Decision Enhancement (DE) is a field of practice aimed at extending lessons, principles and tools built up over a thirty year period, largely under the term 'Decision Support'. Enhancement goes ...beyond support which has mostly focused on helping managers make use of interactive computer models and methods. DE substantially adds to the opportunities, especially in the use of the Internet as both an information resource and communications base for collaboration between groups but it also goes well beyond it in two important regards: a focus on enhancement of the processes that influence the quality of decisions that really matter in an organization; the ones that are most consequential, complex, and uncertain, and a shift from the design of computer- and telecommunications-based tools to a far more comprehensive 'studio' approach to the integration of change management, collaborative development and use, and a new generation of visual technology. DE is a lens that focuses on stakeholders in decision arenas and their decisions that matter. It continues with its invitation to bring stakeholders, domain experts and suite designers into its studios. The invitation extends to experts in domains relevant to making DE studios effective, as well as to the suite designers and providers of technology capabilities needed to provide the tools within the studio. DE provides services to guide a journey where executives, their advisors, change management specialists, experts in multi-disciplinary fields and technology developers can come together to make a substantive new impact on effective decision making in any organization. This book will add to the old - the proven lessons and expertise of these fields - and to their innovation. It is in this sense that it is an invitation and written to encourage reflection and discussion within and across them.
Chronic noncancer pain includes any painful condition that persists for at least three months and is not associated with malignant disease. According to seven national surveys conducted between ...1994-2008, 15%-19% of Canadian adults live with chronic noncancer pain. Chronic noncancer pain interferes with activities of daily living, has a major negative impact on quality of life and physical function, and is the leading cause of health resource utilization and disability among working-age adults. Here, Busse et al inform the prescribing of opioids for adults with chronic noncancer pain.
Co-managed care in cataract pathways allows ophthalmologists more time to treat other patients. However, little is known on how patients experience pathways that greatly reduce the amount of time ...spent with ophthalmologists.
To determine experiences and preferences of cataract patients with co-managed postoperative care.
In a nested-case control study, 194 patients who received their first-day review and final review by an ophthalmologist and 289 patients who received a telephone first-day review by a nurse and a final review by an optometrist were included. The Consumer Quality Index Cataract Questionnaire was used to measure patients' experiences with the quality of care after uncomplicated first-eye cataract surgery.
Patients in the co-managed care pathway reported similarly good experiences with the quality of care as patients who received their reviews by an ophthalmologist. Patients who were reviewed by a nurse reported to prefer the same first-day review method significantly more often than those who were reviewed by an ophthalmologist. Most patients preferred the final review by an ophthalmologist.
Overall, patients with cataract highly rated co-managed care pathways without any postoperative contact with ophthalmologists. Nevertheless, patients still preferred ophthalmologists for their final review to optometrists. Any added patients' benefits should be clearly determined before substituting activities from ophthalmologists to other care professionals.
Room temperature time‐resolved luminescence measurements on single CdSe/ZnS quantum dots (QDs) are presented. Luminescence spectra were recorded over time periods of up to 30 min with a time ...resolution down to 6 ms. A clear 30–40 nm blue shift in the emission wavelength is observed for QDs in ambient air, before the luminescence stops after about 2–3 min due to photobleaching. The blue shift is absent in a nitrogen atmosphere and photobleaching occurs after much longer times, 10–15 min. These observations are explained by photoinduced oxidation. During illumination in the presence of oxygen the surface of CdSe is oxidized, which effectively results in shrinkage of the CdSe core diameter by almost 1 nm and, consequently, in a blue shift. This also influences the blinking behavior. The faster fading of the luminescence in air suggests that photoinduced oxidation results in the formation of nonradiative recombination centers at the CdSe/CdSeOx interface. In a nitrogen atmosphere photoinduced oxidation is prevented by the absence of oxygen. A surprising observation is a higher initial light output for CdSe/ZnS QDs in air. We explain this higher light output by a fast reduction of the lifetime of the long‐lived defect states of CdSe/ZnS QDs by oxygen.
Like the twinkling of stars at night, quantum dots show luminescence intermittence when observed under the confocal laser‐scanning microscope. Moreover, as a result of photoinduced oxidation their spectral properties change in time; a 30 nm blue shift is a direct result of this and the graphic shows the spectral shift over 80 s illumination. However, and unlike stars, oxygen is a key parameter in both luminescent intensity and blinking kinetics.
Background and aims: Raman spectroscopy is a vibrational technique which provides information about the chemical structure. Nevertheless, since many chemicals are present in a cell at very low ...concentration, the Raman signal observed from a single cell is extremely weak. In surface enhanced Raman scattering (SERS), Raman signals can be enhanced by many orders of magnitude when nanoparticles are incorporated into the cell. Materials (subjects) and methods: The tumor biopsies were obtained from 5 patients who were clinically diagnosed with breast cancer. Breast cancer cells isolated from the biopsy were washed, centrifuged and seeded out. Cultivation took place in DMEM at 37°C in a humidified of 5% CO2 in air with addition of colloidal silver nanoparticles of 40 nm into the cell by sonication. Immediately, the washed cells were analyzed in phosphate buffered saline (PBS) at pH 7. Raman analysis was carried out on the Jobin-Yvon LabRAM HR800 microscope system, with a NIR 830 nm laser excitation source. Results: The strongly enhanced Raman signals allow Raman measurements of a single cell in the 200-1800 cm-1 range in relatively short collection times (5 second) using 17 mW near-infrared excitation. Observed spectral features differed across the cell, but chemical constituents in the cell nucleus and cytoplasm, such as DNA, RNA, and amino acids tyrosine and phenylalanine can be identified. Conclusions: Particularly strong field enhancement can be observed when nanoparticles form colloidal clusters. The results suggest that SERS could be a new technique for the identification of breast cancer cell.
Smads are signal transducers for the members of the TGF-beta superfamily. Of these Smads, Smad4 is essential for TGF-beta signaling. The purpose of this study was to elucidate Smad4 expression and ...localization in 65 gastric adenomas, 49 intestinal-type and 39 diffuse type of gastric adenocarcinomas (including 12 cases of fresh frozen tissue) using Real-time RT-PCR and immunohistochemistry. Real-time RT-PCR showed that intestinal type gastric adenocarcinomas have higher Smad4 mRNA expression than diffuse type gastric adenocarcinomas. Immunohistochemical stain for Smad4 revealed that expression of Smad4 was significantly lower in diffuse-type gastric adenocarcinoma than intestinal-type gastric adenocarcinomas. Also, higher Smad4 protein expression in intestinal type gastric adenocarcinomas than overall gastric adenoma was noted. The rate of reduced Smad4 expression was higher in advanced gastric cancer than early gastric cancer. These results suggest that Smad4 might play different roles in human gastric carcinogenesis, especially between intestinal type and diffuse type of gastric adenocarcinoma.
We conducted a multicenter randomized double-blind clinical trial among 626 men with mild to moderate hypertension to determine the effects of captopril, methyldopa, and propranolol on their quality ...of life. Hydrochlorothiazide was added if needed to control blood pressure. After a 24-week treatment period, all three groups had similar blood-pressure control, although fewer patients taking propranolol required hydrochlorothiazide. Patients taking captopril alone or in combination with a diuretic were least likely to withdraw from treatment because of adverse effects (8 percent vs. 20 percent for methyldopa and 13 percent for propranolol). The treatment groups were similar in scores for sleep dysfunction, visual memory, and social participation. However, patients taking captopril, as compared with patients taking methyldopa, scored significantly higher (P less than 0.05 to less than 0.01) on measures of general well-being, had fewer side effects, and had better scores for work performance, visual-motor functioning, and measures of life satisfaction. Patients taking propranolol also reported better work performance than patients taking methyldopa. Patients taking captopril reported fewer side effects and less sexual dysfunction than those taking propranolol and had greater improvement (P less than 0.05 to less than 0.01) on measures of general well-being. Our findings show that antihypertensive agents have different effects on the quality of life and that these can be meaningfully assessed with available psychosocial measures.
The 32 autonomous neighbourhood teams of the Amsterdam Police Force need to utilise each other's knowledge and expertise to deal with the variety and complexity of their daily work assignments. ...However, despite the creation of organisation wide knowledge networks, communication, co-ordination and knowledge sharing between the neighbourhood teams is disappointing. We conducted an action research to investigate how co-ordination in the knowledge networks could be improved with the help of information and communication technologies (ICTs). This article reflects on the choice of co-ordination perspectives and modelling techniques. The above problem is conceptualised and made operational in different ways in research on network co-ordination, knowledge co-ordination and co-ordination of distributed work. The article demonstrates how our initial focus on capturing quantitative measures of the co-ordination problem in a computer simulation was problematic in this case. Instead a social simulation-game that focused on the qualitative issues of this co-ordination problem was developed and played. We conclude that the choice of theoretical perspectives and modelling techniques strongly affected the results of both phases of our action research. Furthermore the article argues that more attention to qualitative issues in co-ordination is required to better understand the impact of ICT-support on co-ordination.
This study was undertaken to improve the solubility and dissolution of a poorly water-soluble drug, celecoxib, by surface modification with a hydrophilic polymer and a surfactant by using a ...spray-drying technique. Based on the preliminary solubility tests, hydroxypropylmethyl cellulose (HPMC) and D-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) were selected as the polymer and the surfactant, respectively. A novel surface-modified celecoxib microparticle was successfully fabricated using a spray-drying process with water, HPMC, and TPGS, and without the use of an organic solvent. The physicochemical properties of the surface-modified celecoxib microparticle were characterized using scanning electron microscopy (SEM), powder X-ray diffraction (PXRD), a particle size analyzer, and contact angle determination. The formulation with drug/HPMC/TPGS at the weight ratio of 1:0.5:1.5 was determined to be the most effective composition in the preparation of the surface-modified celecoxib microparticle, based on the results of wettability, solubility, and dissolution studies. We found that the surface modification of microparticles with HPMC and TPGS can be an effective formulation strategy for new dosage forms of poorly water-soluble active pharmaceutical ingredients (APIs) to provide higher solubility and dissolution.
The levels of streptococcal antibody titers in populations with or without rheumatic fever from an area with a relatively high incidence of rheumatic fever and an area with a low incidence of this ...disease were compared. Streptococcal antibody titers were determined for two populations, each of which included children without rheumatic fever (nonrheumatic children) and rheumatic fever patients. The two populations were derived from two separate geographic areas, one with a high incidence of rheumatic fever (Grenada) and another with a low incidence of this disease (central Florida). The results revealed an absence of consistent differences in the geometric mean antibody titers between the nonrheumatic subjects and the rheumatic fever patients from Grenada. In the population from Grenada, the mean anti-streptolysin O and anti-DNase B titers were higher in the nonrheumatic controls (P of 0.085 and 0.029, respectively). However, the mean titer of the antibody to the group A streptococcal cell wall carbohydrate was higher in the rheumatic fever patients than in the nonrheumatic controls (P = 0.047). This finding contrasted with the finding that the means of all three streptococcal antibody titers in the patients with rheumatic fever were significantly higher than those in the nonrheumatic subjects from Florida (P = 0.01-<0.001). The reason for this paradoxical finding became evident when the streptococcal antibody titers of the nonrheumatic subjects from Grenada and Florida were compared, revealing significantly higher levels of all three antibodies in the nonrheumatic subjects from Grenada than in the nonrheumatic subjects from Florida (P < 0.001). These results suggest that nonrheumatic individuals in an area with a high incidence of rheumatic fever have inordinately elevated levels of streptococcal antibodies in serum. The presence of elevated streptococcal antibody titers in such a population, which probably reflects a high background prevalence of streptococcal infections, should be taken into consideration when evaluating the role of the group A streptococcus in nonpurulent complications of infections.
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