Overview of quality measurement and improvement

BACKGROUND: Oro-mandibular reconstruction using vascularized bone-containing free-flaps can be accomplished with flap survival rates in the range of 95%. Primary reconstruction offers the best opportunity to achieve the optimal aesthetic and functional results. Patients presenting for secondary oro-mandibular reconstruction have a unique set of problems; these include the presence of soft tissue contracture displacing the mandibular segments in malposition and soft tissue deficiencies, that makes surgical correction more difficult and potentially more hazardous. Vascularized bone-containing free-flaps are indicated in secondary oro-mandibular reconstruction where both hard and soft tissues replacement is needed or when the recipient bed is unfavourable due to previous surgery and/or radiation. METHODS: Authors presents personal experience in ten cases of secondary oro-mandibular reconstruction treated at Maxillofacial Department of Parma from September 1995 to September 1996 with secondary oro-mandibular reconstruction using bone containing free flaps. Two different donor sites were used to harvest bone-containing free flaps: iliac crest in 2 cases and fibula in the others. In 4 cases the flap was only osseous while in the other 6 cases it was osteocutaneous. RESULTS: All flaps were transplanted successfully; in 1 case necrosis of the skin component of the flap was observed. CONCLUSIONS: The introduction of vascularized bone containing free flaps transferred from distant sites by microvascular techniques has changed mandibular reconstruction. Vascularized bone transferred into tissue beds compromised by salivary contamination and previous irradiation and the rational use of the soft tissutal components of the flap permit also the restoration of articulation, deglutition and mastication with quality of life better than non-vascularized alternatives.     

The Scarecrow and the Tin Man: The vicissitudes of human sympathy and caring.

Why do some victims elicit outpourings of sympathy from those who are unaffected, while others do not? The authors propose a theoretical framework for making sense of the vicissitudes of sympathy based on the interaction between two qualitatively different mental processes. One, which the authors term "sympathy," is caring but immature and irrational. The other process, which the authors term "deliberation," is rational but uncaring. After proposing a framework for how these two factors interact, the authors first discuss a variety of factors that affect the strength of sympathy, including whether one is in the same state as the victim, one's past and vicarious experiences, proximity, similarity, vividness, and newness. Next, the authors discuss factors that affect the relative influence of deliberation. The framework helps to integrate a wide range of disparate experimental findings and provides a possible resolution to parallel debates taking place in psychology and economics over the nature of altruism. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Micro-X: Mission Overview and Science Goals

Micro-X, the High-Resolution Microcalorimeter X-ray Imaging Rocket, is a sounding rocket space telescope that will combine a transition-edge-sensor (TES) X-ray microcalorimeter array with a conical imaging mirror to obtain high spectral resolution images of extended and point X-ray sources. Microcalorimeters measure the energy of an absorbed photon by sensing the increase in temperature of the sensor from the thermalization of the absorbed photon’s energy. The advantages and scientific promise of this technology have fueled active development for the past 20 years. We will leverage this development and take the next step by producing a flight-qualified system that will serve as a pathfinder for future missions. Our scientific program will initially focus on extended sources, for which our high-spectral-resolution observations have distinct advantages over other technologies. For our initial flight, we will observe the bright eastern knot in the Puppis A remnant, a site of complex cloud-shock interactions and ejecta enrichment. A Micro-X observation of the bright eastern knot of Puppis A will obtain a line-dominated spectrum with 90,000 counts collected in 300 seconds at 2 eV resolution across the 0.3–2.5 keV band.      

Are they really that happy? Exploring scale recalibration in estimates of well-being.

Objective: The authors addressed a lingering concern in research on hedonic adaptation to adverse circumstances. This research typically relies on self-report measures of well-being, which are subjective and depend on the standards that people use in making judgments. The authors employed a novel method to test for, and rule out, such scale recalibration in self-reports of well-being. Design: The authors asked patients with chronic illness (either lung disease or diabetes) and nonpatients to evaluate quality of life (QoL) for the patients' disease. In addition, the authors also asked them to rank and rate the aversiveness of a diverse set of adverse circumstances, allowing examination of both the numerical ratings and ordering among items. Main Outcome Measures: The authors compared patients' and nonpatients' ratings and rankings for the patients' disease and other conditions. Results and Conclusion: The authors found that patients not only assigned higher numerical QoL ratings to their own disease than did nonpatients but also ranked it higher among the broad set of conditions. These results suggest that scale recalibration cannot account for discrepant QoL ratings between patients and nonpatients. More generally, this study presents a new approach for measuring well-being that is not subject to the problem of scale recalibration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fulvenes and Thermochromic Ethylenes. Part 52 The Fine Structure of 2-Arylmethylene-1,3-Indandiones; their NMR and Infrared Spectra

A large number of 2-arylmethylene-1,3-indandiones have been prepared and their nuclear magnetic resonance and infrared spectra have been measured. The measurements have been used to elucidate some details of the fine structure of these compounds.     

Reactor safety research - visible demonstrations and credible computations

The Electric Power Research Institute has been conducting nuclear safety research for a number of years with the primary goal of assuring the safety and reliability of the nuclear plants. The visibility is emphasized by sponsoring or participating in large scale test demonstrations to credibly support the complex computations that are the basis for quantification of safety margins.Recognizing the success of the airline industry in receiving favorable public perception, the authors compare the design and operation practices of the airline industry with those of the nuclear industry practices to identify the elements contributing to public concerns and unfavorable perceptions.In this paper, authors emphasize the importance of proper communications of research results to the public in a manner that non-specialists understand. Further, EPRI supported research and results in the areas of source term, seismic and structural engineering research, analysis using probalistic risk assessment (PRA), quantification of safety margins, digital technology development and implementation, and plant transient and performance evaluations are discussed in the paper.     

The psychology of curiosity: A review and reinterpretation.

Research on curiosity has undergone 2 waves of intense activity. The 1st, in the 1960s, focused mainly on curiosity's psychological underpinnings. The 2nd, in the 1970s and 1980s, was characterized by attempts to measure curiosity and assess its dimensionality. This article reviews these contributions with a concentration on the 1st wave. It is argued that theoretical accounts of curiosity proposed during the 1st period fell short in 2 areas: They did not offer an adequate explanation for why people voluntarily seek out curiosity, and they failed to delineate situational determinants of curiosity. Furthermore, these accounts did not draw attention to, and thus did not explain, certain salient characteristics of curiosity: its intensity, transience, association with impulsivity, and tendency to disappoint when satisfied. A new account of curiosity is offered that attempts to address these shortcomings. The new account interprets curiosity as a form of cognitively induced deprivation that arises from the perception of a gap in knowledge or understanding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structure-function relationship studies in human cholinesterases reveal genomic origins for individual variations in cholinergic drug responses

1. Due to their involvement in the termination of neurotransmission at cholinergic synapses and neuromuscular junctions, cholinesterases are the target proteins for numerous drugs of neuro-psychopharmacology importance. 2. In order to perform structure-function relationship studies on human cholinesterases with respect to such drugs, a set of expression vectors was engineered, all of which include cloned cDNA inserts encoding various forms of human acetyl- and butyrylcholinesterase. These vectors were designed to be transcribed in vitro into their corresponding mRNA products which, when microinjected into Xenopus oocytes, are efficiently translated to yield their catalytically active enzymes, each with its distinct substrate specificity and sensitivity to selective inhibitors. 3. A fully automated microtiter plate assay for evaluating the inhibition of said enzymes by tested cholinergic drugs and/or poisons has been developed, in conjunction with computerized data analysis, which offers prediction of such inhibition data on the authentic human enzymes and their natural or mutagenized variants. 4. Thus, it was found that asp70-->gly substitution renders butyrylcholinesterase succinylcholine insensitive and resistant to oxime reactivation while ser 425-->Pro with gly70 gives rise to the "atypical" butyrylcholinesterase phenotype, abolishing dibucaine binding. 5. Furthermore, differences in cholinesterase affinities to physostigmine, ecothiophate and bambuterol were shown in these natural variants. 6. Definition of key residues important for drug interactions may initiate rational design of more specific cholinesterase inhibitors, with fewer side effects. This, in turn, offers therapeutic potential in the treatment of clinical syndromes such as Alzheimer's and Parkinson's disease, glaucoma and myasthenia gravis.     

When does duration matter in judgment and decision making?

Research on sequences of outcomes shows that people care about features of an experience, such as improvement or deterioration over time, and peak and end levels, which the discounted utility model (DU) assumes they do not care about. In contrast to the finding that some attributes are weighted more than DU predicts, Kahneman and coauthors have proposed that there is one feature of sequences that DU predicts people should care about but that people in fact ignore or underweight: duration. In this article, the authors extend this line of research by investigating the role of conversational norms (H. P. Grice, 1975), and scale-norming (D. Kahneman & T. D. Miller, 1986). The impact of these 2 factors are examined in 4 parallel studies that manipulate these factors orthogonally. The major finding is that response modes that reduce reliance on conversational norms or standard of comparison also increase the attention that participants pay to duration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Egocentric empathy gaps between owners and buyers: Misperceptions of the endowment effect.

In 5 studies, the authors examined people's perceptions of the endowment effect, or the tendency to value an object more once one owns it. In the 1st 2 studies, the authors documented egocentric empathy gaps between owners and buyers regarding the endowment effect: Both owners and buyers overestimated the similarity between their own valuation of a commodity and the valuation of people in the other role. The next 2 studies showed that these empathy gaps may lead to reduced earnings in a market setting. The final study showed that egocentric empathy gaps stem partly from people's misprediction of what their own valuation would be if they were in the other role. (PsycINFO Database Record (c) 2010 APA, all rights reserved)