A critical narrative analysis of shared decision-making in acute, inpatient mental health care

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients? care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

New and low cost plastic membrane electrode with low detection limits for sulfadimethoxine determination in aquaculture waters

Sulfadimethoxine (SDM) is one of the drugs, often used in the aquaculture sector to prevent the spread of disease in freshwater fish aquaculture. Its spread through the soil and surface water can contribute to an increase in bacterial resistance. It is therefore important to control this product in the environment. This work proposes a simple and low-cost potentiometric device to monitor the levels of SDM in aquaculture waters, thus avoiding its unnecessary release throughout the environment. The device combines a micropipette tip with a PVC membrane selective to SDM, prepared from an appropriate cocktail, and an inner reference solution. The membrane includes 1% of a porphyrin derivative acting as ionophore and a small amount of a lipophilic cationic additive (corresponding to 0.2% in molar ratio). The composition of the inner solution was optimized with regard to the kind and/or concentration of primary ion, chelating agent and/or a specific interfering charged species, in different concentration ranges. Electrodes constructed with inner reference solutions of 1 × 10−8 mol/L SDM and 1 × 10−4 mol/L chromate ion showed the best analytical features. Near-Nernstian response was obtained with slopes of −54.1 mV/decade, an extraordinary detection limit of 7.5 ng/mL (2.4 × 10−8 mol/L) when compared with other electrodes of the same type. The reproducibility, stability and response time are good and even better than those obtained by liquid contact ISEs. Recovery values of 98.9% were obtained from the analysis of aquaculture water samples.

Efeito da compressão isquémica no ponto gatilho do trapézio superior no controlo motor do ombro

Introdução: A síndrome dolorosa miofascial (SDM) é uma das causas mais comuns de dor com origem músculo-esquelética, devendo-se sobretudo à existência de pontos gatilho (PG) miofasciais. O PG no músculo trapézio superior (TS), sob a sua forma latente, tem repercussões no equilíbrio muscular do complexo articular do ombro. A intervenção sobre este PG, através da compressão isquémica poderá ter benefícios no próprio músculo e no controlo motor do complexo articular do ombro. Objetivos: Pretende-se estudar a influência da intervenção no PG latente do músculo TS no controlo motor do ombro, analisando as alterações ao nível do timing de ativação muscular, das sequências em que o músculos ativam e do nível de atividade muscular ao longo do movimento. Métodos: Foi realizado um estudo do tipo experimental, aleatório e controlado com uma amostra dividida em dois grupos, grupo experimental (n=15) e grupo controlo (n=14). No grupo experimental foi realizada a técnica de compressão isquémica no PG do TS e no grupo controlo um procedimento placebo. Antes e após a intervenção foi recolhida a atividade eletromiográfica dos músculos grande dentado (GD), infra-espinhoso (IE), deltóide médio (DM), trapézio superior (TS) e trapézio inferior (TI), assim como os dados cinemáticos, durante o movimento de elevação do ombro no plano da omoplata. Foi analisado o timing de ativação muscular, as sequências de ativação e o nível de ativação muscular ao longo do arco de movimento, através da magnitude normalizada à contração muscular voluntária máxima. Resultados: Foi observada uma maior pré ativação do músculo GD, no grupo experimental após a intervenção (p=0,025) relativamente ao primeiro momento de avaliação. É de notar que após a intervenção, no GE, todos os músculos passaram a ativar no período típico dos ajustes posturais antecipatórios, não tendo o mesmo sido observado no grupo de controlo. Após a técnica, 37% dos indivíduos do grupo experimental passaram a ativar o GD em primeiro lugar, quando apenas um sujeito o fazia antes da intervenção. Destaca-se também um predomínio de 32% nas últimas posições, após a técnica, dos músculos trapézio superior e inferior. No GC não se verifica nenhuma tendência após a intervenção. Foram ainda observadas diferenças estatisticamente significativas entre os grupos nos arcos de movimento onde foi atingido 20% da contração isométrica voluntária máxima (CMVI) nos músculos DM (p=0,002), na primeira avaliação, e IE (p=0,021), após a intervenção, com um atraso da ativação do IE para valores superiores a 20% da CMVI. Conclusão: A compressão isquémica reflete-se na antecipação da atividade do músculo GD e num atraso do aumento da magnitude da atividade do IE para valores moderados,

Species distribution models reveal apparent competitive and facilitative effects of a dominant species on the distribution of tundra plants

Abiotic factors are considered strong drivers of species distribution and assemblages. Yet these spatial patterns are also influenced by biotic interactions. Accounting for competitors or facilitators may improve both the fit and the predictive power of species distribution models (SDMs). We investigated the influence of a dominant species, Empetrum nigrum ssp. hermaphroditum, on the distribution of 34 subordinate species in the tundra of northern Norway. We related SDM parameters of those subordinate species to their functional traits and their co-occurrence patterns with E. hermaphroditum across three spatial scales. By combining both approaches, we sought to understand whether these species may be limited by competitive interactions and/or benefit from habitat conditions created by the dominant species. The model fit and predictive power increased for most species when the frequency of occurrence of E. hermaphroditum was included in the SDMs as a predictor. The largest increase was found for species that 1) co-occur most of the time with E. hermaphroditum, both at large (i.e. 750 m) and small spatial scale (i.e. 2 m) or co-occur with E. hermaphroditum at large scale but not at small scale and 2) have particularly low or high leaf dry matter content (LDMC). Species that do not co-occur with E. hermaphroditum at the smallest scale are generally palatable herbaceous species with low LDMC, thus showing a weak ability to tolerate resource depletion that is directly or indirectly induced by E. hermaphroditum. Species with high LDMC, showing a better aptitude to face resource depletion and grazing, are often found in the proximity of E. hermaphroditum. Our results are consistent with previous findings that both competition and facilitation structure plant distribution and assemblages in the Arctic tundra. The functional and co-occurrence approaches used were complementary and provided a deeper understanding of the observed patterns by refinement of the pool of potential direct and indirect ecological effects of E. hermaphroditum on the distribution of subordinate species. Our correlative study would benefit being complemented by experimental approaches.

Scenario-based assessment of future land use change on butterfly species distributions

Species distribution models (SDMs) are increasingly used to predict environmentally induced range shifts of habitats of plant and animal species. Consequently SDMs are valuable tools for scientifically based conservation decisions. The aims of this paper are (1) to identify important drivers of butterfly species persistence or extinction, and (2) to analyse the responses of endangered butterfly species of dry grasslands and wetlands to likely future landscape changes in Switzerland. Future land use was represented by four scenarios describing: (1) ongoing land use changes as observed at the end of the last century; (2) a liberalisation of the agricultural markets; (3) a slightly lowered agricultural production; and (4) a strongly lowered agricultural production. Two model approaches have been applied. The first (logistic regression with principal components) explains what environmental variables have significant impact on species presence (and absence). The second (predictive SDM) is used to project species distribution under current and likely future land uses. The results of the explanatory analyses reveal that four principal components related to urbanisation, abandonment of open land and intensive agricultural practices as well as two climate parameters are primary drivers of species occurrence (decline). The scenario analyses show that lowered agricultural production is likely to favour dry grassland species due to an increase of non-intensively used land, open canopy forests, and overgrown areas. In the liberalisation scenario dry grassland species show a decrease in abundance due to a strong increase of forested patches. Wetland butterfly species would decrease under all four scenarios as their habitats become overgrown

Study of baleen whales’ ecology and interaction with maritime traffic activities to support management of a complex socio-ecological system

Thesis written in co-mentorship with Robert Michaud.

Plan d’intervention visant à soutenir le processus décisionnel concernant l’implantation d’un dispositif d’assistance ventriculaire auprès des patients vivant avec l’insuffisance cardiaque avancée et leur famille

Rapport de stage présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de Maître ès sciences (M.Sc.) en sciences infirmières option expertise-conseil en soins infirmiers

Wideband Low-Distortion Sigma-Delta ADC for WLAN

This work presents a wideband low-distortion sigmadelta analog-to-digital converter (ADC) for Wireless Local Area Network (WLAN) standard. The proposed converter makes use of low-distortion swing suppression SDM architecture which is highly suitable for low oversampling ratios to attain high linearity over a wide bandwidth. The modulator employs a 2-2 cascaded sigma-delta modulator with feedforward path with a single-bit quantizer in the first stage and 4-bit in the second stage. The modulator is designed in TSMC 0.18um CMOS technology and operates at 1.8V supply voltage. Simulation results show that, a peak SNDR of 57dB and a spurious free dynamic range (SFDR) of 66dB is obtained for a 10MHz signal bandwidth, and an oversampling ratio of 8.

GA-based Optimization of a Fourth-order Sigma-delta Modulator for WLAN

Over-sampling sigma-delta analogue-to-digital converters (ADCs) are one of the key building blocks of state of the art wireless transceivers. In the sigma-delta modulator design the scaling coefficients determine the overall signal-to-noise ratio. Therefore, selecting the optimum value of the coefficient is very important. To this end, this paper addresses the design of a fourthorder multi-bit sigma-delta modulator for Wireless Local Area Networks (WLAN) receiver with feed-forward path and the optimum coefficients are selected using genetic algorithm (GA)- based search method. In particular, the proposed converter makes use of low-distortion swing suppression SDM architecture which is highly suitable for low oversampling ratios to attain high linearity over a wide bandwidth. The focus of this paper is the identification of the best coefficients suitable for the proposed topology as well as the optimization of a set of system parameters in order to achieve the desired signal-to-noise ratio. GA-based search engine is a stochastic search method which can find the optimum solution within the given constraints.

Fujaba Days 2011

Fujaba is an Open Source UML CASE tool project started at the software engineering group of Paderborn University in 1997. In 2002 Fujaba has been redesigned and became the Fujaba Tool Suite with a plug-in architecture allowing developers to add functionality easily while retaining full control over their contributions. Multiple Application Domains Fujaba followed the model-driven development philosophy right from its beginning in 1997. At the early days, Fujaba had a special focus on code generation from UML diagrams resulting in a visual programming language with a special emphasis on object structure manipulating rules. Today, at least six rather independent tool versions are under development in Paderborn, Kassel, and Darmstadt for supporting (1) reengineering, (2) embedded real-time systems, (3) education, (4) specification of distributed control systems, (5) integration with the ECLIPSE platform, and (6) MOF-based integration of system (re-) engineering tools. International Community According to our knowledge, quite a number of research groups have also chosen Fujaba as a platform for UML and MDA related research activities. In addition, quite a number of Fujaba users send requests for more functionality and extensions. Therefore, the 8th International Fujaba Days aimed at bringing together Fujaba develop- ers and Fujaba users from all over the world to present their ideas and projects and to discuss them with each other and with the Fujaba core development team.

El crecimiento del parque automotor de motocicletas: un desafío para la apuesta por la priorización del uso del transporte masivo. Estudio de caso: Bogotá 2000-2010

El propósito del presente trabajo de grado es hacer un análisis del estado de la motorización en Bogotá -en cuanto a motocicletas se refiere- a partir del reto que éstas han significado para la priorización del uso del transporte público. El trabajo de grado hace un recorrido por las características de los modos de transporte –tanto el transporte público como las motocicletas-, ahondando en sus problemáticas. Lo anterior se hace con el fin de intentar descubrir una razón por la cual año a año crece el número de motocicletas que circulan por Bogotá. Para lograr una aproximación a lo que busca el trabajo de grado, se logró hacer un acercamiento a un número de propietarios de motocicletas. De ellos, se pudieron establecer las principales razones por las cuales se ha popularizado el uso de la motocicleta.

Species distribution models for crop pollination: a modelling framework applied to Great Britain

Insect pollination benefits over three quarters of the world's major crops. There is growing concern that observed declines in pollinators may impact on production and revenues from animal pollinated crops. Knowing the distribution of pollinators is therefore crucial for estimating their availability to pollinate crops; however, in general, we have an incomplete knowledge of where these pollinators occur. We propose a method to predict geographical patterns of pollination service to crops, novel in two elements: the use of pollinator records rather than expert knowledge to predict pollinator occurrence, and the inclusion of the managed pollinator supply. We integrated a maximum entropy species distribution model (SDM) with an existing pollination service model (PSM) to derive the availability of pollinators for crop pollination. We used nation-wide records of wild and managed pollinators (honey bees) as well as agricultural data from Great Britain. We first calibrated the SDM on a representative sample of bee and hoverfly crop pollinator species, evaluating the effects of different settings on model performance and on its capacity to identify the most important predictors. The importance of the different predictors was better resolved by SDM derived from simpler functions, with consistent results for bees and hoverflies. We then used the species distributions from the calibrated model to predict pollination service of wild and managed pollinators, using field beans as a test case. The PSM allowed us to spatially characterize the contribution of wild and managed pollinators and also identify areas potentially vulnerable to low pollination service provision, which can help direct local scale interventions. This approach can be extended to investigate geographical mismatches between crop pollination demand and the availability of pollinators, resulting from environmental change or policy scenarios.

Testing projected wild bee distributions in agricultural habitats: predictive power depends on species traits and habitat type

Species distribution models (SDM) are increasingly used to understand the factors that regulate variation in biodiversity patterns and to help plan conservation strategies. However, these models are rarely validated with independently collected data and it is unclear whether SDM performance is maintained across distinct habitats and for species with different functional traits. Highly mobile species, such as bees, can be particularly challenging to model. Here, we use independent sets of occurrence data collected systematically in several agricultural habitats to test how the predictive performance of SDMs for wild bee species depends on species traits, habitat type, and sampling technique. We used a species distribution modeling approach parametrized for the Netherlands, with presence records from 1990 to 2010 for 193 Dutch wild bees. For each species, we built a Maxent model based on 13 climate and landscape variables. We tested the predictive performance of the SDMs with independent datasets collected from orchards and arable fields across the Netherlands from 2010 to 2013, using transect surveys or pan traps. Model predictive performance depended on species traits and habitat type. Occurrence of bee species specialized in habitat and diet was better predicted than generalist bees. Predictions of habitat suitability were also more precise for habitats that are temporally more stable (orchards) than for habitats that suffer regular alterations (arable), particularly for small, solitary bees. As a conservation tool, SDMs are best suited to modeling rarer, specialist species than more generalist and will work best in long-term stable habitats. The variability of complex, short-term habitats is difficult to capture in such models and historical land use generally has low thematic resolution. To improve SDMs’ usefulness, models require explanatory variables and collection data that include detailed landscape characteristics, for example, variability of crops and flower availability. Additionally, testing SDMs with field surveys should involve multiple collection techniques.

Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

Understanding the critical distance in sparse distributed memory

Modelos de tomada de decisão necessitam refletir os aspectos da psi- cologia humana. Com este objetivo, este trabalho é baseado na Sparse Distributed Memory (SDM), um modelo psicologicamente e neuro- cientificamente plausível da memória humana, publicado por Pentti Kanerva, em 1988. O modelo de Kanerva possui um ponto crítico: um item de memória aquém deste ponto é rapidamente encontrado, e items além do ponto crítico não o são. Kanerva calculou este ponto para um caso especial com um seleto conjunto de parâmetros (fixos). Neste trabalho estendemos o conhecimento deste ponto crítico, através de simulações computacionais, e analisamos o comportamento desta “Critical Distance” sob diferentes cenários: em diferentes dimensões; em diferentes números de items armazenados na memória; e em diferentes números de armazenamento do item. Também é derivada uma função que, quando minimizada, determina o valor da “Critical Distance” de acordo com o estado da memória. Um objetivo secundário do trabalho é apresentar a SDM de forma simples e intuitiva para que pesquisadores de outras áreas possam imaginar como ela pode ajudá-los a entender e a resolver seus problemas.