The Evaluation of an Interdisciplinary Pain Protocol in Long Term Care

Objectives: To evaluate the effectiveness of (1) dissemination strategies to improve clinical practice behaviors (eg, frequency and documentation of pain assessments, use of pain medication) among health care team members, and (2) the implementation of the pain protocol in reducing pain in long term care (LTC) residents. Design: A controlled before-after design was used to evaluate the effectiveness of the pain protocol, whereas qualitative interviews and focus groups were used to obtain additional context-driven data. Setting: Four LTC facilities in southern Ontario, Canada; 2 for the intervention group and 2 for the control group. Participants: Data were collected from 200 LTC residents; 99 for the intervention and 101 for the control group. Intervention: Implementation of a pain protocol using a multifaceted approach, including a site working group or Pain Team, pain education and skills training, and other quality improvement activities. Measurements: Resident pain was measured using 3 assessment tools: the Pain Assessment Checklist for Seniors with Limited Ability to Communicate, the Pain Assessment in the Communicatively Impaired Elderly, and the Present Pain Intensity Scale. Clinical practice behaviors were measured using a number of process indicators; for example, use of pain assessment tools, documentation about pain management, and use of pain medications. A semistructured interview guide was used to collect qualitative data via focus groups and interviews. Results: Pain increased significantly more for the control group than the intervention group over the 1-year intervention period. There were significantly more positive changes over the intervention period in the intervention group compared with the control group for the following indicators: the use of a standardized pain assessment tool and completed admission/initial pain assessment. Qualitative findings highlight the importance of reminding staff to think about pain as a priority in caring for residents and to be mindful of it during daily activities. Using onsite champions, in this case advanced practice nurses and a Pain Team, were key to successfully implementing the pain protocol. Conclusions: These study findings indicate that the implementation of a pain protocol intervention improved the way pain was managed and provided pain relief for LTC residents.

It's all about relationships:A qualitative study of health researchers' perspectives of conducting interdisciplinary health research

Background. Interdisciplinary research has been promoted as an optimal research paradigm in the health sciences, yet little is known about how researchers experience interdisciplinarity in practice. This study sought to determine how interdisciplinary research was conceptualized and operationalized from the researcher's perspective and to better understand how best to facilitate interdisciplinary research success. Methods. Key informant interviews were conducted with health researchers with expertise or experience in conducting interdisciplinary research. Interviews were completed either in person or over the telephone using a semi-structured interview guide. Data collection occurred simultaneously with data analysis so that emerging themes could be explored in subsequent interviews. A content analysis approach was used. Results. Nineteen researchers took part in this study. Interdisciplinary research was conceptualized disparately between participants, and there was modest attention towards operationalization of interdisciplinary research. There was one overriding theme, "It's all about relationships", that emerged from the data. Within this theme, there were four related subthemes: 1) Involvement in interdisciplinary research; 2) Why do I do interdisciplinary research?; 3) Managing and fostering interdisciplinary relationships; and 4) The prickly side to interdisciplinary research. Together, these themes suggest that the choice to conduct interdisciplinary research, though often driven by the research question, is highly influenced by interpersonal and relationship-related factors. In addition, researchers preferred to engage in interdisciplinary research with those that they had already established relationships and where their role in the research process was clearly articulated. A focus on relationship building was seen as a strong facilitator of interdisciplinary success. Conclusion. Many health researchers experienced mixed reactions towards their involvement in interdisciplinary research. A well thought-out rationale for interdisciplinary research, and strategies to utilize the contribution of each researcher involved were seen as facilitators towards maximizing the benefits that could be derived from interdisciplinary research. © 2008 Nair et al; licensee BioMed Central Ltd.

Embracing an integromic approach to tissue biomarker research in cancer: Perspectives and lessons learned

Modern approaches to biomedical research and diagnostics targeted towards precision medicine are generating ‘big data’ across a range of high-throughput experimental and analytical platforms. Integrative analysis of this rich clinical, pathological, molecular and imaging data represents one of the greatest bottlenecks in biomarker discovery research in cancer and other diseases. Following on from the publication of our successful framework for multimodal data amalgamation and integrative analysis, Pathology Integromics in Cancer (PICan), this article will explore the essential elements of assembling an integromics framework from a more detailed perspective. PICan, built around a relational database storing curated multimodal data, is the research tool sitting at the heart of our interdisciplinary efforts to streamline biomarker discovery and validation. While recognizing that every institution has a unique set of priorities and challenges, we will use our experiences with PICan as a case study and starting point, rationalizing the design choices we made within the context of our local infrastructure and specific needs, but also highlighting alternative approaches that may better suit other programmes of research and discovery. Along the way, we stress that integromics is not just a set of tools, but rather a cohesive paradigm for how modern bioinformatics can be enhanced. Successful implementation of an integromics framework is a collaborative team effort that is built with an eye to the future and greatly accelerates the processes of biomarker discovery, validation and translation into clinical practice.

Integrated coastal geoengineering approach for maritime environments

This dissertation introduces several methodological approaches which integrate a proposed coastal management model in an interdisciplinary perspective. The research presented herein is displayed as a set of publications comprising different thematic outlooks. The thesis develops an integrated coastal geoengineering approach which is intrinsically linked to the studied maritime environments. From sandy coasts and marine works to rocky platforms and sea cliffs, this study includes field work between Caminha – Figueira da Foz (NW Portugal) and Galicia (NW Spain). The research also involves an analysis and geological-geotechnical characterisation of natural rock (armourstone) and artificial units (concrete blocks) applied to coastal structures. The main goal is to contribute to the characterisation and re-evaluation of georesources and to determine armourstone suitability and availability from its source (quarry). It was also important to diagnose the geomaterials in situ concerning their degradation/deterioration level on the basis of the current status of the coastal protection works in order to facilitate more efficient monitoring and maintenance, with economic benefits. In the rocky coast approach the coastal blocks were studied along the platform, but also the geoforms were studied from a coastal morphodynamics point of view. A shoreline evolution analysis was developed for sandy coasts through Digital Shoreline Analysis System (DSAS) extension. In addition, the spatial and statistical analysis applied to sea cliffs allowed the establishment of susceptibility zones to erosion and hazardous areas. All of these studies have different purposes and results however, there is a common denominator – GIS mapping. Hence, apart from the studied coastal environment, there is an integrated system which includes a sequence of procedures and methodologies that persisted during the research period. This is a step forward in the study of different coastal environments by using almost the same methodologies. This will allow the characterisation, monitoring and assessment of coastal protection works, rocky coasts, and shore platforms. With such data, it is possible to propose or recommend strategies for coastal and shoreline management based on several justifications in terms of social, economic, and environmental questions, or even provide a GIS-based planning support system reinforced by geocartographic decisions. Overall the development of the applied cartography embraces six stages which will allow the production of detailed maps of the maritime environment: (1) high-resolution aerial imagery surveys; (2) visual inspection and systematic monitoring; (3) applied field datasheet; (4) in situ evaluation; (5) scanline surveying; and (6) GIS mapping. This thesis covers fundamental matters that were developed over the course of scientific publication and as a consequence they represent the results obtained and discussed. The subjects directly related to the thesis architecture are: (i) cartography applied to coastal dynamics (including an art historical analysis as a tool to comprehend the coastal evolution and the littoral zone); (ii) georesources assessment (the role of cartography in georesources zoning, assessment and armourstone durability); (iii) coastal geoengineering applications and monitoring (Espinho pilot site in NW Portugal as an experimental field); (iv) rocky coast and shore platform studies and characterisation; (v) sandy and mixed environment approaches; (vi) coastal geosciences GIS mapping and photogrammetric surveying (coastal geoengineering); and (vii) shoreline change mapping and coastal management strategies (the CartGalicia Project as an example – NW Spain). Finally, all of these thematic areas were crucial to generate the conceptual models proposed and to shape the future of integrated coastal coastal geoengineering management.

A director’s approach to art and religion : o quadro, um musical da Paixão segundo o sr. João (The masterpiece, a musical of The passion according to John): trabalho de projecto

Trabalho de Projecto submetido à Escola Superior de Teatro e Cinema para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Teatro - especialização em Encenação.

Gestion et communication de l'information en surveillance biologique. Une approche éthique et interdisciplinaire [Biomonitoring information management and communication: an ethical and interdisciplinary perspective]

This study explores biomonitoring communication with workers exposed to risks. Using a qualitative approach, semi-directive interviews were performed. Results show that occupational physicians and workers share some perceptions, but also point out communication gaps. Consequently, informed consent is not guaranteed. This article proposes some recommendations for occupational physicians' practices.

Food choice in an interdisciplinary context

Reform of agricultural policies, notably the continuing elimination of production-enhancing subsidies, makes it possible for policies to respond to social issues such as the rural environment and health in future. In this paper, we draw on a Rural Economy and Land Use (RELU) research project which is examining the potential for the development of healthy food chains and the implications for human health and the environment. One of the key issues to be addressed is consumers' willingness to pay for the nutritionally enhanced food products from these new chains, but it is evident that only a partial understanding can be gained from a traditional economics approach. In the paper, we discuss how economists are beginning to incorporate views from other disciplines into their models of consumer choice.

A value chain approach to animal diseases risk management: technical foundations and practical framework for field application

Classical risk assessment approaches for animal diseases are influenced by the probability of release, exposure and consequences of a hazard affecting a livestock population. Once a pathogen enters into domestic livestock, potential risks of exposure and infection both to animals and people extend through a chain of economic activities related to producing, buying and selling of animals and products. Therefore, in order to understand economic drivers of animal diseases in different ecosystems and to come up with effective and efficient measures to manage disease risks from a country or region, the entire value chain and related markets for animal and product needs to be analysed to come out with practical and cost effective risk management options agreed by actors and players on those value chains. Value chain analysis enriches disease risk assessment providing a framework for interdisciplinary collaboration, which seems to be in increasing demand for problems concerning infectious livestock diseases. The best way to achieve this is to ensure that veterinary epidemiologists and social scientists work together throughout the process at all levels.

Revealing the whiteboard to blind students: An inclusive approach to provide mediation in synchronous e-learning activities

Promoting the inclusion of students with disabilities in e-learning systems has brought many challenges for researchers and educators. The use of synchronous communication tools such as interactive whiteboards has been regarded as an obstacle for inclusive education. In this paper, we present the proposal of an inclusive approach to provide blind students with the possibility to participate in live learning sessions with whiteboard software. The approach is based on the provision of accessible textual descriptions by a live mediator. With the accessible descriptions, students are able to navigate through the elements and explore the content of the class using screen readers. The method used for this study consisted of the implementation of a software prototype within a virtual learning environment and a case study with the participation of a blind student in a live distance class. The results from the case study have shown that this approach can be very effective, and may be a starting point to provide blind students with resources they had previously been deprived from. The proof of concept implemented has shown that many further possibilities may be explored to enhance the interaction of blind users with educational content in whiteboards, and further pedagogical approaches can be investigated from this proposal. (C) 2009 Elsevier Ltd. All rights reserved.

Black-box decomposition approach for computational hemodynamics: One-dimensional models

Increasing efforts exist in integrating different levels of detail in models of the cardiovascular system. For instance, one-dimensional representations are employed to model the systemic circulation. In this context, effective and black-box-type decomposition strategies for one-dimensional networks are needed, so as to: (i) employ domain decomposition strategies for large systemic models (1D-1D coupling) and (ii) provide the conceptual basis for dimensionally-heterogeneous representations (1D-3D coupling, among various possibilities). The strategy proposed in this article works for both of these two scenarios, though the several applications shown to illustrate its performance focus on the 1D-1D coupling case. A one-dimensional network is decomposed in such a way that each coupling point connects two (and not more) of the sub-networks. At each of the M connection points two unknowns are defined: the flow rate and pressure. These 2M unknowns are determined by 2M equations, since each sub-network provides one (non-linear) equation per coupling point. It is shown how to build the 2M x 2M non-linear system with arbitrary and independent choice of boundary conditions for each of the sub-networks. The idea is then to solve this non-linear system until convergence, which guarantees strong coupling of the complete network. In other words, if the non-linear solver converges at each time step, the solution coincides with what would be obtained by monolithically modeling the whole network. The decomposition thus imposes no stability restriction on the choice of the time step size. Effective iterative strategies for the non-linear system that preserve the black-box character of the decomposition are then explored. Several variants of matrix-free Broyden`s and Newton-GMRES algorithms are assessed as numerical solvers by comparing their performance on sub-critical wave propagation problems which range from academic test cases to realistic cardiovascular applications. A specific variant of Broyden`s algorithm is identified and recommended on the basis of its computer cost and reliability. (C) 2010 Elsevier B.V. All rights reserved.

A hands-on approach for fitting long-term survival models under the GAMLSS framework

In many data sets from clinical studies there are patients insusceptible to the occurrence of the event of interest. Survival models which ignore this fact are generally inadequate. The main goal of this paper is to describe an application of the generalized additive models for location, scale, and shape (GAMLSS) framework to the fitting of long-term survival models. in this work the number of competing causes of the event of interest follows the negative binomial distribution. In this way, some well known models found in the literature are characterized as particular cases of our proposal. The model is conveniently parameterized in terms of the cured fraction, which is then linked to covariates. We explore the use of the gamlss package in R as a powerful tool for inference in long-term survival models. The procedure is illustrated with a numerical example. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

A linear optimization approach to the combined production planning model

Two fundamental processes usually arise in the production planning of many industries. The first one consists of deciding how many final products of each type have to be produced in each period of a planning horizon, the well-known lot sizing problem. The other process consists of cutting raw materials in stock in order to produce smaller parts used in the assembly of final products, the well-studied cutting stock problem. In this paper the decision variables of these two problems are dependent of each other in order to obtain a global optimum solution. Setups that are typically present in lot sizing problems are relaxed together with integer frequencies of cutting patterns in the cutting problem. Therefore, a large scale linear optimizations problem arises, which is exactly solved by a column generated technique. It is worth noting that this new combined problem still takes the trade-off between storage costs (for final products and the parts) and trim losses (in the cutting process). We present some sets of computational tests, analyzed over three different scenarios. These results show that, by combining the problems and using an exact method, it is possible to obtain significant gains when compared to the usual industrial practice, which solve them in sequence. (C) 2010 The Franklin Institute. Published by Elsevier Ltd. All rights reserved.

Entropy-Based Approach to Analyze and Classify Mineral Aggregates

This paper presents an automatic method to detect and classify weathered aggregates by assessing changes of colors and textures. The method allows the extraction of aggregate features from images and the automatic classification of them based on surface characteristics. The concept of entropy is used to extract features from digital images. An analysis of the use of this concept is presented and two classification approaches, based on neural networks architectures, are proposed. The classification performance of the proposed approaches is compared to the results obtained by other algorithms (commonly considered for classification purposes). The obtained results confirm that the presented method strongly supports the detection of weathered aggregates.