Three-year-olds' ability to plan for mutually exclusive future possibilities is limited primarily by their representations of possible plans, not possible events.

The ability to prepare for mutually exclusive possible events in the future is essential for everyday decision making. Previous studies have suggested that this ability develops between the ages of 3 and 5 years, and in young children is primarily limited by the ability to represent the set of possible outcomes of an event as "possible". We tested an alternative hypothesis that this ability may be limited by the ability to represent the set of possible actions that could be taken to prepare for those possible outcomes. We adapted the inverted y-shaped tube task of Redshaw and Suddendorf (2016), in which children are asked to catch a marble that is dropped into the top of the tube and can emerge from either the left or right branch of the tube. While 4-year-olds typically place their hands under both openings to catch the marble, preparing for both possible outcomes (optimal action), 3-year-olds often cover only one opening, preparing for only one possible outcome (suboptimal action). In three Experiments, we asked whether first showing children the set of possible actions that could be taken on the tube would enable them to recognize the optimal action that should be used to catch the marble (Experiments 1 and 3, total n = 99 US 3- and 4-year-olds) and enable them to use the optimal action themselves (Experiment 2, n = 96 US 3- and 4-year-olds). We found that 3- and 4-year-olds performed similarly when they were given the opportunity to observe the set of possible actions beforehand. These findings suggest that 3-year-olds' competence at representing mutually exclusive possibilities may be masked by their developing ability to represent and deploy plans to act on these possibilities.

Exergoeconomic analysis and multi-objective optimization of ORC configurations via Taguchi-Grey Relational Methods.

Recovery of low-grade waste heat in industrial processes is an essential energy management topic. Yet, most low-temperature heat sources discharge their heat directly into the environment. The Organic Rankine Cycle (ORC), which has the benefits of being energy-efficient, enabling investment savings, and being ecologically friendly, is crucial in recycling energy from low-temperature waste heat. Both the application of the optimum cycle design and the provision of optimum working conditions are the issues that need to be focused on efficiently using energy. This study performs the energy, exergy, and exergoeconomic analysis of four different organic Rankine cycle configurations operating with renewable or low grade waste heat. The effect degrees and ratios of selected control factors are calculated using Taguchi and variance analysis methods to compare thermal and exergy efficiencies, total system cost, and unit cost of electricity produced by the system. The objective function of the multi-objective optimization problem is defined, and its solution is realized with the Taguchi-Grey Relational Analysis method. The best thermodynamic and exergoeconomic performance result is calculated for the configuration of ORC with Feed Fluid Heater-Internal Heat Exchanger (IHE-FFH-ORC). As a result of Taguchi and ANOVA analysis, the factors that most affect the thermal efficiency of the system, the exergy efficiency, the total system investment cost, and the unit cost of the electricity produced are, respectively, the evaporation temperature (∼50%), turbine efficiency (∼25%), working fluid (∼20%), subcooling (∼4%), pump efficiency (∼0.05%), and superheating (∼0.05%). As a result of the optimization process, the thermal and exergy efficiencies, the total system cost and the unit cost of produced electricity for the IHE-FFH-ORC power system are calculated as 22.6% and 73.5%, 1.06 $/h, 0.039 $/kWh and 2.9 years, respectively.

The Effects of Acupressure on Nausea, Vomiting, and Vital Signs in Patients Undergoing Gynecologic Surgery: A Randomized Controlled Trial.

PURPOSE: This randomized controlled experimental study was conducted to determine the effect of acupressure on nausea, vomiting, and vital signs in patients undergoing gynecologic surgery. DESIGN: A randomized controlled experimental study. METHODS: Study participants consisted of females aged 18 to 65 years who underwent surgery in the gynecology clinic of the related hospital between October 2016 and March 2017. The sample originally consisted of 111 patients: K-K9 group (n = 39), P6 group (n = 37), and control group (n = 35). The point P6 in both wrists was determined, and the patients in that group wore a wristband 1 hour before the operation. The point K-K9 in both hands was determined, and one Black Pepper Seed was fixed on the point with the help of a plaster almost 1 hour before the operation. Once the wristband and the seed were placed, they remained in place for 24 hours. The control group received routine care, with no application of acupressure devices. FINDINGS: Final sample number was 103 after six were lost to follow-up. Vital signs of the patients showed a difference between the intervention groups and control group after the surgical procedure. The pulse values varied at statistically significant levels according to groups in the first and second measurements. The respiratory values of the K-K9 and P6 groups were statistically lower than those in the control group in the first, second, fourth, and fifth measurements (P < .05). The first measurement of nausea scores varied statistically according to the groups. The K-K9 group nausea scores were statistically lower than those in the control group (P < .05). At the time of the first measurement, the number of those who retched in the P6 group was statistically higher than those in the K-K9 group (P < .05). CONCLUSIONS: We examined the effect of two types of acupressure in the management of postoperative nausea and vomiting in the first 24 hours after gynecologic surgeries. Although some findings of ours did not show a statistically significant difference, these alternative therapies showed promise.

Drug-related problems with targeted/immunotherapies at an oncology outpatient clinic.

BACKGROUND: Some studies in the literature describe drug-related problems in patients with cancer, although few studies focused on patients receiving targeted chemotherapy and/or immunotherapy. To identify the incidence of drug-related problems in patients receiving targeted chemotherapy and/or immunotherapy, and demonstrate the impact of a clinical pharmacist in an outpatient oncology care setting. METHODS: Prospective study was conducted in a hospital outpatient oncology clinic between October 2015 and March 2016. Patients greater than 18 years old receiving cetuximab, nivolumab, ipilimumab, or pembrolizumab were included in the study and monitored over a three-month period by a clinical pharmacist. Drug-related problems were analyzed using the Pharmaceutical Care Network Europe classification system. The main outcome measures were the frequency and causes of drug-related problems and the degree of resolution achieved through the involvement of a clinical pharmacist. RESULTS: A total of 54 patients (mean age: 57 ± 12 years) were included. There were 105 drug-related problems and 159 associated causes. Among the planned interventions (n = 149), 92 interventions were at the patient-level with 88 (96%) being accepted by the doctors. This resulted in 68 (65%) drug-related problems being completely resolved and 9 (8.6%) being partially resolved. The most common drug-related problem identified was "adverse drug event" (n = 38, 36%). Of the 105 drug-related problems, 63 (60%) related to targeted chemotherapy and/or immunotherapy with 34 (54%) classified as an "adverse drug event." CONCLUSION: Adverse drug events were the most common drug-related problems in patients with cancer. The involvement of a clinical pharmacist improved the identification of drug-related problems and helped optimize treatment outcomes in patients receiving targeted chemotherapy/immunotherapy.