Linking scientific evidence and decision making : A case study of hand hygiene interventions

We consider how data from scientific research should be used for decision making in health services. Whether a hand hygiene intervention to reduce risk of nosocomial infection should be widely adopted is the case study. Improving hand hygiene has been described as the most important measure to prevent nosocomial infection. 1 Transmission of microorganisms is reduced, and fewer infections arise, which leads to a reduction in mortality2 and cost savings.3 Implementing a hand hygiene program is itself costly, so the extra investment should be tested for cost-effectiveness.4,5 The first part of our commentary is about cost-effectiveness models and how they inform decision making for health services. The second part is about how data on the effectiveness of hand hygiene programs arising from scientific studies are used, and 2 points are made: the threshold for statistical inference of .05 used to judge effectiveness studies is not important for decision making,6,7 and potentially valuable evidence about effectiveness might be excluded by decision makers because it is deemed low quality.8 The ideas put forward will help researchers and health services decision makers to appraise scientific evidence in a more powerful way.

Feminist ethics and menopause : autonomy and decision-making in primary medical care

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners’ accounts of menopause and treatment in Australia, women's ‘choice’, ‘informed decision-making’ and ‘empowerment’ were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of ‘informed decision-making’ in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an ‘ethic of autonomy’ and an ‘offer of choice’ in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Menopause as a long-term risk to health : implications of general practitioner accounts of prevention for women’s choice and decision-making

Over the past two decades medical researchers and modernist feminist researchers have contested the meaning of menopause. In this article we examine various meanings of menopause in major medical and feminist literature and the construction of menopause in a semi-structured interview study of general practitioners in rural South Australia. Three discursive themes are identified in these interviews; (i) the hormonal menopause – symptoms, risk, prevention; (ii) the informed menopausal woman; and (iii) decision-making and hormone replacement therapy. By using the discourse of prevention, general practitioners construct menopause in relation to women's health care choices, empowerment and autonomy. We argue that the ways in which these concepts are deployed by general practitioners in this study produces and constrains the options available to women. The implications of these general practitioner accounts are discussed in relation to the proposition that medical and feminist descriptions of menopause posit alternative but equally-fixed truths about menopause and their relationship with the range of responses available to women at menopause. Social and cultural explanations of disease causality (c.f.Germov 1998, Hardey 1998) are absent from the new menopause despite their being an integral part of the framework of the women's health movement and health promotion drawn on by these general practitioners. Further, the shift of responsibility for health to the individual woman reinforces practice claims to empower women, but oversimplifies power relations and constructs menopause as a site of self-surveillance. The use of concepts from the women's health movement and health promotion have nevertheless created change in both the positioning of women as having ‘choices’ and the positioning of some general practitioners in terms of greater information provision to women and an attention to the woman's autonomy. In conclusion, we propose that a new menopause has evolved from a discursive shift in medicine and that there exists within this new configuration, claiming the empowerment of women as an integral part of health care for menopause, the possibility for change in medical practice which will broaden, strengthen, and maintain this position.

Assessing testamentary and decision-making competence/capacity in the Australian context

Australia lacks a satisfactory, national paradigm for assessing competence and capacity in the context of testamentary, enduring power of attorney and advance care directive documents. Competence/capacity assessments are currently conducted on an ad hoc basis by legal and/or medical professionals. The reliability of the assessment process is subject to the skill set and mutual understanding of the legal and/or medical professional conducting the assessment. There is a growth in the prevalence of diseases such as dementia. Such diseases impact upon cognition which increasingly necessitates collaboration between the legal and medical professions when assessing the effect of mentally disabling conditions upon competency/capacity. Miscommunication and lack of understanding between legal and medical professionals involved could impede the development of a satisfactory paradigm. A qualitative study seeking the views of legal and medical professionals who practise in this area has been conducted. This incorporated surveys and interviews of 10 legal and 20 medical practitioners. Some of the results are discussed here. Practitioners were asked whether there is a standard approach and whether national guidelines were desirable. There was general agreement that uniform guidelines for the assessment of competence/capacity would be desirable. The interviews also canvassed views as to the state of the relationship between the professions. The results of the empirical research support the hypothesis that relations between the professions could be improved. The development of a national paradigm would promote consistency and transparency of process, helping to improve the professional relationship and maximising the principles of autonomy, participation and dignity.

Detouring to Grafton : the Sydney Botanic Gardens and the making of an Australian urban aesthetic

For the last seventy-five years Grafton has celebrated the Jacaranda Festival in late October. The festival commences in the town square with the crowning of the Jacaranda Queen and ends a week later with a parade through the town. The event is now a major regional tourist attraction that aims to bring locals and visitors together to celebrate everything purple. During this week one can attend the jacaranda children's party, the jacaranda maypole dancing, the jacaranda choral service or the jacaranda organ recital. Local businesses are encouraged to compete in the decorated window displays competition and everyone can join in the procession. The festival pays homage to the extraordinary display of beautiful jacaranda blooms which carpet the city during this time. The festival was inaugurated in 1935 when the slow growing jacarandas planted in the late nineteenth and early twentieth centuries were coming to maturity...

How small-sided and conditioned games enhance acquisition of movement and decision-making skills

This article summarizes research from an ecological dynamics program of work on team sports exemplifying how small-sided and conditioned games (SSCG) can enhance skill acquisition and decision-making processes during training. The data highlighted show how constraints of different SSCG can facilitate emergence of continuous interpersonal coordination tendencies during practice to benefit team game players.

Improving safety for driverless city vehicles : real-time communication and decision making

This paper elaborates on the Cybercars-2 Wireless Communication Framework for driverless city vehicles, which is used for Vehicle-to-Vehicle and Vehicle-to-Infrastructure communication. The developed framework improves the safety and efficiency of driverless city vehicles. Furthermore, this paper also elaborates on the vehicle control software architecture. On-road tests of both the communication framework and its application for real-time decision making show that the communication framework is reliable and useful for improving the safe operation of driverless city vehicles.

Australian consumer attitudes and decision making on renewable energy technology and its impact on the transformation of the energy sector

This paper critically examines research on consumer attitudes and behavior towards solar photovoltaic (PV) and renewable energy technology in Australia. The uptake of renewable energy technology by residential consumers in Australia in the past decade has transformed the electricity supply and demand paradigm. Thus, this paper reviews Australian research on consumer behavior, understanding and choices in order to identify gaps in knowledge. As the role of the consumer transforms there is a critical need to understand the ways consumers may respond to future energy policies to mitigate unforeseen negative social and economic consequence of programs designed to achieve positive environmental outcomes.

On mind, mediation and meaning-making

This paper takes inspiration from the integrative model of human mind proposed by Brinkmann (2011, 2012) and argues that the kind of integration that he seeks to attain can only be achieved if the model focuses on the processes that underlie the functioning of the human mind and not on the entities that these processes produce or function by. An alternative integrative model is thus proposed. In the first part of the paper the process of meaning-making will be explored. It will be argued that an integrative conceptualisation of human mind needs to take into account pre-reflective and unmediated as well as reflective and mediated states through which meanings become constructed. In the second part of the paper the idea of semiotic mediation will be explored. It will be argued that an integrative model of human mind needs to focus not only on different kinds of mediators, but also explain how these are used reflectively and non-reflectively by individuals themselves and visibly or invisibly by others in our everyday interactions.

Remaking Guangzhou: Political engagement and place-making on Sina Weibo

This study uses the concept of ‘place-making’ to consider political engagement on Sina Weibo, one of the most popular microblogging services in China. Besides articulating statepublic confrontation during major social controversies, Weibo has been used to recollect and renarrate the memories of a city, such as Guangzhou, where dramatic social and cultural changes took place during the economic reform era. The Chinese government’s ongoing project to create a culturally indifferent ‘national identity’ triggers a defensive response from local places. Through consuming news and information about leisure and entertainment in Guangzhou, the digital narration of the city becomes an important source for Guangzhou people to learn about their geo-identity, and the kind of rights and responsibility attaching to it.

Criteria for interpreting kimberlite as coherent: Insights from the Muskox and Jericho kimberlites (Nunavut, Canada)

The Jurassic Muskox and Jericho kimberlites (Northern Slave Province, Nunavut, Canada) contain a variety of facies exhibiting different geometries, contact relationships, internal organisation, country rock abundance and olivine shapes, although many have similar matrix/groundmass mineralogies and textures. Five facies are examined that either have characteristics consistent with coherent rocks in general (i.e. intrusive and extrusive non-fragmental rocks) or are mineralogically and texturally similar to kimberlite described as coherent (or apparent coherent). Three facies are interpreted as coherent on the basis of: (1) geological setting, (2) apparent-porphyritic texture, (3) sharp contacts with fragmental kimberlite, (4) relative abundance of elongate and unbroken olivine crystals and (5) paucity of country rock xenoliths, while the remaining two facies are interpreted as fragmental on the basis of: (1) the gradational contacts with demonstrably fragmental kimberlite, (2) relative abundance and range of sizes of country rock lithic clasts and (3) numerous broken olivine crystals. Comparisons are made with coherent and apparent-coherent kimberlite from the literature. Our three coherent facies are similar to literature reported coherent kimberlite dykes hosted in country rock (CKd) in terms of internal organisation, low abundance of country rock xenoliths, and apparent-porphyritic texture. Conversely, our two fragmental facies share attributes with previously described pipe-filling coherent and apparent-coherent kimberlite (CKpf) in terms of geometry, internal organisation and abundance of country rock xenoliths. We conclude that CKd and most CKpf, although similar in matrix/groundmass mineralogy and texture, can be distinguished on the basis of internal organisation, country rock lithic clast abundance, texture (e.g. apparent-porphyritic texture) and possibly olivine crystal shapes and suggest that fragmental kimberlite is more common than reported.

Assessing testamentary and decision-making capacity: Approaches and models

The need for better and more accurate assessments of testamentary and decision-making capacity grows as Australian society ages and incidences of mentally disabling conditions increase. Capacity is a legal determination, but one on which medical opinion is increasingly being sought. The difficulties inherent within capacity assessments are exacerbated by the ad hoc approaches adopted by legal and medical professionals based on individual knowledge and skill, as well as the numerous assessment paradigms that exist. This can negatively affect the quality of assessments, and results in confusion as to the best way to assess capacity. This article begins by assessing the nature of capacity. The most common general assessment models used in Australia are then discussed, as are the practical challenges associated with capacity assessment. The article concludes by suggesting a way forward to satisfactorily assess legal capacity given the significant ramifications of getting it wrong.

Remaking Guangzhou: Geo-identity and place-making on Sina Weibo

This study uses the concept of 'place-making' to consider the formation of geo-identity on Sina Weibo, one of the most popular microblogging services in China. Besides articulating state-public confrontation during major social controversies, Weibo has been used to recollect and re-narrate the memories of a city, such as Guangzhou, where dramatic social and cultural changes took place during the economic reform era. This study aims to explore how Weibo sustains political engagement through maintaining Guangzhou people's sense of belonging to their city. By collecting data from a Weibo group over a period of twelve months, I argue that Weibo politics not only takes place during a contentious events, but is sustained within the realm of everyday life. This study has the potential to contribute to the limited knowledge of Weibo use during non-contentious period in China, hence broadening the notion of popular polity in the age of social media.