463 research outputs found

    Reactions to uncertainty and the accuracy of diagnostic mammography.

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    BackgroundReactions to uncertainty in clinical medicine can affect decision making.ObjectiveTo assess the extent to which radiologists' reactions to uncertainty influence diagnostic mammography interpretation.DesignCross-sectional responses to a mailed survey assessed reactions to uncertainty using a well-validated instrument. Responses were linked to radiologists' diagnostic mammography interpretive performance obtained from three regional mammography registries.ParticipantsOne hundred thirty-two radiologists from New Hampshire, Colorado, and Washington.MeasurementMean scores and either standard errors or confidence intervals were used to assess physicians' reactions to uncertainty. Multivariable logistic regression models were fit via generalized estimating equations to assess the impact of uncertainty on diagnostic mammography interpretive performance while adjusting for potential confounders.ResultsWhen examining radiologists' interpretation of additional diagnostic mammograms (those after screening mammograms that detected abnormalities), a 5-point increase in the reactions to uncertainty score was associated with a 17% higher odds of having a positive mammogram given cancer was diagnosed during follow-up (sensitivity), a 6% lower odds of a negative mammogram given no cancer (specificity), a 4% lower odds (not significant) of a cancer diagnosis given a positive mammogram (positive predictive value [PPV]), and a 5% higher odds of having a positive mammogram (abnormal interpretation).ConclusionMammograms interpreted by radiologists who have more discomfort with uncertainty have higher likelihood of being recalled

    A review of clinical decision-making: Models and current research

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    Aims and objectives: The aim of this paper was to review the current literature with respect to clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information processing model, the intuitive-humanist model and the clinical decision making model. Background: Clinical decision-making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognised from the literature; the information processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Design: Literature review Methods: Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 – November 2005

    The GAPS Experiment to Search for Dark Matter using Low-energy Antimatter

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    The GAPS experiment is designed to carry out a sensitive dark matter search by measuring low-energy cosmic ray antideuterons and antiprotons. GAPS will provide a new avenue to access a wide range of dark matter models and masses that is complementary to direct detection techniques, collider experiments and other indirect detection techniques. Well-motivated theories beyond the Standard Model contain viable dark matter candidates which could lead to a detectable signal of antideuterons resulting from the annihilation or decay of dark matter particles. The dark matter contribution to the antideuteron flux is believed to be especially large at low energies (E < 1 GeV), where the predicted flux from conventional astrophysical sources (i.e. from secondary interactions of cosmic rays) is very low. The GAPS low-energy antiproton search will provide stringent constraints on less than 10 GeV dark matter, will provide the best limits on primordial black hole evaporation on Galactic length scales, and will explore new discovery space in cosmic ray physics. Unlike other antimatter search experiments such as BESS and AMS that use magnetic spectrometers, GAPS detects antideuterons and antiprotons using an exotic atom technique. This technique, and its unique event topology, will give GAPS a nearly background-free detection capability that is critical in a rare-event search. GAPS is designed to carry out its science program using long-duration balloon flights in Antarctica. A prototype instrument was successfully flown from Taiki, Japan in 2012. GAPS has now been approved by NASA to proceed towards the full science instrument, with the possibility of a first long-duration balloon flight in late 2020. Here we motivate low-energy cosmic ray antimatter searches and discuss the current status of the GAPS experiment and the design of the payload.Comment: 8 pags, 3 figures, Proc. 35th International Cosmic Ray Conference (ICRC 2017), Busan, Kore

    The Tissue-Engineered Vascular Graft-Past, Present, and Future

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    Cardiovascular disease is the leading cause of death worldwide, with this trend predicted to continue for the foreseeable future. Common disorders are associated with the stenosis or occlusion of blood vessels. The preferred treatment for the long-term revascularization of occluded vessels is surgery utilizing vascular grafts, such as coronary artery bypass grafting and peripheral artery bypass grafting. Currently, autologous vessels such as the saphenous vein and internal thoracic artery represent the gold standard grafts for small-diameter vessels (<6 mm), outperforming synthetic alternatives. However, these vessels are of limited availability, require invasive harvest, and are often unsuitable for use. To address this, the development of a tissue-engineered vascular graft (TEVG) has been rigorously pursued. This article reviews the current state of the art of TEVGs. The various approaches being explored to generate TEVGs are described, including scaffold-based methods (using synthetic and natural polymers), the use of decellularized natural matrices, and tissue self-assembly processes, with the results of various in vivo studies, including clinical trials, highlighted. A discussion of the key areas for further investigation, including graft cell source, mechanical properties, hemodynamics, integration, and assessment in animal models, is then presented

    Time-dependent depletion isotopics with MCNP-5 and SCALE-6.1

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    Thesis (S.M. and S.B.)--Massachusetts Institute of Technology, Dept. of Nuclear Science and Engineering, 2012.Cataloged from PDF version of thesis.Includes bibliographical references (p. 45).In order to operate a reactor safely and efficiently, computer simulations must be used to predict certain nuclear characteristics of the reactor. To determine how materials change in a fission power environment, a time-dependent depletion isotopic code must be used. Over the past several decades, the MIT Reactor (MITR) has taken many steps to prepare for its conversion from the use of highly enriched uranium (HEU) to low enriched uranium (LEU) in its fuel. Throughout this process, detailed neutronics simulations must be run to predict the characteristics of the reactor with its current HEU fuel, with potential forms of LEU fuel, and with combinations of the two. MCODE Version 3 is a linkage code that performs time-dependent burnup calculations by combining the Monte Carlo N-Particle transport code, MCNP, with the Oak Ridge Isotope Generation point depletion code, ORIGEN-S. MCNP provides reaction rates and neutron flux in user-specified irradiation material regions. COUPLE, a data-editing code included in the SCALE- 6.1 software package, uses these data from MCNP to update the cross section libraries, which ORIGEN then uses to perform nuclide depletion calculations in each irradiation zone. The MCNP model is then updated with the depleted material compositions, and the exchange is repeated. The MCNP/ORIGEN coupling utilizes an optional predictor-corrector capability. As a newer version of MCODE Version 2.2, MCODE-3 offers three major changes from its predecessor. The first is the incorporation of ORIGEN-S. MCODE-2 used a previous version of ORIGEN, which is no longer supported by ORNL. ORIGEN-S provides newer nuclear data as well as additional functionality and usability. Secondly, MCODE-3 uses COUPLE to create an entirely unique cross section library from the regionally averaged 238-group flux, which means every cross section value that MCODE-3 uses in its depletion is specific to the input model. MCODE-2 only updates a fraction of nuclides' cross sections, the rest default to a pre-compiled library. Finally, while MCODE-2.2 was written in ANSI C, MCODE-3's main function has been rewritten in the Python scripting language. MCODE's preproc, mcodeout, and mcnpxs programs have not been edited, and are thus still written in ANSI C. Benchmarking has indicated that while the evolution of most nuclides is similar to an MCODE-2 calculation, over many depletion steps some nuclides can diverge due to COUPLE's use of the 238-group flux.by Thomas P. Gerrity, III.S.M.and S.B

    Integration of decision support systems to improve decision support performance

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    Decision support system (DSS) is a well-established research and development area. Traditional isolated, stand-alone DSS has been recently facing new challenges. In order to improve the performance of DSS to meet the challenges, research has been actively carried out to develop integrated decision support systems (IDSS). This paper reviews the current research efforts with regard to the development of IDSS. The focus of the paper is on the integration aspect for IDSS through multiple perspectives, and the technologies that support this integration. More than 100 papers and software systems are discussed. Current research efforts and the development status of IDSS are explained, compared and classified. In addition, future trends and challenges in integration are outlined. The paper concludes that by addressing integration, better support will be provided to decision makers, with the expectation of both better decisions and improved decision making processes

    A review of combined advanced oxidation technologies for the removal of organic pollutants from water

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    Water pollution through natural and anthropogenic activities has become a global problem causing short-and long-term impact on human and ecosystems. Substantial quantity of individual or mixtures of organic pollutants enter the surface water via point and nonpoint sources and thus affect the quality of freshwater. These pollutants are known to be toxic and difficult to remove by mere biological treatment. To date, most researches on the removal of organic pollutants from wastewater were based on the exploitation of individual treatment process. This single-treatment technology has inherent challenges and shortcomings with respect to efficiency and economics. Thus, application of two advanced treatment technologies characterized with high efficiency with respect to removal of primary and disinfection by-products in wastewater is desirable. This review article focuses on the application of integrated technologies such as electrohydraulic discharge with heterogeneous photocatalysts or sonophotocatalysis to remove target pollutants. The information gathered from more than 100 published articles, mostly laboratories studies, shows that process integration effectively remove and degrade recalcitrant toxic contaminants in wastewater better than single-technology processing. This review recommends an improvement on this technology (integrated electrohydraulic discharge with heterogeneous photocatalysts) viz-a-vis cost reduction in order to make it accessible and available in the rural and semi-urban settlement. Further recommendation includes development of an economic model to establish the cost implications of the combined technology. Proper monitoring, enforcement of the existing environmental regulations, and upgrading of current wastewater treatment plants with additional treatment steps such as photocatalysis and ozonation will greatly assist in the removal of environmental toxicants
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