611 research outputs found
NEGOTIATING ETHICAL RESIDUE ASSOCIATED WITH BEDSIDE RATIONING: A GROUNDED THEORY STUDY WITH FAMILY PHYSICIANS
In any health care system where funds are limited, priorities must be set. Resource allocation, also called priority setting or rationing, may determine who receives treatment, what treatment they receive, or amount of time spent with professionals. Bedside rationing decisions are those which health care professionals make at the clinical level. Ethical distress and residue theory may inform the investigation of discomfort and conflict identified in physicians who ration care. Ethical distress is experienced when external constraints make it nearly impossible to do “the right thing,” and ethical residue represents the traces which remain following unresolved ethical distress. This study aims to explore how physicians negotiate ethical residue associated with making bedside rationing decisions on an ongoing basis, using a grounded theory methodology. The findings indicate that “doing everything I think patients need” is central to this process. Findings may inform medical ethics education and training interventions for practicing physicians
Analytic Approximations for the Primordial Power Spectrum with Israel Junction Conditions
This work compares cosmological matching conditions used in approximating
generic pre-inflationary phases of the universe. We show that the joining
conditions for primordial scalar perturbations assumed by Contaldi et al. are
inconsistent with the physically motivated Israel junction conditions, however,
performing general relativistic matching with the aforementioned constraints
results in unrealistic primordial power spectra. Eliminating the need for
ambiguous matching, we look at an alternative semi-analytic model for producing
the primordial power spectrum allowing for finite duration cosmological phase
transitions.Comment: 21 pages, 10 figures. To be submitted to PR
Professional decision-making in medicine: Development of a new measure and preliminary evidence of validity
INTRODUCTION: This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment.
METHODS: Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs.
RESULTS: Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions.
CONCLUSIONS: These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies
Magnetic dipole moments in single and coupled split-ring resonators
We examine the role of magnetic dipoles in single and coupled pairs of
metallic split-ring resonators by numerically computing their magnitude and
examining their relative contributions to the scattering cross section. We
demonstrate that magnetic dipoles can strongly influence the scattering cross
section along particular directions. It is also found that the magnetic dipole
parallel to the incident magnetic field and/or high-order multipoles may play a
significant role in the linear response of coupled split-ring resonators.Comment: 7 pages, 3 figures, 1 tabl
The biochemical pathway for the breakdown of N4-ethyl-L-asparagine in the bacterium Pseudomonas stutzeri
Spectra of weighted algebras of holomorphic functions
We consider weighted algebras of holomorphic functions on a Banach space. We
determine conditions on a family of weights that assure that the corresponding
weighted space is an algebra or has polynomial Schauder decompositions. We
study the spectra of weighted algebras and endow them with an analytic
structure. We also deal with composition operators and algebra homomorphisms,
in particular to investigate how their induced mappings act on the analytic
structure of the spectrum. Moreover, a Banach-Stone type question is addressed.Comment: 25 pages Corrected typo
Strain evolution in GaN Nanowires: from free-surface objects to coalesced templates
Top-down fabricated GaN nanowires, 250 nm in diameter and with various
heights, have been used to experimentally determine the evolution of strain
along the vertical direction of 1-dimensional objects. X-ray diffraction and
photoluminescence techniques have been used to obtain the strain profile inside
the nanowires from their base to their top facet for both initial compressive
and tensile strains. The relaxation behaviors derived from optical and
structural characterizations perfectly match the numerical results of
calculations based on a continuous media approach. By monitoring the elastic
relaxation enabled by the lateral free-surfaces, the height from which the
nanowires can be considered strain-free has been estimated. Based on this
result, NWs sufficiently high to be strain-free have been coalesced to form a
continuous GaN layer. X-ray diffraction, photoluminescence and
cathodoluminescence clearly show that despite the initial strain-free nanowires
template, the final GaN layer is strained
Faraday Rotation as a diagnostic of Galactic foreground contamination of CMB maps
The contribution from the residuals of the foreground can have a significant
impact on the temperature maps of the Cosmic Microwave Background (CMB).
Mostly, the focus has been on the galactic plane, when foreground cleaning has
taken place. However, in this paper, we will investigate the possible
foreground contamination, from sources outside the galactic plane in the CMB
maps. We will analyze the correlation between the Faraday rotation map and the
CMB temperature map. The Faraday rotation map is dependent on the galactic
magnetic field, as well as the thermal electron density, and both may
contribute to the CMB temperature. We find that the standard deviation for the
mean cross correlation deviate from that of simulations at the 99.9% level.
Additionally, a comparison between the CMB temperature extrema and the extremum
points of the Faraday rotation is also performed, showing a general overlap
between the two. Also we find that the CMB Cold Spot is located at an area of
strong negative cross correlation, meaning that it may be explained by a
galactic origin. Further, we investigate nearby supernova remnants in the
galaxy, traced by the galactic radio loops. These super nova remnants are
located at high and low galactic latitude, and thus well outside the galactic
plane. We find some correlation between the Faraday Rotation and the CMB
temperature, at select radio loops. This indicate, that the galactic
foregrounds may affect the CMB, at high galactic latitudesComment: 13 pages, 22 figures, 6 table
Cross-correlation of the CMB and foregrounds phases derived from the WMAP data
We present circular and linear cross-correlation tests and the
"friend-of-friend" analysis for phases of the Internal Linear Combination Map
(ILC) and the WMAP foregrounds for all K--W frequency bands at the range of
multipoles . We compare also Tegmark, de Oliveira-Costa and
Hamilton (2003) and Naselsky et al. (2003) cleaned maps with corresponding
foregrounds. We have found significant deviations from the expected Poissonian
statistics for all the cleaned maps and foregrounds. Our analysis shows that,
for a low multipole range of the cleaned maps, power spectra contains some of
the foregrounds residuals mainly from the W band.Comment: 11 pages, 10 figures. Submitted to MNRA
Serial MR diffusion to predict treatment response in high-grade pediatric brain tumors: a comparison of regional and voxel-based diffusion change metrics
Background
Assessment of treatment response by measuring tumor size is known to be a late and potentially confounded response index. Serial diffusion MRI has shown potential for allowing earlier and possibly more reliable response assessment in adult patients, with limited experience in clinical settings and in pediatric brain cancer. We present a retrospective study of clinical MRI data in children with high-grade brain tumors to assess and compare the values of several diffusion change metrics to predict treatment response.
Methods
Eighteen patients (age range, 1.9–20.6 years) with high-grade brain tumors and serial diffusion MRI (pre- and posttreatment interval range, 1–16 weeks posttreatment) were identified after obtaining parental consent. The following diffusion change metrics were compared with the clinical response status assessed at 6 months: (1) regional change in absolute and normalized apparent diffusivity coefficient (ADC), (2) voxel-based fractional volume of increased (fiADC) and decreased ADC (fdADC), and (3) a new metric based on the slope of the first principal component of functional diffusion maps (fDM).
Results
Responders (n = 12) differed significantly from nonresponders (n = 6) in all 3 diffusional change metrics demonstrating higher regional ADC increase, larger fiADC, and steeper slopes (P < .05). The slope method allowed the best response prediction (P < .01, η2 = 0.78) with a classification accuracy of 83% for a slope of 58° using receiver operating characteristic (ROC) analysis.
Conclusions
We demonstrate that diffusion change metrics are suitable response predictors for high-grade pediatric tumors, even in the presence of variable clinical diffusion imaging protocols
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