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Search Results: 1 - 10 of 208470 matches for " Fraenkel L "
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Development of a tool to improve the quality of decision making in atrial fibrillation
Liana Fraenkel, Richard L Street, Terri R Fried
BMC Medical Informatics and Decision Making , 2011, DOI: 10.1186/1472-6947-11-59
Abstract: We developed a tool based on the principles of the International Patient Decision Aids Standards. The tool focuses on the patient-physician dyad as the decision-making unit and emphasizes improving the interaction between the two. It is built on the recognition that the application of patient values to a specific treatment decision is complex and that the final treatment choice is best made through a process of patient-clinician communication.The tool provides education incorporating patients ' illness perceptions to explain the relationship between NVAF and stroke, and then presents individualized risk estimates, derived using separate risk calculators for stroke and bleeding over a clinically meaningful time period (5 years) associated with no treatment, aspirin, and warfarin. Sequelae of both stroke and bleeding outcomes are also described. Patients are encouraged to verbalize how they value the incremental risks and benefits associated with each option and write down specific concerns to address with their physician. A physician prompt to encourage patients to discuss their opinions is included as part of the decision support tool. In pilot testing with 11 participants (mean age 78 ± 9 years, 64% with ≤ high-school education), 8 (72%) rated ease of completion as "very easy," and 9 (81%) rated amount of information as "just right."The risks and benefits of different treatment options for reduction of stroke in NVAF vary widely according to patients' comorbidities. This tool facilitates the provision of individualized outcome data and encourages patients to communicate with their physicians about these risks and benefits. Future studies will examine whether use of the tool is associated with improved quality of decision making.Nonvalvular atrial fibrillation (NVAF) is associated with an increased risk of stroke. Several randomized controlled trials have demonstrated a reduction in risk of future stroke with oral anticoagulants and antiplatelet agents, but at an in
Patterns and predictors of treatment initiation and completion in patients with chronic hepatitis C virus infection
Clark BT, Garcia-Tsao G, Fraenkel L
Patient Preference and Adherence , 2012, DOI: http://dx.doi.org/10.2147/PPA.S30111
Abstract: tterns and predictors of treatment initiation and completion in patients with chronic hepatitis C virus infection Original Research (2160) Total Article Views Authors: Clark BT, Garcia-Tsao G, Fraenkel L Published Date April 2012 Volume 2012:6 Pages 285 - 295 DOI: http://dx.doi.org/10.2147/PPA.S30111 Received: 22 January 2012 Accepted: 07 February 2012 Published: 04 April 2012 Brian T Clark1,2, Guadalupe Garcia-Tsao1,2, Liana Fraenkel1,2 1Veterans Administration, Connecticut Healthcare System, West Haven, 2Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA Objectives: Guidelines for hepatitis C (HCV) strongly recommend antiviral treatment for patients with more severe liver disease given their increased risk of developing cirrhosis and other liver-related complications. Despite the proven benefits of therapy, 70%–88% of patients chronically infected with HCV do not undergo treatment. The goal of this paper is to describe patterns of treatment initiation among patients with both mild and severe disease and to assess the factors that are associated with treatment initiation and completion. Methods: Subjects completed previously validated questionnaires to ascertain sociodemographic characteristics, choice predisposition, and clinical characteristics prior to meeting with the hepatologist to discuss treatment initiation and were followed for 12 months. We examined the association between patient characteristics and treatment patterns controlling for liver disease severity. Results: Of the 148 eligible subjects entered into our study, 55 (37%) initiated treatment during the 12-month follow-up period. Of the 86 subjects with severe liver disease, 43 (50%) initiated treatment. Financial barriers and geographic access to care were the most common reasons for treatment deferral. Of the 55 patients initiating treatment, 24 (44%) discontinued treatment, with intolerance of side effects being the most common reason for discontinuation. After adjusting for liver disease severity, patient choice predisposition (prior to discussion with their provider) was strongly associated with initiation of treatment, while sociodemographic characteristics were not. Conclusion: Treatment initiation did align with current recommendations (patients with severe disease were more likely to initiate treatment), however, rates of treatment initiation and completion were low. Patient choice predisposition is the strongest predictor of treatment initiation, independent of disease severity. Improving individualized treatment outcomes for patients with chronic HCV requires efforts at identifying patients’ choice predisposition, and improving access for those wishing to initiate therapy.
Patterns and predictors of treatment initiation and completion in patients with chronic hepatitis C virus infection
Clark BT,Garcia-Tsao G,Fraenkel L
Patient Preference and Adherence , 2012,
Abstract: Brian T Clark1,2, Guadalupe Garcia-Tsao1,2, Liana Fraenkel1,21Veterans Administration, Connecticut Healthcare System, West Haven, 2Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USAObjectives: Guidelines for hepatitis C (HCV) strongly recommend antiviral treatment for patients with more severe liver disease given their increased risk of developing cirrhosis and other liver-related complications. Despite the proven benefits of therapy, 70%–88% of patients chronically infected with HCV do not undergo treatment. The goal of this paper is to describe patterns of treatment initiation among patients with both mild and severe disease and to assess the factors that are associated with treatment initiation and completion.Methods: Subjects completed previously validated questionnaires to ascertain sociodemographic characteristics, choice predisposition, and clinical characteristics prior to meeting with the hepatologist to discuss treatment initiation and were followed for 12 months. We examined the association between patient characteristics and treatment patterns controlling for liver disease severity.Results: Of the 148 eligible subjects entered into our study, 55 (37%) initiated treatment during the 12-month follow-up period. Of the 86 subjects with severe liver disease, 43 (50%) initiated treatment. Financial barriers and geographic access to care were the most common reasons for treatment deferral. Of the 55 patients initiating treatment, 24 (44%) discontinued treatment, with intolerance of side effects being the most common reason for discontinuation. After adjusting for liver disease severity, patient choice predisposition (prior to discussion with their provider) was strongly associated with initiation of treatment, while sociodemographic characteristics were not.Conclusion: Treatment initiation did align with current recommendations (patients with severe disease were more likely to initiate treatment), however, rates of treatment initiation and completion were low. Patient choice predisposition is the strongest predictor of treatment initiation, independent of disease severity. Improving individualized treatment outcomes for patients with chronic HCV requires efforts at identifying patients’ choice predisposition, and improving access for those wishing to initiate therapy.Keywords: barriers, access, preferences, utilization, adverse events
Development of a triple GEM UV-photon detector operated in pure CF4 for the PHENIX experiment
A. Kozlov,I. Ravinovich,L. Shekhtman,Z. Fraenkel,M. Inuzuka,I. Tserruya
Physics , 2003, DOI: 10.1016/j.nima.2003.12.018
Abstract: Results obtained with a triple GEM detector operated in pure CF4 with and without a reflective CsI photocathode are presented. The detector operates in a stable mode at gains up to 10^4. A deviation from exponential growth starts to develop when the total charge exceeds ~ 4 10^6 e leading to gain saturation when the total charge is ~ 2 10^7 e and making the structure relatively robust against discharges. No aging effects are observed in the GEM foils after a total accumulated charge of ~ 10 mC/cm^2 at the anode. The ion back-flow current to the reflective photocathode is comparable to the electron current to the anode. However, no significant degradation of the CsI photocathode is observed for a total ion back-flow charge of ~ 7 mC/cm^2.
On Embedding Singular Poisson Spaces
Aaron Fraenkel McMillan
Mathematics , 2011,
Abstract: This dissertation investigates the problem of locally embedding singular Poisson spaces. Specifically, it seeks to understand when a singular symplectic quotient V/G of a symplectic vector space V by a group G \subseteq Sp_2n(R) is realizable as a Poisson subspace of some Poisson manifold (R^n,{.,.}). The local embedding problem is recast in the language of schemes and reinterpreted as a problem of extending the Poisson bracket to infinitesimal neighborhoods of an embedded singular space. Such extensions of a Poisson bracket near a singular point p of V/G are then related to the cohomology and representation theory of the cotangent Lie algebra at p. Using this framework, it is shown that the real 4-dimensional quotient V/\ZZ_n (n odd) is not realizable as a Poisson subspace of any (R^{2n+6},{.,.}), even though the underlying variety algebraically embeds into R^{2n+6}. The proof of this nonembedding result hinges on a refinement of the Levi decomposition for Poisson manifolds to partially linearize any extension with respect to the Levi decomposition of the cotangent Lie algebra of V/G at the origin. Moreover, in the case n=3, this nonembedding result is complemented by a concrete realization of V/\ZZ_3 as a Poisson subspace of R^78.
Multivision: an intractable impartial game with a linear winning strategy
Aviezri S. Fraenkel
Mathematics , 1998,
Abstract: Something is definitely wrong. If the game has a linear winning strategy, then it is tractable. What's going on? Well, we describe a two-person game which has a definite winner, that is, a player who can force a win in a finite number of moves, and we determine the winner in linear time. Moreover, the winner's winning moves can be computed in linear time, yet the game is highly intractable. In particular, at each step, except the very last ones, a player can make the length of play arbitrarily long. Unfortunately, the space for this summary is too small to contain a proof that these properties are not contradictory.
Heap games, numeration systems and sequences
Aviezri S. Fraenkel
Mathematics , 1998,
Abstract: We propose and analyse a 2-parameter family of 2-player games on two heaps of tokens, and present a strategy based on a class of sequences. The strategy looks easy, but is actually hard. A class of exotic numeration systems is then used, which enables us to decide whether the family has an efficient strategy or not. We introduce yet another class of sequences, and demonstrate its equivalence with the class of sequences defined for the strategy of our games.
Error-correcting codes derived from combinatorial games
Aviezri S. Fraenkel
Mathematics , 1995,
Abstract: The ``losing positions" of certain combinatorial games constitute linear error detecting and correcting codes. We show that a large class of games that can be cast in the form of *annihilation games*, provides a potentially polynomial method for computing codes (*anncodes*). We also give a short proof of the basic properties of the previously known *lexicodes*, which are defined by means of an exponential algorithm, and are related to game theory. The set of lexicodes is seen to constitute a subset of the set of anncodes. In the final section we indicate, by means of an example, how the method of producing lexicodes can be applied optimally to find anncodes. Some extensions are indicated.
Extensions of Poisson Structures on Singular Hypersurfaces
Aaron McMillan Fraenkel
Mathematics , 2013,
Abstract: Fix a codimension-1 affine Poisson variety $(X,\pi_X)$ in $\mathbb{C}^n$ with an isolated singularity at the origin. We characterize possible extensions of $\pi_X$ to $\mathbb{C}^n$ using the Koszul complex of the Jacobian ideal of $X$. In the particular case of a singular surface, we show that there always exists an extension of $\pi_X$ to $\mathbb{C}^n$.
Scenic trails ascending from sea-level Nim to alpine chess
Aviezri S. Fraenkel
Mathematics , 1995,
Abstract: Aim: Present a systematic development of part of the theory of combinatorial games from the ground up. Approach: Computational complexity. Combinatorial games are completely determined; the questions of interest are efficiencies of strategies. Methodology: Divide and conquer. Ascend from Nim to chess in small strides at a gradient that's not too steep. Presentation: Informal; examples of games sampled from various strategic viewing points along scenic mountain trails, which illustrate the theory.
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