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Informed Decisions (informed + decision)
Selected AbstractsInformed decision making for cancer screening , not all of the ethical issues have been consideredCYTOPATHOLOGY, Issue 1 2003C. Millett No abstract is available for this article. [source] Damage-based design with no repairs for multiple events and its sensitivity to seismicity modelEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 3 2007S. Das Abstract Conventional design methodology for the earthquake-resistant structures is based on the concept of ensuring ,no collapse' during the most severe earthquake event. This methodology does not envisage the possibility of continuous damage accumulation during several not-so-severe earthquake events, as may be the case in the areas of moderate to high seismicity, particularly when it is economically infeasible to carry out repairs after damaging events. As a result, the structure may collapse or may necessitate large scale repairs much before the design life of the structure is over. This study considers the use of design force ratio (DFR) spectrum for taking an informed decision on the extent to which yield strength levels should be raised to avoid such a scenario. DFR spectrum gives the ratios by which the yield strength levels of single-degree-of-freedom oscillators of different initial periods should be increased in order to limit the total damage caused by all earthquake events during the lifetime to a specified level. The DFR spectra are compared for three different seismicity models in case of elasto-plastic oscillators: one corresponding to the exponential distribution for return periods of large events and the other two corresponding to the lognormal and Weibull distributions. It is shown through numerical study for a hypothetical seismic region that the use of simple exponential model may be acceptable only for small values of the seismic gap length. For moderately large to large seismic gap lengths, it may be conservative to use the lognormal model, while the Weibull model may be assumed for very large seismic gap lengths. Copyright © 2006 John Wiley & Sons, Ltd. [source] Experience of Hong Kong patients awaiting kidney transplantation in mainland ChinaJOURNAL OF CLINICAL NURSING, Issue 11c 2007Sylvie SH Leung MN Aim., This paper describes the experience of Hong Kong Chinese patients awaiting kidney transplantation in mainland China. Background., While travelling to mainland China for kidney transplantation is a controversial issue, there is an increasing trend of Hong Kong Chinese patients with chronic kidney disease seeking this treatment choice, which outnumbers that performed in Hong Kong. Although these patients seek pre- and post-transplantation care from Hong Kong public healthcare system, little is known about their experience during the waiting period. Methods., This experience is examined in an exploratory qualitative study. In-depth interviews were used to collect data from a purposive sample of 12 kidney recipients. Results., Three major findings are identified: (i) transplant waiting patients may travel to mainland China for transplantation in search of normal life, (ii) they need informational support from their continuing healthcare providers in Hong Kong to make the informed decision and (iii) they perceive a variation of attitudes of nurses and doctors in Hong Kong towards transplantation in mainland China. Conclusions., This study contributes to the literature by researching patients' perspective. The findings highlight the importance and controversy of addressing these patients' informational needs. While the authors have no inclination for or against travelling to mainland China for transplantation, the findings reveal a tenacious clinical dilemma, which deserves debate in international transplant community and further research to inform the debate. Nurse and doctors in Hong Kong may contribute to the debate by articulating their experience of caring for these patients. Relevance to clinical practice., Health information that is readily available for patients scheduled for kidney transplantation in Hong Kong should be made accessible to the whole community of patients with chronic kidney disease. To address the complexity of patients travelling to elsewhere for transplantation and the needs of these patients, provider reticence may be counterproductive. [source] The application of carbon isotope ratio mass spectrometry to doping controlJOURNAL OF MASS SPECTROMETRY (INCORP BIOLOGICAL MASS SPECTROMETRY), Issue 7 2008Adam T. Cawley Abstract The administration of synthetic steroid copies is one of the most important issues facing sports. Doping control laboratories accredited by the World Anti-Doping Agency (WADA) require methods of analysis that allow endogenous steroids to be distinguished from their synthetic analogs in urine. The ability to measure isotope distribution at natural abundance with high accuracy and precision has increased the application of Gas Chromatography,Combustion,Isotope Ratio Mass Spectrometry (GC,C,IRMS) to doping control in recent years. GC,C,IRMS is capable of measuring the carbon isotope ratio (,13C) of urinary steroids and confirm their synthetic origin based on the abnormal 13C content. This tutorial describes some of the complexities encountered by obtaining valid ,13C measurements from GC,C,IRMS and the need for careful interpretation of all relevant information concerning an individual's metabolism in order to make an informed decision with respect to a doping violation. Copyright © 2008 John Wiley & Sons, Ltd. [source] Proteomic profiling of animal models mimicking skeletal muscle disordersPROTEOMICS - CLINICAL APPLICATIONS, Issue 9 2007Philip Doran Abstract Over the last few decades of biomedical research, animal models of neuromuscular diseases have been widely used for determining pathological mechanisms and for testing new therapeutic strategies. With the emergence of high-throughput proteomics technology, the identification of novel protein factors involved in disease processes has been decisively improved. This review outlines the usefulness of the proteomic profiling of animal disease models for the discovery of new reliable biomarkers, for the optimization of diagnostic procedures and the development of new treatment options for skeletal muscle disorders. Since inbred animal strains show genetically much less interindividual differences as compared to human patients, considerably lower experimental repeats are capable of producing meaningful proteomic data. Thus, animal model proteomics can be conveniently employed for both studying basic mechanisms of molecular pathogenesis and the effects of drugs, genetic modifications or cell-based therapies on disease progression. Based on the results from comparative animal proteomics, a more informed decision on the design of clinical proteomics studies could be reached. Since no one animal model represents a perfect pathobiochemical replica of all of the symptoms seen in complex human disorders, the proteomic screening of novel animal models can also be employed for swift and enhanced protein biochemical phenotyping. [source] Estimation of adult skeletal age-at-death using the Sugeno fuzzy integralAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 1 2010Melissa F. Anderson Abstract Age-at-death estimation of an individual skeleton is important to forensic and biological anthropologists for identification and demographic analysis, but it has been shown that the current aging methods are often unreliable because of skeletal variation and taphonomic factors. Multifactorial methods have been shown to produce better results when determining age-at-death than single indicator methods. However, multifactorial methods are difficult to apply to single or poorly preserved skeletons, and they rarely provide the investigator with information about the reliability of the estimate. The goal of this research is to examine the validity of the Sugeno fuzzy integral as a multifactorial method for modeling age-at-death of an individual skeleton. This approach is novel because it produces an informed decision of age-at-death utilizing multiple age indicators while also taking into consideration the accuracies of the methods and the condition of the bone being examined. Additionally, the Sugeno fuzzy integral does not require the use of a population and it qualitatively produces easily interpreted graphical results. Examples are presented applying three commonly used aging methods on a known-age skeletal sample from the Terry Anatomical Collection. This method produces results that are more accurate and with smaller intervals than single indicator methods. Am J Phys Anthropol 2010. © 2009 Wiley-Liss, Inc. [source] Implants, Mechanical Devices, and Vascular Surgery for Erectile DysfunctionTHE JOURNAL OF SEXUAL MEDICINE, Issue 1pt2 2010Wayne J.G. Hellstrom MD ABSTRACT Introduction., The field of erectile dysfunction (ED) is evolving and there is a need for state-of-the-art information in the area of treatment. Aim., To develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery. Methods., To provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period. Main Outcome Measure., Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Results., The inflatable penile prosthesis (IPP) is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis. Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma. Currently, surgery to limit venous leakage is not recommended. Conclusions., It is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient's medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery. Hellstrom WJG, Montague DK, Moncada I, Carson C, Minhas S, Faria G, and Krishnamurti S. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med 2010;7:501,523. [source] An Introduction to Simulation and Visualization of Biological Systems at Multiple Scales: A Summer Training Program for Interdisciplinary ResearchBIOTECHNOLOGY PROGRESS, Issue 1 2006Rajan Munshi Advances in biomedical research require a new generation of researchers having a strong background in both the life and physical sciences and a knowledge of computational, mathematical, and engineering tools for tackling biological problems. The NIH-NSF Bioengineering and Bioinformatics Summer Institute at the University of Pittsburgh (BBSI @ Pitt;www.ccbb.pitt.edu/bbsi) is a multi-institutional 10-week summer program hosted by the University of Pittsburgh, Duquesne University, the Pittsburgh Supercomputing Center, and Carnegie Mellon University, and is one of nine Institutes throughout the nation currently participating in the NIH-NSF program. Each BBSI focuses on a different area; the BBSI @ Pitt, entitled "Simulation and Computer Visualization of Biological Systems at Multiple Scales", focuses on computational and mathematical approaches to understanding the complex machinery of molecular-to-cellular systems at three levels, namely, molecular, subcellular (microphysiological), and cellular. We present here an overview of the BBSI@Pitt, the objectives and focus of the program, and a description of the didactic training activities that distinguish it from other traditional summer research programs. Furthermore, we also report several challenges that have been identified in implementing such an interdisciplinary program that brings together students from diverse academic programs for a limited period of time. These challenges notwithstanding, presenting an integrative view of molecular-to-system analytical models has introduced these students to the field of computational biology and has allowed them to make an informed decision regarding their future career prospects. [source] Dissecting racial disparities in the treatment of patients with locoregional pancreatic cancerCANCER, Issue 4 2010A 2-Step Process Abstract BACKGROUND: Previous studies have demonstrated that black patients with pancreatic cancer are less likely to undergo resection and have worse overall survival compared with white patients. The objective of this study was to determine whether these disparities occur at the point of surgical evaluation or after evaluation has taken place. METHODS: The authors used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data (1992-2002) to compare black patients and white patients with locoregional pancreatic cancer in univariate models. Logistic regression was used to determine the effect of race on surgical evaluation and on surgical resection after evaluation. Cox proportional hazards models were used to identify which factors influenced 2-year survival. RESULTS: Nine percent of 3777 patients were black. Blacks were substantially less likely than whites to undergo evaluation by a surgeon (odds ratio, 0.57; 95% confidence interval, 0.42-0.77) when the model was adjusted for demographics, tumor characteristics, surgical evaluation, socioeconomic status, and year of diagnosis. Patients who were younger and who had fewer comorbidities, abdominal imaging, and a primary care physician were more likely to undergo surgical evaluation. Once they were seen by a surgeon, blacks still were less likely than whites to undergo resection (odds ratio, 0.64; 95% confidence interval, 0.49-0.84). Although black patients had decreased survival in an unadjusted model, race no longer was significant after accounting for resection. CONCLUSIONS: Twenty-nine percent of black patients with potentially resectable pancreatic cancers never received surgical evaluation. Without surgical evaluation, patients cannot make an informed decision and will not be offered resection. Attaining higher rates of surgical evaluation in black patients would be the first step to eliminating the observed disparity in the resection rate. Cancer 2010. © 2010 American Cancer Society [source] A probabilistic framework for quantification of aftershock ground-motion hazard in California: Methodology and parametric studyEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 1 2009Gee Liek Yeo Abstract This paper presents a proposed method of aftershock probabilistic seismic hazard analysis (APSHA) similar to conventional ,mainshock' PSHA in that it estimates the likelihoods of ground motion intensity (in terms of peak ground accelerations, spectral accelerations or other ground motion intensity measures) due to aftershocks following a mainshock occurrence. This proposed methodology differs from the conventional mainshock PSHA in that mainshock occurrence rates remain constant for a conventional (homogeneous Poisson) earthquake occurrence model, whereas aftershock occurrence rates decrease with increased elapsed time from the initial occurrence of the mainshock. In addition, the aftershock ground motion hazard at a site depends on the magnitude and location of the causative mainshock, and the location of aftershocks is limited to an aftershock zone, which is also dependent on the location and magnitude of the initial mainshock. APSHA is useful for post-earthquake safety evaluation where there is a need to quantify the rates of occurrence of ground motions caused by aftershocks following the initial rupture. This knowledge will permit, for example, more informed decisions to be made for building tagging and entry of damaged buildings for rescue, repair or normal occupancy. Copyright © 2008 John Wiley & Sons, Ltd. [source] Using disease risk estimates to guide risk factor interventions: field test of a patient workbook for self-assessing coronary riskHEALTH EXPECTATIONS, Issue 1 2002J. Michael Paterson MSc Objective,To assess the feasibility and acceptability of a patient workbook for self-assessing coronary risk. Design,Pilot study, with post-study physician and patient interviews. Setting and subjects,Twenty southern Ontario family doctors and 40 patients for whom they would have used the workbook under normal practice conditions. Interventions,The study involved convening two sequential groups of family physicians: the first (n=10) attended focus group meetings to help develop the workbook (using algorithms from the Framingham Heart Study); the second (n=20) used the workbook in practice with 40 patients. Follow-up interviews were by interviewer-administered questionnaire. Main outcome measures,Physicians' and patients' opinions of the workbook's format, content, helpfulness, feasibility, and potential for broad application, as well as patients' perceived 10-year risk of a coronary event measured before and after using the workbook. Results,It took an average of 18 minutes of physician time to use the workbook: roughly 7 minutes to introduce it to patients, and about 11 minutes to discuss the results. Assessments of the workbook were generally favourable. Most patients were able to complete it on their own (78%), felt they had learned something (80%) and were willing to recommend it to someone else (98%). Similarly, 19 of 20 physicians found it helpful and would use it in practice with an average of 18% of their patients (range: 1,80%). The workbook helped to correct misperceptions patients had about their personal risk of a coronary event over the next 10 years (pre-workbook (mean (SD) %): 35.2 (16.9) vs. post-workbook: 17.3 (13.5), P < 0.0001; estimate according to algorithm: 10.6 (7.6)). Conclusions,Given a simple tool, patients can and will assess their own risk of CHD. Such tools could help inform otherwise healthy individuals that their risk is increased, allowing them to make more informed decisions about their behaviours and treatment. [source] A judicial,mental health partnership to heal young children in juvenile courtINFANT MENTAL HEALTH JOURNAL, Issue 1 2008Judge Cindy Lederman In this article, we describe the background and issues to be addressed related to dependent children in juvenile court. In an important effort to systematically examine developmental functioning and treatment needs in maltreated and violence-exposed young children, the Prevention and Evaluation of Early Neglect and Trauma (PREVENT) initiative of the Dependency Court Intervention Program for Family Violence, a national demonstration project in the Miami-Dade Juvenile Court, developed a program to evaluate all infants, toddlers, and preschoolers who are adjudicated dependent by the court. The goal of the intervention is to raise awareness of the needs of infants and toddlers in juvenile court and to work toward healing the child. The PREVENT program involved the evolution of a judicial,mental health partnership designed to assist the court in making more informed decisions about the best interest of the child by adding scientific knowledge about development, prevention, intervention, evaluation, and treatment. The outcome of the partnership and multidisciplinary approach is illustrated through presenting a case vignette of a mother and baby showing the challenges and strengths of intervention. Finally, we consider overall outcomes of the intervention and directions for the future. [source] Lymphoma risk in inflammatory bowel disease: Is it the disease or its treatment?INFLAMMATORY BOWEL DISEASES, Issue 10 2007Jennifer L. Jones MD Abstract With the increasingly widespread use of immunosuppressive and biologic agents for the treatment of Crohn's disease and ulcerative colitis come concerns about potential long-term consequences of such therapies. Disentangling the potential confounding effects of the underlying disease, its extent, severity, duration, and behavior, and concomitant medical therapy has proven to be exceedingly difficult. Unlike the case in rheumatoid arthritis, the overwhelming preponderance of population-based evidence suggests that a diagnosis of inflammatory bowel disease (IBD) is not associated with an increased relative risk of lymphoma. However, well-designed studies that evaluate the potential modifying effect of IBD severity have yet to be performed. Although the results from hospital- and population-based studies have conflicted, the results of a recent meta-analysis suggest that patients receiving purine analogs for the treatment of IBD have a lymphoma risk ,4-fold higher than expected. Analyses of lymphoma risk in patients receiving biologic agents directed against tumor necrosis factor-alpha are confounded by concomitant use of immunosuppressive agents in most of these patients. Nevertheless, there may be a small but real risk of lymphoma associated with these therapies. Although the relative risk of lymphoma may be elevated in association with some of the medical therapies used in the treatment of IBD, this absolute risk is low. Weighing the potential risk of lymphoma associated with select medical therapies against the risk of undertreating IBD will help physicians and patients to make more informed decisions pertaining to the medical management of IBD. (Inflamm Bowel Dis 2007) [source] Modernizing times: UK hearing-impaired consumers at the policy crossroadsINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 2 2008Liz Ross Abstract Although there is now a long-standing belief in the UK that free consumer choice improves market efficiency, the supply of some consumer products and services remained controlled by the state. In the interests of consumers, it regards as vulnerable to misdirection and malpractice or unlikely to have the technical expertise to make informed decisions. Historically, the supply of hearings aids has been restricted to the National Health Service and specific licensed practitioners in the independent sector. Recent changes to both product and service provision have brought about a radical alteration to this situation, and to the framework of control. This case study of a changing healthcare system demonstrates more generally the difficulties experienced by people trying to improve or maintain auditory functions for speech communication. Access to appropriate technological solutions may be precluded by cost, distribution arrangements or lack of knowledge. Overarching these difficulties, regional health policy variations within the UK mean that consumer experiences vary according to where they live. Consumer influence over the direction and scope of changes to the hearing aid market is limited despite the rhetoric of choice. This article examines the emerging ,liberalized' market and its contradictions. [source] Bladder cancer: an updateINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 3 2008Bruce Turner Abstract Bladder cancer remains a significant public health problem in the UK with considerable health and economic consequences. This article focuses on the anatomical, pathological, diagnostic and treatment perspectives of bladder cancer to help equip nurses with a thorough knowledge of the disease to help diagnose, treat and monitor patients with bladder cancer and to impart this knowledge onto patients to help them make informed decisions regarding their care. [source] Sources of knowledge in clinical practice in postgraduate medical students and faculty members: a conceptual mapJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2007Reza Yousefi-Nooraie MD Abstract Objectives, To determine the most important knowledge sources that can influence clinical practice and to cluster them in conceptual groups based on their relative importance. Methods, Faculty members, fellows and residents of a large teaching tertiary care hospital were asked to rate the importance of different resources in their daily clinical practice and their understanding of some common terms from evidence-based medicine. The knowledge sources were distributed in a two-dimensional map using multidimensional scaling and hierarchical cluster analysis. Results, A total of 250 of 320 recruited hospital staff returned the questionnaires. The most important resources in daily practice were English journals, text books and literature searching for faculty members, experience, text books and English journals for fellows and text books, experience and peers for residents. Regional journals were the least important resources for all study groups. About 62.7% of residents did not know the meaning of ,number needed to treat', 36.8%,confidence interval', 54.9%,confounding factor' and 44.6%,meta-analysis'. The percentages for faculty members were 41.3%, 37%, 42.2% and 39.1%. The knowledge sources were placed in four clusters in a point map derived from the multidimensional scaling process. Conclusion, The dominance of the traditional information resources and experience-based medicine debate which is the consequence of traditional approaches to medical education may be one of the considerable barriers to the dissemination of evidence-based medicine in developing countries. The evidence-based clinical practice guidelines could be used as a useful passive-predigested source for busy clinicians to make informed decisions. A considerable Western bias may undermine the local research in developing world. [source] Critical habitat during the transition from maternal provisioning in freshwater fish, with emphasis on Atlantic salmon (Salmo salar) and brown trout (Salmo trutta)JOURNAL OF ZOOLOGY, Issue 4 2006J. D. Armstrong Abstract In freshwater fish, the transition from dependence on maternal yolk reserves to independent foraging can be an early critical period, with survival during this stage having a strong influence on population abundance and cohort strength. Information concerning Atlantic salmon Salmo salar and brown trout Salmo trutta as model species is reviewed to show how population dynamics are influenced by habitat use during the transitional stage and illustrate the role of maternal provisioning along with density-dependent and -independent factors. The allocation of resources in yolk and timing and position of spawning strongly influence the biotic and abiotic environments of juveniles and their subsequent performance. Vulnerability to predators, adverse environmental conditions and restricted conditions over which they can successfully forage result in specific habitat requirements for newly independent juveniles. The availability of slow-flowing habitats at stream margins during the first month of independence is crucial. Alteration of natural flow regimes and physical habitat structure, associated with a wide range of anthropogenic influences, can have significant deleterious effects on the availability of critical juvenile habitat. A model combining habitat structure and the relationship between density-dependent and -independent mortality is presented to explore the range of conditions under which the transitional period would have a strong influence on population abundance. This model provides a framework for establishing thresholds or optima for habitat availability that will favour sufficient recruitment out of the transitional stage. Using the modelling framework, managers can make informed decisions on the utility and cost effectiveness of fisheries and habitat management activities designed to increase juvenile survival during the transition to independence. A range of management options is outlined for improving habitat quality and increasing juvenile survival during the transitional period, including restoration of structural complexity, provision of suitable flow regimes, and tailoring stocking and reintroduction strategies to mimic natural dynamics. [source] Review of methods for measuring and comparing center performance after organ transplantationLIVER TRANSPLANTATION, Issue 10 2010James Neuberger The assessment of outcomes after transplantation is important for several reasons: it provides patients with data so that they can make informed decisions about the benefits of transplantation and the success of the transplant unit; it informs commissioners that resources are allocated properly; and it provides clinicians reassurance that results are acceptable or, if they are not, provides early warning so that problems can be identified, corrections can be instituted early, and all interested parties can be reassured that scarce resources are used fairly. The need for greater transparency in reporting outcomes after liver transplantation and for comparisons both between and within centers has led to a number of approaches being adopted for monitoring center performance. We review some of the commonly used methods, highlight their strengths and weaknesses, and concentrate on methods that incorporate risk adjustment. Measuring and comparing outcomes after transplantation is complex, and there is no single approach that gives a complete picture. All those using analyses of outcomes must understand the merits and limitations of individual methods. When used properly, such methods are invaluable in ensuring that a scarce resource is used effectively, any adverse trend in outcomes is identified promptly and remedied, and best performers are identified; they thus allow the sharing of best practices. However, when they are used inappropriately, such measurements may lead to inappropriate conclusions, encourage risk-averse behavior, and discourage innovation. Liver Transpl 16:1119,1128, 2010. © 2010 AASLD. [source] Facilitating substance phase-out through material information systems and improving environmental impacts in the recycling stage of a productNATURAL RESOURCES FORUM, Issue 3 2010Daniel PaskaArticle first published online: 4 AUG 2010 Abstract The amount of electrical and electronic products is increasing rapidly, and this inevitably leads to the generation of large quantities of waste from these goods. Some of the generated e-waste ends up in regions with sub-standard recycling systems and may be processed under poor conditions. During uncontrolled incineration, halogenated dioxins and furans can be generated from brominated and chlorinated compounds in the products. In order to reduce the health and environmental risks involved in the recycling stage of the life cycle of electronics, an effective design-for-environment process must be established during the product development phase. Knowledge of the chemical substances in the product is crucial to being able to make informed decisions. Through full knowledge of the material content of procured components, phase-outs of unwanted substances, such as halogenated substances, can be performed in an effective manner. Therefore, information is the key to success in phasing-out substances; facilitating compliance of legal provisions for manufacturers of electrical and electronic devices; and improving the environmental footprint of products as they reach the end of the life cycle. After an introduction to the challenges of electronics waste management, this paper describes supply chain information systems and how they are used to facilitate substance phase-outs in the electronics industry. Sony Ericsson has been working with phase-outs of unwanted substances since it was founded in 2001. Through the introduction of a material declaration system that keeps track of all substances in the components used in the company's products, Sony Ericsson has been able to replace unwanted substances to improve environmental impacts at the recycling stage of a product. [source] A single-center experience in 20 patients with infantile malignant osteopetrosis,AMERICAN JOURNAL OF HEMATOLOGY, Issue 8 2009Evelina Mazzolari Infantile malignant osteopetrosis (IMO) includes various genetic disorders that affect osteoclast development and/or function. Genotype,phenotype correlation studies in IMO have been hampered by the rarity and heterogeneity of the disease and by the severity of the clinical course, which often leads to death early in life. We report on the clinical and molecular findings and treatment in 20 consecutive patients (11 males, nine females) with IMO, diagnosed at a single center in the period 1991,2008. Mean age at diagnosis was 3.9 months, and mean follow-up was 66.75 months. Mutations in TCIRG1, OSTM1, ClCN7, and TNFRSF11A genes were detected in nine, three, one, and one patients, respectively. Six patients remain genetically undefined. OSTM1 and ClCN7 mutations were associated with poor neurologic outcome. Among nine patients with TCIRG1 defects, six presented with hypogammaglobulinemia, and one showed primary pulmonary hypertension. Fourteen patients received hematopoietic cell transplantation; of these, nine are alive and eight of them have evidence of osteoclast function. These data may provide a basis for informed decisions regarding the care of patients with IMO. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] Quantitative versus qualitative evaluation: A tool to decide which to usePERFORMANCE IMPROVEMENT, Issue 4 2008Jackie L. Dobrovolny Evaluation is often avoided in human performance technology (HPT), but it is an essential and frequently catalytic activity that adds significant value to projects. Knowing how to approach an evaluation and whether to use qualitative, quantitative, or both methods makes evaluation much easier. In this article, we provide tools to help determine appropriate evaluation methods. Successful evaluation provides insightful data with which to make informed decisions. [source] Instructional Design Practice: Career Environments, Job Roles, and a Climate of ChangePERFORMANCE IMPROVEMENT QUARTERLY, Issue 1 2004Miriam B. Larson ABSTRACT Instructional Design and Technology (IDT) professionals practice their skills in a broad range of career environments and job roles. The resulting collection of competency lists and wide range of practice environments, coupled with the frequent changes that have always characterized the field, produce complexity that is difficult to communicate to IDT students. However, students need to understand these complex aspects of the field so that they can make informed decisions about their career goals and educational direction. This review of the current literature looks at the current issues impacting practice and preparation. It concludes that the path professional academic preparation programs choose will depend on their orientation to instructional design and performance improvement, and whether they see themselves as preparing students for specific career environments or are pursuing a generalist program. [source] Making sense of genetic uncertainty: The role of religion and spirituality,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 1 2009Mary T. White Abstract This article argues that to the extent that religious and spiritual beliefs can help people cope with genetic uncertainty, a limited spiritual assessment may be appropriate in genetic counseling. The article opens by establishing why genetic information is inherently uncertain and why this uncertainty can be medically, morally, and spiritually problematic. This is followed by a review of the range of factors that can contribute to risk assessments, including a few heuristics commonly used in responses to uncertainty. The next two sections summarize recent research on the diverse roles of religious and spiritual beliefs in genetic decisions and challenges to conducting spiritual assessments in genetic counseling. Based on these findings, religious and spiritual beliefs are posited as serving essentially as a heuristic that some people will utilize in responding to their genetic risks. In the interests of helping such clients make informed decisions, a limited spiritual assessment is recommended and described. Some of the challenges and risks associated with this limited assessment are discussed. Since some religious and spiritual beliefs can conflict with the values of medicine, some decisions will remain problematic. © 2009 Wiley-Liss, Inc. [source] Identifying best practices and skills for workforce development in data curationPROCEEDINGS OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE & TECHNOLOGY (ELECTRONIC), Issue 1 2007P. Bryan Heidorn The nature of science and scholarship is being transformed by the ability to collect and integrate vast quantities of information. Some sciences such as ecology and environmental science are inherently integrative, requiring the combination of many types of information from many sources in order to answer more complex questions than has been previously possible. This new information and the information management tools designed to deal with this volume of data will help us make informed decisions that will impact human health and prosperity. To enable this cross-scale, interdisciplinary integration for the coming generations of scholars, data must be managed to facilitate interoperability, preservation, and sharing. This panel will explore best practices in data curation and models of education for new data curation professionals. [source] Public library websites for teenagers: How are they addressing the consumer health information needs of today's teens?PROCEEDINGS OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE & TECHNOLOGY (ELECTRONIC), Issue 1 2007Jennifer E. Burke Young adult use of the Web both for creating and reviewing content continues to grow and the Internet has become an important tool for teenagers seeking health information (Borzekowski & Rickert 2001, Gray et al 2005; Rideout 2001; Richardson 2002; Vargas 2005). More than 70 percent of 15 to 17 year olds say they have used the Internet to look up health information (Rideout 2001, Richardson et al 2002). In fact, the Kaiser Family Foundation study reported in "Generation Rx.com" found that more youth had looked for health information than had engaged in various Web 2.0 behaviors as purchasing something online or using a chat room (Rideout 2001). Researchers cite availability, anonymity, and affordability as the key reasons teenagers turn to the web for answers to their health-related questions (Barak & Fisher 2001; Gray et al 2005). While the Internet provides teenagers with access to a wealth of health-related resources, it also presents challenges that can negatively impact the ability of adolescents to access quality information online. Difficulty conducting searches, judging the credibility of the information retrieved, and accessing sites due to filtering software are just a few of the barriers teenagers face (Gray et al 2002; Gray et al 2005; Richardson et al 2002). Like many Web users, teenagers also express concerns about privacy and confidentiality, especially in chat rooms or email correspondences (Vargas 2005). Given the issues teens face when searching for health information online, it seems natural that public libraries take the lead in providing assistance to teenagers who need help finding health information. Libraries, particularly public libraries, have a long history of providing consumer heath information to adults in their communities, and this service has transitioned online as libraries provide Internet access to electronic consumer health information (Smith 2006). In addition, many public libraries have developed websites specifically for teenagers. As more teens look for personalized information or the ability to ,create' their own content, these library web pages often serve as centers for reference, educational support, popular materials, community information, and library programming (Hughes-Hassell & Miller 2003; Jones 1997). Including links to useful websites would alleviate some of the frustration teenagers face when searching for quality health information on the Internet and allow them to make their own informed decisions (Vargas 2005). But how common is it for these web pages to provide consumer health information for teenagers? [source] A Decision Tool for Predicting Sentinel Node Accuracy from Breast Tumor Size and GradeTHE BREAST JOURNAL, Issue 6 2007FRCS (Gen. Surg.), Nathan Coombs BSc Abstract:, The ability to predict axillary lymph node involvement in breast cancer patients in the preoperative setting is invaluable. This study provides a simple set of formulae to enable clinicians to make informed decisions in the management of screen-detected breast cancer. The tumor pathology reports were obtained of all 4,585 women identified between 1996 and 1999 in New South Wales (NSW) with T1 or T2 breast cancer by the statewide co-ordinated breast screening service (BreastScreen NSW). Equations predicting node positivity were calculated by linear regression analysis and, from published sentinel node false-negative rates, the probability of retrieval of a false-negative axillary lymph node by sentinel node biopsy was calculated for tumors of different size and grade. Node involvement was identified in 1,089 (23.8%) of women. A linear relationship for tumor size, grade, and nodal involvement was predicted by: frequency (%) = 1.5 × tumor size (mm) + 2 (or 6 or 10) for grade I (or II or III) tumors. Assuming a 7.5% false-negative rate, the probability of retrieving a false-negative sentinel node ranged from 0.8% for a patient with a 5 mm, grade I carcinoma to 6.0% for a 50 mm, grade III tumor. These simple formulae are easy to use in a clinical setting. The reference table enables breast surgeons to inform a patient about the absolute probability of false-negative sentinel biopsy rates for patients with screen-detected carcinomas when size can be estimated from preoperative imaging and when tumor grade is often available from preoperative core biopsy. Patients with large, T2 breast tumors may be best treated with axillary dissection rather than sentinel node biopsy alone due to the risk of under-staging the woman's disease and also the high probability of finding a positive sentinel node. [source] Evaluation: Using evaluation research to improve medical educationTHE CLINICAL TEACHER, Issue 3 2010Mohsen Tavakol Summary Background:, Evaluation research is a form of applied research that scrutinises how well a particular programme, practice, procedure or policy is operating. Evaluation researchers use both quantitative and qualitative research data to construct a collective picture of the programme under evaluation. Context:, Medical educators need to provide information about a particular programme using the methods of evaluation research in order to make a decision on the potential adoption, improvements and refinements of the programme. Improving curricula and pedagogical methods using these methods may enhance health care education. Innovation:, We provide an overview of the methods of evaluation research in the context of medical education. We discuss the application, general methodology, methods of collecting data and analysis for each type of evaluation research. Implications:, The methods of evaluation research described in this article enable medical educators to gain a comprehensive understanding of evaluation research in the context of medical education. The use of evaluation research findings helps medical educators to make informed decisions regarding a programme and any future actions related to it. [source] A not so Well-Lit Path: Employers' Perspectives on Employing Ex-offendersTHE HOWARD JOURNAL OF CRIMINAL JUSTICE, Issue 1 2008ILONA HASLEWOOD-PÓCSIK The findings also reveal that employers need more information on the relevance and the provisions of the Rehabilitation of Offenders Act 1974, as well as guidance on risk assessment and management procedures, in order to enable them to make informed decisions about, and increase their confidence in, employing ex-offenders. [source] Research on Rural Veterans: An Analysis of the LiteratureTHE JOURNAL OF RURAL HEALTH, Issue 4 2008William B. Weeks MD ABSTRACT:,Context: The Veterans Health Administration (VA) provides comprehensive health care services to veterans across the United States. Recently, the VA established an Office of Rural Health to address the health care needs of rural veterans. Purpose: To review the literature on rural veterans' health care needs in order to identify areas for future research. Methods: We conducted a literature review of articles listed in the Medline, CINAHL, and BIOSIS datasets since 1950. We reviewed and summarized the findings of 50 articles that specifically examined rural veterans. Findings: The literature on rural veterans included 4 articles examining access to care, 7 evaluating distance technology, 4 examining new models of care delivery, 11 studying rural veterans' patient characteristics, 10 evaluating programs provided in a rural setting, 6 examining rural health care settings, and 8 exploring rural veterans' health services utilization patterns. Most studies were small, based on data obtained before 2000, and consisted of uncontrolled, retrospective, descriptive studies of health care provided in rural VA settings. Definitions of rural were inconsistent, and in 20% of the articles examined the rural aspect of the setting was incidental to the study. Conclusions: The literature on rural veterans' health care needs warrants expansion and investment so that policy makers can make informed decisions in an environment of limited resources and competing interests. [source] TUMOUR SIZE AS A PREDICTOR OF AXILLARY NODE METASTASES IN PATIENTS WITH BREAST CANCERANZ JOURNAL OF SURGERY, Issue 11 2006Sharon Laura Background: The ability to predict the behaviour of breast cancer from its dimensions allows the clinician to inform a woman about the absolute benefits of adjuvant therapies or further surgery to control her disease. Tumour size and grade are independent predictors of nodal disease. This study aims to generate a tool, using Australian data, allowing surgeons to calculate the probability of axillary lymph node involvement in a preoperative setting. Methods: The histological reports of patients with breast cancer treated in 1995 in New South Wales were examined and tumour size, grade and nodal status recorded. Univariate and multivariate analyses identified predictors of node positivity and, using linear regression analysis, a simple formula to predict nodal involvement was derived. Results: In a 6-month period, 754 women had non-metastatic, unifocal breast cancer treated with surgery and complete axillary dissection and 283 (37.5%) had positive nodes. Tumour size remained an independent predictor of node positivity and the probability (%), y, of nodal involvement may be predicted by the formula y = 1.5 × tumour size (mm) + 7, r = 0.939 and P = 0.001. Conclusions: This paper shows the need to assess the axilla in every patient because even patients with small tumours (0,5 mm) have the possibility of axillary involvement (7,14.5%). Use of this simple formula allows clinicians and patients to make informed decisions about the possible need for a full axillary dissection to reduce the chance of understaging and potentially undertreating a woman's breast cancer. [source] | |||||||||||||||||||||||||||||||||||||