Part Of Decision Research Articles

Abstract P1-07-03: Unmet needs and future applications of breast cancer multigene signatures in routine clinical practice: results from the European PROCURE Project

Abstract Background: Several Breast Cancer Multigene Signatures (BCMS) are available to profile early breast cancer (eBC) that according to current evidence, can provide reliable information on the risk of recurrence. However, knowledge regarding their perceived value and use in clinical practice is scarce. The first results regarding the panelists’ opinions on the clinical utility of BCMS were presented at SABCS Symposium 2021 (Poster P4-06-08). Here we discuss present and future recommendations for improving the use of BCMS resulting from the PROCURE Project. Methods: The Delphi survey developed by the 8 members of the Scientific Committee was administered twice to oncologists, pathologists, and surgeons across Europe. The questionnaire included 5 sections: 1) Participants’ profile and experience with BCMS, 2) Current clinical practice in eBC and use of BCMS, 3) Participants’ opinion on the utility of the BCMS in eBC according to patient profiles, 4) Agreement with a set of recommendations on the use of BCMS in clinical practice and 5) Identification of unmet needs and future applications of BCMS. 70% agreement was used to determine consensus on a topic. Results: 133 panelists from 11 European countries completed both rounds of the survey. Experts were mostly medical oncologists (72.2%) with extensive experience (more than 5 years) in the management of BC patients (97.0%) and in the use of BCMS (73.4%). Most of them worked in university hospitals (86.5%). Regarding recommendations for improving BCMS utility, according to panelists’ opinion, these genomic tests should provide prognostic as well as predictive information (82.0%), especially to help physicians when deciding on the most appropriate adjuvant chemotherapy (81.2%). Also, their evidence should be based mostly on prospective randomized clinical trials (85.0%) and they should evaluate the clinical and pathological features of the disease (91.0%). Another aspect agreed by panelists is that patients should have the right to access their BCMS results to take part in treatment decisions (85.7%). Finally, when thinking about future applications of BCMS, consensus was only reached after the second Delphi round, and according to panelists, there is a need for validating BCMS in order to know if they can predict treatment benefits in patients with ER-positive advanced/metastatic BC (78.2%) and in triple-negative eBC patients (72.2%). Likewise, panelists also agreed on the need of developing newly validated tests to evaluate the risk of distant recurrence and predict treatment benefits in the neoadjuvant setting (71.4% and 81.2%, respectively). However, no consensus was reached on the need for BCMS to give an accurate prognosis for patients with ER+ advanced and/or metastatic BC (50.4%), HER2+ advanced BC (21.8%), or triple-negative advanced BC (36.8%). Conclusions: The panelists who participated in the PROCURE Project had an extensive experience in the management of eBC patients as well as using BCMS; however, the high degree of importance that they attributed to both prognostic and predictive information reflects a misconception on the correct interpretation of BCMS results because, even if those test can be used to predict the benefit of adjuvant chemotherapy, they are primarily prognostic tools but not predictive about the effect of a specific cytotoxic intervention. These results in conjunction with the agreements regarding treatment benefit prediction reached in the neoadjuvant, the triple-negative eBC, and the metastatic settings reinforce the idea that more training is needed to highlight that BCMS should be used in the context of risk assessment in intermediate-risk eBC as well as the possibility of running those tests in core biopsies. Citation Format: Michael Gnant, Anne-Vibeke Lænkholm, Aleix Prat, Judy King, Giuseppe Curigliano, Nadia Harbeck, Frédérique Penault-Llorca, Fatima Cardoso. Unmet needs and future applications of breast cancer multigene signatures in routine clinical practice: results from the European PROCURE Project [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-07-03.

A new stage of humanization of the criminal-legal impact regarding the application of punishment in the type of life imprisonment: the problem of correspondence.

The scientific article explores a new stage of humanization of the criminal-legal influence on the application of punishment in the form of life imprisonment. It has been established that a number of decisions of the European Court of Human Rights served as a prerequisite for this process, which generally stated the absence of a mechanism for early release of convicts from serving a sentence of life imprisonment in Ukraine, which would allow the educational purpose of this punishment to be realized. Attention is focused on the fact that the European Court of Human Rights does not oblige the state to provide specific forms of early release from serving a sentence of life imprisonment. At the same time, it is emphasized that this process should be legally defined, transparent and provide the person sentenced to life imprisonment with the "right to hope". An inconsistency was established in the text of the motivational and operative parts of the decision of the Constitutional Court of Ukraine dated September 16, 2021 No. 6-р (II)/2021 (case on review of the sentence of a person sentenced to life imprisonment) in the part of determining the types of early release from serving a sentence in life imprisonment. In the decisive part of the decision, the Constitutional Court of Ukraine obliged the Verkhovna Rada of Ukraine to introduce two independent, independent measures of a criminal law nature - the replacement of the punishment in the form of life imprisonment with a milder punishment and conditional early release from serving the punishment in the form of life imprisonment will. The article focuses attention on the need to observe the reasonableness and justice of criminal law influence in the process of humanizing life imprisonment. It is argued that excessive humanization of life imprisonment may lead to a decrease in the protective function of criminal legislation and the ability to prevent new criminal offenses. It was concluded that in the conditions of martial law there is an increase in the number of crimes punishable by life imprisonment. The position is expressed that it should be recognized as socially determined to introduce the replacement of punishment in the form of life imprisonment with a milder one and subsequent conditional early release from serving the prescribed sentence, if the convicted person corrects himself and shows his readiness for further resocialization.

Candrive-Development of a Risk Stratification Tool for Older Drivers.

Assessing an older adult's fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults. Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures. A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD]=4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD=1.6) years. The derived Candrive RST included 4 predictors. Out of 4483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval=2.81-9.84) compared to the lowest risk group. For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation.

Development of Bali's Traditional Villages with Participation of the Local Community

A region's culture will change as a result of the introduction of a foreign culture. In order to preserve the culture, which is currently being used as a marketing tool to draw tourists to Bali, the community is essential. This study intends to depict community involvement during the construction of a traditional village in the Bali province amid the influx of foreign culture. This study's methodology draws on literary analyses from a variety of sources, including books and the findings of other investigations. The study's findings indicate that the community is development's primary concern and ultimate goal, making community participation a logical outgrowth of this claim. Community participation also fosters a sense of self-worth and the personal capacity to take part in strategic decisions affecting the community's interests. Because development is carried out based on the outcomes of agreements and cooperative performance between customary village officials and indigenous village communities in the region, it will produce a favourable atmosphere for community growth in the area itself.

Quality of life of patients treated for kidney stones 10–20 mm in diameter in terms of the type of operation performed: A qualitative study

Urolithiasis is a common chronic disease whose effect on patients' quality of life (QOL) is considerable but depends on the treatment received, differing between types of surgery. Intrarenal stones can be treated with different techniques: extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy (fURS), and mini percutaneous nephrolithotomy (mini-PCNL), with proportional success and complication rates. The aim of this study was to qualitatively explore the impact of the different techniques on patients' QOL and understand their experiences of treatment choices. Patients treated for medium-sized kidney stones (10-20mm in diameter) were interviewed in a semi-structured manner. The interview data were transcribed and analyzed by theme according to consolidated criteria for reporting qualitative research (COREQ) guidelines. Data saturation was achieved after interviewing 15 patients. The mean interview time was 34min (standard deviation (SD), 6.8min). The mean patient age was 54 years (SD, 9.5 years). Eight patients underwent ESWL, 10 were treated with fURS, and 8 underwent mini-PCNL. Twenty-seven subthemes were coded and regrouped into eight major themes, namely: no sense of choice in the decision-making process for eleven patients; extremely negative experiences of double-J stents for fourteen patients; concern about the risk of recurrence or treatment failure for thirteen patients; complicated hygiene and dietary recommendations for nine patients; technique-dependent postoperative outcomes; relatively well-tolerated operations for thirteen patients; a poor experience of sick leave, often because of a double-J stent; different views regarding future operations. In fact, a third of patients would choose the most effective treatment, a third would choose the simplest procedure and the last third would trust their urologist. Patients' experiences of these operations are variable. Urologists must support their patients by presenting the different treatment options with clear, appropriate, and unbiased information. This should ensure patients take part in treatment decisions as part of a personalized treatment plan.

Habitats: Managing the Ecological Impacts of Noise on Wildlife Habitats for Sustainable Development

The objective of the Habitats project is to integrate research in the fields of ecological impacts and of environmental noise to develop management tools and processes to enable sustainable development. Rapid population expansion and economic development against the backdrop of climate and biodiversity crises presents major global challenges. Global society is dependent on ecosystem services, underpinned by biodiversity. In the UK alone, these ecosystem services are valued at £761 billion/year and human noise impacts will significantly degrade that value unless managed appropriately. We can no longer consider nature to be separate from our economy and society, it needs to be part of business, cultural and economic decision making. The Habitats project is leading the development of an international industrial and academic network to research and explore new ways and new technologies to better measure, understand and model the effects of noise on wildlife habitats. However, current noise pollution legislation is focused on humans; despite policy aspirations, there is no systematic approach to assessing, regulating, or mitigating noise impacts on wildlife. This paper will review the scientific evidence available for underpinning environmental noise legislation, regulation, and policy development for managing the ecological impacts of noise on wildlife habitats.

Automated Well-Log Pattern Alignment and Depth-Matching Techniques: An Empirical Review and Recommendations

Well logging has been an integral part of decision making at different stages (drilling, completion, production, abandonment) of a well’s history. However, the traditional human-reliant approach to well-log interpretation, which has been the most common practice in the industry, can be time consuming, subjective, and incapable of identifying fine details in log curves. Previous studies have recommended automated approaches as a candidate for addressing these challenges. Despite the progress made so far, what is not yet clear from the existing literature is the extent to which these automated approaches can dispense with human interventions in real-life scenarios. This paper presents an empirical review of different depth-matching techniques in real-life timelapse well logs, primarily focusing on gamma ray and the extent to which the outcomes of these techniques match the results from a human expert. Specifically, the performances of dynamic time warping (DTW), constrained DTW (CDTW), and correlation optimized warping (COW) are investigated. The experiments also consider the effects of filtering and normalization on the performance of each of the techniques. Concerning the correlations of each technique’s outcome with the reference data and an expert-generated outcome, this research identifies and discusses its key challenges, as well as provides recommendations for future research directions. Although the COW technique has its limitations, as discussed in this paper, our experiments demonstrate that it shows more potential than DTW and its variants in the well-log pattern alignment task. The work entailed by this research is significant because identifying and discussing the limitations of these techniques is vital for solution-oriented future research in this area.

“Women Activism – A Pragmatic Analysis”

The purpose of this paper is to acquire an understanding and analyze pragmatically the oppressed status of women in ancient India. In recent years the role and status of women have undergone some drastic changes, maybe due to globalization and commercialism. To render social transformation a reality, it is imperative for women to break free from the oppressive shell that has taken shape through centuries and seek empowerment. Unlike oppression, which curbs personal growth and development, empowering implies building the self-esteem of every woman in society, irrespective of education, social status and other factors, rather than limiting the focus to celebrities. To feel less oppressed and more empowered, there are certain factors that play a seminal role. Education is one of the most important requisites, wherein an educated woman is less likely to feel oppressed owing to being sufficiently qualified to seek employment and enjoy some degree of financial independence. Provision of equal opportunity, particularly in context of gender discrimination, can make a big difference because it would enable women to take proactive part in decision making and achieve their objectives. Ease of access to vocational programs, especially in rural areas, can effectively foster self- employment and entrepreneurship, and in the process, reduce oppression. Social protection, through prevention of female feticide and infanticide, and monitoring and regulating social practices like marriage, divorce, dowry, harassment and so on can negate social oppression. At the same time, awareness in terms of legal rights and human rights, saving schemes and rehabilitation programs would enable women to fight against oppression, both at the personal and social level.

The Patient as an Actor in His Care Pathway: Insights From the French Case.

In France, patients' right to take part in decisions regarding their health has been recognized by law since 2002. This legal recognition was the outcome of a long-standing call to allow all individuals to be "actors in their own health" and to co-develop their care pathway with the professionals involved. In practice, care pathways simultaneously intertwine both standardization and personalization dynamics, which involve different forms of professional-patient interaction. This article analyses the links between the organizational variables of care pathways, and the ways in which patients are involved in the management of their own pathway. To date, these links have received little attention in the management science and health literatures. We draw on material from a case study carried out in 2 French territories, combining the analysis of patient pathways with interviews conducted with professionals and carers. Building on this analysis, we propose a typology of patient profiles which distinguishes between their different forms of involvement in the development of their care pathway, based on its organizational characteristics.

The location and capacity-dependent price impacts of biofuel production and its effect on the forest industry

Forest-based biofuel stands out as a promising solution to avoid fossil emissions in parts of the transport sector. Biofuel production will need large amounts of forest biomass, collected from a large area. Roundwood is costly to transport compared with other goods. Therefore, the location of forest-based biofuel production is a crucial part of an investment decision. This study analyses the optimal location of biofuel plants in Norway and the implications for the traditional forest sector in the Nordic countries. We test different numbers of production units, different sizes of the units, and various raw materials. The study applies a partial equilibrium model that covers the Norwegian and Nordic forest sectors, with 356 regions in Norway. The results indicate that small biofuel plants have the potential to turn exporting regions into importing regions. Larger biofuel plants are suitable for areas with large harvest activity today or regions with access to harbour or timber terminals along railways. We find that forest owners close to a biofuel plant will profit the most from biofuel production. Policymakers and investors should take into account that different locations and production capacities have different impacts on the forest sectors.

Long Short-Time Memory Neural Networks for Human Driving Behavior Modelling

In this paper, a long short-term memory (LSTM) neural network model is proposed to replicate simultaneously car-following and lane-changing behaviors in road networks. By combining two kinds of LSTM layers and three input designs of the neural network, six variants of the LSTM model have been created. These models were trained and tested on the NGSIM 101 dataset, and the results were evaluated in terms of longitudinal speed and lateral position respectively. We compared the LSTM model with a classical car- following model (the Intelligent Driving Model (IDM)) in the part of speed decision. In addition, the LSTM model is compared with a model using classical neural networks. LSTM model demonstrates higher accuracy than IDM in car-following behavior and displays better performance regarding both car-following and lane-changing behavior compared to the classical neural network model.

Тенденция упрощения процессуальной формы судебных решений в уголовном судопроизводстве

The article is devoted to one of the modern trends in the development of criminal justice - simplification of the procedure for making and announcing court decisions. This vector of development of domestic justice is outlined in the Resolution of the X All-Russian Congress of Judges. Purpose. The purpose of the article is to study the positive manifestations, as well as possible negative consequences of the indicated trend and ways to overcome them. Methodology. The conclusions and recommendations contained in the work are based on the complex application of methods of analysis and synthesis, comparative legal, formal legal, system-structural and concrete sociological methods. Results. The paper identifies a positive manifestation of the simplification trend - the possibility of announcing the introductory and operative parts of court decisions. At the same time, it is noted that the accelerated procedures of judicial proceedings, the reduction of the descriptive and motivational part of court decisions do not fully ensure the achievement of the purpose of criminal proceedings, and therefore need to be improved. Conclusion. The goal set in the work has been achieved, the problems of simplifying the procedural form of judicial decisions in criminal cases have been studied. Proposals for improving legislation are formulated. The obtained results can be used for further research of the indicated trend.

Should Neuroleptics Be Used in Patients With Delirium Seen by Palliative Care?

Delirium commonly occurs in the palliative care setting and impacts many aspects of patient care, such as symptom assessment, patient-clinician communication, and medical decision-making. One controversial topic regarding the management of delirium in the palliative care setting is whether neuroleptics should be used. In this "Controversies in Palliative Care" article, 3 expert clinicians independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. Interestingly, all 3 experts arrived at similar conclusions-they underscored the importance of identification and treatment of any reversible causes of delirium and endorsed a trial of non-pharmacologic measures. They also agreed that neuroleptics should be considered for patients with hyperactive or mixed delirium when the conservative measures fail to control delirium symptoms and for delirious patients with days of life expectancy and thus limited time to try other measures. Risk of adverse effects such as extrapyramidal symptoms and seizures should be considered as part of the treatment decision. There is also a need to conduct high quality research to examine both neuroleptics and neuroleptic-sparing strategies for the management of delirium.

Períodos de lockup durante períodos de lockdown no contexto de fundos brasileiros

ABSTRACT This article aimed to test the effect of lockup periods on the performance of Brazilian equity funds and multimarket funds, considering the period affected by the 2019 coronavirus disease (COVID-19). This study contributes to better understanding the effects of redemption restrictions imposed on quotaholders, a relevant subject considering the increase in the number of funds in Brazil. This effect is analyzed with particular focus on the period affected by the COVID-19 pandemic. The results of this study have implications for individual and professional investors and may also interest large families of Brazilian funds, given that the establishment of lockup periods forms part of a long-term decision. The research has the potential to impact planning in the fund industry, the financial planning of small and large investors, as well as the literature on the subject, motivating the undertaking of new research. The sample was composed of 17,417 Brazilian funds, 13,581 of which were multimarket funds and 3,836 were equity funds, covering the period from January of 2018 to December of 2021. Various subsamples were evaluated for robustness purposes. The hypotheses were tested using a difference-in-difference model operationalized through a panel. Fund performance was estimated every quarter based on the four-factor alpha. The main results of the study reveal that lockup periods were positively associated with fund performance. On the other hand, during the period negatively affected by COVID-19, funds with greater lockup periods did not record better performance than the other funds (considering in the comparison the performance of groups with a shorter lockup and that of the funds before the pandemic), a result that may advance the discussion on the effects of redemption restrictions.

OUTRO JOGO DE LINGUAGEM COMO PROPOSTA TEÓRICO-METODOLÓGICA DA LEITURA DO LUGAR

The article presents a theoretical-methodological proposition aimed at understanding urban dynamics through the incorporation of the narratives of the inhabitants who occupy and produce the spaces of daily life. Critical to the categories, concepts, indicators and indexes of urban planning, architecture and urbanism and especially to the way they are normally used, the article proposes to transform the diagnosis of territory that is part of the current decision- making processes related to the production of the city, into a reading of place that allows for a different language game in the contemporary political arena. In this direction, the article presents the lines of analysis associated with the field observations and literature that come close to the concepts of reading and place in three disciplinary fields - education, human geography and urban design -, linking them to the spheres form in the territory, activity in the territory and sense of the inhabitant. In short, according to a critical approach, in some extent phenomenological, the proposal aims to decrypt the city through a series of lines of analysis that understand the territory from the perspective of those who live and occupy it, leading to a possible disruption of the valued institutional, technical and academic narratives in force.

Gender responsive budgeting and its implementation efforts in Nepal

The purpose of this article is to analyze the contemporary experiences of gender responsive budgeting and its implementation efforts in Nepal. In recent years, the introduction of gender responsive budgeting has become an important topic on the government agenda to meaningfully internalize gender equality in public finance. Gender responsive budgeting, as an integral part in fiscal and budgetary decision making, can make gender equality and help differentiate the impacts on men and women. This article is based on the analytical and descriptive research design based on literature review of secondary data and information used for the analysis of the information. Therefore, the analysis of public expenditure and revenue policies and practices should consider this differentiated gender impact. Gender responsive budgeting in Nepal is committed to maintaining progressive social change, but efforts that are more concrete are needed to match political commitments. In the entire world, women only make 77 cents for every $1 earned by males. This gender responsive budgeting receives the highest share of the Nepal's budget in fiscal year 2021/22 (2078/79), accounting for 39 percent of all investments. Nepal has been associated with various gender responsive activities through different national policies, budgets, periodic and yearly plans and projects since the fiscal year 2007/08; and it is dedicated to the global commitment for the sustainable development goals and its timely achievements with the national targets; and leading the nation towards the gender inclusive society and gender friendly behaviors by the nation in all processes of the governance of Nepal.

Has Demographic Revolution Come to a Halt? An Approximation to Successful Aging and the Need for Socio-Educational Action in the New Normal

In the recent years, there has been an increasing interest in how the aging process in integrated in current societies. The existing body of research on aging suggests that society must promote support for successful aging, which implies living more and living better. In this way, extensive research shows that older adults need to be engaged in social participation (Raymond and Grenier, 2015), and therefore, in recent years, older adult education has become a decisive part of the different policies applied to achieve successful aging. The purpose of this paper is to review the different ways in which society acts when facing aging, with special attention devoted to the Spanish situation. This study examines demographic revolution and the different implications that it poses for quality of live and successful aging. A revision of the main aging theories and recommendations to achieve successful aging are provided. Socio-educational actions linked to successful aging promotion are presented, highlighting some university programmes specifically designed for older adults. This lifelong learning scheme has the potential to revolutionize current educational practice to socially integrate older adults in postmodern societies.

Penerapan Algoritma Naive Bayes dan Multiple Linear Regression Untuk Prediksi Status dan Plafon Kredit (Studi Kasus: Bank ABC)

Along with changing technology, Human resources are still needed in many parts of decision making. The companies and organizations still use human to analysis data. Despite of that performance, human analysis took longer time and effort to complete. And sometimes there is always a negative factor of human resources such as unmanageable human. Therefore, it’s always important to provide an excellent training source so this human resource able to reach an outcome that needed. Machine learning is one of the most common knowledge that use in decision making. There are many forms of machine learning such as regression, classification, clustering, etc. two of which is used in this application, regression and classification. Naive Bayes regression is one of classification method which rooted on Bayes theorem. Naïve Bayes use historical data to predict future outcome based on the characteristic on that historical data. Multiple Linear Regression involves more than one independent variable or predictor. With machine learning and human resources, man can easily to analyse credit worthiness and determine the credit limit of one bank costumer without taking a long time and much effort.

Decube Framework: An Introduction to a New Energy Modelling and Planning Process for Sustainable Utilisation of Pakistan’s Energy Resources

Sustainable Development—which ensures that the use of resources and the environment today does not restrict their use by future generations [UNEP (2007)]—is the most significant challenge facing today’s governments. Consequently, the notion of Sustainable Development [Matthews (1979)] has become a fundamental part of any policy and decision carried out at national and international levels. If the current acceleration of human advancement is not reduced it poses the biggest threat to long term sustainability of the entire globe, arising from the development and industrialisation in the twenty-first century, dwarfing the impact of twentieth century. This further compounds the work of policy-makers faced with the challenge of fast tracking the economies of developing countries. Since the Industrial Revolution energy has become the lifeline of economic development and progress. This led to exponential increase in use of fossil fuels. However, rampant, unchecked and accelerated burning of fossil fuels in the twentieth century has resulted disastrous and long term damaging effects to earth’s climate. Consequently, world has begun this century with the aim “to develop a coherent and practical approach to climate change [World Energy Council (2007)].” “Safe, environmentally sound and economically viable energy pathway that will sustain human progress into the distant future is clearly imperative [WCEW (1987)]” to achieve the above goal. As a result environment has become an integral part of any energy system and policy. On the whole today’s energy policies and decisions have to be carefully woven into an intricate web traversing the boundaries of economy, environment and society.

RACIAL AND ETHNIC VARIATIONS IN DEMENTIA DIAGNOSIS, SURVIVAL, AND END-OF-LIFE CARE QUALITY

Abstract In the United States most adults have a preference to die at home and is an indicator of good end-of-life care. In the context of dementia, family members and caregivers are decision makers and part of good and equitable care involves understanding cultural variation in attitudes and social norms related to dementia, death and dying, and the meaning of a good death. This symposium explores racial and ethnic variation in lifetime dementia diagnosis and end-of-life care quality indicators. The first presentation examines racial, ethnic, and geographic variation in the rarely discussed lifetime prevalence of dementia and survival time from dementia diagnosis to death using national Medicare data. The second presentation describes the relationship between end-of-life care planning and satisfaction with end-of-life care using data from the Health and Retirement Study. The third presentation describes variation in place of death, a key indicator of end-of-life care quality, by dementia diagnosis and race/ethnicity using national Medicare data. The fourth presentation examines variation in hospice use, another indicator of end-of-life-care quality, and place of death by dementia diagnosis, race, and ethnicity using national Medicare data. The symposium concludes with a presentation examining the relationship between place of death and satisfaction with care received using data from the Health and Retirement Study. The Institute for Healthcare Improvement’s Triple Aim (improving the experience of care, improving the health of populations, and reducing per capita costs of health care) serves as a lens for discussing policy and practice implications of the major findings from each presentation.