Research participation of individuals with dementia : decisional capacity, informed consent, and considerations for nurse investigators

Decisional capacity is a precious component of personhood and is progressively diminished in dementia. Conducting research with individuals with dementia demands a commitment to ensure the quest for knowledge does not overwhelm the rights of those it is intended to protect. The purposes of this article are to describe current understandings of the concept of decisional capacity, describe recent regulatory developments related to the consideration of additional protections for decisionally impaired adults, and provide recommendations for nurse investigators working with this vulnerable group.

Incorporating Multiculturalism in Medical Decisional Capacity Assessment

As the demography of the U.S. population becomes increasingly older and culturally diverse, psychologists must develop greater multicultural competency and abilities to provide culturally and linguistically appropriate clinical services. This paper focuses on the dire need for the development of multicultural approach to medical decisional capacity evaluation. The purpose of this paper is to examine the common clinical and ethical dilemmas faced by psychologists when evaluating culturally diverse geriatric population. For instance, the lack of culturally and linguistically appropriate cognitive and functional assessment measures with sound reliability, validity, and normative properties is discussed in detail. This paper introduces possible solutions to the dilemmas and aims to ultimately contribute to increased multicultural awareness within the U.S. healthcare system.

End-of-life decision making in Europe and Australia - A physician survey

Background: The frequencies with which physicians make different medical end-of-life decisions (ELDs) may differ between countries, but comparison between countries has been difficult owing to the use of dissimilar research methods. Methods: A written questionnaire was sent to a random sample of physicians from 9 specialties in 6 European countries and Australia to investigate possible differences in the frequencies of physicians' willingness to perform ELDs and to identify predicting factors. Response rates ranged from 39% to 68% (N= 10 139). Using hypothetical cases, physicians were asked whether they would ( probably) make each of 4 ELDs. Results: In all the countries, 75% to 99% of physicians would withhold chemotherapy or intensify symptom treatment at the request of a patient with terminal cancer. In most cases, more than half of all physicians would also be willing to deeply sedate such a patient until death. However, there was generally less willingness to administer drugs with the explicit intention of hastening death at the request of the patient. The most important predictor of ELDs was a request from a patient with decisional capacity (odds ratio, 2.1-140.0). Shorter patient life expectancy and uncontrollable pain were weaker predictors but were more stable across countries and across the various ELDs (odds ratios, 1.1-2.4 and 0.9-2.4, respectively). Conclusion: Cultural and legal factors seem to influence the frequencies of different ELDs and the strength of their determinants across countries, but they do not change the essence of decision making.

Measurement of Advance Directive and Medical Treatment Decision-Making Capacity of Older Adults

The objective of this study was to characterize two components of decisional competence that are relevant to advance directive (AD) completion and medical treatment decision making among a subsample of older adults hospitalized in acute care settings.

Characterization of commercial double-walled carbon nanotube material : composition, structure, and heat capacity

A purified commercial double-walled carbon nanotube (DWCNT) sample was investigated by transmission electron microscopy (TEM), thermogravimetry (TG), and Raman spectroscopy. Moreover, the heat capacity of the DWCNT sample was determined by temperature-modulated differential scanning calorimetry in the range of temperature between -50 and 290 °C. The main thermo-oxidation characterized by TG occurred at 474 °C with the loss of 90 wt% of the sample. Thermo-oxidation of the sample was also investigated by high-resolution TG, which indicated that a fraction rich in carbon nanotube represents more than 80 wt% of the material. Other carbonaceous fractions rich in amorphous coating and graphitic particles were identified by the deconvolution procedure applied to the derivative of TG curve. Complementary structural data were provided by TEM and Raman studies. The information obtained allows the optimization of composites based on this nanomaterial with reliable characteristics.

Pedestrians Effects on Indoor MIMO-OFDM Channel Capacity

Temporal variations caused by pedestrian movement can significantly affect the channel capacity of indoor MIMOOFDM wireless systems. This paper compares systematic measurements of MIMO-OFDM channel capacity in presence of pedestrians with predicted MIMO-OFDM channel capacity values using geometric optics-based ray tracing techniques. Capacity results are presented for a single room environment using 5.2 GHz with 2x2, 3x3 and 4x4 arrays as well as a 2.45 GHz narrowband 8x8 MIMO array. The analysis shows an increase of up to 2 b/s/Hz on instant channel capacity with up to 3 pedestrians. There is an increase of up to 1 b/s/Hz in the average capacity of the 4x4 MIMO-OFDM channel when the number of pedestrians goes from 1 to 3. Additionally, an increment of up to 2.5 b/s/Hz in MIMO-OFDM channel capacity was measured for a 4x4 array compared to a 2x2 array in presence of pedestrians. Channel capacity values derived from this analysis are important in terms of understanding the limitations and possibilities for MIMO-OFDM systems in indoor populated environments.

Effect of Pedestrian Movement on MIMO-OFDM Channel Capacity in an Indoor Environment

Effects of pedestrian movement on multiple-input multiple-output orthogonal frequency division multiplexing (MIMO-OFDM) channel capacity have been investigated using experiment and simulation. The experiment was conducted at 5.2 GHz by a MIMO-OFDM packet transmission demonstrator using four transmitters and four receivers built in-house. Geometric optics based ray tracing technique was used to simulate the experimental scenarios. Changes in the channel capacity dynamic range have been analysed for different number of pedestrian (0-3) and antennas (2-4). Measurement and simulation results show that the dynamic range increases with the number of pedestrian and the number of antennas on the transmitter and receiver array.

Research monograph : emergence of smart urban ecosystems : application of ICT for capacity building in environmental decision making

Since the industrial revolution, our world has experienced rapid and unplanned industrialization and urbanization. As a result, we have had to cope with serious environmental challenges. In this context, explanation of how smart urban ecosystems can emerge, gains a crucial importance. Capacity building and community involvement have always been the key issues in achieving sustainable development and enhancing urban ecosystems. By considering these, this paper looks at new approaches to increase public awareness of environmental decision making. This paper will discuss the role of Information and Communication Technologies (ICT), particularly Web-based Geographic Information Systems (Web-based GIS) as spatial decision support systems to aid public participatory environmental decision making. The paper also explores the potential and constraints of these web-based tools for collaborative decision making.

The role of relational capabilities in developing the capacity for supply chain innovation

The purpose of this paper is to gain a better understanding of the types of relational capabilities supply chain participants develop to enable ongoing supply chain innovation capacity building that produces improved business outcomes. This is exploratory research using qualitative data gathered by using five interviews, with the Australian road freight industry as the context. Two key relational capabilities and the improvement of four key business outcomes were identified as being present in the interaction of freight transport service providers with members of their supply chain. The data also demonstrates that by entering into competence building relationships with customers and suppliers firms can build capabilities that will increase their capacity for supply chain innovation. Even in short term arm’s length relationships firms can acquire improved skills behaviours and practices that enhance their operation effectiveness and the efficiency of the supply chain relationships.

A framework for predicting the residual load carrying capacity of concrete structures exposed to aggressive environments

Reinforced concrete structures are susceptible to a variety of deterioration mechanisms due to creep and shrinkage, alkali-silica reaction (ASR), carbonation, and corrosion of the reinforcement. The deterioration problems can affect the integrity and load carrying capacity of the structure. Substantial research has been dedicated to these various mechanisms aiming to identify the causes, reactions, accelerants, retardants and consequences. This has improved our understanding of the long-term behaviour of reinforced concrete structures. However, the strengthening of reinforced concrete structures for durability has to date been mainly undertaken after expert assessment of field data followed by the development of a scheme to both terminate continuing degradation, by separating the structure from the environment, and strengthening the structure. The process does not include any significant consideration of the residual load-bearing capacity of the structure and the highly variable nature of estimates of such remaining capacity. Development of performance curves for deteriorating bridge structures has not been attempted due to the difficulty in developing a model when the input parameters have an extremely large variability. This paper presents a framework developed for an asset management system which assesses residual capacity and identifies the most appropriate rehabilitation method for a given reinforced concrete structure exposed to aggressive environments. In developing the framework, several industry consultation sessions have been conducted to identify input data required, research methodology and output knowledge base. Capturing expert opinion in a useable knowledge base requires development of a rule based formulation, which can subsequently be used to model the reliability of the performance curve of a reinforced concrete structure exposed to a given environment.

Variations in MIMO-OFDM channel capacity due to random human movement in an indoor environment

Channel measurements and simulations have been carried out to observe the effects of pedestrian movement on multiple-input multiple-output orthogonal frequency division multiplexing (MIMO-OFDM) channel capacity. An in-house built MIMO-OFDM packet transmission demonstrator equipped with four transmitters and four receivers has been utilized to perform channel measurements at 5.2 GHz. Variations in the channel capacity dynamic range have been analysed for 1 to 10 pedestrians and different antenna arrays (2 × 2, 3 × 3 and 4 × 4). Results show a predicted 5.5 bits/s/Hz and a measured 1.5 bits/s/Hz increment in the capacity dynamic range with the number of pedestrian and the number of antennas in the transmitter and receiver array.