(Re)Construction of Quantum Space-Time: Transcribing Hilbert into Configuration Space.

Space-time in quantum mechanics is about bridging Hilbert and configuration space. Thereby, an entirely new perspective is obtained by replacing the Newtonian space-time theater with the image of a presumably high-dimensional Hilbert space, through which space-time becomes an epiphenomenon construed by internal observers.

SAFIR-I: Design and Performance of a High-Rate Preclinical PET Insert for MRI.

(1) Background: Small Animal Fast Insert for MRI detector I (SAFIR-I) is a preclinical Positron Emission Tomography (PET) insert for the Bruker BioSpec 70/30 Ultra Shield Refrigerated (USR) preclinical 7T Magnetic Resonance Imaging (MRI) system. It is designed explicitly for high-rate kinetic studies in mice and rats with injected activities reaching 500MBq, enabling truly simultaneous quantitative PET and Magnetic Resonance (MR) imaging with time frames of a few seconds in length. (2) Methods: SAFIR-I has an axial field of view of 54.2mm and an inner diameter of 114mm. It employs Lutetium Yttrium OxyorthoSilicate (LYSO) crystals and Multi Pixel Photon Counter (MPPC) arrays. The Position-Energy-Timing Application Specific Integrated Circuit, version 6, Single Ended (PETA6SE) digitizes the MPPC signals and provides time stamps and energy information. (3) Results: SAFIR-I is MR-compatible. The system's Coincidence Resolving Time (CRT) and energy resolution are between separate-uncertainty 209.0(3)ps and separate-uncertainty 12.41(02) Full Width at Half Maximum (FWHM) at low activity and separate-uncertainty 326.89(12)ps and separate-uncertainty 20.630(011) FWHM at 550MBq, respectively. The peak sensitivity is ∼1.6. The excellent performance facilitated the successful execution of first in vivo rat studies beyond 300MBq. Based on features visible in the acquired images, we estimate the spatial resolution to be ∼2mm in the center of the Field Of View (FOV). (4) Conclusion: The SAFIR-I PET insert provides excellent performance, permitting simultaneous in vivo small animal PET/MR image acquisitions with time frames of a few seconds in length at activities of up to 500MBq.

Remediation management of complex sites using an adaptive site management approach.

Complex sites require a disproportionate amount of resources for environmental remediation and long timeframes to achieve remediation objectives, due to their complex geologic conditions, hydrogeologic conditions, geochemical conditions, contaminant-related conditions, large scale of contamination, and/or non-technical challenges. A recent team of state and federal environmental regulators, federal agency representatives, industry experts, community stakeholders, and academia worked together as an Interstate Technology & Regulatory Council (ITRC) team to compile resources and create new guidance on the remediation management of complex sites. This article summarizes the ITRC team's recommended process for addressing complex sites through an adaptive site management approach. The team provided guidance for site managers and other stakeholders to evaluate site complexities and determine site remediation potential, i.e., whether an adaptive site management approach is warranted. Adaptive site management was described as a comprehensive, flexible approach to iteratively evaluate and adjust the remedial strategy in response to remedy performance. Key aspects of adaptive site management were described, including tools for revising and updating the conceptual site model (CSM), the importance of setting interim objectives to define short-term milestones on the journey to achieving site objectives, establishing a performance model and metrics to evaluate progress towards meeting interim objectives, and comparing actual with predicted progress during scheduled periodic evaluations, and establishing decision criteria for when and how to adapt/modify/revise the remedial strategy in response to remedy performance. Key findings will be published in an ITRC Technical and Regulatory guidance document in 2017 and free training webinars will be conducted. More information is available at www.itrc-web.org.

The Influence Exerted by Time Frames on Consumers' Willingness to Buy Nearly Expired Food.

With the development of Internet e-commerce channels, online shopping platforms have become the main channel for consumers to buy nearly expired food. Date labels, as one of the main external clues, play a decisive role in nearly expired food purchasing. Therefore, based on attention-related theory, this study attempts to explore the influence exerted by different time frames on consumers' willingness to buy and its mechanism. The results show that compared with the date, consumers have a higher willingness to buy nearly expired food when the expiration time is framed by delay. More specifically, compared to the date, the delay causes the individual to have a longer time perception, thus more preference for nearly expired food. Meanwhile, the mediating effect of time perception is moderated by food type. The conclusion of this research is helpful to expand the theoretical framework of time frames and related fields on nearly expired food, as well as provide practical guidance for marketers to effectively promote nearly expired food.

Unintended Regulatory Caused Early Death-A Difficult Endpoint in Cancer Patient Care and Treatment.

The pharmacological armory against cancer has been growing, with many new drugs approved. The Good Clinical Practice (GCP)-based Clinical Trials Directive was adopted in the EU in 2001, with the important objectives of achieving better patient safety and improved quality of clinical trial conduct. However, clinical experience with the implementation of the regulation raises the question as to whether aspects of this regulatory framework can cause harm to some patients. This question also arises in daily clinical cancer patient care when the time between the publication of pivotal study results and their approval, and details of post-approval regulations, are scrutinized. Clinical observations, provocatively summarized as "unintended regulatory caused early death", are discussed.

Decision-making and health system strengthening: bringing time frames into perspective.

In many low-and middle-income countries, health systems decision-makers are facing a host of new challenges and competing priorities. They must not only plan and implement as they used to do but also deal with discontented citizens and health staff, be responsive and accountable. This contributes to create new political hazards susceptible to disrupt the whole execution of health plans. The starting point of this article is the observation by the first author of the limitations of the building-blocks framework to structure decision-making as for strengthening of the Moroccan health system. The management of a health system is affected by different temporalities, the recognition of which allows a more realistic analysis of the obstacles and successes of health system strengthening approaches. Inspired by practice and enriched thanks a consultation of the literature, our analytical framework revolves around five dynamics: the services dynamic, the programming dynamic, the political dynamic, the reform dynamic and the capacity-building dynamic. These five dynamics are differentiated by their temporalities, their profile, the role of their actors and the nature of their activities. The Moroccan experience suggests that it is possible to strengthen health systems by opening up the analysis of temporalities, which affects both decision-making processes and the dynamics of functioning of health systems.

Perceptions of prognostic risks in chronic kidney disease: a national survey.

BACKGROUND: Predicting the clinical trajectories of chronic kidney disease (CKD) to discern personalized care remains a complex challenge in nephrology. Understanding the appropriate risk thresholds and time frame associated with predicting risks of key outcomes (kidney failure, cardiovascular (CV) events, and death) is critical in facilitating decision-making. As part of an exploratory research and practice support needs assessment, we aimed to determine the importance of the time frames for predicting key outcomes, and to assess the perceived demand for risk prediction tools among Canadian nephrologists. METHODS: A web-based survey was developed by a pan-Canadian expert panel of practitioners. Upon pre-test for clarity and ease of completion, the final survey was nationally deployed to Canadian nephrologists. Anonymous responses were gathered over a 4-month period. The results were analyzed using descriptive statistics. RESULTS: One hundred eleven nephrologists responded to our survey. The majority of the respondents described prediction of events over time frames of 1-5 years as being "extremely important" or "very important" to decision-making on a 5-point Likert scale. To plan for arteriovenous fistula referral, the respondents deemed thresholds which would predict probability of kidney failure between >30 and >50 % at 1 year, as useful, while many commented that the rate of progression should be included for decision-making. Over 80 % of the respondents were not satisfied with their current ability to predict the progression to kidney failure, CV events, and death. Most of them indicated that they would value and use validated risk scores for decision-making. CONCLUSIONS: Our national survey of nephrologists shows that the risk prediction for major adverse clinical outcomes is valuable in CKD at multiple time frames and risk thresholds. Further research is required in developing relevant and meaningful risk prediction models for clinical decision-making in patient-centered CKD care.

CONTEXTE: Un défi de taille subsiste dans le domaine de la néphrologie. En effet, il demeure difficile de prévoir l'évolution de la néphropathie chronique et donc, d'établir un programme de soin personnalisé pour les patients. Pour ce faire, il serait essentiel de comprendre les seuils de risque ainsi que les marges de temps qui pourraient aider à prévoir l'évolution de la maladie vers les complications inhérentes (l'insuffisance rénale chronique, des événements cardiovasculaires ou la mort). La connaissance de ces paramètres pourrait s'avérer un outil indispensable pour aider les néphrologues à prendre des décisions plus rapidement et plus efficacement quant à la suite du traitement à offrir à leurs patients. Dans le but d'offrir du support à la pratique et de faciliter la prise de décisions cliniques, cette étude exploratoire faite auprès des néphrologues canadiens visait à évaluer l'importance d'établir des cadres temporels et des seuils de risque permettant de prévoir l'évolution défavorable de la néphropathie chronique vers ses principales complications. MÉTHODE: Un groupe d'experts provenant de tous les coins du pays a mis au point un sondage sur le web pour questionner directement les néphrologues. Une version pilote du test a d'abord été distribuée à un groupe restreint pour en vérifier la clarté et faire en sorte de le rendre le plus convivial possible pour les répondants. La version définitive été envoyée par courriel à des néphrologues pratiquant à travers le Canada. Les réponses au questionnaire ont été compilées en préservant l'anonymat des répondants, sur une période de quatre mois, et ont été analysées par statistique descriptive. RÉSULTATS: Un total de cent-onze néphrologues ont répondu au sondage, et sur une échelle de Likert en cinq points, la majorité d'entre eux a qualifié d'« extrêmement importante ¼ ou de « très importante ¼ pour faciliter la prise de décision, la possibilité de prévoir les événements défavorables sur une période de un à cinq ans. Dans le cas précis de la pose d'une fistule artérioveineuse, une bonne proportion de répondants a mentionné qu'ils la recommanderaient à leurs patients s'ils pouvaient estimer le risque de développer une insuffisance rénale chronique à plus de 50 % à l'intérieur d'une période d'un an, alors que d'autres ont mentionné qu'ils le feraient si ce risque se situait à plus de 30 % pour la même période. Tous ont mentionné qu'ils trouveraient utile d'avoir la capacité de prévoir une telle issue, et plusieurs ont ajouté que le rythme de progression de la maladie devrait être considéré dans la prise de décision. En tout, plus de 80 % des répondants se sont dits insatisfaits de leur capacité actuelle à prévoir la progression de la maladie vers l'insuffisance rénale chronique, des complications d'ordre cardiovasculaires ou la mort. Enfin, la plupart d'entre eux ont indiqué qu'ils jugeraient utile la création d'une charte validée de seuils de risques permettant de prédire l'évolution défavorable de la maladie et qu'ils seraient enclins à l'utiliser dans leurs prises de décisions. CONCLUSION: Les résultats de ce sondage national effectué auprès de néphrologues-praticiens montrent que la capacité de prévoir, dans une gamme de périodes de référence donnée, les risques de résultats cliniques défavorables chez les patients atteints de néphropathie chronique serait grandement utile pour la prise de décisions quant au choix du traitement. Des recherches plus approfondies sont requises en vue de développer des modèles pertinents et concrets de prévision des risques d'évolution défavorable de la maladie, dans le but de faciliter la prise de décisions cliniques et d'offrir aux patients des soins axés sur leurs besoins particuliers.