Communication practices in physician decision-making for an unstable critically ill patient with end-stage cancer.

BACKGROUND: Shared decision-making has become the standard of care for most medical treatments. However, little is known about physician communication practices in the decision making for unstable critically ill patients with known end-stage disease. OBJECTIVE: To describe communication practices of physicians making treatment decisions for unstable critically ill patients with end-stage cancer, using the framework of shared decision-making. DESIGN: Analysis of audiotaped encounters between physicians and a standardized patient, in a high-fidelity simulation scenario, to identify best practice communication behaviors. The simulation depicted a 78-year-old man with metastatic gastric cancer, life-threatening hypoxia, and stable preferences to avoid intensive care unit (ICU) admission and intubation. Blinded coders assessed the encounters for verbal communication behaviors associated with handling emotions and discussion of end-of-life goals. We calculated a score for skill at handling emotions (0-6) and at discussing end of life goals (0-16). SUBJECTS: Twenty-seven hospital-based physicians. RESULTS: Independent variables included physician demographics and communication behaviors. We used treatment decisions (ICU admission and initiation of palliation) as a proxy for accurate identification of patient preferences. Eight physicians admitted the patient to the ICU, and 16 initiated palliation. Physicians varied, but on average demonstrated low skill at handling emotions (mean, 0.7) and moderate skill at discussing end-of-life goals (mean, 7.4). We found that skill at discussing end-of-life goals was associated with initiation of palliation (p = 0.04). CONCLUSIONS: It is possible to analyze the decision making of physicians managing unstable critically ill patients with end-stage cancer using the framework of shared decision-making.

Imaging Learned Song Representations in Populations of Sensorimotor Neurons Essential to Vocal Communication

Perceiving or producing complex vocalizations such as speech and birdsongs require the coordinated activity of neuronal populations, and these activity patterns can vary over space and time. How learned communication signals are represented by populations of sensorimotor neurons essential to vocal perception and production remains poorly understood. Using a combination of two-photon calcium imaging, intracellular electrophysiological recording and retrograde tracing methods in anesthetized adult male zebra finches (Taeniopygia guttata), I addressed how the bird's own song and its component syllables are represented by the spatiotemporal patterns of activity of two spatially intermingled populations of projection neurons (PNs) in HVC, a sensorimotor area required for song perception and production. These experiments revealed that neighboring PNs can respond at markedly different times to song playback and that different syllables activate spatially intermingled HVC PNs within a small region. Moreover, noise correlation analysis reveals enhanced functional connectivity between PNs that respond most strongly to the same syllable and also provides evidence of a spatial gradient of functional connectivity specific to PNs that project to song motor nucleus (i.e. HVC_RA cells). These findings support a model in which syllabic and temporal features of song are represented by spatially intermingled PNs functionally organized into cell- and syllable-type networks.

Using the interact system model to analyze computer mediated communication during a small group problem-solving task

The Interact System Model (ISM) developed by Fisher and Hawes (1971) for the analysis of face-to-face communication during small-group problem solving activities was used to study online communication. This tool proved to be of value in the analysis, but the conversation patterns reported by Fisher (1980) did not fully appear in the online environment. Participants displayed a habit of "being too polite" and not fully voicing their disagreements with ideas posed by others. Thus progress towards task completion was slow and incomplete.

Acoustic features of song categories and their possible implications for communication in the common nightingale (Luscinia megarhynchos)

In many passerine species, males sing more than one distinct song type. Commonly, songs are assigned to different song types or song categories based on phonological and syntactical dissimilarities. However, temporal aspects, such as song length and song rate, also need to be considered to understand the possible functions of different songs. Common nightingales (Luscinia megarhynchos) have large vocal repertoires of different song types but their songs additionally can be grouped into two distinct categories (particular groups of song types): whistle songs and nonwhistle songs. Whistle songs are hypothesised to be important to attract migrating females. We studied temporal properties of whistle songs and nonwhistle songs and examined the relationship between those song parameters and song output parameters, such as song rate and song length. To investigate how song parameters vary among males, we calculated the coefficients of variation for different song traits. We found that the variation in the proportion of whistle songs was significantly higher among males than variation in other song parameters. Furthermore, the proportion of whistle songs was negatively correlated with other sona output patterns. These findings suggest that the production of whistle songs might be constrained and/or that whistle songs and their succeeding pauses may act as a functional unit in communication.

The ParaPhrase Project:Parallel patterns for adaptive heterogeneous multicore systems

This paper describes the ParaPhrase project, a new 3-year targeted research project funded under EU Framework 7 Objective 3.4 (Computer Systems), starting in October 2011. ParaPhrase aims to follow a new approach to introducing parallelism using advanced refactoring techniques coupled with high-level parallel design patterns. The refactoring approach will use these design patterns to restructure programs defined as networks of software components into other forms that are more suited to parallel execution. The programmer will be aided by high-level cost information that will be integrated into the refactoring tools. The implementation of these patterns will then use a well-understood algorithmic skeleton approach to achieve good parallelism. A key ParaPhrase design goal is that parallel components are intended to match heterogeneous architectures, defined in terms of CPU/GPU combinations, for example. In order to achieve this, the ParaPhrase approach will map components at link time to the available hardware, and will then re-map them during program execution, taking account of multiple applications, changes in hardware resource availability, the desire to reduce communication costs etc. In this way, we aim to develop a new approach to programming that will be able to produce software that can adapt to dynamic changes in the system environment. Moreover, by using a strong component basis for parallelism, we can achieve potentially significant gains in terms of reducing sharing at a high level of abstraction, and so in reducing or even eliminating the costs that are usually associated with cache management, locking, and synchronisation. © 2013 Springer-Verlag Berlin Heidelberg.

Methodologies for traffic profiling in communication networks

Internet Tra c, Internet Applications, Internet Attacks, Tra c Pro ling, Multi-Scale Analysis abstract Nowadays, the Internet can be seen as an ever-changing platform where new and di erent types of services and applications are constantly emerging. In fact, many of the existing dominant applications, such as social networks, have appeared recently, being rapidly adopted by the user community. All these new applications required the implementation of novel communication protocols that present di erent network requirements, according to the service they deploy. All this diversity and novelty has lead to an increasing need of accurately pro ling Internet users, by mapping their tra c to the originating application, in order to improve many network management tasks such as resources optimization, network performance, service personalization and security. However, accurately mapping tra c to its originating application is a di cult task due to the inherent complexity of existing network protocols and to several restrictions that prevent the analysis of the contents of the generated tra c. In fact, many technologies, such as tra c encryption, are widely deployed to assure and protect the con dentiality and integrity of communications over the Internet. On the other hand, many legal constraints also forbid the analysis of the clients' tra c in order to protect their con dentiality and privacy. Consequently, novel tra c discrimination methodologies are necessary for an accurate tra c classi cation and user pro ling. This thesis proposes several identi cation methodologies for an accurate Internet tra c pro ling while coping with the di erent mentioned restrictions and with the existing encryption techniques. By analyzing the several frequency components present in the captured tra c and inferring the presence of the di erent network and user related events, the proposed approaches are able to create a pro le for each one of the analyzed Internet applications. The use of several probabilistic models will allow the accurate association of the analyzed tra c to the corresponding application. Several enhancements will also be proposed in order to allow the identi cation of hidden illicit patterns and the real-time classi cation of captured tra c. In addition, a new network management paradigm for wired and wireless networks will be proposed. The analysis of the layer 2 tra c metrics and the di erent frequency components that are present in the captured tra c allows an e cient user pro ling in terms of the used web-application. Finally, some usage scenarios for these methodologies will be presented and discussed.

An automatic voice pleasantness classification system based on prosodic and acoustic patterns of voice preference

In the last few years the number of systems and devices that use voice based interaction has grown significantly. For a continued use of these systems the interface must be reliable and pleasant in order to provide an optimal user experience. However there are currently very few studies that try to evaluate how good is a voice when the application is a speech based interface. In this paper we present a new automatic voice pleasantness classification system based on prosodic and acoustic patterns of voice preference. Our study is based on a multi-language database composed by female voices. In the objective performance evaluation the system achieved a 7.3% error rate.

Profils d'utilisation d'antipsychotiques en conditions réelles dans la population de personnes âgées démentes vivant à domicile : impact des interventions de communication de risque

Les antipsychotiques (APs) sont fréquemment prescrits pour les troubles comportementaux associés à la démence. Or, ces produits ont fait l'objet de trois mises en garde (2002, 2004, 2005) en raison d'une augmentation du risque d'événement cérébrovasculaire et de décès. L’objectif de ce mémoire est d’évaluer l'utilisation d’APs dans la population de personnes âgées démentes vivant à domicile, et de déterminer l’effet des mises en garde sur les profils observés. Une cohorte rétrospective de 10,969 personnes âgées démentes ayant débuté un traitement par AP entre le 1er janvier 2000 et le 31 décembre 2009 fut identifiée à partir des banques de données de la Régie de l'assurance maladie du Québec (RAMQ). Des séries chronologiques segmentées ont permis de quantifier l’effet des mises en garde sur l'utilisation d’APs. L'effet de la mise en garde de 2005 sur les caractéristiques des patients traités ainsi que sur les profils d'utilisation (dose et durée) a été évalué, respectivement par des modèles de régression logistique et de régression linéaire multivariés. Le taux délivrance d'APs atypiques a augmenté au cours du temps jusqu'à la mise en garde de 2005 pour ensuite diminuer de 8.96% (IC 95% : -11.91% – -6.02%). L'analyse par produit a révélé la même tendance pour la rispéridone, le seul AP approuvé au Canada pour les personnes âgées démentes. En revanche, le taux de délivrance de quétiapine, qui est hors-indication, a continué d'augmenter. Le taux d'initiation de traitement par APs a cependant diminué au cours du temps pour tous les produits. Les mises en garde ne semblent pas être associées avec un changement dans les caractéristiques des patients traités, ni avec les doses et durées d’utilisation. Le manque d'efficacité des mises en garde est probablement en partie lié à l'absence d'alternatives thérapeutiques pour le traitement des troubles psychologiques et comportementaux chez les patients atteints de démence.

Acoustic composition : exploring metaphorical and perceived connections between patterns of sound in the Opera The Beast in the Jungle

La version intégrale de ce mémoire est disponible uniquement pour consultation individuelle à la Bibliothèque de musique de l ’Université de Montréal (www.bib.umontreal.ca/MU).

Axially Symmetric Radiation Patterns from Flanged E-Plane Sectoral Horn

A simple technique for obtaining identical E- and H-plane patterns from E-plane sectoral feed horn is presented. Halfpower beam width and gain of the antenna are also improved considerably. Experimental results for a number of horns with flanges of various parameters are also presented. This system may find practical application in radar and space communication systems

Design of a microstip fed step slot antenna for UWB communication

The design and performance of a stepped slot printed monopole antenna in the ultrawideband is presented in this article. Multiple resonances generated by the stepped slot geometry are matched in the ultrawideband using a modified microstrip feed. The impedance bandwidth (SWR < 2) of the antenna is from 3 to 11 GHz. Radiation patterns are stable and omnidirectional with appreciable gain throughout the band. Performance of the antenna is also analyzed in the time domain, which reveals good pulse handling capabilities. Compact geometry of the antenna allows easy commercial deployment.

Re-engineering and Re-defining University Libraries in the context of modern Information and Communication Technologies: a study with special reference to the University Libraries in Kerala

Information and communication technologies are the tools that underpin the emerging “Knowledge Society”. Exchange of information or knowledge between people and through networks of people has always taken place. But the ICT has radically changed the magnitude of this exchange, and thus factors such as timeliness of information and information dissemination patterns have become more important than ever.Since information and knowledge are so vital for the all round human development, libraries and institutions that manage these resources are indeed invaluable. So, the Library and Information Centres have a key role in the acquisition, processing, preservation and dissemination of information and knowledge. ln the modern context, library is providing service based on different types of documents such as manuscripts, printed, digital, etc. At the same time, acquisition, access, process, service etc. of these resources have become complicated now than ever before. The lCT made instrumental to extend libraries beyond the physical walls of a building and providing assistance in navigating and analyzing tremendous amounts of knowledge with a variety of digital tools. Thus, modern libraries are increasingly being re-defined as places to get unrestricted access to information in many formats and from many sources.The research was conducted in the university libraries in Kerala State, India. lt was identified that even though the information resources are flooding world over and several technologies have emerged to manage the situation for providing effective services to its clientele, most of the university libraries in Kerala were unable to exploit these technologies at maximum level. Though the libraries have automated many of their functions, wide gap prevails between the possible services and provided services. There are many good examples world over in the application of lCTs in libraries for the maximization of services and many such libraries have adopted the principles of reengineering and re-defining as a management strategy. Hence this study was targeted to look into how effectively adopted the modern lCTs in our libraries for maximizing the efficiency of operations and services and whether the principles of re-engineering and- redefining can be applied towards this.Data‘ was collected from library users, viz; student as well as faculty users; library ,professionals and university librarians, using structured questionnaires. This has been .supplemented by-observation of working of the libraries, discussions and interviews with the different types of users and staff, review of literature, etc. Personal observation of the organization set up, management practices, functions, facilities, resources, utilization of information resources and facilities by the users, etc. of the university libraries in Kerala have been made. Statistical techniques like percentage, mean, weighted mean, standard deviation, correlation, trend analysis, etc. have been used to analyse data.All the libraries could exploit only a very few possibilities of modern lCTs and hence they could not achieve effective Universal Bibliographic Control and desired efficiency and effectiveness in services. Because of this, the users as well as professionals are dissatisfied. Functional effectiveness in acquisition, access and process of information resources in various formats, development and maintenance of OPAC and WebOPAC, digital document delivery to remote users, Web based clearing of library counter services and resources, development of full-text databases, digital libraries and institutional repositories, consortia based operations for e-journals and databases, user education and information literacy, professional development with stress on lCTs, network administration and website maintenance, marketing of information, etc. are major areas need special attention to improve the situation. Finance, knowledge level on ICTs among library staff, professional dynamism and leadership, vision and support of the administrators and policy makers, prevailing educational set up and social environment in the state, etc. are some of the major hurdles in reaping the maximum possibilities of lCTs by the university libraries in Kerala. The principles of Business Process Re-engineering are found suitable to effectively apply to re-structure and redefine the operations and service system of the libraries. Most of the conventional departments or divisions prevailing in the university libraries were functioning as watertight compartments and their existing management system was more rigid to adopt the principles of change management. Hence, a thorough re-structuring of the divisions was indicated. Consortia based activities and pooling and sharing of information resources was advocated to meet the varied needs of the users in the main campuses and off campuses of the universities, affiliated colleges and remote stations. A uniform staff policy similar to that prevailing in CSIR, DRDO, ISRO, etc. has been proposed by the study not only in the university libraries in kerala but for the entire country.Restructuring of Lis education,integrated and Planned development of school,college,research and public library systems,etc.were also justified for reaping maximum benefits of the modern ICTs.

Service quality and reliability assessment of mobile communication infrastructure

The service quality of any sector has two major aspects namely technical and functional. Technical quality can be attained by maintaining technical specification as decided by the organization. Functional quality refers to the manner which service is delivered to customer which can be assessed by the customer feed backs. A field survey was conducted based on the management tool SERVQUAL, by designing 28 constructs under 7 dimensions of service quality. Stratified sampling techniques were used to get 336 valid responses and the gap scores of expectations and perceptions are analyzed using statistical techniques to identify the weakest dimension. To assess the technical aspects of availability six months live outage data of base transceiver were collected. The statistical and exploratory techniques were used to model the network performance. The failure patterns have been modeled in competing risk models and probability distribution of service outage and restorations were parameterized. Since the availability of network is a function of the reliability and maintainability of the network elements, any service provider who wishes to keep up their service level agreements on availability should be aware of the variability of these elements and its effects on interactions. The availability variations were studied by designing a discrete time event simulation model with probabilistic input parameters. The probabilistic distribution parameters arrived from live data analysis was used to design experiments to define the availability domain of the network under consideration. The availability domain can be used as a reference for planning and implementing maintenance activities. A new metric is proposed which incorporates a consistency index along with key service parameters that can be used to compare the performance of different service providers. The developed tool can be used for reliability analysis of mobile communication systems and assumes greater significance in the wake of mobile portability facility. It is also possible to have a relative measure of the effectiveness of different service providers.

Modifications of secondary reflector antenna patterns due to shaped beams from flanged primary horn feeds

With the advent of satellite communication and radio astronomy, the need for large and efficient reflector antennas had triggered a widespread investigation in reflector feed design techniques. Major improvements sought are reduction in spill-over, cross polarization losses and the enhancement of aperture efficiency. The search for such a feed culminated in the corrugated horn. The main idea behind the present work is to use the H-plane sectoral horns fitted with,corrugated flanges as feeds of a paraboloid and see how the secondary pattern of the reflector antenna varies with different parameters of the feed. An offset paraboloid is used as the secondary reflector in order to avoid the adverse effect of aperture ‘blocking by the feed horn structure on the secondary radiation pattern. The measurements were repeated for three different H-plane sectoral horns with the same set of corrugated flanges at various X-band frequencies. The following parameters of the whole system are studied: (a) Beam shaping. (b) Gain. (c) Variation of VSWR and (d) Cross polarization

Self-organized sociopolitical interactions as the best way to achieve organized patterns in human social systems: going beyond the top-down control of classical political regimes

La monografía presenta la auto-organización sociopolítica como la mejor manera de lograr patrones organizados en los sistemas sociales humanos, dada su naturaleza compleja y la imposibilidad de las tareas computacionales de los regímenes políticos clásico, debido a que operan con control jerárquico, el cual ha demostrado no ser óptimo en la producción de orden en los sistemas sociales humanos. En la monografía se extrapola la teoría de la auto-organización en los sistemas biológicos a las dinámicas sociopolíticas humanas, buscando maneras óptimas de organizarlas, y se afirma que redes complejas anárquicas son la estructura emergente de la auto-organización sociopolítica.