Putting children forward for epilepsy surgery:a qualitative study of UK parents' and health professionals' decision-making experiences

Background Against a backdrop of recommendations for increasing access to and uptake of early surgical intervention for children with medically intractable epilepsy, it is important to understand how parents and professionals decide to put children forward for epilepsy surgery and what their decisional support needs are. Aim The aim of this study was to explore how parents and health professionals make decisions regarding putting children forward for pediatric epilepsy surgery. Methods Individual interviews were conducted with nine parents of children who had undergone pediatric epilepsy surgery at a specialist children's hospital and ten healthcare professionals who made up the children's epilepsy surgery service multidisciplinary healthcare team (MDT). Three MDT meetings were also observed. Data were analyzed thematically. Findings Four themes were generated from analysis of interviews with parents: presentation of surgery as a treatment option, decision-making, looking back, and interventions. Three themes were generated from analysis of interviews/observations with health professionals: triangulating information, team working, and patient and family perspectives. Discussion Parents wanted more information and support in deciding to put their child forward for epilepsy surgery. They attempted to balance the potential benefits of surgery against any risks of harm. For health professionals, a multidisciplinary approach was seen as crucial to the decision-making process. Advocating for the family was perceived to be the responsibility of nonmedical professionals. Conclusion Decision-making can be supported by incorporating families into discussions regarding epilepsy surgery as a potential treatment option earlier in the process and by providing families with additional information and access to other parents with similar experiences.

A bizonytalanságnak és a vevőkör nagyságának együttes hatása az árakra (Investigating how the number of policies effect the optimum insurance premium)

Ebben a cikkben azzal foglalkozom, hogy a kockázat és a vevőkör nagysága együttesen hogyan hat a termék árára. Kétféle piacot hasonlítok össze: egy biztosítási piacot, és egy termékpiacot. A kétféle piac között az a legfontosabb különbség, hogy termékpiac esetében az eladó számára csak ott jelentkezik kockázat, hogy el tudja-e adni a terméket, míg biztosítási piac esetében az eladó a termék értékesítése után is szembesül kockázattal. A cikk során megmutatom, hogy a vevőkör növekedésének ellentétes hatása lehet a termék árára termék- illetve biztosítási piacok esetében. / === / An economic approach for modeling the insurance markets. The study focuses on the monopolistic market, where one insurance company sells a product with predetermined benefits for the customers. An outline of the company and the insureds' behavior with utility functions is given. The study investigates the problem of policy pricing in relation to the number of clients the company acquires. Analytic tools will be used to further clarify the points.

An ArcGIS Tool for Modeling the Climate Envelope with Feed-Forward ANN

This paper is about the development and the application of an ESRI ArcGIS tool which implements multi-layer, feed-forward artificial neural network (ANN) to study the climate envelope of species. The supervised learning is achieved by backpropagation algorithm. Based on the distribution and the grids of the climate (and edaphic data) of the reference and future periods the tool predicts the future potential distribution of the studied species. The trained network can be saved and loaded. A modeling result based on the distribution of European larch (Larix decidua Mill.) is presented as a case study.

Odüsszeuszi utazás – az előretekintő iránymutatás tapasztalatai = An Odysseian journey - experience with forward guidance

Az alsó kamatkorlát melletti előretekintő iránymutatás a kamatpolitika helyettesítője, a várakozások és a pénzpiaci hozamok befolyásolásának nem konvencionális monetáris politikai eszköze. A jegybank a piaci szereplők számára előre jelezheti az alacsony kamatkörnyezet tartós fennmaradását (delphoi típus), és kötelezettséget is vállalhat erre (odüsszeuszi típus). Ez utóbbi esetben megváltozik a jegybanki reakciófüggvény: a jegybanki kamatdöntésekben nem az inflációs kilátások és az inflációs cél közötti eltérés, illetve a kibocsátási rés jut kitüntetett szerephez, hanem valamilyen állapotváltozó alakulása vagy az időtényező. A reakciófüggvény változásának hitelessége esetén a hozamok csökkenésére lehet számítani. Ha a jegybank a kamatszint fenntartásának feltételéül az állapotváltozók olyan értékeit jelöli meg, amelyek teljesülése esetén az inflációs célkövetés szabályai szerint amúgy sem emelt volna kamatot, akkor az előretekintő iránymutatás „üres beszéd”, és a hozamokra gyakorolt hatás is elmaradhat. Egyelőre nem eldönthető, hogy az előretekintő iránymutatás a kamatpolitika átmeneti helyettesítőjéből annak tartós kiegészítő elemévé válik-e. _____ Forward guidance is a substitute for interest-rate policy where the zero lower boundary applies. It is an unconventional monetary policy instrument intended to influence market yields and expectations. The central bank may give signals (forecasts) to the market on lasting maintenance of a low interest-rate environment (Delphi type) or may commit itself to do so (Odysseus type). In the latter case the reaction function changes: instead of inflation prospects and output gap, the main role in central bank rate decisions becomes the evolution of given macroeconomic state variables or the time factor. If changes of the reaction function are credible, a drop in security yields are expected. Forward guidance is just cheap talk if such values in economic state variables are set as conditions for keeping interest rates unchanged, which based on the rules of inflation targeting would not trigger an interest rate increase, regardless. In that case, no impact on yields may occur. For the time being it cannot be decided whether forward guidance is transitory or a lasting instrument of monetary policy.

Detection of self-complementary inverted repeats by single forward primer driven PCR

Inverted repeat gene structures designed for silencing functional genes have been widely used both in academic and applied research. The correct orientations of such structures are usually validated with restriction analysis and/or sequencing. We speculated that the inverted repeat nature of such constructs can be shown by a simple PCR reaction with a single forward primer. To test this hypothesis five different constructs were established from grapevine sequences in a hairpin-intron style silencing system. We were able to amplify the appropriate products in each case. Thus a forward-primed PCR alone may be sufficient to prove the inverted repeat nature of the desired constructs.

A Look Back To Look Forward: New Patterns In The Supply/Demand Equation In The Lodging Industry

In his dialogue entitled - A Look Back to Look Forward: New Patterns In The Supply/Demand Equation In The Lodging Industry - by Albert J. Gomes, Senior Principal, Pannell Kerr Forster, Washington, D.C. What the author intends for you to know is the following: “Factors which influence the lodging industry in the United States are changing that industry as far as where hotels are being located, what clientele is being served, and what services are being provided at different facilities. The author charts these changes and makes predictions for the future.” Gomes initially alludes to the evolution of transportation – the human, animal, mechanical progression - and how those changes, in the last 100 years or so, have had a significant impact on the hotel industry. “A look back to look forward treats the past as prologue. American hoteliers are in for some startling changes in their business,” Gomes says. “The man who said that the three most important determinants for the success of a hotel were “location, location, location” did a lot of good only in the short run.” Gomes wants to make you aware of the existence of what he calls, “locational obsolescence.” “Locational obsolescence is a fact of life, and at least in the United States bears a direct correlation to evolutionary changes in transportation technology,” he says. “…the primary business of the hospitality industry is to serve travelers or people who are being transported,” Gomes expands the point. Tied to the transportation element, the author also points out an interesting distinction between hotels and motels. In addressing, “…what clientele is being served, and what services are being provided at different facilities,” Gomes suggests that the transportation factor influences these constituents as well. Also coupled with this discussion are oil prices and shifts in transportation habits, with reference to airline travel being an ever increasing method of travel; capturing much of the inter-city travel market. Gomes refers to airline deregulation as an impetus. The point being, it’s a fluid market rather than a static one, and [successful] hospitality properties need to be cognizant of market dynamics and be able to adjust to the variables in their marketplace. Gomes provides many facts and figures to bolster his assertions. Interestingly and perceptively, at the time of this writing, Gomes alludes to America’s deteriorating road and bridge network. As of right now, in 2009, this is a major issue. Gomes rounds out this study by comparing European hospitality trends to those in the U.S.

The Occupy Movement: Two Steps Forward, One Step Back

The op-ed evaluates the successes and limitations of the Occupy Movement in the United States. Ronald W. Cox argues that the Movement was inspirational in directing media focus to the trends of growing inequality and the privileges and power of the one percent. The critique of establishment parties and progressive organizations was a key part of the Occupiers efforts to rethink the meaning of social change. The limitations of the Movement became evident, however, in its extremely decentralized structures that emphasized consensus over majoritarian decision-making, and in its refusal to acknowledge and hold accountable its own leaders.

Treatment for Complicated Grief : State of the Science and Ways Forward

Peer reviewed

Is social partnership the way forward for Indian trade unions? Evidence from public services in India

Trade unions in India find themselves excluded from the political process and marginalized in collective bargaining in the post economic reforms period since 1991. Influential policy analysts and academics alike have called upon Indian trade unions to engage in social partnership with employers as a route to regain influence and protect workers’ interests. Using survey and interview data from two large national trade union federations in Maharashtra India, this article examines whether social partnership is a viable option for Indian trade unions as an industrial relations approach. Findings indicate that despite a supportive labour regulatory framework which in theory should facilitate cooperative industrial relations, the ground realities of workplace employment relations coupled with state indifference and judicial interventions weakens labour’s prospects for meaningful social partnership.

Performance improvement of broadband distributed Raman amplifier using bidirectional pumping with first and dual order forward pumps

In this paper, a new bidirectional pumping scheme with dual order forward pumps is proposed. Performance is compared numerically with conventional bidirectional and backward only pumping schemes for a 70 nm bandwidth, 61.5 km distributed Raman amplifier. We demonstrate that it is possible to design a flat gain spectrum with improved noise figure and OSNR, as well as a low gain ripple (<1 dB).

Youth Sports: Implementing Findings and Moving Forward with Research

This paper reviews the literature, outlines practical implications, and discusses future studies in youth sport researc h. The literature is discussed in light of three potential benefits of youth sport participation 1) physic al health, 2) psycho- social development, and 3) motor skills acquisition. The ultimate objective of youth sport programs is to consider all the benefits of youth sport participation rather than focusing on one or two at the cost of the other(s). It is suggested that researchers, s port administrators, coaches, and parents work together to promote sporting activities and programs that are more likely to enhance children’s physical health, psychosocia l development and lifelong recreational or elite sport participation.

The effects of conflict in driving forward innovation in shared leadership management consultant teams

It is argued in this study that current investigations of the role of conflict in shared leadership teams and, thus, teams in which all members have the opportunity to participate in its decision-making process are insufficient as they have focused on the downsides of these conflicts. This study demonstrates that task conflict is beneficial in that it can have positive effects on innovation in teams. It shows that particularly in shared leadership management consultant teams task conflict can stimulate innovation. Therefore, this research investigates the relationships among shared leadership, conflict and innovation. The research develops and empirically tests a conceptual model which demonstrates the relationships between these concepts and for which the inclusion of multiple research methods was essential. The sequential explanatory approach included a combination of quantitative and qualitative methods, the order of which can be adapted for other domains of application. The conceptual model was first tested with a sample of 329 management consultants. This was followed by 25, in-depth, face-to-face interviews conducted with individual survey respondents. In addition, weekly meetings of a management consultant team in action were video recorded over several months. This allowed for an in-depth explanation of the findings from the survey by providing an understanding of the underlying processes. The inclusion of observational methods provided a validating role and explained how and why conflicts contributed to the development of team innovation, through the analysis of subtleties and fleeting disagreements in a real-life management consultant team. The results deliver an assessment of the theoretical model and demonstrate that task conflict can allow for additional innovation in management consultant teams operating under a shared leadership structure. A practical model and guidelines for management consultant teams wanting to enhance their innovatory capacities are provided. In addition, a novel-user methodology which includes video observations is developed, with recommendations and steps aiding researchers aiming to employ a similar combination of methods. An original contribution to knowledge is made regarding the positive effects that task conflict can have towards innovation in shared leadership teams. Collaboration and trust are identified as important mediators between shared leadership and task conflict and significant regarding the development of innovation. The effectiveness of shared leadership in reducing negative relationship conflict and the benefits of both shared leadership and task conflict in enhancing innovation are demonstrated.

Forward-in-Time, Spatially Explicit Modeling Software to Simulate Genetic Lineages Under Selection

SELECTOR is a software package for studying the evolution of multiallelic genes under balancing or positive selection while simulating complex evolutionary scenarios that integrate demographic growth and migration in a spatially explicit population framework. Parameters can be varied both in space and time to account for geographical, environmental, and cultural heterogeneity. SELECTOR can be used within an approximate Bayesian computation estimation framework. We first describe the principles of SELECTOR and validate the algorithms by comparing its outputs for simple models with theoretical expectations. Then, we show how it can be used to investigate genetic differentiation of loci under balancing selection in interconnected demes with spatially heterogeneous gene flow. We identify situations in which balancing selection reduces genetic differentiation between population groups compared with neutrality and explain conflicting outcomes observed for human leukocyte antigen loci. These results and three previously published applications demonstrate that SELECTOR is efficient and robust for building insight into human settlement history and evolution.

Rate Maximization of Decode-and-Forward Relaying Systems with RF Energy Harvesting

We consider a three-node decode-and-forward (DF) half-duplex relaying system, where the source first harvests RF energy from the relay, and then uses this energy to transmit information to the destination via the relay. We assume that the information transfer and wireless power transfer phases alternate over time in the same frequency band, and their time fraction (TF) may change or be fixed from one transmission epoch (fading state) to the next. For this system, we maximize the achievable average data rate. Thereby, we propose two schemes: (1) jointly optimal power and TF allocation, and (2) optimal power allocation with fixed TF. Due to the small amounts of harvested power at the source, the two schemes achieve similar information rates, but yield significant performance gains compared to a benchmark system with fixed power and fixed TF allocation.