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This review utilizes a sociotechnical perspective to gain deeper insights into the nature of reductions in energy demand. We suggest a broader perspective that more fully addresses the complexity of the challenges involved. Improvements in energy efficiency and reductions in energy demand are expected to contribute more than half of the reduction in global carbon emissions over the next few decades. These unprecedented reductions require transformations in the systems that provide energy services. However, the dominant analytical perspectives, grounded in neoclassical economics and social psychology, focus upon marginal changes and provide only limited guidance on how such transformations may occur and how they can be shaped.

We argue that a socio-technical transitions perspective is more suited to address the complexity of the challenges involved. The images are of a patient who did not receive any preparation prior to the MR-exam. The presence of air and stool in the rectum induces discrete linear artifactual distortion in the region of the prostate, restricting the diagnostic accuracy of both the DWI and ADC series. Here an example of a patient who did receive a minimal preparation enema administered a few hours prior to the exam.

This resulted in an evacuated rectum. Although an enema may induce rectal peristalsis, no artifacts were observed in this patient. Here images of a patient with a hematoma following systematic TRUS-guided biopsies 3 weeks earlier. Furthermore, a suspicious lesion was identified right anteriorly in the transition zone with low signal intensity on T2W and ADC and high signal intensity on DWI black arrow. A large FOV up to the aortic bifurcation helps to assess extraperitoneal and pelvic lymph node involvement and osseous metastatic disease arrow in figure.

T2W images show anatomical information on normal and abnormal prostatic tissue. Additional 3D T2 acquisitions can be used for reconstruction in all three anatomic planes and potential radiotherapeutic purposes. The video nicely demonstrates the high resolution of the transverse 3D images with coronal and sagittal reconstructions. Diffusion restriction is present when a lesion with high DWI signal corresponds to low signal on the ADC map, which is highly correlated to malignant cells. The exact ADC value of the lesion is inversely correlated to the likelyhood of a malignant lesion.

High b-values are necessary to create a high signal-to-noise ratio. A b-value of at least is recommended. Prostate cancer may reveal early and increased enhancement but also normal enhancement compared to normal prostate tissue. Lack of enhancement does not exclude malignancy, and increased enhancement can be the result of acute or chronic inflammation. Post-biopsy changes, i. These changes may adversely affect the interpretation of multiparametric MRI whereas signal intensities might be altered. In current daily practice there is a tendency to perform multiparametric MRI before obtaining biopsies which consequently resolve this issue.

Gleason score The Gleason score is used by pathologists to grade prostate cancers. Click to enlarge image. Click to enlarge the image. Zonal anatomy Scroll through the images to see the zones in which the prostate is divided: Transition zone surrounds the prostatic urethra. This zone enlarges in aging men resulting in benign prostatic hyperplasia.

Central zone lies in the base of the prostate behind the transition zone and surrounds the left and the right ejaculatory duct. A nterior fibromuscular stroma is a small area of tissue that is situated on the anterior side of the prostate.


Peripheral zone is situated on the posterior and lateral side of the prostate. Very few prostate cancers manifest in the central zone or in the anterior fibromuscular stroma.

Video The sector map used in the PI-RADS version 2 employs 39 sectors 12 in the base, 12 in the midportion, 12 in the apex of the prostate, 2 seminal vesicles and 1 urethral sphincter. Base has 6 sectors on each side: AS: anterior fibromuscular stroma TZ: anterior and posterior transition zone PZ: anterior and posterior zone CZ: central zone around the ejaculatory ducts Midportion also has 6 sectors on each side: AS: anterior fibromuscular stroma TZ: anterior and posterior transition zone PZ: anterior, posteromedial and posterolateral peripheral zone Apex also has 6 sectors on each side: AS: anterior fibromuscular stroma TZ: anterior and posterior transition zone PZ: anterior, posteromedial and posterolateral peripheral zone Seminal vesicles are divided into left and right Urethral sphincter is marked in the prostate apex and along the membranous segment of the urethra.

MR anatomy Scroll through the axial T2 images of a patient with benign hyperplasia of the prostate, which is otherwise normal. The seminal vesicles have a uniform high T2 intensity.

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No lymphadenopathy is seen. Peripheral zone First look at the images and describe what you see. The lesion does not abut the pseudocapsule, and there is no sign of extraprostatic growth. First look at the images and then continue reading. The findings are: A 17 mm lesion measurement not shown is located in the peripheral zone, dorsally on the left in the mid-portion of the prostate. It corresponds to a hypointense area on T2W. On T2W there is broad-based contact with the capsula. The findings are scroll through the images : PI-RADS 4 lesion located in the left peripheral zone in the mid-portion of the prostate.

Focal markedly hypointense on ADC yellow arrow score 4 , corresponding an hypointense area on T2W score 4. No DCE was performed and no further discrimination could be determined. Biopsy did not show any sign of malignancy.

Transitions and Tools

Suspicious lesions in the peripheral zone typically have the following characteristics on T2W-images: ill-defined hypointense Less suspicious lesions have the following characteristics on T2W-images: bilateral symmetric diffusely distributed signal changes wedge shaped sharply demarcated foci of hypointensity. Transition zone Suspicious lesions typically have the following characteristics: non-circumscribed homogeneous relatively hypointense smudged appearance on T2W images, sometimes mentioned as "erased charcoal" appearance.

High-grade tumors often reveal a lower T2W intensity than low-grade tumors. Extension into the anterior fibromuscular stroma or the urethral sphincter can be seen. The agents in our model are schools and students. Students vary in ability and background. Students rank schools by using a preference function based on the mean achievement and geographic proximity of a school.

Their academic achievement results from a combination of individual traits and the "value-added" parameter of the school they attended. We use data from Chicago Public Schools to initialize the model in a plausible manner. Analysis of the model further reveals a paradoxical mismatch between micro- and macro-levels of behavior, as increased emphasis on school achievement at the household-level often does not lead to increased district-level achievement.

The intuition is as follows: A high emphasis on school achievement results in new schools entering the system earlier in the life of the program. Since the primary improvement mechanism of the system involves new entrants imitating the top performers, such front-loaded entry of new schools forgoes the benefit that comes from late entrants who have an opportunity to imitate a population of higher quality schools.

The first section introduces existing empirical and computational work and literature on school choice. The second section presents a highly stylized agent-based model of the transition from a catchment area to public choice system to illustrate our approach, and further motivates the importance of understanding the relationship between student behavior and district-level outcomes. The third section develops and presents results from a more detailed model of the transition to school choice, using data from Chicago Public School's school choice program to initialize parameters.

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The final section discusses limitations and outlines areas of future work. School choice 2. One distinguishing feature is the inclusion of private schools.

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For example, in countries such as Chile, Sweden, and Denmark, public funds can be utilized to attend privately operated schools; while in other countries, such as the United Kingdom and New Zealand, have implemented "open enrollment" programs where households can only choose among other public schools; yet in others such as the United States and Canada, the inclusion of private schools varies by locality.

Another distinguishing feature is the creation of new schools, often with a specialized theme or mission, and sometimes with selective admissions criteria for students. In the United States, for example, an early form of choice involved the development of specialized and publicly operated "magnet" to which students could apply to attend instead of their catchment area school.

More recently, states and school districts have allowed professional school operators and interested community members to apply for "charters" to create and run schools that receive public funding on a per-pupil basis. Oversubscription at publicly funded schools without selective criteria is often handled by a randomized lottery. One line of research investigates whether the students who attend choice schools e. Observational studies using a variety of approaches to account for selection bias have resulted in disputed findings, with some finding better educational outcomes for students who attend magnet Gamoran or Catholic schools Bryk et al.

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Moreover, field studies taking advantage of the lotteries put in place to deal with oversubscription to choice programs have not yielded conclusive evidence on the "treatment effect" for choosers. Randomized field trials of pilot voucher programs in Milwaukee Greene et al. Howell et al. Cullen et al. Improvement could arise from a number of mechanisms that go beyond students' sorting themselves into better schools, particularly through the competition and new investment induced by household choice e.

America in Transition

Indeed, embedded in the logic of school choice reform is the following dynamic causal story: More choice leads to the movement of students. Schools losing students feel pressure to change in order to attract and keep students, which in turn creates pressure for all schools to change.

Choice also creates the opportunity for new schools to enter the market, providing students with a wider range of options, and further increasing the competitive pressure on existing schools. Bad or undesirable schools improve or close; good or desirable ones survive; and new, stable levels of enrollments, school types, and student achievement are reached.

If the subsequent resorting of students does not lead to clusters of low achieving students, or if the spillover effects of that clustering are not large, the mean level of student achievement will be higher than before. These studies typically investigate the relationship between indicators of competition levels such as market concentration ratios or private school enrollments, and academic outcomes such as test scores and graduation rates. The potentially endogenous nature of the competition measures used in this work, however, make pinpointing the causal effect difficult, and have led to substantial controversy over the techniques used to ameliorate such concerns e.

Part II: CLD Youth with Disabilities in Transition

Such models have been employed to examine interactions between education choice and residential mobility, as well as understanding the implication of various designs of systems that allow government-issued vouchers to be used in private schools for review, see Nechyba First, CGE models typically make assumptions about school and student behavior required to ensure an equilibrium, calibrate parameters of that model to values consistent with aggregate data, and then ask questions about how different school financing systems would impact the equilibrium characteristics of that system given the calibration.

In our agent-based model, we initialize students and schools with micro-level data, and then ask the complementary question of how educational outcomes for a given choice program might vary under different assumptions about how students choose schools. Second, in addition to examining the systems' long-term outcomes, our approach also closely examines the paths to those outcomes.

From a policy perspective, the paths are equally important both because key outcomes may reach unacceptable levels en route to equilibrium, as well as because policymakers may want to implement adaptive policies that conscientiously change over time. The most fully developed work in this area has focused on how agent- based modeling can be used inside the classroom to improve student learning Stonedahl et al. A much smaller body of literature uses ABM and the complex systems perspective to reconceptualize and investigate educational systems themselves Montes ; Maroulis et al.

Our paper contributes to this literature by operationalizing many of the implications of a complex systems perspective in the context of choice-based reforms in the United States. Model I: An illustrative example 3. The district is comprised of nine neighborhoods, each containing one school, and students residing in a particular neighborhood can only attend their neighborhood school. For illustrative purposes, Model I leaves out complicating factors such as capacity constraints and heterogeneity in student decision-making and simply asks: What if we could change the world in a way where, from this point forward, all new students were able to attend the school with the highest mean achievement?

The district is equally divided into nine neighborhoods with clear boundaries, as shown in Figure 1. One school is set in each of the nine neighborhoods of the district, and each school is comprised of four grades, with an approximately equal number of students in each grade. Each neighborhood differs in its mean level of socioeconomic status SES.