Developing a cultural competence assessment tool for people in recovery from racial, ethnic and cultural backgrounds: the journey, challenges and lessons learned.

In 1997, Maryland implemented a new managed care mental health system. Consumer satisfaction, evaluation and cultural competency were considered high priorities for the new system. While standardized tools for measuring consumer satisfaction were readily available, no validated, reliable and standardized tool existed to measure the perception of people from minority groups receiving mental health services. The MHA*/MHP* Cultural Competency Advisory Group (CCAG) accepted the challenge of developing a consumer assessment tool for cultural competency. The CCAG, composed of people in recovery, clinicians and administrators used their collective knowledge and experiences to develop a 52-item tool that met standards for validity and reliability. Consultation from a researcher helped to further develop the tool into one possessing tremendous potential for statewide implementation within Maryland's Public Mental Health System. Recognizing the limitations of the study and the need for further research, this instrument is a work in progress. Strategies to improve the instrument are currently underway with the Mental Hygiene Administration's Systems Evaluation Center of the University of Maryland and several national researchers

A Large Nonmetastatic Anaplastic Thyroid Cancer with Complete Thyroidal Confinement

Anaplastic thyroid cancer (ATC) is rare but extremely aggressive, which accounts for about 2% of all thyroid cancers yet nearly 50% of thyroid-cancer-associated deaths in the United States. The median survival time from diagnosis is 5 months, with a 1-year survival rate of only 20%. We report here a case of ATC in a 56-year-old man who survived a large ATC. Preoperative fine-needle aspiration biopsy study to a large right thyroid mass suggested ATC. Total thyroidectomy with radical lateral neck and central neck dissection removed a well-circumscribed 9.5 cm tumor without extrathyroidal extension or lymphovascular invasion. All 73 lymph nodes removed were negative for metastasis. The tumor consisted of highly pleomorphic, undifferentiated cells with large zones of necrosis and loss of thyroid transcription factor-1 and thyroglobulin expression. A focal well-differentiated component and PAX8 expression confirmed its thyroid follicular cell origin. Nine months after postsurgical adjuvant concurrent radiation therapy and chemotherapy, the patient remained well without clinical, biochemical, and radiographical evidence for cancer recurrence. This is an unusual case of ATC in that it is one of the largest ATC tumors reported to display mild pathologic behavior and relatively long-term patient survival

1D numerical and experimental investigations of an ultralean pre-chamber engine

In recent years, lean-burn gasoline Spark-Ignition (SI) engines have been a major subject of investigations. With this solution, in fact, it is possible to simultaneously reduce NOx raw emissions and fuel consumption due to decreased heat losses, higher thermodynamic efficiency, and enhanced knock resistance. However, the real applicability of this technique is strongly limited by the increase in cyclic variation and the occurrence of misfire, which are typical for the combustion of homogeneous lean air/fuel mixtures. The employment of a Pre-Chamber (PC), in which the combustion begins before proceeding in the main combustion chamber, has already shown the capability of significantly extending the lean-burn limit. In this work, the potential of an ultralean PC SI engine for a decisive improvement of the thermal efficiency is presented by means of numerical and experimental analyses. The SI engine is experimentally investigated with and without the employment of the PC with the aim to analyze the real gain of this innovative combustion system. For both configurations, the engine is tested at various speeds, loads, and air-fuel ratios. A commercial gasoline fuel is directly injected into the Main Chamber (MC), while the PC is fed in a passive or active mode. Compressed Natural Gas (CNG) or Hydrogen (H2) is used in the actual case. A 1D model of the engine under study is implemented in a commercial modeling framework and is integrated with “in-house developed” sub-models for the simulation of the combustion and turbulence phenomena occurring in this unconventional engine. The numerical approach proves to reproduce the experimental data with good accuracy, without requiring any case-dependent tuning of the model constants. Both the numerical and experimental results show an improvement of the indicated thermal efficiency of the active PC, compared to the conventional ignition device, especially at high loads and low speeds. The injection of H2 into the PC leads to a significant benefit only with very lean mixtures. With the passive fueling of the PC, the lean-burn limit is less extended, with the consequent lower improvement potential for thermal efficiency

Reexamining how utility and weighting functions get their shapes: A quasi-adversarial collaboration providing a new interpretation

In a paper published in Management Science in 2015, Stewart, Reimers, and Harris (SRH) demonstrated that shapes of utility and probability weighting functions could be manipulated by adjusting the distributions of outcomes and probabilities on offer as predicted by the theory of decision by sampling. So marked were these effects that, at face value, they profoundly challenge standard interpretations of preference theoretic models in which such functions are supposed to reflect stable properties of individual risk preferences. Motivated by this challenge, we report an extensive replication exercise based on a series of experiments conducted as a quasi-adversarial collaboration across different labs and involving researchers from both economics and psychology. We replicate the SRH effect across multiple experiments involving changes in many design features; importantly, however, we find that the effect is also present in designs modified so that decision by sampling predicts no effect. Although those results depend on model-based inferences, an alternative analysis using a model-free comparison approach finds no evidence of patterns akin to the SRH effect. On the basis of simulation exercises, we demonstrate that the SRH effect may be a consequence of misspecification biases arising in parameter recovery exercises that fit imperfectly specified choice models to experimental data. Overall, our analysis casts the SRH effect in an entirely new light. This paper was accepted by Yuval Rottenstreich, judgment and decision making </jats:p

Multiscenario flood hazard assessment using probabilistic runoff hydrograph estimation and 2D hydrodynamic modelling

In this paper, we aim to define a procedure of flood hazard assessment applicable to large river basins in which flood events can be induced/sustained by the full basin area or by fractions of the total area as functions of the extent of the triggering precipitation event. The proposed procedure is based on a combined approach accounting for (1) the reconstruction of intensity–duration–frequency curves expressing the magnitude in terms of intensity for multiple return periods; (2) the application of the soil conservation service method for runoff estimation from a selected rainfall scenario considering some characteristics of the basin (i.e. soil type, land use/treatment, surface condition, and antecedent moisture conditions); (3) 2D hydrodynamic modelling conducted by the HEC-RAS model using runoff hydrographs as hydrological input data; (4) the reconstruction of flood hazard maps by overlaying multiple inundation maps depicting flood extent for different return periods. To account for the variability in the extent of the triggering precipitation event and the resulting input hydrograph, multiple contributing areas are considered. The procedure is tested at the archaeological site of Sybaris in southern Italy, which is periodically involved in flood events of variable magnitude. The obtained results highlight that the variable extent of the floodable area is strongly conditioned by the extent of the contributing area and return period, as expected. The archaeological site is always involved in the simulated flooding process, except for the smallest contributing area for which only a 300-year event involves this part of the site. Our findings may be useful for developing and supporting flood risk management plans in the area. The developed procedure might be easily exported and tested in other fluvial contexts in which evaluations of multiple flood hazard scenarios, due to the basin geometry and extent, are needed

American Thyroid Association Consensus Review and Statement Regarding the Anatomy, Terminology, and Rationale for Lateral Neck Dissection in Differentiated Thyroid Cancer

Background: Cervical lymph node metastases from differentiated thyroid cancer (DTC) are common. Thirty to eighty percent of patients with papillary thyroid cancer harbor lymph node metastases, with the central neck being the most common compartment involved. The goals of this study were to: (1) identify appropriate methods for determining metastatic DTC in the lateral neck and (2) address the extent of lymph node dissection for the lateral neck necessary to control nodal disease balanced against known risks of surgery. Methods: A literature review followed by formulation of a consensus statement was performed. Results: Four proposals regarding management of the lateral neck are made for consideration by organizations developing management guidelines for patients with thyroid nodules and DTC including the next iteration of management guidelines developed by the American Thyroid Association (ATA). Metastases to lateral neck nodes must be considered in the evaluation of the newly diagnosed thyroid cancer patient and for surveillance of the previously treated DTC patient. Conclusions: Lateral neck lymph nodes are a significant consideration in the surgical management of patients with DTC. When current guidelines formulated by the ATA and by other international medical societies are followed, initial evaluation of the DTC patient with ultrasound (or other modalities when indicated) will help to identify lateral neck lymph nodes of concern. These findings should be addressed using fine-needle aspiration biopsy. A comprehensive neck dissection of at least nodal levels IIa, III, IV, and Vb should be performed when indicated to optimize disease control.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98486/1/thy%2E2011%2E0312.pd