Patient participation in the clinical encounter and clinical practice guidelines: The case of patients’ participation in a GRADEd world

It is widely acknowledged that the patient's perspective should be considered when making decisions about how her care will be managed. Patient participation in the decision making process may play an important role in bringing to light and incorporating her perspective. The GRADE framework is touted as an evidence-based process for determining recommendations for clinical practice; i.e. determining how care ought to be managed. GRADE recommendations are categorized as “strong” or “weak” based on several factors, including the “values and preferences” of a “typical” patient. The strength of the recommendation also provides instruction to the clinician about when and how patients should participate in the clinical encounter, and thus whether an individual patient's values and preferences will be heard in her clinical encounter. That is, a “strong” recommendation encourages “paternalism” and a “weak” recommendation encourages shared decision making. We argue that adoption of the GRADE framework is problematic to patient participation and may result in care that is not respectful of the individual patient's values and preferences. We argue that the root of the problem is the conception of “values and preferences” in GRADE – the framework favours population thinking (e.g. “typical” patient “values and preferences”), despite the fact that “values and preferences” are individual in the sense that they are deeply personal. We also show that tying the strength of a recommendation to a model of decision making (paternalism or shared decision making) constrains patient participation and is not justified (theoretically and/or empirically) in the GRADE literature.     

Development of gas tungsten arc welding using current pulsing technique to preclude chromium carbide precipitation in aerospace-grade alloy 80A

Weldments were produced using gas tungsten arc welding(GTAW) and pulsed current gas tungsten arc welding(PCGTAW) techniques with ERNiCr-3 filler wire. Macro examination revealed that the resultant weldments were free from defects. A refined microstructure was observed in the weldment fabricated through PCGTAW. Scanning electron microscopy(SEM) analysis revealed secondary phases in the grain boundaries. Energy-dispersive X-ray spectroscopy(EDS) analysis revealed that microsegregation of Cr carbide precipitates was completely eradicated through PCGTAW. The microsegregation of Nb precipitates was observed in the GTA and PCGTA weldments. X-ray diffraction(XRD) analysis revealed the existence of M_(23)C?_6 Cr-rich carbide and Ni_8Nb phases in the GTA weldments. By contrast, in the PCGTA weldments, the Ni_8Nb phase was observed. The Cr_2Ti phase was observed in both the GTA and the PCGTA weldments. Tensile tests showed that the strength and ductility of the PCGTA weldments were slightly higher than those of the GTA weldments.     

Synthesis of the 3D porous carbon-manganese oxide (3D-C@MnO) nanocomposite and its supercapacitor behavior study

A 3D porous carbon-manganese oxide ([email protected]) nanocomposite is successfully synthesized via a thermal plasma deposition method. The chemical bonds and compositions, phase structures, surface morphologies, etc. of as-obtained [email protected] nanocomposite were characterized by the various equipment, such as X-ray diffractometer, X-ray photoelectron spectroscopy, and electron microscopes. The electrochemical performances of the [email protected] nanocomposite electrode showed a specific capacitance of 780 F g^?1 at a current density of 2 A g^?1 and a capacitance retention rate of 99% after 5000 charge-discharge cycles at a high current density of 10 A g^?1. These excellent capacitive performances may be attributed to the encapsulation of MnO nanoparticles by porous carbon sheets in the [email protected] MnO nanocomposite structure. It is believed that the carbon-encapsulated MnO nanoparticles can be protected from a volume deformation during the charge adsorption/desorption cycle and can be electrically improved by the encapsulated carbon sheets, resulting in better overall capacitive performance. In addition, this study also demonstrates the practical applicability by assembling a supercapacitor using the as-obtained [email protected] nanocomposite to glow a light emitting diode.     

页岩气低伤害超临界CO2凝胶压裂液研究

针对常规水压裂液会对页岩造成伤害，容易产生水锁，不易返排，还造成水资源消耗和污染环境等问题，制备了低伤害二氧化碳凝胶压裂液。将自备的F2EU和F4EU增稠剂加入到超临界CO₂基液中，探究两种增稠剂的加入量对CO₂凝胶压裂液黏度的影响，综合考虑成本与效果，优选了2%的F4EU增稠剂，可将CO₂的黏度增至15.4 mPa·s。研究了温度、压力以及剪切速率对凝胶压裂液黏度的影响。实验结果表明，随着温度升高黏度总体降低，但中间出现一个短暂升高阶段；随着压力上升压裂液黏度增加；随着剪切速率的增加压裂液黏度下降，属于一种典型的剪切变稀的假塑性流体。F4EU超临界CO₂凝胶压裂液的平均伤害率为1.39%，远远小于常规压裂液对岩芯的伤害率。实验表明，F4EU超临界CO₂凝胶压裂液在页岩气压裂开采中具有良好的应用前景。     

Theoretical and experimental design of Pt-Co(OH)_2 electrocatalyst for efficient HER performance in alkaline solution

Design efficient electrocatalysts become significant for the hydrogen evolution reaction (HER) in alkaline solution.Here,the HER performance on Pt-Co(OH)2 has been investigated by using DFT calculations.Compared with pure Pt,the Pt-Co(OH)2 shows excellent hydrogen binding energy (-0.29 eV) and hydrogen adsorption free energy (0.02 eV).More strikingly,the water dissociation process on Pt-Co(OH)2 is an exothermic reaction while that of Pt is an endothermic reaction,demonstrating that the Pt-Co(OH)_2 is an excellent catalyst for HER in alkaline medium.Then the two-step electrodepositions was used to fabricate Pt-Co(OH)2 on the carbon paper (CP).The Pt-Co(OH)_2/CP shows the lowest overpotential of only 37.6 mV at a current density of 10 mA cm~(-2) in 0.1M KOH,the smallest Tafel slope of58 mV dec~(-1) and the good stability for 20000s without obvious degradation.     

Exemplification and the use-values of cases and case studies

This paper provides an account of the ‘use-value’ of case-based research by showing how social scientists exploit cases, and case studies, in a variety of practices of inference and extension. The critical basis for making such extensions relies on the power of a case, or the account given of a case (the case-study account), to exemplify certain features of the social world in ways which prove valuable for further analysis: either of the same case, or in many domains beyond the original case study. Framing use-values in terms of exemplification compares favourably with understanding reasoning beyond the case either as a form of analogical reasoning or in taking cases as experimentable objects.     

Comparative genetic differentiation study of three coexisting mangrove crabs in western Atlantic

ABSTRACT

A multispecies approach may reveal the factors influencing the genetic differentiation of coexisting species along a wide geographic area. Our aim was to compare the genetic differentiation of mangrove crabs coexisting along the western Atlantic in order to verify if there are common barriers, using two mitochondrial DNA markers to quantify genetic differentiation, variance and diversity. In addition, we included a mismatch distribution to check demographic history. Our data revealed that species with similar pelagic larval duration had either high genetic differentiation or the absence of genetic structure. These results can be explained by factors that contribute to genetic differentiation, such as the presence of large estuarine areas (acting as barriers), ocean currents, and larval behaviour. Also, historical events that promoted the isolation of some areas in the past, such as glacial cycles during the Pleistocene, could have caused the observed high levels of genetic divergence in some species.     

Designing Uniform Computer Sequential Experiments with Mixture Levels Using Lee Discrepancy

Computer experiments are constructed to simulate the behavior of complex physical systems. Uniform designs have good performance in computer experiments from several aspects. In practical use, the experimenter needs to choose a small size uniform design at the beginning of an experiment due to a limit of time, budget, resources, and so on, and later conduct a follow up experiment to obtain precious information about the system, that is, a sequential experiment. The Lee distance has been widely used in coding theory and its corresponding discrepancy is an important measure for constructing uniform designs. This paper proves that all the follow up designs of a uniform design are uniform and at least two of them can be used as optimal follow up experimental designs. Thus, it is not necessary that the union of any two uniform designs yields a uniform sequential design. Therefore, this article presents a theoretical justification for choosing the best follow up design of a uniform design to construct a uniform sequential design that involves a mixture of ω≥ 1 factors with β_k ≥ 2, 1 ≤ k ≤ωlevels. For illustration of the usage of the proposed results, a closer look is given at using these results for the most extensively used six particular cases, three symmetric and three asymmetric designs, which are often met in practice.