Computed Ultrasound Tomography in Echo Mode for Imaging Speed of Sound Using Pulse-Echo Sonography: Proof of Principle

The limitations of diagnostic echo ultrasound have motivated research into novel modalities that complement ultrasound in a multimodal device. One promising candidate is speed of sound imaging, which has been found to reveal structural changes in diseased tissue. Transmission ultrasound tomography shows speed of sound spatially resolved, but is limited to the acoustically transparent breast. We present a novel method by which speed-of-sound imaging is possible using classic pulse-echo equipment, facilitating new clinical applications and the combination with state-of-the art diagnostic ultrasound. Pulse-echo images are reconstructed while scanning the tissue under various angles using transmit beam steering. Differences in average sound speed along different transmit directions are reflected in the local echo phase, which allows a 2-D reconstruction of the sound speed. In the present proof-of-principle study, we describe a contrast resolution of 0.6% of average sound speed and a spatial resolution of 1 mm (laterally) × 3 mm (axially), suitable for diagnostic applications.

Collaboration patterns, external shocks and uncertainty: Swiss nuclear energy politics before and after Fukushima

Energy shocks like the Fukushima accident can have important political consequences. This article examines their impact on collaboration patterns between collective actors in policy processes. It argues that external shocks create both behavioral uncertainty, meaning that actors do not know about other actors' preferences, and policy uncertainty on the choice and consequences of policy instruments. The context of uncertainty interacts with classical drivers of actor collaboration in policy processes. The analysis is based on a dataset comprising interview and survey data on political actors in two subsequent policy processes in Switzerland and Exponential Random Graph Models for network data. Results first show that under uncertainty, collaboration of actors in policy processes is less based on similar preferences than in stable contexts, but trust and knowledge of other actors are more important. Second, under uncertainty, scientific actors are not preferred collaboration partners.

The Value of Waiting: Foreign Direct Investment with Uncertainty and Imperfect Local Knowledge

This paper examines the role of uncertainty and imperfect local knowledge in foreign direct investment. The main idea comes from the literature on investment under uncertainty, such as Pindyck (1991) and Dixit and Pindyck (1994). We empirically test .the value of waiting. with a dataset on foreign direct investment (FDI). Many factors (e.g., political and economic regulations) as well as uncertainty and the risks due to imperfect local knowledge, determine the attractiveness of FDI. The uncertainty and irreversibility of FDI links the time interval between permission and actual execution of such FDI with explanatory variables, including information on foreign (home) countries and domestic industries. Common factors, such as regulatory change and external shocks, may affect the uncertainty when foreign investors make irreversible FDI decisions. We derive testable hypotheses from models of investment under uncertainty to determine those possible factors that induce delays in FDI, using Korean data over 1962 to 2001.

Uncertainty analysis of cost effectiveness in a tailored intervention to promote screening for colorectal cancer

Background. Screening for colorectal cancer (CRC) is considered cost effective but screening compliance in the US remains low. There have been very few studies on economic analyses of screening promotion strategies for colorectal cancer. The main aim of the current study is to conduct a cost effectiveness analysis (CEA) and examine the uncertainty involved in the results of the CEA of a tailored intervention to promote screening for CRC among patients of a multispeciality clinic in Houston, TX. ^ Methods. The two intervention arms received a PC based tailored program and web based educational information to promote CRC screening. The incremental cost of implementing a tailored PC based program was compared to the website based education and the status quo of no intervention for each unit of effect after 12 months of delivering the intervention. Uncertainty analysis in the point estimates of cost and effect was conducted using nonparametric bootstrapping. ^ Results. The cost of implementing a web based educational intervention was $36.00 per person and the cost of the tailored PC based interactive intervention was $43.00 per person. The additional cost per person screened for the web-based strategy was $2374 and the effect of the tailored intervention was negative. ^

Theory of uncertainty in illness in patients with cancer of unknown primary origin: Structure providers as antecedents of uncertainty in a population of cancer patients with an unknown primary diagnosis

Uncertainty has been found to be a major component of the cancer experience and can dramatically affect psychosocial adaptation and outcomes of a patient's disease state (McCormick, 2002). Patients with a diagnosis of Carcinoma of Unknown Primary (CUP) may experience higher levels of uncertainty due to the unpredictability of current and future symptoms, limited treatment options and an undetermined life expectancy. To date, only one study has touched upon uncertainty and its' effects on those with CUP but no information exists concerning the effects of uncertainty regarding diagnosis and treatment on the distress level and psychosocial adjustment of this population (Parker & Lenzi, 2003). ^ Mishel's Uncertainty in Illness Theory (1984) proposes that uncertainty is preceded by three variables, one of which being Structure Providers. Structure Providers include credible authority, the degree of trust and confidence the patient has with their doctor, education and social support. It was the goal of this study to examine the relationship between uncertainty and Structure Providers to support the following hypotheses: (1) There will be a negative association between credible authority and uncertainty, (2) There will be a negative association between education level and uncertainty, and (3) There will be a negative association between social support and uncertainty. ^ This cross-sectional analysis utilized data from 219 patients following their initial consultation with their oncologist. Data included the Mishel Uncertainty in Illness Scale (MUIS) which was used to determine patients' uncertainty levels, the Medical Outcomes Study-Social Support Scale (MOSS-SSS) to assess patients, levels of social support, the Patient Satisfaction Questionnaire (PSQ-18) and the Cancer Diagnostic Interview Scale (CDIS) to measure credible authority and general demographic information to assess age, education, marital status and ethnicity. ^ In this study we found that uncertainty levels were generally higher in this sample as compared to other types of cancer populations. And while our results seemed to support most of our hypothesis, we were only able to show significant associations between two. The analyses indicated that credible authority measured by both the CDIS and the PSQ was a significant predictor of uncertainty as was social support measured by the MOSS-SS. Education has shown to have an inconsistent pattern of effect in relation to uncertainty and in the current study there was not enough data to significantly support our hypothesis. ^ The results of this study generally support Mishel's Theory of Uncertainty in Illness and highlight the importance of taking into consideration patients, psychosocial factors as well as employing proper communication practices between physicians and their patients.^

Understanding and Characterizing Shared Decision-Making and Behavioral Intent in Medical Uncertainty

Applying Theoretical Constructs to Address Medical Uncertainty Situations involving medical reasoning usually include some level of medical uncertainty. Despite the identification of shared decision-making (SDM) as an effective technique, it has been observed that the likelihood of physicians and patients engaging in shared decision making is lower in those situations where it is most needed; specifically in circumstances of medical uncertainty. Having identified shared decision making as an effective, yet often a neglected approach to resolving a lack of information exchange in situations involving medical uncertainty, the next step is to determine the way(s) in which SDM can be integrated and the supplemental processes that may facilitate its integration. SDM involves unique types of communication and relationships between patients and physicians. Therefore, it is necessary to further understand and incorporate human behavioral elements - in particular, behavioral intent - in order to successfully identify and realize the potential benefits of SDM. This paper discusses the background and potential interaction between the theories of shared decision-making, medical uncertainty, and behavioral intent. Identifying Shared Decision-Making Elements in Medical Encounters Dealing with Uncertainty A recent summary of the state of medical knowledge in the U.S. reported that nearly half (47%) of all treatments were of unknown effectiveness, and an additional 7% involved an uncertain tradeoff between benefits and harms. Shared decision-making (SDM) was identified as an effective technique for managing uncertainty when two or more parties were involved. In order to understand which of the elements of SDM are used most frequently and effectively, it is necessary to identify these key elements, and understand how these elements related to each other and the SDM process. The elements identified through the course of the present research were selected from basic principles of the SDM model and the “Data, Information, Knowledge, Wisdom” (DIKW) Hierarchy. The goal of this ethnographic research was to identify which common elements of shared decision-making patients are most often observed applying in the medical encounter. The results of the present study facilitated the understanding of which elements patients were more likely to exhibit during a primary care medical encounter, as well as determining variables of interest leading to more successful shared decision-making practices between patients and their physicians. Understanding Behavioral Intent to Participate in Shared Decision-Making in Medically Uncertain Situations Objective: This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent of men between the ages of 45-70 with regard to participating in shared decision-making in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information which may facilitate greater understanding, efficiency and effectiveness of doctor-patient consultations.Design: Qualitative Study using deductive content analysisSetting: Individual semi-structure patient interviews were conducted until data saturation was reached. Researchers read the transcripts and developed a list of codes.Subjects: 25 subjects drawn from the Philadelphia community.Measurements: Qualitative indicators were developed to measure respondents’ experiences and beliefs related to behavioral intent to participate in shared decision-making during medical uncertainty. Subjects were also asked to complete the Krantz Health Opinion Survey as a method of triangulation.Results: Several factors were repeatedly described by respondents as being essential to participate in shared decision-making in medical uncertainty. These factors included past experience with medical uncertainty, an individual’s personality, and the relationship between the patient and his physician.Conclusions: The findings of this study led to the development of a category framework that helped understand an individual’s needs and motivational factors in their intent to participate in shared decision-making. The three main categories include 1) an individual’s representation of medically uncertainty, 2) how the individual copes with medical uncertainty, and 3) the individual’s behavioral intent to seek information and participate in shared decision-making during times of medically uncertain situations.

Exilio, migración, destierro? : Los trabajadores chilenos que se asentaron en el Nor Este de Chubut a partir de Septiembre de 1973. Memorias, historias e implicancias

En este trabajo abordamos el análisis de experiencias exiliares de trabajadores chilenos que se radicaron en el Noreste de la Provincia de Chubut, en Patagonia Argentina, después de producido el golpe de estado contra el presidente democrático Salvador Allende Gossens, en Septiembre de 1973. Cuando revisé la factibilidad de la investigación, y en mérito a los escasos repositorios documentales, decidí, dando continuidad a indagaciones previas, trabajar con historia oral. Esta metodología o práctica, involucra una dimensión personal, subjetiva y afectiva, que supone una constante relación entre los sujetos que participan, lo que implica una cualitativa diferencia en relación a las fuentes más tradicionales. No minimizo el valor de la estadística, pero hago una opción por nombrar y conocer a quienes han compartido con nosotros vivencias y experiencias, explicitando nuestra inscripción en la construcción de la información documental, no objetivándonos. El trabajo desarrollado se halla en la encrucijada entre la historia del pasado reciente y la memoria; con una perspectiva "desde abajo", buscando conjugar la no uniformidad de la experiencia humana, con la pretensión de generalidad y explicación de la ciencia social. Las narraciones o testimonios obtenidos las he revisado, procurando develar las representaciones que subyacen, y comprendiendo el modo en que actuaron. Las memorias tienen un carácter subjetivo y en permanente transformación, lo que en cierto sentido puede singularizarlas, pero como historiadores debemos inscribirlas en un contexto histórico global, para procurar esclarecer las causas, las condiciones, y las estructuras, aportando a una historia total. Hemos rescatado prácticas, percepciones, y discursos; develando la importancia del trabajo como factor organizador y estabilizador, al dotar a estos sujetos, de un sitio en la sociedad receptora, y permitiéndoles "ir desarmando sus valijas", es decir, ir superando la transitoriedad. Al caracterizar al exilio chileno, en el contexto internacional y local; y atendiendo a las escasas producciones que dan cuenta del universo obrero en estas experiencias traumáticas, han sido evidentes los límites que supone una estricta separación entre exilio, y migración económica o política; ya que dicha conceptualización encierra una mirada que invisibiliza derroteros que en principio, o superficialmente, pueden ser leídos como poco organizados. La aplicación del análisis de red, por cierto contribuyó a hacerlos visibles, transformándolos en actores racionales, con objetivos que se movilizaron a partir de los recursos de que dispusieron; tratando de superar el paradigma que hacía de ellos seres desesperados: fueron mujeres y hombres que eligieron un destino posible, siempre atendiendo al doble carácter de la experiencia en que estuvieron inmersos: la salida de su país por un lado los liberó, pero también los privó; asociando indisolublemente sentimientos de dolor por el desprendimiento de lo propio -de los afectos personales y colectivos-, agravados por los efectos de la derrota y la incertidumbre. Son sujetos que pusieron su identidad en riesgo. Pretendemos lograr que esta investigación, no sea sólo un estudio de caso, sino que pueda inscribirse a partir de su especificidad, en tanto exilio obrero, en una perspectiva comparativa, superando una definición espacial específica, en el Nor Este de Chubut.

Exilio, migración, destierro? : Los trabajadores chilenos que se asentaron en el Nor Este de Chubut a partir de Septiembre de 1973. Memorias, historias e implicancias

En este trabajo abordamos el análisis de experiencias exiliares de trabajadores chilenos que se radicaron en el Noreste de la Provincia de Chubut, en Patagonia Argentina, después de producido el golpe de estado contra el presidente democrático Salvador Allende Gossens, en Septiembre de 1973. Cuando revisé la factibilidad de la investigación, y en mérito a los escasos repositorios documentales, decidí, dando continuidad a indagaciones previas, trabajar con historia oral. Esta metodología o práctica, involucra una dimensión personal, subjetiva y afectiva, que supone una constante relación entre los sujetos que participan, lo que implica una cualitativa diferencia en relación a las fuentes más tradicionales. No minimizo el valor de la estadística, pero hago una opción por nombrar y conocer a quienes han compartido con nosotros vivencias y experiencias, explicitando nuestra inscripción en la construcción de la información documental, no objetivándonos. El trabajo desarrollado se halla en la encrucijada entre la historia del pasado reciente y la memoria; con una perspectiva "desde abajo", buscando conjugar la no uniformidad de la experiencia humana, con la pretensión de generalidad y explicación de la ciencia social. Las narraciones o testimonios obtenidos las he revisado, procurando develar las representaciones que subyacen, y comprendiendo el modo en que actuaron. Las memorias tienen un carácter subjetivo y en permanente transformación, lo que en cierto sentido puede singularizarlas, pero como historiadores debemos inscribirlas en un contexto histórico global, para procurar esclarecer las causas, las condiciones, y las estructuras, aportando a una historia total. Hemos rescatado prácticas, percepciones, y discursos; develando la importancia del trabajo como factor organizador y estabilizador, al dotar a estos sujetos, de un sitio en la sociedad receptora, y permitiéndoles "ir desarmando sus valijas", es decir, ir superando la transitoriedad. Al caracterizar al exilio chileno, en el contexto internacional y local; y atendiendo a las escasas producciones que dan cuenta del universo obrero en estas experiencias traumáticas, han sido evidentes los límites que supone una estricta separación entre exilio, y migración económica o política; ya que dicha conceptualización encierra una mirada que invisibiliza derroteros que en principio, o superficialmente, pueden ser leídos como poco organizados. La aplicación del análisis de red, por cierto contribuyó a hacerlos visibles, transformándolos en actores racionales, con objetivos que se movilizaron a partir de los recursos de que dispusieron; tratando de superar el paradigma que hacía de ellos seres desesperados: fueron mujeres y hombres que eligieron un destino posible, siempre atendiendo al doble carácter de la experiencia en que estuvieron inmersos: la salida de su país por un lado los liberó, pero también los privó; asociando indisolublemente sentimientos de dolor por el desprendimiento de lo propio -de los afectos personales y colectivos-, agravados por los efectos de la derrota y la incertidumbre. Son sujetos que pusieron su identidad en riesgo. Pretendemos lograr que esta investigación, no sea sólo un estudio de caso, sino que pueda inscribirse a partir de su especificidad, en tanto exilio obrero, en una perspectiva comparativa, superando una definición espacial específica, en el Nor Este de Chubut.

Exilio, migración, destierro? : Los trabajadores chilenos que se asentaron en el Nor Este de Chubut a partir de Septiembre de 1973. Memorias, historias e implicancias

En este trabajo abordamos el análisis de experiencias exiliares de trabajadores chilenos que se radicaron en el Noreste de la Provincia de Chubut, en Patagonia Argentina, después de producido el golpe de estado contra el presidente democrático Salvador Allende Gossens, en Septiembre de 1973. Cuando revisé la factibilidad de la investigación, y en mérito a los escasos repositorios documentales, decidí, dando continuidad a indagaciones previas, trabajar con historia oral. Esta metodología o práctica, involucra una dimensión personal, subjetiva y afectiva, que supone una constante relación entre los sujetos que participan, lo que implica una cualitativa diferencia en relación a las fuentes más tradicionales. No minimizo el valor de la estadística, pero hago una opción por nombrar y conocer a quienes han compartido con nosotros vivencias y experiencias, explicitando nuestra inscripción en la construcción de la información documental, no objetivándonos. El trabajo desarrollado se halla en la encrucijada entre la historia del pasado reciente y la memoria; con una perspectiva "desde abajo", buscando conjugar la no uniformidad de la experiencia humana, con la pretensión de generalidad y explicación de la ciencia social. Las narraciones o testimonios obtenidos las he revisado, procurando develar las representaciones que subyacen, y comprendiendo el modo en que actuaron. Las memorias tienen un carácter subjetivo y en permanente transformación, lo que en cierto sentido puede singularizarlas, pero como historiadores debemos inscribirlas en un contexto histórico global, para procurar esclarecer las causas, las condiciones, y las estructuras, aportando a una historia total. Hemos rescatado prácticas, percepciones, y discursos; develando la importancia del trabajo como factor organizador y estabilizador, al dotar a estos sujetos, de un sitio en la sociedad receptora, y permitiéndoles "ir desarmando sus valijas", es decir, ir superando la transitoriedad. Al caracterizar al exilio chileno, en el contexto internacional y local; y atendiendo a las escasas producciones que dan cuenta del universo obrero en estas experiencias traumáticas, han sido evidentes los límites que supone una estricta separación entre exilio, y migración económica o política; ya que dicha conceptualización encierra una mirada que invisibiliza derroteros que en principio, o superficialmente, pueden ser leídos como poco organizados. La aplicación del análisis de red, por cierto contribuyó a hacerlos visibles, transformándolos en actores racionales, con objetivos que se movilizaron a partir de los recursos de que dispusieron; tratando de superar el paradigma que hacía de ellos seres desesperados: fueron mujeres y hombres que eligieron un destino posible, siempre atendiendo al doble carácter de la experiencia en que estuvieron inmersos: la salida de su país por un lado los liberó, pero también los privó; asociando indisolublemente sentimientos de dolor por el desprendimiento de lo propio -de los afectos personales y colectivos-, agravados por los efectos de la derrota y la incertidumbre. Son sujetos que pusieron su identidad en riesgo. Pretendemos lograr que esta investigación, no sea sólo un estudio de caso, sino que pueda inscribirse a partir de su especificidad, en tanto exilio obrero, en una perspectiva comparativa, superando una definición espacial específica, en el Nor Este de Chubut.

Global LAI uncertainty and relative uncertainty datasets derived from a Triple Collocation Error Model (TCEM)

Uncertainty information for global leaf area index (LAI) products is important for global modeling studies but usually difficult to systematically obtain at a global scale. Here, we present a new method that cross-validates existing global LAI products and produces consistent uncertainty information. The method is based on a triple collocation error model (TCEM) that assumes errors among LAI products are not correlated. Global monthly absolute and relative uncertainties, in 0.05° spatial resolutions, were generated for MODIS, CYCLOPES, and GLOBCARBON LAI products, with reasonable agreement in terms of spatial patterns and biome types. CYCLOPES shows the lowest absolute and relative uncertainties, followed by GLOBCARBON and MODIS. Grasses, crops, shrubs, and savannas usually have lower uncertainties than forests in association with the relatively larger forest LAI. With their densely vegetated canopies, tropical regions exhibit the highest absolute uncertainties but the lowest relative uncertainties, the latter of which tend to increase with higher latitudes. The estimated uncertainties of CYCLOPES generally meet the quality requirements (± 0.5) proposed by the Global Climate Observing System (GCOS), whereas for MODIS and GLOBCARBON only non-forest biome types have met the requirement. Nevertheless, none of the products seems to be within a relative uncertainty requirements of 20%. Further independent validation and comparative studies are expected to provide a fair assessment of uncertainties derived from TCEM. Overall, the proposed TCEM is straightforward and could be automated for the systematic processing of real time remote sensing observations to provide theoretical uncertainty information for a wider range of land products.