Health Care Power of Attorney FAQs

A health care power of attorney (HC-POA) is a document authorizing an attorney-in-fact (your designated agent) to make health care decisions on your behalf if you (the principal) are unable, in the judgment of your attending physician, to make health care decisions. Health care is defined as any care, treatment, service or procedure required to maintain, diagnose or treat a physical or mental condition. Through your HC-POA, you may authorize someone else to consent, refuse or withdraw consent to health care on your behalf.

The Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for excessive drinking in primary care: reliability and validity of a French version.

BACKGROUND: Excessive drinking is a major problem in Western countries. AUDIT (Alcohol Use Disorders Identification Test) is a 10-item questionnaire developed as a transcultural screening tool to detect excessive alcohol consumption and dependence in primary health care settings. OBJECTIVES: The aim of the study is to validate a French version of the Alcohol Use Disorders Identification Test (AUDIT). METHODS: We conducted a validation cross-sectional study in three French-speaking areas (Paris, Geneva and Lausanne). We examined psychometric properties of AUDIT as its internal consistency, and its capacity to correctly diagnose alcohol abuse or dependence as defined by DSM-IV and to detect hazardous drinking (defined as alcohol intake >30 g pure ethanol per day for men and >20 g of pure ethanol per day for women). We calculated sensitivity, specificity, positive and negative predictive values and Receiver Operator Characteristic curves. Finally, we compared the ability of AUDIT to accurately detect "alcohol abuse/dependence" with that of CAGE and MAST. RESULTS: 1207 patients presenting to outpatient clinics (Switzerland, n = 580) or general practitioners' (France, n = 627) successively completed CAGE, MAST and AUDIT self-administered questionnaires, and were independently interviewed by a trained addiction specialist. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT > or =13 for males, sensitivity 70.1%, specificity 95.2%, PPV 85.7%, NPV 94.7% and for females sensitivity 94.7%, specificity 98.2%, PPV 100%, NPV 99.8%); and hazardous drinkers (with AUDIT > or =7, for males sensitivity 83.5%, specificity 79.9%, PPV 55.0%, NPV 82.7% and with AUDIT > or =6 for females, sensitivity 81.2%, specificity 93.7%, PPV 64.0%, NPV 72.0%). AUDIT gives better results than MAST and CAGE for detecting "Alcohol abuse/dependence" as showed on the comparative ROC curves. CONCLUSIONS: The AUDIT questionnaire remains a good screening instrument for French-speaking primary care.

Diagnostic interview for genetic studies (DIGS): inter-rater and test-retest reliability of alcohol and drug diagnoses

The semi-structured diagnostic interview for genetic studies (DIGS) was developed to assess major mood and psychotic disorders and their spectrum manifestations in genetic studies. Our research group developed a French version of the DIGS and tested its inter-rater and test-retest reliability in psychiatric patients. In this article, we present estimates of the reliability of substance use and antisocial personality disorders. High kappa coefficients for inter-rater reliability were found for drug and alcohol as well as antisocial personality diagnoses and slightly lower kappas for test-retest reliability. Combined with evidence of the reliability of major mood and psychotic disorders, these findings support the suitability of the DIGS for studies of familial aggregation and comorbidity of psychiatric disorders including substance use and antisocial personality disorders.

Accuracy of indirect estimation of power output from uphill performance in cycling.

PURPOSE: To use measurement by cycling power meters (Pmes) to evaluate the accuracy of commonly used models for estimating uphill cycling power (Pest). Experiments were designed to explore the influence of wind speed and steepness of climb on accuracy of Pest. The authors hypothesized that the random error in Pest would be largely influenced by the windy conditions, the bias would be diminished in steeper climbs, and windy conditions would induce larger bias in Pest. METHODS: Sixteen well-trained cyclists performed 15 uphill-cycling trials (range: length 1.3-6.3 km, slope 4.4-10.7%) in a random order. Trials included different riding position in a group (lead or follow) and different wind speeds. Pmes was quantified using a power meter, and Pest was calculated with a methodology used by journalists reporting on the Tour de France. RESULTS: Overall, the difference between Pmes and Pest was -0.95% (95%CI: -10.4%, +8.5%) for all trials and 0.24% (-6.1%, +6.6%) in conditions without wind (<2 m/s). The relationship between percent slope and the error between Pest and Pmes were considered trivial. CONCLUSIONS: Aerodynamic drag (affected by wind velocity and orientation, frontal area, drafting, and speed) is the most confounding factor. The mean estimated values are close to the power-output values measured by power meters, but the random error is between ±6% and ±10%. Moreover, at the power outputs (>400 W) produced by professional riders, this error is likely to be higher. This observation calls into question the validity of releasing individual values without reporting the range of random errors.

The Internet as an enhancer of the consumers' empowerment - A power to be managed by online firms?

Abstract.

The interrater reliability of the pulmonary embolism severity index

RésuméLe PESI (Pulmonary Embolism Severity Index) est un score clinique pronostique s'appliquant à des patients présentant un diagnostic d'embolie pulmonaire. Notre objectif était de démontrer la reproductibilité de ce score entre différents médecins chez des patients présentant une embolie pulmonaire. Nous avons donc identifié, de façon prospective, des patients présentant une embolie pulmonaire nouvellement diagnostiquée aux urgences d'un Hôpital Universitaire (CHUV, Lausanne). Pour tous ces patients, le médecin assistant en charge ainsi que le chef de clinique superviseur ont individuellement collecté les différentes variables permettant d'établir le score selon le PESI. Ils ont, ensuite, de façon indépendante, classifié les patients dans 5 classes de risque (1-V) ainsi qu'en deux groupes à bas risque versus haut risque, respectivement les classes i-ll et les classes III à V.Nous avons examiné la reproductibilité des données entre deux groupes de médecins (médecins assistants vs chefs de clinique), pour chacune des variables constituant le PESI, pour le score total en points, pour l'attribution aux 5 classes de risque ainsi que pour la classification en deux groupes à haut risque versus bas risque. Cette évaluation de la reproductibilité des résultats obtenus par les différents médecins s'est basée sur le calcul du Kappa (K) ainsi sur les Coefficients de Corrélation Intra-classe (ICC).Parmi les 48 patients présentant une Embolie Pulmonaire inclus dans notre étude, les coefficients de reproductibilité entre médecins assistants et chefs de clinique étaient supérieurs à 0.60 pour 10 des 11 variables du PESI. La reproductibilité entre les 2 groupes de médecins, pour le total des points, pour l'attribution à une classe de risque I à V, ainsi que pour la classification en bas versus haut risque était presque parfaite.Nos résultats démontrent la haute reproductibilité du PESI, et appuient donc l'intérêt de son utilisation pour la stratification du risque chez des patients présentant une embolie pulmonaire.

Report on theorerical results of power generation and conversion

Experimental results of a new controller able to support bidirectional power flow in a full-bridge rectifier with boost-like topology are obtained. The controller is computed using port Hamiltonian passivity techniques for a suitable generalized state space averaging truncation system, which transforms the control objectives, namely constant output voltage dc-bus and unity input power factor, into a regulation problem. Simulation results for the full system show the essential correctness of the simplifications introduced to obtain the controller, although some small experimental discrepancies point to several aspects that need further improvement.

Power supply noise and logic error probability

Voltage fluctuations caused by parasitic impedances in the power supply rails of modern ICs are a major concern in nowadays ICs. The voltage fluctuations are spread out to the diverse nodes of the internal sections causing two effects: a degradation of performances mainly impacting gate delays anda noisy contamination of the quiescent levels of the logic that drives the node. Both effects are presented together, in thispaper, showing than both are a cause of errors in modern and future digital circuits. The paper groups both error mechanismsand shows how the global error rate is related with the voltage deviation and the period of the clock of the digital system.

Robust power allocation algorithms for MIMO OFDM systems with imperfect CSI

This paper presents a Bayesian approach to the design of transmit prefiltering matrices in closed-loop schemes robust to channel estimation errors. The algorithms are derived for a multiple-input multiple-output (MIMO) orthogonal frequency division multiplexing (OFDM) system. Two different optimizationcriteria are analyzed: the minimization of the mean square error and the minimization of the bit error rate. In both cases, the transmitter design is based on the singular value decomposition (SVD) of the conditional mean of the channel response, given the channel estimate. The performance of the proposed algorithms is analyzed,and their relationship with existing algorithms is indicated. As withother previously proposed solutions, the minimum bit error rate algorithmconverges to the open-loop transmission scheme for very poor CSI estimates.

Power quality improving with virtual flux-based voltage source line converter

Line converters have become an attractive AC/DC power conversion solution in industrial applications. Line converters are based on controllable semiconductor switches, typically insulated gate bipolar transistors. Compared to the traditional diode bridge-based power converters line converters have many advantageous characteristics, including bidirectional power flow, controllable de-link voltage and power factor and sinusoidal line current. This thesis considers the control of the lineconverter and its application to power quality improving. The line converter control system studied is based on the virtual flux linkage orientation and the direct torque control (DTC) principle. A new DTC-based current control scheme is introduced and analyzed. The overmodulation characteristics of the DTC converter are considered and an analytical equation for the maximum modulation index is derived. The integration of the active filtering features to the line converter isconsidered. Three different active filtering methods are implemented. A frequency-domain method, which is based on selective harmonic sequence elimination, anda time-domain method, which is effective in a wider frequency band, are used inharmonic current compensation. Also, a voltage feedback active filtering method, which mitigates harmonic sequences of the grid voltage, is implemented. The frequency-domain and the voltage feedback active filtering control systems are analyzed and controllers are designed. The designs are verified with practical measurements. The performance and the characteristics of the implemented active filtering methods are compared and the effect of the L- and the LCL-type line filteris discussed. The importance of the correct grid impedance estimate in the voltage feedback active filter control system is discussed and a new measurement-based method to obtain it is proposed. Also, a power conditioning system (PCS) application of the line converter is considered. A new method for correcting the voltage unbalance of the PCS-fed island network is proposed and experimentally validated.

The evolution ofRussian power industry from monopoly to market operation

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Monipolttoainekattilan päästöjen tarkkailu ja raportointi

Suurten polttolaitosten päästöjen tarkkailu- ja raportointivaatimukset ovat uudistuneet viime vuosina paljon. Suurimpia muutosten aiheuttajia ovat Valtioneuvoston asetus 1017/2002 ja standardi EN-14181. Tässä työssä kuvataan uudet vaatimukset täyttävän päästöjen tarkkailu- ja raportointijärjestelmän rakentaminen monipolttoainekattilalle. Aluksi esitellään mitä uusia vaatimuksia päästöjen tarkkailulle ja raportoinnille on tullut viime aikoina. Lisäksi selvitetään vaatimusten mahdolliset ristiriidat ja ristiriitatilanteiden ratkaisutavat. Seuraavaksi esitellään vaatimukset täyttävän järjestelmän määritelmät. Erityisestiselvitetään kattilan erityispiirteiden vaatimia ratkaisuja. Lopuksi esitellään päästöjen tarkkailu- ja raportointijärjestelmän käyttökokemuksia ja parantamismahdollisuuksia. Kaikki tarkastelut tehdään ensisijaisesti toiminnanharjoittajan näkökulmasta. Järjestelmä toteutettiin Stora Enso Oyj:n Heinolan Flutingtehtaan voimalaitoksen pääkattilalle, jossa käytetään laajaa polttoainevalikoimaa. Toteutuspaikan valinta tehtiin sillä perusteella, että uudet päästöjen tarkkailu- ja raportointivaatimukset ovat erityisen haasteellisia monipolttoainekattiloiden tapauksessa. Työssä selvitetään järjestelmän soveltamismahdollisuuksia myös kahdella muulla Stora Enson tehtaalla. Käyttöönottovaiheen johtopäätöksenä todettiin päästöjen tarkkailu- ja raportointijärjestelmän täyttävän sille asetetut vaatimukset. Lisäksi havaittiin, että toiminnanharjoittajan kannattaa panostaa erityisesti järjestelmän joustavuuteen, luotettavuuteen, helppokäyttöisyyteen ja vikasietoisuuteen. Toiminnanharjoittaja pystyy määrittelyvaiheessa vaikuttamaan järjestelmän ominaisuuksiin helpommin ja edullisemmin kuin käyttöönoton jälkeen. Toiminnanharjoittajalta vaadittu työtuntimäärä arvioitiin Heinolan Flutingtehtaan tapauksen perusteella. Lopuksi selvitettiin mahdollisia tulevaisuuden kehityskohteita vastaavissa järjestelmissä.

Pintaemittoivan VCSEL-diodin käyttö aallonpituusmodulaatiospektroskopiaan perustuvissa hapen konsentraation mittauksissa

Teollisuuden sovelluksissa kaasun mittauslaitteilta vaaditaan suurta luotettavuutta sekä niiden huollontarve tulee olla minimaalista. Jatkuva-aikaisissa mittauksissa nämä vaatimuksetlunastaa viritettävän diodilaser-spektroskopian käyttö. Pienen kokonsa, vähäisten tehohäviöiden ja hyvien säätömahdollisuuksien ansiosta, VCSEL:t (vertical cavity surface emitting laser) ovat sopivia vaihtoehtoja valonlähteeksi mitattaessapäästökaasuja, tässä tapauksessa happea. Työssä rakennettiin mittauslaitteisto, jota käytettiin hapen konsentraation määrittämiseen. Mittauslaitteistolla suoritettiin hapen pitoisuusmittauksia ja saatuja tuloksia verrattiin teoreettisen mallin antamien tulosten kesken. Mittaukset perustuvat toisen harmonisen signaalin havainnointiin. Lisäksi tarkasteltiin paineen ja lämpötilanvaikutusta mittaustuloksiin.

Laivan voimalaitoksen ja jännitevälipiirillisen ruoripotkurikäytön vuorovaikutusten mallintaminen

Diplomityössä on tutkittu sähköisellä potkurijärjestelmällä varustetun laivan voimalaitoksen ja jännitevälipiirillisen propulsiokäytön vuorovaikutusta laivan hätäpysäytyksen aikana. Työssä on kehitetty simulointimalleja jännitevälipiirillisten sähkökäyttöjen simuloimiseksi Saber -simulontiohjelmistolla.Työn alkuosassa esitetään lyhyt yhteenveto laivan sähköisestä potkurijärjestelmästä komponentteineen, käsitellään laivan hätäpysäytyksen teoriaa sekä simuloinneissa huomioonotettavia laivan ja potkurin hydrodynaamisia ominaisuuksia. Työssä käytettävän simulointiohjelmiston toimintaa selvitetään lyhyesti. Jännitevälipiirillisellä propulsiokäytöllä varustetun laivan hätäpysäytyksen simulointimalli esitellään kokonaisuudessaan ja käsitellään simulointimallin sisältämien osakokonaisuuksien teoriaa ja toimintaa. Kehitetyn simulointimallin toimintaa on tarkasteltu vertaamalla tuloksia vastaavansyklokonvertterikäytöllä varustetun laivan simulointituloksiin sekä vertaamallasimulointituloksia laivan merikoeajon yhteydessä tehtyihin mittauksiin. Simulointitulokset vastasivat teoriaa sekä mittaustuloksia varsin hyvin. Voimalaitoksenosalta ei mittaustuloksia ollut käytettävissä, mutta simulointitulokset ovat teorian mukaisia.

Distributed Energy Production in the North-West Region of Russia

The energy system of Russia is the world's fourth largest measured by installed power. The largest are that of the the United States of America, China and Japan. After 1990, the electricity consumption decreased as a result of the Russian industry crisis. The vivid economic growth during the latest few years explains the new increase in the demand for energy resources within the State. In 2005 the consumption of electricity achieved the maximum level of 1990 and continues to growth. In the 1980's, the renewal of power facilities was already very slow and practically stopped in the 1990's. At present, the energy system can be very much characterized as outdated, inefficient and uneconomic because of the old equipment, non-effective structure and large losses in the transmission lines. The aim of Russia's energy reform, which was started in 2001, is to achieve a market based energy policy by 2011. This would thus remove the significantly state-controlled monopoly in Russia's energy policy. The reform will stimulateto decrease losses, improve the energy system and employ energy-saving technologies. The Russian energy system today is still based on the use of fossil fuels, and it almost totally ignores the efficient use of renewable sources such as wind, solar, small hydro and biomass, despite of their significant resources in Russia. The main target of this project is to consider opportunities to apply renewable energy production in the North-West Federal Region of Russia to partly solve the above mentioned problems in the energy system.