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Literature about public decision making experiences, including stakeholders' engagement, offers best practices but also reports of unsuccessful case studies. Meaningful participation activities require direct integration of stakeholders into all the phases of the public decision process to unleash innovation. Often, policy making incorporates participation late in the process, after the problem definition has occurred, alternatives have been defined, without considering stakeholders' knowledge and problem understanding. The early stage of policy alternatives design is essential to the development of policy. Our research presents an extensive literature review with respect to policy design and design theory in order to show that the formal process of generation of alternatives has been little investigated. There is a demand for methodologies aiming at supporting policy makers and relevant stakeholders during policy design. In this regard, this paper introduces (and explores) the operational role of design theory in the policy making process for the generation of policy alternatives. Design thinking, as a way to inform a collective problem definition leading to innovation, highlights the value of early stakeholders' engagement. The aim of this paper is to understand, from an operational point of view, what "design" means in a policy making context, developing an innovative approach for assisting the formalization of policy design. The paper uses the results of a pilot case study to illustrate the application of the Concepts-Knowledge (C-K) theory framework to support the innovative design of policy alternatives for the groundwater protection policy of the Apulia Region (southern Italy). [ABSTRACT FROM AUTHOR]

Objective: To determine the ability of dynamic contrast enhanced (DCE-MRI) to predict pathological complete response (pCR) after preoperative chemotherapy for rectal cancer. Methods: In a prospective clinical trial, 23/34 enrolled patients underwent pre- and post-treatment DCE-MRI performed at 1.5T. Gadolinium 0.1 mmol/kg was injected at a rate of 2 mL/s. Using a two-compartmental model of vascular space and extravascular extracellular space, K, k, v, AUC90, and AUC180 were calculated. Surgical specimens were the gold standard. Baseline, post-treatment and changes in these quantities were compared with clinico-pathological outcomes. For quantitative variable comparison, Spearman's Rank correlation was used. For categorical variable comparison, the Kruskal-Wallis test was used. P ≤ 0.05 was considered significant. Results: Percentage of histological tumour response ranged from 10 to 100%. Six patients showed pCR. Post chemotherapy K (mean 0.5 min vs. 0.2 min, P = 0.04) differed significantly between non-pCR and pCR outcomes, respectively and also correlated with percent tumour response and pathological size. Post-treatment residual abnormal soft tissue noted in some cases of pCR prevented an MR impression of complete response based on morphology alone. Conclusion: After neoadjuvant chemotherapy in rectal cancer, MR perfusional characteristics have been identified that can aid in the distinction between incomplete response and pCR. Key Points: [ABSTRACT FROM AUTHOR]

Objectives: To assess the incremental value of diffusion-weighted (DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI) to T2-weighted MRI (T2WI) in detecting locally recurrent prostate cancer after radiotherapy.Methods: Twenty-four patients (median age, 70 years) with a history of radiotherapy-treated prostate cancer underwent multi-parametric MRI (MP-MRI) and transrectal prostate biopsy. Two readers independently scored the likelihood of cancer on a 1-5 scale, using T2WI alone and then adding DW-MRI and DCE-MRI. Areas under receiver operating characteristic curves (AUCs) were estimated at the patient and prostate-side levels. The apparent diffusion coefficient (ADC) from DW-MRI and the K(trans), k(ep), v(e), AUGC90 and AUGC180 from DCE-MRI were recorded.Results: Biopsy was positive in 16/24 (67%) and negative in 8/24 (33%) patients. AUCs for readers 1 and 2 increased from 0.64 and 0.53 to 0.95 and 0.86 with MP-MRI, at the patient level, and from 0.73 and 0.66 to 0.90 and 0.79 with MP-MRI, at the prostate-side level (p values < 0.05). Biopsy-positive and biopsy-negative prostate sides differed significantly in median ADC [1.44 vs. 1.68 (×10(-3) mm(2)/s)], median K(trans) [1.07 vs. 0.34 (1/min)], and k(ep) [2.06 vs 1.0 (1/min)] (p values < 0.05).Conclusions: MP-MRI was significantly more accurate than T2WI alone in detecting locally recurrent prostate cancer after radiotherapy. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of interactive dedicated training on radiology fellows' accuracy in assessing prostate cancer on MRI.Methods: Eleven radiology fellows, blinded to clinical and pathological data, independently interpreted preoperative prostate MRI studies, scoring the likelihood of tumour in the peripheral and transition zones and extracapsular extension. Each fellow interpreted 15 studies before dedicated training (to supply baseline interpretation accuracy) and 200 studies (10/week) after attending didactic lectures. Expert radiologists led weekly interactive tutorials comparing fellows' interpretations to pathological tumour maps. To assess interpretation accuracy, receiver operating characteristic (ROC) analysis was conducted, using pathological findings as the reference standard.Results: In identifying peripheral zone tumour, fellows' average area under the ROC curve (AUC) increased from 0.52 to 0.66 (after didactic lectures; p<0.0001) and remained at 0.66 (end of training; p<0.0001); in the transition zone, their average AUC increased from 0.49 to 0.64 (after didactic lectures; p=0.01) and to 0.68 (end of training; p=0.001). In detecting extracapsular extension, their average AUC increased from 0.50 to 0.67 (after didactic lectures; p=0.003) and to 0.81 (end of training; p<0.0001).Conclusion: Interactive dedicated training significantly improved accuracy in tumour localization and especially in detecting extracapsular extension on prostate MRI. [ABSTRACT FROM AUTHOR]

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In a radial flow pump operating in off-design conditions, regions of stall can exist on the rotating impeller blade and on the downstream diffuser blade, vane or tongue. Interaction of these stall zones can generate complex patterns of vorticity concentrations. In turn, these vorticity concentrations are related to sources of unsteady stagnation enthalpy. The form of these patterns is strongly dependent on the instantaneous location of the impeller trailing-edge relative to the leading-edge of the vane. Comparison of instantaneous with ensemble-averaged images shows that the flow structure in the gap region between the impeller and the vane is highly repetitive. Away from this region, in particular in the separated shear layer from the vane, the nonrepetitive nature of the vorticity field is manifested in substantial reduction of peak levels of vorticity in the ensemble-averaged image, relative to the instantaneous image. The three-dimensional flow structure resulting from these separation zone interactions was characterized via end views of the flow patterns. Particularly pronounced concentrations of vorticity can occur in this plane. They tend to be located in the shear layer at the outer edge of the large-scale separation zone. These vorticity concentrations are, however, highly non-stationary for successive passages of the impeller blade. Ensemble-averaging reveals that they persist primarily on the endwalls of the diffuser. [ABSTRACT FROM AUTHOR]

Laser scanning, corresponding to time-dependent deflections of laser beam across a field of interest, can provide relatively high illumination intensity of small particles, thereby allowing implementation of high image-density particle image velocimetry (PIV). Scanning techniques employing a rotating (multi-faceted) mirror, an oscillating mirror, and an acousto-optic deflector are addressed. Issues of illumination intensity and exposure, rate of scan of the laser beam, and retrace time of the scanning beam are assessed. Representative classes of unsteady separated flows investigated with laser-scanning PIV are described. [ABSTRACT FROM AUTHOR]

Syringomyelia, which is generally related to congenital malformations and tumors, may lead to paresthesia and dysfunctions in thermo-algesic perception. Post-traumatic syringomyelia (PTS) is a rare type of this disease characterised by the development of a cystic formation containing cerebrospinal fluid (CSF), which develops inside the spinal cord after spinal trauma. The description of a case diagnosed as painless burn injury caused by PTS. One case report. Although there are a number of reports regarding the formation of neuropathic ulcers related to syringomyelia, painless burn injury descriptions are very rare. Despite available limited data related to this subject, it is important to warn patients about traumas—especially burns—after a diagnosis of PTS. [ABSTRACT FROM AUTHOR]

Air embolism to brain occurs following iatrogenic or post-traumatic introduction of air into arterial or venous systems. Although arterial air embolism to brain is usually fatal, venous air embolism is not always fatal, but both conditions may result in severe neurologic deficits. In this case report, we discussed the mechanism and computed tomography findings of post-traumatic cerebral venous air embolism in a patient who survived without any neurologic deficit. [ABSTRACT FROM AUTHOR]