Comparison of Web-Based and Paper Advance Directives: A Pilot Randomized Clinical Trial

Background: Digital tools to document care preferences in serious illnesses are increasingly common, but their impact is unknown. We developed a web-based advance directive (AD) featuring (1) modular content eliciting detailed care preferences, (2) the ability to electronically transmit ADs to the electronic health record (EHR), and (3) use of nudges to promote document transmission and sharing. Objective: To compare a web-based, EHR-transmissible AD to a paper AD. Methods: Patients with gastrointestinal and lung malignancies were randomized to the web or paper AD. The primary outcome was the proportion of patients with newly documented advance care plans in the EHR at 8 weeks. Secondary outcomes assessed through an e-mail survey included the change in satisfaction with end-of-life plans, AD acceptability, and self-reported sharing with a surrogate. Results: Ninety-one participants were enrolled: 46 randomly allocated to the web AD and 45 to paper. Thirteen patients assigned to web AD (28%) had new documentation versus 7 (16%) assigned to paper ( P = .14). Adjusted for demographic factors and primary diagnosis, the odds ratio of new documentation with web AD was 3.7 (95% CI: 0.8-17.0, P = .10). Satisfaction with advance care planning and AD acceptability were high in both groups and not significantly different. Among patients completing web ADs, 79% reported sharing plans with their caregivers, compared with 65% of those completing paper ADs ( P = .40). Conclusion: Web-based ADs hold promise for promoting documentation and sharing of preferences, but larger studies are needed to quantify effects on these intermediate end points and on patient-centered outcomes.

Estimating Annual Average Daily Bicycle Traffic without Permanent Counter Stations

Traffic volumes are a basic unit of measurement for understanding the transportation system. As investments in bicycle infrastructure are made, similar measures are necessary for understanding this non-motorized mode of travel. Methods for estimating annual average daily bicycle traffic (AADBT) are still developing, but generally employ techniques used in the motorized traffic monitoring field whereby data from permanent counters are used to construct expansion factors that are then applied to short-duration counts. This approach requires a network of permanent counters and knowledge about how to group factors into appropriate categories based on patterns observed in both the short-duration and permanent counter data. The methods presented in this paper advance a new approach to estimating AADBT solely using short-duration counts. The Seasonal Adjustment Regression Model uses statistical models that relate the daily bicycle volume to daily conditions and weather variables at a given count location. These models are then used to predict daily volumes for the remaining days of the year. To verify this approach and determine the resulting error, levels of available short-duration counts using varying amounts of permanent count data were simulated. This method was then applied to short-duration bicycle counts from Eugene, Oregon. With sufficient short-duration count data, this method can produce AADBT estimates with minimal error and without requiring a network of permanent counters. This approach also circumvents the need to determine which expansion factors should be applied to different short-term count locations by using statistical models in place of expansion factors.

Dementia and advance directives: some empirical and normative concerns

The authors of the paper ‘Advance euthanasia directives: a controversial case and its ethical implications’ articulate concerns and reasons with regard to the conduct of euthanasia in persons with dementia based on advance directives. While we agree on the conclusion that there needs to be more attention for such directives in the preparation phase, we disagree with the reasons provided by the authors to support their conclusions. We will outline two concerns with their reasoning by drawing on empirical research and by providing reasons that contradict their assumptions about competence of people with dementia and the (un)importance of happiness in reasoning about advance directives of people with dementia. We will draw attention to the important normative questions that have been overstepped in their paper, and we will outline why further research is required.

Tournament Incentives and Stock Price Crash Risk

SYNOPSIS Using a large sample of U.S. public firms, I provide robust evidence that promotion-based tournament incentives, which are measured as the pay gaps between the CEO and other senior executives, are significantly and positively related to the firm's future stock price crash risk. The documented relationship is robust to controlling for corporate governance quality, and is attenuated for firms with a recent CEO turnover and for firms with more effective external monitoring. In contrast, the relationship is accentuated for firms that experience consecutive underperformance and for firms with greater opacity. Findings of this paper advance our understanding of the benefits and downsides of promotion incentives for non-CEO executives, and highlight the implications of inter-executive incentive scheme design for firm-specific stock price crash risk. JEL Classifications: G34; G12; G30.

Acoustical Radiation Characteristics Test of Magnesium Alloy Sheets with Element Method

Structure vibration is one of the main causes of noise. Thin-walled workpiece has a smaller stiffness,it will easily produce vibrations at work ,and become a source of noice. It is very necessary to study acoustic radiation characteristics of plat,so can we effectively control the structure and connection type of panel structure to change acoustical radiation characteristics.This paper advance a element method to test acoustical radiation characteristics of plat,and take experiment with magnesium alloy sheets.

Vibration Analysis of Main Shaft of Paper Advance Mechanism Based on Laser Doppler Vibrometer

Modal analysis was done to steel shaft and rubber shaft, and their top ten orders of nature frequency were obtained. The lowest nature frequency of steel shaft is 64HZ and the rubber steel’s is 2.2463HZ. Doppler vibration measurement was done to main shaft of paper advance mechanism and the time domain signal and frequency domain signal were obtained when the rotational speed is 80, 160, 240, 320, 400 Rpm. The frequency and amplitude were obtained by signal analysis. It proves that the nature frequency of steel main shaft is much higher than measuring result, but the seventh and eighth order nature frequency of rubber material is in accord with measuring result of laser doppler vibration.

The Study of Detecting of Real Time of Printing

In the orientation of presswork, this paper prospects that an offset of presswork is a limited numerical value. The numerical value of offset is confirmed from register. These dates will be transferred to paper advance mechanism for its revised. This paper prospects a rapidly detect arithmetic whether a presswork has deflection. In detecting of presswork, if the orientation of presswork and the detecting of quality will be integrated, it will rapidly find the area of blot and revise the quality of printing.

Does political instability lead to higher and more volatile inflation?: A panel data analysis

Economists generally accept the proposition that high and volatile inflation rates generate inefficiencies that reduce society?s welfare. Furthermore studies have shown that inflation is harmful to economic growth. However determining the causes of the worldwide diversity of inflationary experiences is an important challenge not yet satisfactorily confronted by the profession. Based on a broad dataset covering over 100 countries for the period 1975-1997 and using dynamic and static panel data econometric techniques, this paper shows that a higher degree of political instability is associated with both higher inflation levels and volatility. Not only does this paper advance the political economy literature establishing a relationship between inflation moments and political instability, but it also has important policy implications regarding the optimal design of inflation stabilization programs and of the institutions favorable to price stability.