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Background: Haemato-oncology patients are likely to be referred later to palliative care than patients with solid tumours, despite experiencing similar symptom burden. Patients prior to stem cell transplant may benefit from symptom control, advance care planning and shared decision-making, and previous studies have demonstrated feasibility and benefit of such a service. However, the views of patients are not yet established, and are vital to ensure acceptability of the service.Aims: To identify areas where a palliative care team may help to support patients being considered for a stem cell transplant, and to explore the attitudes and perceptions of patients towards palliative care at this time.Design: A qualitative study including interviews (N = 12) and a focus group (N = 4) for patients pre- and post-transplant, using a semi-structured format via telephone, online video-conferencing and face-to-face discussions. Recordings were transcribed and analysed using thematic analysis.Setting: A tertiary cancer centre in the UK.Findings: Themes identified were the following: Identified needs, Information and decision-making, Importance of relationships, Changing perceptions of what palliative care means, and The future. Patients associate palliative care with terminal care due to indirect experiences. Patients were open to palliative care once its purpose was explained and described emotional and physical needs relevant to early palliative care.Conclusions: The involvement of early palliative care alongside haematology treatment prior to stem cell transplant may improve quality of life for patients and facilitate shared decision-making at a crucial stage of treatment. Early palliative care should be offered alongside haematology care around the time of stem cell transplant, with information provided to patients regarding its role. [ABSTRACT FROM AUTHOR]

Background: In modern neurosurgery, there are often several treatment alternatives, with different risks and benefits. Shared decision-making (SDM) has gained interest during the last decade, although SDM in the neurosurgical field is not widely studied. Therefore, the aim of this scoping review was to present the current landscape of SDM in neurosurgery. Methods: A literature review was carried out in PubMed and Scopus. We used a search strategy based on keywords used in existing literature on SDM in neurosurgery. Full-text, peer-reviewed articles published from 2000 up to the search date February 16, 2021, with patients 18 years and older were included if articles evaluated SDM in neurosurgery from the patient's perspective. Results: We identified 22 articles whereof 7 covered vestibular schwannomas, 7 covered spinal surgery, and 4 covered gliomas. The other topics were brain metastases, benign brain lesions, Parkinson's disease and evaluation of neurosurgical care. Different methods were used, with majority using forms, questionnaires, or interviews. Effects of SDM interventions were studied in 6 articles; the remaining articles explored factors influencing patients' decisions or discussed SDM aids. Conclusion: SDM is a tool to involve patients in the decision-making process and considers patients' preferences and what the patients find important. This scoping review illustrates the relative lack of SDM in the neurosurgical literature. Even though results indicate potential benefit of SDM, the extent of influence on treatment, outcome, and patient's satisfaction is still unknown. Finally, the use of decision aids may be a meaningful contribution to the SDM process. [ABSTRACT FROM AUTHOR]

Data envelopment analysis (DEA) is a broadly used non-parametric technique for performance evaluation and data analytics. While conventional single-stage DEA models overlook the internal interactions of decision making units (DMUs), network DEA opens this black box to investigate the internal structure of DMUs. Practically, many network DEA models involve shared performance measures that are not easily divisible among individual components of a network. Based upon a two-stage network DEA model, the current study treats such performance measures as inseparable links, implying that no proportions are optimized and allocated to the two stages of the network. The shared and unsplittable links in the proposed two-stage DEA model manifest integrality while both ends of the link are maximized or minimized simultaneously, and this setting has not been modeled in any existing DEA studies. The shared and unsplittable links in our model can be considered intermediate measures, but they are different from the two existing types of dual-role intermediate measures, which are traditional intermediate measures and feedback measures. Our performance link is a new type of intermediate measure that is minimized or maximized in both stages of the network. The resulting network DEA model is highly non-linear. To address the non-linearity, a parametric linear model is adopted. The proposed approach is construed in four variants, and then illustrated using a set of 100 banks in the United States. [ABSTRACT FROM AUTHOR]

Introduction: Discordance (misalignment) regarding treatment satisfaction may exist in real-life clinical practice between patients and their physicians. We aimed to assess physician and patient treatment satisfaction levels and associated degree of misalignment in rheumatoid arthritis (RA). Method: A point-in-time, multinational survey of patients and physicians was conducted in Latin America from December 2014 to October 2015. Physician- and patient-reported satisfaction levels with current RA treatment, alignment levels in satisfaction perception, and factors associated with satisfaction misalignment were assessed through bivariate and logistic regression analyses. Results: Participating physicians (N = 114) completed 555 patient record forms (PRFs); 372 patients completed self-complete questionnaires (PSC). A total of 346 physician-patient pairs were analyzed. Physicians reported satisfaction with current disease control in 270/346 (78.0%) PRFs; patients reported such satisfaction in 286/346 (82.7%) PSCs. Physician-patient alignment was observed in 78.6% of pairs. Compared with aligned patients, misaligned patients were younger, more likely to have moderate or severe disease (physician subjectively defined), deteriorating or unstable disease (physician subjectively defined), been exposed to a greater number of advanced therapy lines (biologic or Janus kinase inhibitor), greater current pain, a current acute episode, poorer health, and greater disability and impairment. Misaligned patients were less likely to be in remission. Logistic regression analysis revealed that misaligned patients were more likely to experience greater activity impairment. Conclusions: High treatment satisfaction and alignment were observed among RA patients and their physicians in Latin America. Misaligned patients were more likely to report more severe disease and were less likely to be in remission. Addressing misalignment may lead to improved RA disease control. Key Points • High treatment satisfaction was observed among RA patients and their treating physicians in Latin America. • One-fifth of physician-patient pairs were misaligned in treatment satisfaction. • Patients misaligned with their physicians reported higher disease activity, lower quality of life, and greater disability than those who were aligned with their physicians. • Understanding and addressing misalignment in treatment satisfaction may improve outcomes in this patient population. [ABSTRACT FROM AUTHOR]

In Peer to Peer systems (P2P); an only companion is connected to another associate in a different stockpiling framework. A different gathering of resolutions depicts disseminated hash tables outlines resources onto hubs in P2P system. It offers a “find - obtain” development where getting the advantages in the framework is available, and like this it can get back. DHT offers a liberal position of hubs and administrations yet don’t protect adjacent to vindictive hub moving lookups (the movement used to arrange the benefits in the system). Malicious hubs on a look-up pathway can precisely undermine question. Frameworks like Halo (in light of the harmony) reduction such ambushes by utilizing pointless lookup inquiries. To supply better affirmation; Reputation for Directory administrations is an establishment for training so as to boost lookups in abundance DHT how well new hubs administration lookup wishes. ReDS technique can be executed too for all intents and purposes any abundance DHT containing corona. Additionally, it perceives shared acknowledgment and dispenses with of difficult lookup paths. This acknowledgment does not wager on the partitioning of notoriety numbers and isolating is helpless to assaults that make larger part use of ReDS unfit. Corona is a plan that deeds the deterministic arranging of access to hubs in the harmony to introduce a “high-affirmation situate” through pointless investigates. Radiance was proposed to contain dynamic lookups and can browse different ways. Partitioned notoriety technique for Halo, has deterministic finger gathering. In deciding notoriety organize; the holes of attackers are diminished by utilizing unique Reciprocal Channel Variation based Identification (RCVI) technique. Load imbalance issue emerges through this lookup activity. Each Peer handles the heap by contrasting its ability. ReDS creates accomplishment lookup rates for Halo, yet next to think assailant was trying to brandish their notoriety achieves and in the presence of hub twirl. [ABSTRACT FROM AUTHOR]

To improve efficiency, reduce cost, ensure quality effectively, researchers on CNC machining have focused on virtual machine tool, cloud manufacturing, wireless manufacturing. However, low level of information shared among different systems is a common disadvantage. In this paper, a machining database with data evaluation module is set up to ensure integrity and update. An online monitoring system based on internet of things and multi-sensors 'feel' a variety of signal features to 'percept' the state in CNC machining process. A high efficiency and green machining parameters optimization system 'execute' service-oriented manufacturing, intelligent manufacturing and green manufacturing. The intelligent CNC machining system is applied in production. CNC machining database effectively shares and manages process data among different systems. The prediction accuracy of online monitoring system is up to 98.8% by acquiring acceleration and noise in real time. High efficiency and green machining parameters optimization system optimizes the original processing parameters, and the calculation indicates that optimized processing parameters not only improve production efficiency, but also reduce carbon emissions. The application proves that the shared and service-oriented CNC machining system is reliable and effective. This research presents a shared and service-oriented CNC machining system for intelligent manufacturing process. [ABSTRACT FROM AUTHOR]

Purpose: Although surrogate decision-making in cancer patients is well-known, few studies investigating the prevalence of surrogate decision-making over time have been reported. The objectives of this study were to investigate the level of surrogate decision-making in advanced cancer patients over time and the impact of demographic and clinical variables on surrogate decision-making. Methods: The level of surrogate decision-making was measured in 572 consecutive cancer patients who died between January 1 and December 31, 2009. We reviewed 8,639 informed consent forms of these patients, calculated the proportion of decisions made by a surrogate (PDS) for each patient, and analyzed the association of PDS with demographic and clinical variables. Results: Surrogates completed 40.3 % of all consent forms. The prevalence of surrogate decision-making was higher in the end-of-life period (death <7 days, OR = 29.05; reference, >365 days). Surrogates signed consent forms more frequently for do-not-resuscitate directives, intensive care unit admission, emergency hemodialysis, surgery and invasive interventions compared with chemotherapy, radiotherapy, and diagnostic tests (OR = 3.88, P < 0.001). Patients of older age ( P = 0.036) and those with a shorter duration of management ( P < 0.001) were independently associated with greater PDS. Conclusions: Surrogate decision-making was frequently observed among Korean cancer patients in this study, especially when the patient's death was imminent, and for decisions related to end-of-life care. Surrogates were also frequently involved in decisions for elderly or rapidly deteriorating patients. Healthcare professionals should consider the significant role of familial surrogates in the end-of-life period; comprehensive approaches are needed to preserve the best interest of the patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate which is the minimum number of oocytes to be allocated to each recipient in a shared egg donor program. Methods: We analyzed 953 recipients that received at least 4 metaphase II (MII) oocytes in the period 2006-2008. We retrospectively divided the recipients according to the number of MII oocytes actually received. Results: No statistically significant differences were found among the analyzed strata in clinical pregnancy rate (A:43.7%; B:45.6%; C:48.6%; D:45.5%; E:53%, P = NS) and miscarriage rate. However, the rate of top quality transferred embryos, and the embryo freezing rate were significantly higher among those recipients that received 7 or more mature eggs. Conclusions: After a large sample was analyzed, no significant differences in fresh embryo transfer outcome were encountered when a different number of oocytes was allocated. A minimum of 4 MII oocytes seems to achieve satisfactory pregnancy rates in our shared egg donor program. [ABSTRACT FROM AUTHOR]

This article aims to explore how democratic community is manifest in schools in Korea. It also tries to examine how leadership, specifically transformational leadership, functions in shaping a democratic community within a school. Toward this aim, we have conducted a case study of two religious high schools in Korea. Based on the findings from the schools, we have discussed five aspects related to democratic community and transformational leadership. When school principals’ leadership has transformational characteristics and consistency over the years, the leaders’ mission and vision become shared values among the school members. The shared vision and cultural values make democratic systems work effectively. This article includes implications for educational policy and practice. [ABSTRACT FROM AUTHOR]