[Map of the Capitol grounds, eastern end of the Mall, and adjacent squares, Washington D.C.].

Covers area bounded by 7th St. west, C St. north, 1st St. east, and C St. south.

[Map of part of the Washington Canal at the eastern end of the Mall, Washington D.C.].

Shows "Present direction of the Canal" and "New canal."

Map of Jackson City opposite the city of Washington at the south end of the Potomac Free Bridge.

Shows proposed town of Jackson City in Alexandria County D.C.

End-of-life care in a cardiology department: have we improved?

nd-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate (DNR) order protocol. Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet (Group A), a conventional DNR order (Group B) or the absence of any DNR order (Group C). The number of deaths was similar in both periods (n = 198 vs. n = 197). The rate of patients dying with a DNR order increased significantly (57.1% vs. 68.5%; P = 0.02). Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission (vs. 2.6% in the first period; P < 0.001). All patients in Group A with an implantable cardioverter defibrillator (ICD) had shock therapies deactivated (vs. 25.0% in the first period; P = 0.02). The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.

Essays on Innovative Activity and the Protection of Innovations

This dissertation looks at three widely accepted assumptions about how the patent system works: patent documents disclose inventions; this disclosure happens quickly, and patent owners are able to enforce patents. The first chapter estimates the effect of stronger trade secret protection on the number of patented innovations. When firms find it easier to protect business information, there is less need for patent protection, and accordingly less need for the disclosure of technical information that is required by patent law. The novel finding is that when it is easier to keep innovations, there is not only a reduction in the number of patents but also a sizeable reduction in disclosed knowledge per patent. The chapter then shows how this endogeneity of the amount of knowledge per patent can affect the measurement of innovation using patent data. The second chapter develops a game-theoretic model to study how the introduction of fee-shifting in US patent litigation would influence firms’ patenting propensities. When the defeated party to a lawsuit has to bear not only their own cost but also the legal expenditure of the winning party, manufacturing firms in the model unambiguously reduce patenting, with small firms affected the most. For fee-shifting to have the same effect as in Europe, the US legal system would require shifting of a much smaller share of fees. Lessons from European patent litigation may, therefore, have only limited applicability in the US case. The third chapter contains a theoretical analysis of the influence of delayed disclosure of patent applications by the patent office. Such a delay is a feature of most patent systems around the world but has so far not attracted analytical scrutiny. This delay may give firms various kinds of strategic (non-)disclosure incentives when they are competing for more than a single innovation.

Design of an innovative electric vehicle simulator for Charging Systems' End-of-Line Testing

The trend related to the turnover of internal combustion engine vehicles with EVs goes by the name of electrification. The push electrification experienced in the last decade is linked to the still ongoing evolution in power electronics technology for charging systems. This is the reason why an evolution in testing strategies and testing equipment is crucial too. The project this dissertation is based on concerns the investigation of a new EV simulator design. that optimizes the structure of the testing equipment used by the company who commissioned this work. Project requirements can be summarized in the following two points: space occupation reduction and parallel charging implementation. Some components were completely redesigned, and others were substituted with equivalent ones that could perform the same tasks. In this way it was possible to reduce the space occupation of the simulator, as well as to increase the efficiency of the testing device. Moreover, the possibility of conjugating different charging simulations could be investigated by parallelly launching two testing procedures on a unique machine, properly predisposed for supporting the two charging protocols used. On the back of the results achieved in the body of this dissertation, a new design for the EV simulator was proposed. In this way, space reduction was obtained, and space occupation efficiency was improved with the proposed new design. The testing device thus resulted to be way more compact, enabling to gain in safety and productivity, along with a 25% cost reduction. Furthermore, parallel charging was implemented in the proposed new design since the conducted tests clearly showed the feasibility of parallel charging sessions. The results presented in this work can thus be implemented to build the first prototype of the new EV simulator.

Economic preferences in the health setting. Three case studies concerning the needs of breast cancer patients, pain management in oncology and extreme end-of-life decisions

The thesis describes three studies concerning the role of the Economic Preference set investigated in the Global Preference Survey (GPS) in the following cases: 1) the needs of women with breast cancer; 2) pain undertreament in oncology; 3) legal status of euthanasia and assisted suicide. The analyses, based on regression techniques, were always conducted on the basis of aggregate data and revealed in all cases a possible role of the Economic Preferences studied, also resisting the concomitant effect of the other covariates that were considered from time to time. Regarding individual studies, the related conclusion are: 1) Economic Preferences appear to play a role in influencing the needs of women with breast cancer, albeit of non-trivial interpretation, statistically "resisting" the concomitant effect of the other independent variables considered. However, these results should be considered preliminary and need further confirmation, possibly with prospective studies conducted at the level of the individual; 2) the results show a good degree of internal consistency with regard to pro-social GPS scores, since they are all found to be non-statistically significant and united, albeit only weakly in trend, by a negative correlation with the % of pain undertreated patients. Sharper, at least statistically, is the role of Patience and Willingness to Take Risk, although of more complex empirical interpretation. 3) the results seem to indicate an obvious role of Economic Preferences, however difficult to interpret empirically. Less evidence, at least on the inferential level, emerged, however, regarding variables that, based on common sense, should play an even more obvious role than Economic Preferences in orienting attitudes toward euthanasia and assisted suicide, namely Healthcare System, Legal Origin, and Kinship Tightness; striking, in particular, is the inability to prove a role for the dominant religious orientation even with a simple bivariate analysis.

Progettazione ed Implementazione Front-End di un Sistema Integrato di Customer Assistance in ambito Industry 4.0

Al giorno d'oggi, l'industry 4.0 è un movimento sempre più prominente che induce ad equipaggiare gli impianti industriali con avanzate infrastrutture tecnologiche digitali, le quali operano sinergicamente con l'impianto, al fine di controllare ed aumentare la produttività, monitorare e prevenire i futuri guasti, ed altro ancora. In questo ambito, gli utenti sono parte integrante della struttura produttiva, in cui ricoprono ruoli strategici e flessibili, collaborano fra loro e con le macchine, con l’obiettivo di affrontare e risolvere proattivamente una vasta gamma di problemi complessi. In particolare, la customer assistance nel settore industriale può certamente variare in relazione a molteplici elementi: il tipo di produzione e le caratteristiche del prodotto; l'organizzazione ed infrastruttura aziendale interna; la quantità di risorse disponibili che possono essere impiegate; il grado di importanza ricoperto dalla customer assistance nel settore industriale di riferimento; altri eventuali fattori appartenenti ad un dominio specifico. Per queste ragioni, si è cercato di individuare e categorizzare nel modo più accurato possibile, il lavoro svolto in questo elaborato ed il contesto nel quale è stato sviluppato. In questa tesi, viene descritta un'applicazione web per erogare assistenza al cliente in ambito di industria 4.0, attraverso il paradigma di ticketing o ticket di supporto/assistenza. Questa applicazione è integrata nel sistema Mentor, il quale è attivo già da anni nel settore industriale 4.0. Il progetto Mentor è una suite di applicazioni cloud-based creata dal gruppo Bucci Industries, una multinazionale attiva nell'industria e nell'automazione con sede a Faenza. In questo caso di studio, si presenta la progettazione ed implementazione della parte front-end del suddetto sistema di assistenza, il quale è integrato ed interconnesso con un paio di applicazioni tipiche di industria 4.0, presenti nella stessa suite di applicazioni.

End of life treatment options for bioplastics; a composting efficency case study

The constant increase in plastic production creates many problems, from its oil-based production all the way to end-of-life treatment, as the same proprieties that make plastic useful make conventional plastic into long-lasting waste that’s quickly piling up. One alternative is a different kind of plastic, bioplastic, a polymeric compound that is both functionally like synthetic plastics and largely environmentally sustainable. It is not necessarily enough to solve the plastic waste issue there's a need for effective strategies to manage bioplastic products at their end of life, to avoid undoing the reduction of environmental impact. One such treatment, unique to biodegradable bioplastics, is composting. This prompts a closer study of how efficient this process is in degrading bioplastics.

Innovation and new business through mutually beneficial collaboration and proactive procurement

ABSTRACT This dissertation focuses on new technology commercialization, innovation and new business development. Industry-based novel technology may achieve commercialization through its transfer to a large research laboratory acting as a lead user and technical partner, and providing the new technology with complementary assets and meaningful initial use in social practice. The research lab benefits from the new technology and innovation through major performance improvements and cost savings. Such mutually beneficial collaboration between the lab and the firm does not require any additional administrative efforts or funds from the lab, yet requires openness to technologies and partner companies that may not be previously known to the lab- Labs achieve the benefits by applying a proactive procurement model that promotes active pre-tender search of new technologies and pre-tender testing and piloting of these technological options. The collaboration works best when based on the development needs of both parties. This means that first of all the lab has significant engineering activity with well-defined technological needs and second, that the firm has advanced prototype technology yet needs further testing, piloting and the initial market and references to achieve the market breakthrough. The empirical evidence of the dissertation is based on a longitudinal multiple-case study with the European Laboratory for Particle Physics. The key theoretical contribution of this study is that large research labs, including basic research, play an important role in product and business development toward the end, rather than front-end, of the innovation process. This also implies that product-orientation and business-orientation can contribute to basic re-search. The study provides practical managerial and policy guidelines on how to initiate and manage mutually beneficial lab-industry collaboration and proactive procurement.

Decision-support tools to manage drug incompatibilities: evaluation by nurses

Introduction Preventing drug incompatibilities has a high impact onthe safety of drug therapy. Although there are no internationalguidelines to manage drug incompatibilities, different decision-supporttools such as handbooks, cross-tables and databases are available.In a previous study, two decision-support tools have been pre-selectedby pharmacists as fitting nurses' needs on the wards1. The objective ofthis study was to have these both tools evaluated by nurses todetermine which would be the most suitable for their daily practice.Materials & Methods Evaluated tools were:1. Cross-table of drug pairs (http://files.chuv.ch/internet-docs/pha/medicaments/pha_phatab_compatibilitessip.pdf)2. Colour-table (a colour for each drug according to the pH: red =acid; blue = basic; yellow = neutral; black = to be infused alone)2Tools were assessed by 48 nurses in 5 units (PICU, adult andgeriatric intensive care, surgery, onco-hematology) using a standardizedform1. The scientific accuracy of the tools was evaluated bydetermining the compatibility of five drugs pairs (rate of correctanswers according to the Trissel's Handbook on Injectable Drugs,chi-square test). Their ergonomics, design, reliability and applicabilitywere estimated using visual analogue scales (VAS 0-10; 0 =null, 10 = excellent). Results are expressed as the median and interquartilerange (IQR) for 25% and 75% (Wilcoxon rank sum test).Results The rate of correct answers was above 90% for both tools(cross-table 96.2% vs colour-table 92.5%, p[0.05).The ergonomics and the applicability were higher for the crosstable[7.1 (IQR25 4.0, IQR75 8.0) vs 5.0 (IQR25 2.7, IQR75 7.0), p =0.025 resp. 8.3 (IQR25 7.4, IQR75 9.2) vs 7.6 (IQR25 5.9, IQR75 8.8)p = 0.047].The design of the colour-table was judged better [4.6 (IQR25 2.9,IQR75 7.1) vs 7.1 (IQR25 5.4, IQR75 8.4) p = 0.002].No difference was observed in terms of reliability [7.3 (IQR25 6.5,IQR75 8.4) vs 6.7 (IQR25 5.0, IQR758.6) p[0.05].The cross-table was globally preferred by 65% of the nurses (27%colour-table, 8% undetermined) and 68% would like to have thisdecision-support tool available for their daily practice.Discussion & Conclusion Both tools showed the same accuracy toassess drug compatibility. In terms of ergonomics and applicabilitythe cross-table was better than the colour-table, and was preferred bythe nurses for their daily practice. The cross-table will be implementedin our hospital as decision-support tool to help nurses tomanage drug incompatibilities.

Pharmaceutical care in an inpatient pediatric intensive care unit: an international multicentric study

Introduction Pediatric intensive care patient represent a population athigh risk for drug-related problems. Our objective is to describe drugrelated problems and intervention of four decentralized pharmacists inpediatric and cardiac intensive care unit.Materials & Methods Multicentric, descriptive and prospectivestudy over a six-month period (August 1st 2009-January 31st 2010).Drug-related problems and clinical interventions were compiled infour pediatric centers using a tool developed by the Socie´te´ Franc¸aisede Pharmacie Clinique. Data concerning patients, drugs, intervention,documentation, approval (if needed), and estimated impact werecompiled. The four pharmacists participating were from Belgium (B),France (F), Quebec (Q) and Switzerland (S).Results A total of 996 interventions were collected: 129 (13%) in B,238 (24%) in F, 278 (28%) in Q and 351 (35%) in S. These interventionstargeted 269 patients (median 22 month-old, 52% male): 69(26%) in B, 88 (33%) in F, 56 (21%) in Q and in S. These data werecollected during 28 non consecutive days in the clinical unit in B, 59days in F, 42 days in Q and 63 days in S. The main drug-relatedproblems were inappropriate administration technique (293, 29%),untreated indication (254, 25%) and supra therapeutic dosage (106,11%). The pharmacist's interventions concerned mainly administrationmode optimization (223, 22%), dose adjustment (200, 20%) andtherapeutic monitoring (164, 16%). The three major drug classesleading to interventions were anti-infectives for systemic use (233,23%) and alimentary tract and metabolism drugs (218, 22%). Interventionsconcerned mainly residents and all clinical staff (209, 21%).Among the 879 (88%) interventions requiring a physician's approval,731 (83%) were accepted. Interventions were considered as having amoderate (51%) or major (17%) clinical impact. Among the interventionsprovided, 10% were considered to have an economicalpositive impact. Differences and similarities between countries willbe presented at the poster session.Discussion & Conclusion Decentralized pharmacist at patient bedsideis a pre-requisite for pharmaceutical care. There are limitedstudies comparing the activity of clinical pharmacists betweencountries. This descriptive study illustrates the ability of clinicalpharmacist to identify and solve drug-related problems in pediatricintensive care unit in four different francophone countries.

Aligning Technology Innovation Processes for Possible Collaboration

Diplomityön tavoitteena on innovaatioprosessien selventäminen ja yhteensovittaminen radikaalien teknologia innovaatioiden osalta. Prosessien yhteensovittamisen edellytyksenä on teknologia innovaation radikaalisuuden ymmärtäminen. Kohteena on alkuvaiheen innovaatioprosessi jonka aikana virallinen yhteistyö ei vielä ole mandollista. Kehitetyn mallinavulla voidaan arvioida yrityksen kokemaa radikaalisuutta innovaatioprosessin alkuvaiheessa. On tärkeää ymmärtää miten vuorovaikutuksessa olevat yritykset kokevat innovaation radikaalisuuden prosessin alkuvaiheessa. Prosessien eroavaisuudet voidaan sanoa riippuvan yritysten näkökulmasta, koska niiden toiminnot määrittyvät koetun radikaalisuuden mukaan.Yhtäläisenä koettu radikaalisuus luo pohjan avoimelle vuorovaikutukselle ja antaa viitteitä syvemmästä yhteistyöstä tulevaisuudessa. Vertikaalisti sijoittuneiden yritysten prosessien esitetty yhteensovitus perustuu molemminpuoliseen radikaalisuuteen ja sisäisen hyväksynnän vastaavuuteen. Tällöin osapuolet ovat mukana samalla sitoumuksella prosessin jatkumisen ollessa epävarma.

Virtausjakauman kokeellinen määritys levylämmönsiirtimissä

Diplomityön tavoitteena oli kokeellisen tutkimuksen keinoin selvittää juotettujen levylämmönsiirtimien levypakkarakenteessa virtausten käyttäytyminen ja jakautuminen sekä löytää ideoita ja kehitysehdotuksia levylämmönsiirtimen levypakan ja levyprofiilin kehittämiseksi. Kokeellinen tutkimus suoritettiin Oy Danfoss Ab LPM:n levylämmönsiirtimien tutkimuslaboratoriossa. Virtausjakauman tutkimusta varten suunniteltiin ja valittiin tutkimuslaitteisto, joka koostui termoelementtiantureista, tiedonkeruulaitteistosta sekä ohjelmistosta. Lämmönsiirtimistä mitattiin ensiö- ja toisiopuolen tilavuusvirrat ja painehäviöt sekä lämpötilat ennen ja jälkeen lämmönsiirtimen. Tutkimuslaitteiston avulla mitattiin lämpötiloja lämmönsiirtimen sisältä levyväleistä. Mittaukset suoritettiin neljällä levypakkarakenteella useilla massavirran arvoilla. Mittaustuloksista määritettiin levylämmönsiirtimien lämpö- ja virtaustekniset ominaisuudet nesteen Reynoldsin luvun funktiona sekä selvitettiin nesteen virtausjakaumat. Mittaustuloksien perusteella laskettuja virtausjakauman arvoja verrattiin teorian mukaan laskettuihin jakaumiin. Mitatuista siirtimistä lasketut massavirrat viittaavat siihen, että suurin osa nesteestä virtaa siirtimien keskeltä tai lähempää loppupäätä kuin alkupäästä. Teorian mukaan suurin nestemäärä virtaisi siirtimen alkupäästä vähentyen tasaisesti kohti levypakan loppupäätä. Teorian mukaiselle virtausjakaumalle ja lasketuille jakaumille ei löydetty yhteyttä. Tutkimuksessa havaittiin suuria, jopa yli 20 asteen, lämpötilaeroja levyväleistä ulostulevissa virtauksissa. Levyvälien virtauksen käyttäytymisen ja jakautumisen tutkiminen nähdäänkin levypakan pitkittäistä kehittämistä suurempana mielenkiinnon ja kehittämisen kohteena.