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.

Um modelo de EIS - enterprise information system - que identifica características para comportamentos proativos na recuperação de informações

Este documento constitui uma dissertação de mestrado, requisito parcial para a obtenção do grau de Mestre em Administração pela Universidade Federal do Rio Grande do Sul. O tema da pesquisa é o relacionamento existente entre as características técnicas de um projeto de sistema de informação e apoio à decisão e os comportamentos dos usuários no seu uso. O objetivo é desenvolver e apresentar um modelo conceitual de EIS (“Enterprise Information Systems”), a partir da literatura, das tendências tecnológicas e de estudos de caso, que identifique características para comportamentos proativos dos usuários na recuperação de informações. Adotou-se o conceito de comportamento proativo na recuperação de informações como a combinação das categorias exploração de dados e busca focada. Entre os principais resultados, pode-se destacar a definição de categorias relacionadas com as características dos sistemas - flexibilidade, integração e apresentação - e de categorias relacionadas com os comportamentos dos usuários na recuperação de informações - exploração de dados e busca focada, bem como a apresentação de um modelo conceitual para sistemas EIS. Pode-se destacar também a exploração de novas técnicas para análise qualitativa de dados, realizada com o objetivo de buscar uma maior preservação do contexto nos estudos de caso.

ARISupport - Interaction support for augmented reality systems

The communication between user and software is a basic stage in any Interaction System project. In interactive systems, this communication is established by the means of a graphical interface, whose objective is to supply a visual representation of the main entities and functions present in the Virtual Environment. New ways of interacting in computational systems have been minimizing the gap in the relationship between man and computer, and therefore enhancing its usability. The objective of this paper, therefore, is to present a proposal for a non-conventional user interface library called ARISupport, which supplies ARToolKit applications developers with an opportunity to create simple GUI interfaces, and provides some of the functionality used in Augmented Reality systems. © Springer-Verlag Berlin Heidelberg 2005.

Conflitos por múltiplos usos da água no reservatório da UHE de Tucuruí

Os conflitos por múltiplos usos da água, no reservatório da UHE Tucuruí, surgem com o anúncio da construção da mega hidrelétrica na região, e os conflitos socioambientais subseqüentes. Aliada a elevação do nível de percepção social em relação aos problemas ambientais cresce também a busca por eficientes processos de gestão e gerenciamento de recursos hídricos. Este estudo objetiva analisar e tipificar os conflitos por múltiplos usos da água no reservatório da UHE Tucuruí, utilizando-se como ferramenta de apoio à decisão o software de modelagem qualitativa NVivo 8, e dessa forma verificar as melhores alternativas a serem adotadas para a conciliação dos usos múltiplos no reservatório. As tipificações realizadas basearam-se na análise dos conflitos, seus componentes, elementos e aspectos, tipo, natureza e origem. Sendo assim, identificaram-se três principais tipos de conflitos no reservatório da UHE Tucuruí: conflitos entre distintos grupos de usuários da água, conflitos por obras hidráulicas e conflitos decorrentes de poluição ambiental. Para este estudo adotou - se uma abordagem qualitativa, através do método de mapeamento cognitivo. Este tipo de mapeamento possibilitou a construção de um modelo cognitivo para a gestão dos conflitos no reservatório de Tucuruí. Sendo assim, o software NVivo 8 possibilitou, além da análise dos dados obtidos nas entrevistas e no levantamento bibliográfico, a construção do modelo gráfico de apoio à gestão de conflitos por múltiplos usos da água. Verificou-se que uma das formas de solução dos conflitos é através da análise destes, em vistas de se investigar os mecanismos adequados para sua resolução, e posterior proposição de medidas estruturais e/ou nãoestruturais para a gestão de recursos hídricos. As principais ações para a solução dos conflitos estão enquadradas nos métodos de resolução institucional de longo prazo. O modelo pode funcionar como suporte ao planejamento e tomada de decisão, tendo em vista os problemas ambientais, a participação dos usuários da água no sistema hídrico, as políticas públicas, e também a gestão integrada dos recursos hídricos. Concluiu- se, então, que a exploração dos recursos hídricos deve proporcionar os múltiplos usos da água em atendimento aos princípios da sustentabilidade ambiental, inseridos num processo de gestão dos conflitos por múltiplos usos da água e gerenciamento integrado dos recursos hídricos.

Quality assessment of a landslide inventory map and its application to land‐use planning. A case study in the Northern Apennines (Emilia‐Romagna region, Italy)

Landslide hazard and risk are growing as a consequence of climate change and demographic pressure. Land‐use planning represents a powerful tool to manage this socio‐economic problem and build sustainable and landslide resilient communities. Landslide inventory maps are a cornerstone of land‐use planning and, consequently, their quality assessment represents a burning issue. This work aimed to define the quality parameters of a landslide inventory and assess its spatial and temporal accuracy with regard to its possible applications to land‐use planning. In this sense, I proceeded according to a two‐steps approach. An overall assessment of the accuracy of data geographic positioning was performed on four case study sites located in the Italian Northern Apennines. The quantification of the overall spatial and temporal accuracy, instead, focused on the Dorgola Valley (Province of Reggio Emilia). The assessment of spatial accuracy involved a comparison between remotely sensed and field survey data, as well as an innovative fuzzylike analysis of a multi‐temporal landslide inventory map. Conversely, long‐ and short‐term landslide temporal persistence was appraised over a period of 60 years with the aid of 18 remotely sensed image sets. These results were eventually compared with the current Territorial Plan for Provincial Coordination (PTCP) of the Province of Reggio Emilia. The outcome of this work suggested that geomorphologically detected and mapped landslides are a significant approximation of a more complex reality. In order to convey to the end‐users this intrinsic uncertainty, a new form of cartographic representation is needed. In this sense, a fuzzy raster landslide map may be an option. With regard to land‐use planning, landslide inventory maps, if appropriately updated, confirmed to be essential decision‐support tools. This research, however, proved that their spatial and temporal uncertainty discourages any direct use as zoning maps, especially when zoning itself is associated to statutory or advisory regulations.

Divorce and Family Support in Later Life: Emerging Concerns.

Two patterns are among the most important considerations in planning services for the elderly of the future: (1) the current role of family members in supporting older adults and (2) the present high rate of divorce. Thus far, these patterns may not have significantly affected each other. However, if forecasts of increasing service demands by older adults are correct, service planners must consider what resources will be available to the elderly of the future. In this article, literature from a variety of areas is reviewed focusing on one question: How will the currently high rate of divorce affect the family support system of older adults in the future? Current divorce and remarriage patterns could undermine this support system of the elderly. Possible short-and long-term effects of the demands and emotional consequences of divorce are discussed within this context, and implications for public policy are suggested.

Impact of a self-developed planning and self-constructed navigation system on skull base surgery: 10 years experience

CONCLUSION: Our self-developed planning and navigation system has proven its capacity for accurate surgery on the anterior and lateral skull base. With the incorporation of augmented reality, image-guided surgery will evolve into 'information-guided surgery'. OBJECTIVE: Microscopic or endoscopic skull base surgery is technically demanding and its outcome has a great impact on a patient's quality of life. The goal of the project was aimed at developing and evaluating enabling navigation surgery tools for simulation, planning, training, education, and performance. This clinically applied technological research was complemented by a series of patients (n=406) who were treated by anterior and lateral skull base procedures between 1997 and 2006. MATERIALS AND METHODS: Optical tracking technology was used for positional sensing of instruments. A newly designed dynamic reference base with specific registration techniques using fine needle pointer or ultrasound enables the surgeon to work with a target error of < 1 mm. An automatic registration assessment method, which provides the user with a color-coded fused representation of CT and MR images, indicates to the surgeon the location and extent of registration (in)accuracy. Integration of a small tracker camera mounted directly on the microscope permits an advantageous ergonomic way of working in the operating room. Additionally, guidance information (augmented reality) from multimodal datasets (CT, MRI, angiography) can be overlaid directly onto the surgical microscope view. The virtual simulator as a training tool in endonasal and otological skull base surgery provides an understanding of the anatomy as well as preoperative practice using real patient data. RESULTS: Using our navigation system, no major complications occurred in spite of the fact that the series included difficult skull base procedures. An improved quality in the surgical outcome was identified compared with our control group without navigation and compared with the literature. The surgical time consumption was reduced and more minimally invasive approaches were possible. According to the participants' questionnaires, the educational effect of the virtual simulator in our residency program received a high ranking.

Economic efficiency analysis of different strategies to control post-weaning multi-systemic wasting syndrome and porcine circovirus type 2 subclinical infection in 3-weekly batch system farms.

The study assessed the economic efficiency of different strategies for the control of post-weaning multi-systemic wasting syndrome (PMWS) and porcine circovirus type 2 subclinical infection (PCV2SI), which have a major economic impact on the pig farming industry worldwide. The control strategies investigated consisted on the combination of up to 5 different control measures. The control measures considered were: (1) PCV2 vaccination of piglets (vac); (2) ensuring age adjusted diet for growers (diets); (3) reduction of stocking density (stock); (4) improvement of biosecurity measures (bios); and (5) total depopulation and repopulation of the farm for the elimination of other major pathogens (DPRP). A model was developed to simulate 5 years production of a pig farm with a 3-weekly batch system and with 100 sows. A PMWS/PCV2SI disease and economic model, based on PMWS severity scores, was linked to the production model in order to assess disease losses. This PMWS severity scores depends on the combination post-weaning mortality, PMWS morbidity in younger pigs and proportion of PCV2 infected pigs observed on farms. The economic analysis investigated eleven different farm scenarios, depending on the number of risk factors present before the intervention. For each strategy, an investment appraisal assessed the extra costs and benefits of reducing a given PMWS severity score to the average score of a slightly affected farm. The net present value obtained for each strategy was then multiplied by the corresponding probability of success to obtain an expected value. A stochastic simulation was performed to account for uncertainty and variability. For moderately affected farms PCV2 vaccination alone was the most cost-efficient strategy, but for highly affected farms it was either PCV2 vaccination alone or in combination with biosecurity measures, with the marginal profitability between 'vac' and 'vac+bios' being small. Other strategies such as 'diets', 'vac+diets' and 'bios+diets' were frequently identified as the second or third best strategy. The mean expected values of the best strategy for a moderately and a highly affected farm were £14,739 and £57,648 after 5 years, respectively. This is the first study to compare economic efficiency of control strategies for PMWS and PCV2SI. The results demonstrate the economic value of PCV2 vaccination, and highlight that on highly affected farms biosecurity measures are required to achieve optimal profitability. The model developed has potential as a farm-level decision support tool for the control of this economically important syndrome.

Tools for better SLM knowledge management and informed decision-making in addressing land degradation at different scales: the WOCAT–LADA–DESIRE methodology

Desertification research conventionally focuses on the problem – that is, degradation – while neglecting the appraisal of successful conservation practices. Based on the premise that Sustainable Land Management (SLM) experiences are not sufficiently or comprehensively documented, evaluated, and shared, the World Overview of Conservation Approaches and Technologies (WOCAT) initiative (www.wocat.net), in collaboration with FAO’s Land Degradation Assessment in Drylands (LADA) project (www.fao.org/nr/lada/) and the EU’s DESIRE project (http://www.desire-project.eu/), has developed standardised tools and methods for compiling and evaluating the biophysical and socio-economic knowledge available about SLM. The tools allow SLM specialists to share their knowledge and assess the impact of SLM at the local, national, and global levels. As a whole, the WOCAT–LADA–DESIRE methodology comprises tools for documenting, self-evaluating, and assessing the impact of SLM practices, as well as for knowledge sharing and decision support in the field, at the planning level, and in scaling up identified good practices. SLM depends on flexibility and responsiveness to changing complex ecological and socioeconomic causes of land degradation. The WOCAT tools are designed to reflect and capture this capacity of SLM. In order to take account of new challenges and meet emerging needs of WOCAT users, the tools are constantly further developed and adapted. Recent enhancements include tools for improved data analysis (impact and cost/benefit), cross-scale mapping, climate change adaptation and disaster risk management, and easier reporting on SLM best practices to UNCCD and other national and international partners. Moreover, WOCAT has begun to give land users a voice by backing conventional documentation with video clips straight from the field. To promote the scaling up of SLM, WOCAT works with key institutions and partners at the local and national level, for example advisory services and implementation projects. Keywords: Sustainable Land Management (SLM), knowledge management, decision-making, WOCAT–LADA–DESIRE methodology.

The Houston Academy of Medicine--Texas Medical Center Library management information system.

A management information system (MIS) provides a means for collecting, reporting, and analyzing data from all segments of an organization. Such systems are common in business but rare in libraries. The Houston Academy of Medicine-Texas Medical Center Library developed an MIS that operates on a system of networked IBM PCs and Paradox, a commercial database software package. The data collected in the system include monthly reports, client profile information, and data collected at the time of service requests. The MIS assists with enforcement of library policies, ensures that correct information is recorded, and provides reports for library managers. It also can be used to help answer a variety of ad hoc questions. Future plans call for the development of an MIS that could be adapted to other libraries' needs, and a decision-support interface that would facilitate access to the data contained in the MIS databases.

AUTOFLY-Aid: Flight Deck Automation Support with Dynamic 4D Trajectory Management for Responsive and Adaptive Airborne Collision Avoidance

AUTOFLY-Aid Project aims to develop and demonstrate novel automation support algorithms and tools to the flight crew for flight critical collision avoidance using “dynamic 4D trajectory management”. The automation support system is envisioned to improve the primary shortcomings of TCAS, and to aid the pilot through add-on avionics/head-up displays and reality augmentation devices in dynamically evolving collision avoidance scenarios. The main theoretical innovative and novel concepts to be developed by AUTOFLY-Aid project are a) design and development of the mathematical models of the full composite airspace picture from the flight deck’s perspective, as seen/measured/informed by the aircraft flying in SESAR 2020, b) design and development of a dynamic trajectory planning algorithm that can generate at real-time (on the order of seconds) flyable (i.e. dynamically and performance-wise feasible) alternative trajectories across the evolving stochastic composite airspace picture (which includes new conflicts, blunder risks, terrain and weather limitations) and c) development and testing of the Collision Avoidance Automation Support System on a Boeing 737 NG FNPT II Flight Simulator with synthetic vision and reality augmentation while providing the flight crew with quantified and visual understanding of collision risks in terms of time and directions and countermeasures.

Consolidation of a wsn and minimax method to rapidly neutralise intruders in strategic installations

Due to the sensitive international situation caused by still-recent terrorist attacks, there is a common need to protect the safety of large spaces such as government buildings, airports and power stations. To address this problem, developments in several research fields, such as video and cognitive audio, decision support systems, human interface, computer architecture, communications networks and communications security, should be integrated with the goal of achieving advanced security systems capable of checking all of the specified requirements and spanning the gap that presently exists in the current market. This paper describes the implementation of a decision system for crisis management in infrastructural building security. Specifically, it describes the implementation of a decision system in the management of building intrusions. The positions of the unidentified persons are reported with the help of a Wireless Sensor Network (WSN). The goal is to achieve an intelligent system capable of making the best decision in real time in order to quickly neutralise one or more intruders who threaten strategic installations. It is assumed that the intruders’ behaviour is inferred through sequences of sensors’ activations and their fusion. This article presents a general approach to selecting the optimum operation from the available neutralisation strategies based on a Minimax algorithm. The distances among different scenario elements will be used to measure the risk of the scene, so a path planning technique will be integrated in order to attain a good performance. Different actions to be executed over the elements of the scene such as moving a guard, blocking a door or turning on an alarm will be used to neutralise the crisis. This set of actions executed to stop the crisis is known as the neutralisation strategy. Finally, the system has been tested in simulations of real situations, and the results have been evaluated according to the final state of the intruders. In 86.5% of the cases, the system achieved the capture of the intruders, and in 59.25% of the cases, they were intercepted before they reached their objective.

Deployment and validation of a smart system for screening of language disorders in primary care

Neuro-evolutive development from birth until the age of six years is a decisive factor in a child?s quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in its detection as they can undertake the preventive and therapeutic actions requested to promote a child?s optimal development. However, the lack of time and little specific knowledge at primary-care avoid to applying continuous early-detection anomalies procedures. This research paper focuses on the deployment and evaluation of a smart system that enhances the screening of language disorders in primary care. Pediatricians get support to proceed with early referral of language disorders. The proposed model provides them with a decision-support tool for referral actions to trigger essential diagnostic and/or therapeutic actions for a comprehensive individual development. The research was conducted by starting from a sample of 60 cases of children with language disorders. Validation was carried out through two complementary steps: first, by including a team of seven experts from the fields of neonatology, pediatrics, neurology and language therapy, and, second, through the evaluation of 21 more previously diagnosed cases. The results obtained show that therapist positively accepted the system proposal in 18 cases (86%) and suggested system redesign for single referral to a speech therapist in three remaining cases.

Bounded non-deterministic planning for multimedia adaptation

This paper proposes a novel combination of artificial intelligence planning and other techniques for improving decision-making in the context of multi-step multimedia content adaptation. In particular, it describes a method that allows decision-making (selecting the adaptation to perform) in situations where third-party pluggable multimedia conversion modules are involved and the multimedia adaptation planner does not know their exact adaptation capabilities. In this approach, the multimedia adaptation planner module is only responsible for a part of the required decisions; the pluggable modules make additional decisions based on different criteria. We demonstrate that partial decision-making is not only attainable, but also introduces advantages with respect to a system in which these conversion modules are not capable of providing additional decisions. This means that transferring decisions from the multi-step multimedia adaptation planner to the pluggable conversion modules increases the flexibility of the adaptation. Moreover, by allowing conversion modules to be only partially described, the range of problems that these modules can address increases, while significantly decreasing both the description length of the adaptation capabilities and the planning decision time. Finally, we specify the conditions under which knowing the partial adaptation capabilities of a set of conversion modules will be enough to compute a proper adaptation plan.

Case-based reasoning to support decision making for managing drinking water quality events in distribution systems

Peer reviewed