Myths and Realities of Inter-professional Working

Introduction: Childhood cancers are rare and community based health care professionals have limited experience in caring for these children and often even less experience in providing their palliative care. It is well recognised that the provision of palliative care falls beyond the remit of any one profession, thus inter professional working is the standard model. This qualitative study aims to examine the experiences of the range of health care professionals involved in providing palliative care at home for children with cancer, focusing on how knowledge is exchanged; the level of communication and support both interprofessionally and at the community/specialist interface. It also aims to examine interprofessional collaboration in palliative care; identifying healthcare professional's perceptions of problems involved, interprofessional boundaries, specific areas of the organisation or provision of care that could be enhanced through changes in practice, support issues and the educational needs of health professionals. Methods The study involves three types of data collection; in-depth interviews, facilitated case discussion (FCD) and field notes from up to 20 cases (a "case" refers to the provision of palliative care to one child). Cases are selected from children who were treated at one regional childhood caner centre. For each case the community based health care professionals (for example the GP, community nurse or health visitor) involved in the care of the child at home are invited to participate in a one-to-one tape recorded in-depth interview followed by a group discussion in the form of a FCD. Field notes are completed following each interview. Data analysis follows a grounded theory approach. The term "social worlds theory" (SWT) his used to define a type of social organisation with no fixed or formal boundaries (such as membership boundaries), for example the range of health professionals that work together to provide palliative care. The boundaries of SW's are determined by the interaction and communication between recognised organisations, such as community nursing teams and general practitioners. SWT examines encounters between different professional groups and can be used to extend knowledge in both the organisation (for example general practice) and the content of what is being provisioned (for example, palliative care). The use of SWT in the analysis of the data is through examining the ethos of the different professions and the associated individual approaches to palliative care, exploring how this determines their roles in the provision of palliative care. Results 10 cases have so far been completed: 47 1:1 interviews (with a range of between 2-7 health care professionals being involved in each case): ( 9 x GP, 19 x CCN, 4 x DN, 3 x HV, 1 x HV assistant 7 x paediatric palliative care nurses, 1 x home support worker, 1 x OT, 1 x physiotherapist, 1 x community paediatrician) and 5 x FCD. The range of participants in the FCDs reflected that of the individual interview sampler. Data obtained to date gives clear insight into the personal experience of the individual health care professional in providing palliative care. Two themes emerging from the data will be focused upon: the continuity of care provision throughout treatment and palliation and the emotional burden experiences by the health care professional. Conclusions SWT can provide a useful framework in examining the social worlds of a disparate group of health care professionals working together for the first and maybe, the only time. A wide variation in the continuity of care provision has been found not only between professions, but also within professions. The emotional burden is evident across the professions.

How game changers catalyzed, disrupted, and incentivized social innovation: three historical cases of nature conservation, assimilation, and women’s rights

We explore the impact of “game changers” on the dynamics of innovation over time in three problem domains, that of wilderness protection, women’s rights, and assimilation of indigenous children in Canada. Taking a specifically historical and cross-scale approach, we look at one social innovation in each problem domain. We explore the origins and history of the development of the National Parks in the USA, the legalization of contraception in the USA and Canada, and the residential school system in Canada. Based on a comparison of these cases, we identify three kinds of game changers, those that catalyze social innovation, which we define as “seminal,” those that disrupt the continuity of social innovation, which we label exogenous shocks, and those that provide opportunities for novel combinations and recombinations, which we label as endogamous game changers.

The Genesis Of The Mycenaean Citadel: A Philosophical Quest For The Origins Of The Architectural Forms

This thesis deals with the origins of the architectural forms as expressed in the Homeric Mycenaean citadel. The Genesis of the Mycenaean Citadel is a philosophical quest which reveals the poetic dimension of the Mycenaean architecture. The Introduction deals with general theories on the subject of space, which converge into one, forming the spinal idea of the thesis. The ‘process of individuation’, the process by which a person becomes ‘in-dividual’ that is a separate, indivisible unity or ‘whole’, is a process of transformation and renewal which at collective level takes place within the citadel. This is built on the archetype which expresses both the nature of the soul as a microcosm and of the divinely ordered Cosmos. The confrontation of the rational ‘ego’ with the unconscious is the process which brings us to the ‘self’, that organising center of the human psyche which is symbolised through the centre of the citadel. . Chapter I refers to ‘the Archetype of the Mycenaean citadel’. The Mycenaean citadel, which is built on a certain pattern of placement and orientation in relation to landscape formations, reproduces images which belong to the category of the ‘archetypal mother’. On the other hand, its adjustment to a central point with ‘high’ significance, recalls the archetypal image of Shiva-Shakti. The citadel realises the concept of a Kantian ‘One-all embracing space’; it is a cosmogonic symbol but also a philosophical one. Chapter II examines the column in its dual meaning, which is expressed in one structure; column and capital unite within their symbolism the conscious and unconscious contents of the human psyche and express the archetype of wholeness and goal of the individuation process. 33 Chapter III is a philosophical research into the ‘symbolism of the triangle’, the sacred Pythagorean symbol which expresses certain cosmological beliefs about the relation between human nature and the divinely ordered Cosmos. The triangular slab over the Lion Gate is a representation of the Dionysiac ‘palingenesia’, that is the continuity of One life, which was central to the Mycenaean religion. Chapter IV deals with the tripartite ‘megaron’. The circular hearth within the four-columned hall expresses the ‘quaternity of the One’, one of the oldest religious symbols of humanity. Zeus is revealed in the ‘fiery monadic unit-cubit’ as an all-embracing god next to goddess Hestia, symbolised by the circular hearth. The ‘megaron’ expresses the alchemical quaternity and the triad but also the psychological stages of development in the process towards wholeness. In the Conclusions it is emphasised that the Mycenaean citadel was created as if in a repetition of a cosmogony. It is a ‘mandala’, the universal image which is identified with God-image in man. Moreover it is built in order to be experienced by its citizen in the process of his psychological transformation towards the ‘self’, the divine element within the psyche which unites with the divinely ordered Cosmos

The efficiency of four transtibial suspension systems: a malformation case study

This work was developed in the form of a case study to measure the efficiency of gait and conclude if the tested suspension systems differ in the efficiency in a various tested transtibial prostheses,based on the data provided by radiologic images, indirect calorimetry and perception of the patient. Introduction - The suspension system and the stump adjustment to the socket plays an important role in the functionality of the prosthesis, the mobility of the amputee and overall satisfaction with the device. The comfort and functional effectiveness of the prosthesis are closely related. The harmony between the residual limb and prosthesis is crucial to that this meets its function and enable effective March and allow the amputated the continuity of their Daily day activities, keeping the stump functional. Comfort and functional effectiveness of the prosthesis are closely related, suspension systems should prevent excessive longitudinal and rotational transverse displacement of the stump within the socket, these systems should help stabilize and enhance the connection of the prosthesis to the residual limb, reducing the pistonning, increased proprioception and providing a more natural gait.

Systems of exchange values as tools for multi-agent organizations

This paper introduces systems of exchange values as tools for the organization of multi-agent systems. Systems of exchange values are defined on the basis of the theory of social exchanges, developed by Piaget and Homans. A model of social organization is proposed, where social relations are construed as social exchanges and exchange values are put into use in the support of the continuity of the performance of social exchanges. The dynamics of social organizations is formulated in terms of the regulation of exchanges of values, so that social equilibrium is connected to the continuity of the interactions. The concept of supervisor of social equilibrium is introduced as a centralized mechanism for solving the problem of the equilibrium of the organization The equilibrium supervisor solves such problem making use of a qualitative Markov Decision Process that uses numerical intervals for the representation of exchange values.

Exact Solution of Bayes and Minimax Change-Detection Problems

The challenge of detecting a change in the distribution of data is a sequential decision problem that is relevant to many engineering solutions, including quality control and machine and process monitoring. This dissertation develops techniques for exact solution of change-detection problems with discrete time and discrete observations. Change-detection problems are classified as Bayes or minimax based on the availability of information on the change-time distribution. A Bayes optimal solution uses prior information about the distribution of the change time to minimize the expected cost, whereas a minimax optimal solution minimizes the cost under the worst-case change-time distribution. Both types of problems are addressed. The most important result of the dissertation is the development of a polynomial-time algorithm for the solution of important classes of Markov Bayes change-detection problems. Existing techniques for epsilon-exact solution of partially observable Markov decision processes have complexity exponential in the number of observation symbols. A new algorithm, called constellation induction, exploits the concavity and Lipschitz continuity of the value function, and has complexity polynomial in the number of observation symbols. It is shown that change-detection problems with a geometric change-time distribution and identically- and independently-distributed observations before and after the change are solvable in polynomial time. Also, change-detection problems on hidden Markov models with a fixed number of recurrent states are solvable in polynomial time. A detailed implementation and analysis of the constellation-induction algorithm are provided. Exact solution methods are also established for several types of minimax change-detection problems. Finite-horizon problems with arbitrary observation distributions are modeled as extensive-form games and solved using linear programs. Infinite-horizon problems with linear penalty for detection delay and identically- and independently-distributed observations can be solved in polynomial time via epsilon-optimal parameterization of a cumulative-sum procedure. Finally, the properties of policies for change-detection problems are described and analyzed. Simple classes of formal languages are shown to be sufficient for epsilon-exact solution of change-detection problems, and methods for finding minimally sized policy representations are described.

Some Like It Hot: The Influence and Implications of Climate Change on Coffee Berry Borer (Hypothenemus hampei) and Coffee Production in East Africa

The negative effects of climate change are already evident for many of the 25 million coffee farmers across the tropics and the 90 billion dollar (US) coffee industry. The coffee berry borer (Hypothenemus hampei), the most important pest of coffee worldwide, has already benefited from the temperature rise in East Africa: increased damage to coffee crops and expansion in its distribution range have been reported. In order to anticipate threats and prioritize management actions for H. hampei we present here, maps on future distributions of H. hampei in coffee producing areas of East Africa. Using the CLIMEX model we relate present-day insect distributions to current climate and then project the fitted climatic envelopes under future scenarios A2A and B2B (for HADCM3 model). In both scenarios, the situation with H. hampei is forecasted to worsen in the current Coffea arabica producing areas of Ethiopia, the Ugandan part of the Lake Victoria and Mt. Elgon regions, Mt. Kenya and the Kenyan side of Mt. Elgon, and most of Rwanda and Burundi. The calculated hypothetical number of generations per year of H. hampei is predicted to increase in all C. arabica-producing areas from five to ten. These outcomes will have serious implications for C. arabica production and livelihoods in East Africa. We suggest that the best way to adapt to a rise of temperatures in coffee plantations could be via the introduction of shade trees in sun grown plantations. The aims of this study are to fill knowledge gaps existing in the coffee industry, and to draft an outline for the development of an adaptation strategy package for climate change on coffee production. An abstract in Spanish is provided as Abstract S1.

THE MUSIC PERFORMED FOR THE SACRIFICIAL RITE AT THE ROYAL ANCESTRAL SHRINE OF THE CHOSŎN DYNASTY (1392–1910): INDIVIDUAL AGENCY AND DISCOURSE ON MUSIC EXPRESSED IN THE EIGHTEENTH-CENTURY KOREAN ENCYCLOPEDIA _TONGGUK MUNHŎN PIGO_ (1770)

In 1964, the South Korean government designated the music for the sacrificial rite at the Royal Ancestral Shrine (Chongmyo) as Intangible Cultural Property No. 1, and in 2001 UNESCO awarded the rite and music a place in the Intangible Cultural Heritage of Humanity. The Royal Ancestral Shine sacrificial rite and music together have long been an admired symbol of Korean cultural history, and they are currently performed annually and publicly in an abridged form. While the significance of the modern version of the music mainly rests on the claimed authenticity and continuity of the tradition since the fifteenth century, scholarly inquiry sheds further light on contextual issues such as nationalism, identity, and modernity in the post-colonial era (after 1945), as well as providing additional insights into the music. This dissertation focuses on the Royal Ancestral Shrine’s musical past as reflected in documentary sources, especially those compiled in the eighteenth century during the Chosŏn dynasty (1392–1910). In particular, the substantial music section of an encyclopedic work, Tongguk Munhŏn pigo (Encyclopedia of Documents and Institutions of the East Kingdom, 1770), mainly compiled by a government official, Sŏ Myŏngŭng (1716–1787), provides a considerable amount of information on not only the music and sacrificial rite program, but also on eighteenth-century and earlier concerns about them, as discussed by the kings and ministers at the Chosŏn royal court. After detailed examination of various relevant documentary sources on the historical, social and political contexts, I investigate the various discourses on music and ritual practices. I then focus on Sŏ Myŏngŭng’s familial background, his writings on music prior to the compilation of the encyclopedia, and the corresponding content in the encyclopedia. I argue that Sŏ successfully converted the music section of the encyclopedia from a straightforward scholarly reference work to a space for publishing his own research on and interpretation of the musical past, illustrating what he considered to be the inappropriateness of the existing music for the sacrificial rite at the Royal Ancestral Shrine in the later eighteenth century.

Racionalidade substantiva no processo decisório: um estudo em instituições que lidam com o tratamento oncológico infantojuvenil na cidade de Natal-RN

The present study regards an applied social research (qualitative) performed in two institutions which lead children s cancer treatment in Natal, Rio Grande do Norte. The main goal of this study is, as of a literature review at works which characterizes the first generations of study about substantive rationality, to detect Decision Making process related aspects that may serve as a basis to elaborate analysis categories from decision making process, aggregating them into a new study that may provide an advance to the theme in administrative science. The academic works based on the analysis model created by Mauricio Serva served as a basis to deep research into such theme, which verifies the predominant rationality in eleven administrative internal processes in productive organizations. This dissertation intends to go beyond the identification of the predominant rationality by elaborating new categories of analysis, and making possible the continuity of the subject in administrative science. Based on Guerreiro Ramos s work, which sees a kind of ideal organization, as known as isonomies, this study still calls upon Karl Polanyi s thoughts, which with the objective of comprehending the independent economic phenomenon of the value that allows considering non-market economies, find that the economy of the men is submerged in his social relations; it also rescues the studies from Max Weber who investigates the meaning of social action to better understand the rationality, and refers to the study of Jürgen Habermas, who proposes a broader conception about rationality, within the theory of communicative action. As a result of this theme s review, seven analysis categories of the decision making process have been formulated. They were applied in the institutions that had been chosen and helped to detect the type of predominant rationality in the categories of the decision making process. The results confirm that, although the decisions making process involves rational elements, such as information, identification of alternatives, there are also specific values of each individual with his experience and view oh the world, permeated not only by instrumental rationality, but also by substantive rationality. The study has verified that two similar institutions may show different types of rationality in the decision making process, when decision factors may tend to instrumental rationality, according to administration classic way, as well as they may emerge from substantive rationality, thus contributing to the process of emancipation of the human being in his sphere of work

Ontology-Based Workflow Design for the Coordination of Homecare Interventions

Part 20: Health and Care Networks

Convolution of Orbital Measures on Symmetric Spaces of type Cp and Dp

International audience

Blame Attributions Among Child Sexual Abuse Survivors and Disclosure of the Abuse

Child sexual abuse (CSA) disclosure is critical for survivor´s psychosocial adjustment later in life. The aim of the present study was to analyze the relationship between attributions of blame for child sexual abuse by the victim and the disclosure of the abuse to parents or caregivers while controlling for characteristics of the abuse. Female college students between 17 and 24 years of age (M = 19.44, SD = 1.64) from a southern Spanish University were surveyed. Of 1547 respondents, 153 (9.90%) reported having suffered some form of CSA before the age of 15. Information about the characteristics of abuse (age of onset, type of abuse suffered, continuity of abuse, and relationship with and age of the perpetrator) and the existence of abuse disclosure by the survivor was obtained from a self-reported questionnaire developed for the present study. The Attributions of Responsibility and Blame Scale (McMillen & Zuravin, 1997) was used to assess attributions made about CSA (self-blame, perpetrator blame and family blame). The results of a logistic regression model was statistically significant, χ² (9) = 43.856, p < .001. The model explained 41% (Nagelkerke R²) of the variance of abuse disclosure and correctly classified 85.6% of cases. Survivor disclosure was 5.50 times more likely to occur when the perpetrator was not a family member (Wald = 8.14, p < .01) and 3.95 times more likely to occur when there was not physical contact with the perpetrator (Wald = 4.30, p < .05). The occurrence of disclosure was also related to increased perpetrator age (Wald = 4.83, p < .05). With regard to the attributions of blame, the occurrence of disclosure was related to lower scores on self-blame (Wald = 6.78, p < .01) and higher scores on family blame (Wald = 9.67, p < .001). However, no relationship was found between perpetrator blame and disclosure of abuse. The results confirm the idea that not only self-blame attributions, but also family blame attributions are critical to the decision of a CSA victim to disclose abuse. The possibility that children who do not disclose abuse have a greater need to deny the occurrence of abuse, or have more confusion about being abused is discussed. Attributions of blame should be taken into serious consideration when evaluating children for possible sexual abuse.

3D Block Modeling and Reserve Estimation of a Garnet Deposit

The purpose of this project is to develop a three-dimensional block model for a garnet deposit in the Alder Gulch, Madison County, Montana. Garnets occur in pre-Cambrian metamorphic Red Wash gneiss and similar rocks in the vicinity. This project seeks to model the percentage of garnet in a deposit called the Section 25 deposit using the Surpac software. Data available for this work are drillhole, trench and grab sample data obtained from previous exploration of the deposit. The creation of the block model involves validating the data, creating composites of assayed garnet percentages and conducting basic statistics on composites using Surpac statistical tools. Variogram analysis will be conducted on composites to quantify the continuity of the garnet mineralization. A three-dimensional block model will be created and filled with estimates of garnet percentage using different methods of reserve estimation and the results compared.

First report of Ciguatoxins in two starfish species: Ophidiaster ophidianus and Marthasterias glacialis

Ciguatera fish poisoning (CFP) is a syndrome caused by the ingestion of fish contaminated with Ciguatoxins (CTXs). These phycotoxins are produced mainly by dinoflagellates that belong to the genus Gambierdiscus that are transformed in more toxic forms in predatory fish guts, and are more present in the Indo-Pacific and Caribbean areas. It is estimated that CFP causes per year more than 10,000 intoxications worldwide. With the rise of water temperature and anthropogenic intervention, it is important to study the prevalence of CFP in more temperate waters. Through inter- and subtidal sampling, 22 species of organisms were collected, in Madeira and Azores archipelagos and in the northwestern Moroccan coast, during September of 2012 and June and July of 2013. A total of 94 samples of 22 different species of bivalves, gastropods, echinoderms and crustaceans where analyzed by Ultra Performance Liquid Chromatography-Mass Spectometry-Ion Trap-Time of Flight (UPLC-MS-IT-TOF) and Ultra Performance Chromatography- Mass Spectrometry (UPLC-MS). Our main aim was to detect new vectors and ascertain if there were some geographical differences. We detected for the first time putative CTXs in echinoderms, in two starfish species—M. glacialis and O. ophidianus. We detected differences regarding uptake values by organisms and geographical location. Toxin amounts were significant, showing the importance and the need for continuity of these studies to gain more knowledge about the prevalence of these toxins, in order to better access human health risk. In addition, we suggest monitoring of these toxins should be extended to other vectors, starfish being a good alternative for protecting and accessing human health risk.

A national referral of an integrated network of continuing care a study case

This study aims to characterize the National Long-Term Care Network (NL-TCN) users. The Portuguese National Health Service, was restructured in 2006 with the creation of the National Long-Term Care Network to respond to new health and social needs concerning the continuity of care. Objectives- Analyse the sociodemographic profile of the network users and the review of hospital, local and regional management procedures. Methods-we used various methods of observational or experimental nature (data processing and presentation of results with the program Statistical Package for Social Sciences, version 20, descriptive statistics (frequencies, crosstabs and test chi-square)). The Pearson correlation test showed a positive correlation between time procedures at the local and regional management and hospital’s length of stay. Results- from a sample of 805 cases, 595 (74%) were admitted in the NL-TCN, a rate lower than the national average (86%). Almost half of the sample was admitted in Rehabilitation Units (46%), while nationally the highest number of admissions was in Home Care Teams (30%). The average time from hospital referral to network admission was 9.73 days with a positive correlation between referred network management procedures and hospital length of stay. Conclusions- For specialized units, the maximum waiting times were for the Long-Term and Support Units (mean 30.27 days) and the minimum waiting times were for Home Care Teams (mean 5.57 days). The average time between the local and regional management was 3.59 days. Almost 90% of referrals were orthopaedics, internal medicine and neurology and Network users were mostly elderly (average 75 years old), female and married. Most users were admitted to inpatient units (78%) and only 15% remained in their home town.