612 research outputs found

    The Spectrum of Competency: Determining a Standard of Competence for Pro Se Representation

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    Severe hepatic and pulmonary involvement in Rendu-Osler-Weber syndrome

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    We report the case of a young woman with hereditary hemorrhagic telangiectasia (HHT) with severe liver involvement and pulmonary shunting. The medical imaging in this patient illustrates the severe shunting that can occur in these patients who often are asymptomatic. By showing this case, we want to highlight the role of liver transplantation in HHT with hepatic involvement

    The psychophysics of absolute threshold and signal duration: A probabilistic approach

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    The absolute threshold for a tone depends on its duration; longer tones have lower thresholds. This effect has traditionally been explained in terms of ?temporal integration? involving the summation of energy or perceptual information over time. An alternative probabilistic explanation of the process is formulated in terms of simple equations that predict not only the time=duration dependence but also the shape of the psychometric function at absolute threshold. It also predicts a tight relationship between these two functions. Measurements made using listeners with either normal or impaired hearing show that the probabilistic equations adequately fit observed threshold-duration functions and psychometric functions. The mathematical formulation implies that absolute threshold can be construed as a two-valued function: (a) gain and (b) sensory threshold, and both parameters can be estimated from threshold-duration data. Sensorineural hearing impairment is sometimes associated with a smaller threshold=duration effect and sometimes with steeper psychometric functions. The equations explain why these two effects are expected to be linked. The probabilistic approach has the potential to discriminate between hearing deficits involving gain reduction and those resulting from a raised sensory threshold

    Supplemental health insurance and equality of access in Belgium.

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    It has been suggested that the unequal coverage of different socio-economic groups by supplemental insurance could be a partial explanation for the inequality in access to health care in many countries. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. We find that this institutional background is crucial for the explanation of the effects of supplemental insurance. We find no evidence of adverse selection in the coverage of supplemental health insurance, but strong effects of socio-economic background. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spells, but a negative effect on the number of nights. This is in line with patterns of socio-economic stratification that have been well documented for Belgium. It is also in line with the regulation on extra-billing protecting patients in common rooms. For ambulatory care, we find a positive effect of supplemental insurance on visits to a dentist and on number of spells at a day centre but no effect on visits to a GP, on drugs consumption and on visits to a specialist.Costs; Cost; Risk; Policy; Choice; Insurance; Equality; Belgium;

    Vehicle routing with stochastic time-dependent travel times

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    Assigning and scheduling vehicle routes in a stochastic time-dependent environment is a crucial management problem. The assumption that in a real-life environment everything goes according to an a priori determined static schedule is unrealistic. Our methodology builds on earlier work in which the traffic congestion is captured in an analytical way using queueing theory. The congestion is then applied to the VRP problem. In this paper, we introduce the variability in traffic flows into the model. This allows for an evaluation of the routes based on the uncertainty involved. Different experiments show that the risk taking behavior of the planner can be taken into account during optimization. As more weight is given to the variability component, the resulting optimal route will take a slightly longer travel time, but will be more reliable. We propose a powerful objective function that is easily implemented and that captures the trade-off between the average travel time and its variance. The evaluation of the solution is done in terms of the 95th-percentile of the travel time distribution (assumed to be lognormal), which reflects well the quality of the solution in this stochastic time-dependent environment

    Tinnitus and Patterns of Hearing Loss

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    Tinnitus is strongly linked with the presence of damaged hearing. However, it is not known why tinnitus afflicts only some, and not all, hearingimpaired listeners. One possibility is that tinnitus patients have specific inner ear damage that triggers tinnitus. In this study, differences in cochlear function inferred from psychophysical measures were measured between hearing-impaired listeners with tinnitus and hearing-impaired listeners without tinnitus. Despite having similar average hearing loss, tinnitus patients were observed to have better frequency selectivity and compression than those without tinnitus. The results suggest that the presence of subjective tinnitus may not be strongly associated to outer hair cell impairment, at least where hearing impairment is evident. The results also show a different average pattern of hearing impairment amongst the tinnitus patients, consistent with the suggestion that inner hair cell dysfunction with subsequent reduce
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