Medical Decision Making and the Counting of Uncertainty

In economic theory, homo economicus is a concept used to explain decision making as a rational exercise.1 The “economic man,” to use the term often associated with the work of the utilitarian philosopher John Stuart Mills, is someone who makes decisions by carefully weighing the benefits and costs of his or her options and then deciding on a course of action that maximizes his or her utility. Although now considered overly simplistic, this idea is often implicit in how we as clinicians have traditionally approached medical decision making. In the case of statins for the primary prevention of cardiovascular diseases, the choice is frequently framed in terms of the tradeoff between the potential benefit of preventing a future heart attack or stroke (ie, utility) and the side effects and inconveniences of taking a medication (ie, disutility). Thus, the recently released 2013 American Heart Association/American College of Cardiology guideline on the treatment of blood cholesterol reminds us that, in addition to calculating estimated atherosclerotic cardiovascular disease risk to determine statin eligibility, we should engage with patients “in a discussion…to consider the potential for ASCVD [atherosclerotic cardiovascular disease] benefit and for adverse effects, for drug-drug interactions, and patient preferences for treatment.”2 However, although much of the debate over the current guidelines has focused on the accuracy of risk estimation,3,4 the evidence base is limited for how to engage with patients during the decision-making process to assess their disutility for taking statin therapy

Miniaturization of Electrical Ultrafine Particle Sizers

Nanoparticles, or ultrafine particles, have potential risks for human health, and the adverse health effects caused by ultrafine particles have been proven to be size related. To meet the increasing demanding for personal exposure monitoring and spatial distribution measurements of ultrafine particles, this dissertation studied the development and miniaturization of electrical ultrafine particle sizers (EUPS). There are three essential components for developing a EUPS unit: a charger to electrically charge the sample particles, an electrical mobility classifier to classify the charged particles, and a downstream particle count detector to measure the number concentrations. Two generations of EUPS were developed in this dissertation. The first generation was a precipitator–type (p–type EUPS, which was assembled with a miniature corona–discharge unipolar charger, a miniature disk–type precipitator, and a portable condensation particle counter. All three components were calibrated under the optimized operation conditions. By combining the component calibration results, a data inversion scheme was developed to retrieve particle size distribution from measured signals. Size distribution measurement performance of the p–type EUPS prototype was then evaluated with both laboratory generated aerosols and field ambient aerosols. Evaluation results solidly verified the size distribution measurement reliability and flexibility of the p–type EUPS. Several possible improvements were implied, for a more precise EUPS size distribution measurement, based on the p–type EUPS development. These improvements were realized in the second part of this dissertation, as the component development and evaluation for a second generation EUPS. A new corona–discharge based, miniature unipolar aerosol charger was developed and evaluated. The new charger design made significant improvements in both intrinsic and extrinsic charging efficiency, and it also maintained a more stable charging performance. To improve the electrical mobility classification resolution, a miniature electrostatic aerosol classifier (EAC) prototype, named the Dumbbell EAC, was designed as an improved replacement of the mini–disk precipitator for the next generation EUPS. It had a novel axial–symmetric dumbbell–shaped curved classification channel design, to achieve an extended classification length within the compact overall device size. The Dumbbell EAC classification performance was evaluated both numerically and experimentally. According to both evaluation results, this palm size device, with its higher aerosol to sheath flow ratio as up to 1:5, and extended detectable size range from 10 to 850 nm, provided an improved solution for more precise portable size distribution measurements by the next generation EUPS

Hitting and Missing the Mark: Feminist Inquiry and Pedagogy in United States Women’s Studies Graduate Programs

From the Introduction: This essay looks specifically at reflection in these areas undertaken in one sector of women’s studies: the master’s degree in women’s studies in the United States. That graduate education in women’s studies is the focal point of this essay is especially timely because graduate programs in women’s studies are experiencing substantial growth. This essay addresses one aspect of graduate education: the correspondence between feminist intellectual inquiry and pedagogy in master’s programs in women’s studies. In particular, the essay aims to assess women’s studies at the graduate level by asking graduate students what they think about the attention paid by their programs to the issues fore grounded in feminist inquiry. Questions about the diverse groups that make up “women,” the classroom climate, and ways in which feminist inquiry can balance theory and activism are engaged in this essay from the perspective of graduate students. Furthermore, this essay analyzes the students’ satisfaction with the attention paid by their graduate programs to these major components of feminist inquiry. What we find is that there are ways in which the pedagogy of women’s studies programs closely corresponds with feminist theoretical inquiry and other ways in which women’s studies graduate programs are missing the mark

Analysis of Turbulence on Cylinder with Additional Fairing with Free Surface

In this study, two dimensional unsteady flows of cylinder and cylinder with additional fairing close to a free surface were numerically investigated. The governing momentum equations were solved by using the Semi Implicit Method for Pressure Linked Equations(SIMPLE). The Volume of Fluid(VOF) method applied to simulate a free surface. Non- uniform grid structures were used in the simulation with denser grids near the cylinder. Under the conditions of Reynolds number 150624, 271123, 210874 and 331373, the cylinders were simulated with different depths of invasion. It was shown that the flow characteristics were influenced by submergence depth and Reynolds numbers. When the cylinder close to the free surface, the drag coefficient, lift coefficient and Strouhal numbers will increase due to the effect of free liquid surface on vortex shedding. With additional fairing, can effectively reduce the influence of the free surface on the drag coefficient. Fairing will reduce lift coefficient at high Reynolds numbers, but increase lift coefficient when Reynolds numbers are small. Fairing can effectively reduce Strouhal numbers, thus can well suppress the vortex induced vibratio

Adherence to Cardiovascular Medications: Lessons Learned and Future Directions

Approximately 50% of patients with cardiovascular disease and/or its major risk factors have poor adherence to their prescribed medications. Finding novel methods to help patients improve their adherence to existing evidence-based cardiovascular drug therapies has enormous potential to improve health outcomes while potentially reducing health care costs. The goal of this report is to provide a review of the current understanding of adherence to cardiovascular medications from the point of view of prescribing clinicians and cardiovascular researchers. Key topics addressed include: 1) definitions of medication adherence; 2) prevalence and impact of non-adherence; 3) methods for assessing medication adherence; 4) reasons for poor adherence; and 5) approaches to improving adherence to cardiovascular medications. For each of these topics, the report seeks to identify important gaps in knowledge and opportunities for advancing the field of cardiovascular adherence research

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