determining patient trajectory using multiple parameters. Visual pattern overload was observed with multiple parameter data streams. Automated data processing using shading and sparklines was often ignored but the 16-parameter data reduction algorithm, displayed as a persistent bar graph, was visually intuitive. However, by selecting or automatically processing data, triggering aids distorted the raw data that clinicians use regularly. Consequently, clinicians could not rely on new data representations because they did not know how they were established or derived. Usability issues, observed through contextual use, provided directions for tangible design improvements of data integration software that may lessen use errors and promote safe use. Data-driven decision making can benefit from iterative interface redesign involving clinician-users in simulated environments. This study is a first step in understanding how software can support clinicians' decision making with integrated continuous monitoring data. Importantly, testing of similar platforms by all the different disciplines who may become clinician users is a fundamental step necessary to understand the impact on clinical outcomes of decision aids.

Development of coverage with evidence development for medical technologies in Switzerland from 1996 to 2012.

PubMed

Brügger, Urs; Ruckstuhl, Andreas; Horisberger, Bruno; Gratwohl, Alois

2014-07-01

The aim of this study was to assess incidence, time frame, and outcome of "Coverage with Evidence Development" (CED) decisions in the Swiss Basic Health Insurance scheme. Analysis of all controversial medical technologies submitted to review by the Swiss Federal Office of Public Health (FOPH) from 1996 to 2012 with focus on decisions with constraints. Description of types of technology, type of initial decision, duration of evaluation period, final decision, and search for potential factors associated with changes over time. Forty-five (37.5 percent) of 120 controversial health technologies were classified as "yes, in evaluation, reimbursed" for a certain period of time and thirty-five (29.2 percent) as "no, in evaluation, not reimbursed" by the Federal Department of Home Affairs from 1996 to 2012. The rate of CED decisions ranged between zero and nine per year and was influenced by type of technology and calendar year. Forty-four of forty-five decisions were subject to further restrictions, to a "center or a specialist" (76 percent), "indications" (49 percent), "registry" (31 percent), or "other" (49 percent). The time to a final decision ranged from 1.5 to 11 years (median, 6 years). No factors associated with initial decision and final outcome could be identified. CED as a reality in Switzerland might have enabled patients to obtain access to promising technologies early in their life cycle. CED might have acted as a trigger to a successful implementation of a comprehensive national registry. The lack of qualitative data stresses the urgent need for evaluation of the HTA decisions and their impact on patient outcome and costs.

Parents' information needs, self-efficacy and influences on consulting for childhood respiratory tract infections: a qualitative study.

PubMed

Ingram, Jenny; Cabral, Christie; Hay, Alastair D; Lucas, Patricia J; Horwood, Jeremy

2013-07-28

Acute respiratory tract infection (RTI) is the most common reason why parents consult primary care in the UK. Little is known about parents' perceptions of what may help them to make an appropriate decision to consult when their child is ill and how to improve self-care.Using qualitative methods, this study aimed to explore parents' views on support and information needs prior to consulting when children have RTIs with cough, and identify the triggers and barriers to consulting primary care. 7 focus groups and 30 semi-structured interviews were held with 60 parents (with children aged 5 months - 17 years) from a range of socio-economic backgrounds. Topics discussed were informed by the Health Belief Model, and explored parents' concerns and beliefs about susceptibility and severity of RTIs, beliefs about the triggers and barriers to consulting, and information and support seeking behaviour undertaken before consulting primary care. Discussions were audio-recorded, transcribed and analysed using thematic methods. Parents from all socio-economic backgrounds sought information from a wide range of sources about RTIs in children in order to identify which of their child's symptoms should be of concern and trigger a visit to the doctor. The perception of threat to a child of RTI (with cough) was increased with more severe illness and by perceived susceptibility to illness of a particular child; whilst experience with other children increased parental efficacy to cope with childhood cough at home. Psychological models of health behaviour informed the understanding of cultural beliefs and attitudes that underpin health related behaviours. A wide range of perceptions influence the likelihood that parents will seek help from primary care for a child with cough; these perceptions are similar across socio-economic groups. Parents' experience, confidence and efficacy influence the likelihood of consulting primary care for their child's RTI. Parents would value consistent advice from a trusted source that addresses common concerns and supports home care and decision making about help seeking.

Beat-to-beat control of human optokinetic nystagmus slow phase durations

PubMed Central

Furman, Joseph M.

2016-01-01

This study provides the first clear evidence that the generation of optokinetic nystagmus fast phases (FPs) is a decision process that is influenced by performance of a concurrent disjunctive reaction time task (DRT). Ten subjects performed an auditory DRT during constant velocity optokinetic stimulation. Eye movements were measured in three dimensions with a magnetic search coil. Slow phase (SP) durations were defined as the interval between FPs. There were three main findings. Firstly, human optokinetic nystagmus SP durations are consistent with a model of a Gaussian basic interval generator (a type of biological clock), such that FPs can be triggered randomly at the end of a clock cycle (mean duration: 200–250 ms). Kolmogorov-Smirnov tests could not reject the modeled cumulative distribution for any data trials. Secondly, the FP need not be triggered at the end of a clock cycle, so that individual SP durations represent single or multiple clock cycles. Thirdly, the probability of generating a FP at the end of each interval generator cycle decreases significantly during performance of a DRT. These findings indicate that the alternation between SPs and FPs of optokinetic nystagmus is not purely reflexive. Rather, the triggering of the next FP is postponed more frequently if a recently presented DRT trial is pending action when the timing cycle expires. Hence, optokinetic nystagmus FPs show dual-task interference in a manner usually attributed to voluntary movements, including saccades. NEW & NOTEWORTHY This study provides the first clear evidence that the generation of optokinetic nystagmus (OKN) fast phases is a decision process that is influenced by performance of a concurrent disjunctive reaction time task (DRT). The slow phase (SP) durations are consistent with a Gaussian basic interval generator and multiple interval SP durations occur more frequently in the presence of the DRT. Hence, OKN shows dual-task interference in a manner observed in voluntary movements, such as saccades. PMID:27760815

Beat-to-beat control of human optokinetic nystagmus slow phase durations.

PubMed

Balaban, Carey D; Furman, Joseph M

2017-01-01

This study provides the first clear evidence that the generation of optokinetic nystagmus fast phases (FPs) is a decision process that is influenced by performance of a concurrent disjunctive reaction time task (DRT). Ten subjects performed an auditory DRT during constant velocity optokinetic stimulation. Eye movements were measured in three dimensions with a magnetic search coil. Slow phase (SP) durations were defined as the interval between FPs. There were three main findings. Firstly, human optokinetic nystagmus SP durations are consistent with a model of a Gaussian basic interval generator (a type of biological clock), such that FPs can be triggered randomly at the end of a clock cycle (mean duration: 200-250 ms). Kolmogorov-Smirnov tests could not reject the modeled cumulative distribution for any data trials. Secondly, the FP need not be triggered at the end of a clock cycle, so that individual SP durations represent single or multiple clock cycles. Thirdly, the probability of generating a FP at the end of each interval generator cycle decreases significantly during performance of a DRT. These findings indicate that the alternation between SPs and FPs of optokinetic nystagmus is not purely reflexive. Rather, the triggering of the next FP is postponed more frequently if a recently presented DRT trial is pending action when the timing cycle expires. Hence, optokinetic nystagmus FPs show dual-task interference in a manner usually attributed to voluntary movements, including saccades. This study provides the first clear evidence that the generation of optokinetic nystagmus (OKN) fast phases is a decision process that is influenced by performance of a concurrent disjunctive reaction time task (DRT). The slow phase (SP) durations are consistent with a Gaussian basic interval generator and multiple interval SP durations occur more frequently in the presence of the DRT. Hence, OKN shows dual-task interference in a manner observed in voluntary movements, such as saccades. Copyright © 2017 the American Physiological Society.

Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting.

PubMed

Elholm, Bjarne; Larsen, Klaus; Hornnes, Nete; Zierau, Finn; Becker, Ulrik

2011-01-01

To investigate whether, in the treatment with chlordiazepoxide for outpatient alcohol withdrawal, there are advantages of symptom-triggered self-medication over a fixed-schedule regimen. A randomized controlled trial in outpatient clinics for people suffering from alcohol dependence (AD) and alcohol-related problems; 165 adult patients in an outpatient setting in a specialized alcohol treatment unit were randomized 1:1 to either a symptom-triggered self-medication or tapered dose, using chlordiazepoxide. Alcohol withdrawal symptoms, amount of medication, duration of symptoms, time to relapse and patient satisfaction were measured. Patients assessed their symptoms using the Short Alcohol Withdrawal Scale (SAWS). Patient satisfaction was monitored by the Diabetes Treatment Satisfaction Questionnaire. We used the Well-Being Index and the European addiction severity index for the 1-year follow-up. We found no differences in the quantity of medication consumed, time to relapse, well being or treatment satisfaction. Symptom-triggered self-medication was as safe as fixed-schedule medication in treating outpatients with AD and mild to moderate symptoms of AWS. The SAWS is a powerful monitoring tool, because it is brief and permits the subject to log the withdrawal symptoms.

Psychometric assessment of the Family Satisfaction in the Intensive Care Unit questionnaire in the United Kingdom.

PubMed

Harrison, David A; Ferrando-Vivas, Paloma; Wright, Stephen E; McColl, Elaine; Heyland, Daren K; Rowan, Kathryn M

2017-04-01

To establish the psychometric properties of the Family Satisfaction in the Intensive Care Unit 24-item (FS-ICU-24) questionnaire in the United Kingdom. The Family-Reported Experiences Evaluation study recruited family members of patients staying at least 24 hours in 20 participating intensive care units. Questionnaires were evaluated for nonresponse, floor/ceiling effects, redundancy, and construct validity. Internal consistency was evaluated with item-to-own scale correlations and Cronbach α. Confirmatory and exploratory factor analyses were used to explore the underlying structure. Twelve thousand three hundred forty-six family members of 6380 patients were recruited and 7173 (58%) family members of 4615 patients returned a completed questionnaire. One family member per patient was included in the psychometric assessment. Six items had greater than 10% nonresponse; 1 item had a ceiling effect; and 11 items had potential redundancy. Internal consistency was high (Cronbach α, overall .96; satisfaction with care, .94; satisfaction with decision making, .93). The 2-factor solution was not a good fit. Exploratory factor analysis indicated that satisfaction with decision making encompassed 2 constructs-satisfaction with information and satisfaction with the decision-making process. The Family Satisfaction in the Intensive Care Unit 24-item questionnaire demonstrated good psychometric properties in the United Kingdom setting. Construct validity could be improved by use of 3 domains and some scope for further improvement was identified. Copyright © 2016 Elsevier Inc. All rights reserved.

Paediatric cerebrovascular CT angiography—towards better image quality

PubMed Central

Thust, Stefanie C.; Chong, Wui Khean Kling; Gunny, Roxana; Mazumder, Asif; Poitelea, Marius; Welsh, Anna; Ederies, Ash

2014-01-01

Background Paediatric cerebrovascular CT angiography (CTA) can be challenging to perform due to variable cardiovascular physiology between different age groups and the risk of movement artefact. This analysis aimed to determine what proportion of CTA at our institution was of diagnostic quality and identify technical factors which could be improved. Materials and methods a retrospective analysis of 20 cases was performed at a national paediatric neurovascular centre assessing image quality with a subjective scoring system and Hounsfield Unit (HU) measurements. Demographic data, contrast dose, flow rate and triggering times were recorded for each patient. Results Using a qualitative scoring system, 75% of studies were found to be of diagnostic quality (n=9 ‘good’, n=6 ‘satisfactory’) and 25% (n=5) were ‘poor’. Those judged subjectively to be poor had arterial contrast density measured at less than 250 HU. Increased arterial opacification was achieved for cases performed with an increased flow rate (2.5-4 mL/s) and higher intravenous contrast dose (2 mL/kg). Triggering was found to be well timed in nine cases, early in four cases and late in seven cases. Of the scans triggered early, 75% were poor. Of the scans triggered late, less (29%) were poor. Conclusions High flow rates (>2.5 mL/s) were a key factor for achieving high quality paediatric cerebrovascular CTA imaging. However, appropriate triggering by starting the scan immediately on contrast opacification of the monitoring vessel plays an important role and could maintain image quality when flow rates were lower. Early triggering appeared more detrimental than late. PMID:25525579

77 FR 5781 - Record of Decision for the Air Space Training Initiative Shaw Air Force Base, South Carolina...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-06

... DEPARTMENT OF DEFENSE Department of the Air Force Record of Decision for the Air Space Training Initiative Shaw Air Force Base, South Carolina Final Environmental Impact Statement ACTION: Notice of Availability (NOA) of a Record of Decision (ROD). SUMMARY: On December 9, 2011, the United States Air Force...

Using Sanctioned Athletics Programs to Understand Stakeholders' Perceived Influence in Decisions at Major Research Universities

ERIC Educational Resources Information Center

Hirko, Scott

2011-01-01

This study set out to learn more about the perceived influence of stakeholders on academic decisions affecting intercollegiate athletics, with the intent that such knowledge would help provide useful implications for future leaders making decisions that impact unique student populations. As an area of research, the semi-autonomous unit of…

77 FR 71396 - Humboldt-Toiyabe National Forest; Nevada and California Greater Sage Grouse Bi-State Distinct...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-30

... decision makers as to render them inadequate to ameliorate the threats to the Bi-State DPS''. The major... three records of decision. The development of this EIS will be coordinated across management units of..., but precluded'' Endangered Species Act (ESA) listing petition decision for the Greater Sage grouse Bi...

"City of Richmond v. J.A. Croson Company": The Decision and Some of Its Implications.

ERIC Educational Resources Information Center

Bell, A. Fleming, II

1989-01-01

The Supreme Court's "Croson" decision has major implications for local government and school administrative units that wish to encourage the use of minority contractors. Discusses the decision and some of the effects that the rules announced in the case may have on North Carolina's local governments and schools. (MLF)

A Hierarchical Analysis of Bridge Decision Makers ... The Role of New Technology Adoption in the Timber Bridge Market: Special Project

Treesearch

Robert L. Smith; Robert J. Bush; Daniel L. Schmoldt

1995-01-01

Bridge design engineers and local highway officials make bridge replacement decisions across the United States. The Analytical Hierarchy Process was used to characterize the bridge material selection decision of these individuals. State Department of Transportation engineers, private consulting engineers, and local highway officials were personally interviewed in...

Research Practice Partnerships: A Strategy for Promoting Evidence-Based Decision-Making in Education

ERIC Educational Resources Information Center

Wentworth, Laura; Mazzeo, Christopher; Connolly, Faith

2017-01-01

Background: In the United States, an emphasis on evidence-based decision-making in education has received renewed interest with the recent passage of the Every Student Succeeds Act. However, how best, in practice, to support the use of evidence in educational decision-making remains unclear. Research Practice Partnerships (RPPs) are a popular…

76 FR 24064 - Arizona Public Service Company, Palo Verde Nuclear Generating Station, Units 1, 2, and 3, Notice...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-29

... Decision Notice is hereby given that the U.S. Nuclear Regulatory Commission (NRC, the Commission) has... notice also serves as the record of decision for Renewed Facility Operating License Nos. NPF-41, NPF-51... Decision--General.'' NUREG-1437, ``Generic Environmental Impact Statement for License Renewal of Nuclear...

29 CFR 790.18 - “Administrative practice or enforcement policy.”

Code of Federal Regulations, 2010 CFR

2010-07-01

... may be, and frequently are, based upon decisions or views which the agency has set forth in its... happening of some contingency, such as a final decision in pending litigation. 112 See United States v... court decisions he has changed his view as to coverage of a certain class of employees under the Fair...

Real Men Do Not Read Labels: The Effects of Masculinity and Involvement on College Students' Food Decisions

ERIC Educational Resources Information Center

Levi, Annette; Chan, Kenny K.; Pence, Dan

2006-01-01

Consumer literature shows that a decision's degree of personal importance and relevance--one's level of involvement in the decision--indicates which type of intervention strategy will be effective in influencing consumers' choices. The authors surveyed 358 college students at a state university in the western United States to test the…