Advocating alcohol abstinence to pregnant women: some observations about British policy

In 2007, the English Department of Health (DH) issued advice stating 'pregnant woman' and 'those trying to conceive' should abstain from drinking alcohol. As others have noted, this advice was issued despite their being no new evidence about the deleterious effects of low levels of alcohol consumption. In this paper, we argue this development is significant for the social construction of 'risk', since in advocating abstinence without an evidence base for this advice, policy makers formalise a connection between uncertainty and danger. We suggest this development has important implications, most obviously for pregnant women, certainly impacting on the nature of the advice they will now receive and likely more generally on their experience of the transition to motherhood. We suggest it has wider implications for individuals' experience also, as policy makers appear to be advocating the same approach to risk to non-pregnant people. Further, it suggests a noteworthy formalisation of a new definition of risk, which should be debated far more extensively, as it matters for the future development of health policy.

Predictive gene lists for breast cancer prognosis: a topographic visualisation study

Background: The controversy surrounding the non-uniqueness of predictive gene lists (PGL) of small selected subsets of genes from very large potential candidates as available in DNA microarray experiments is now widely acknowledged 1. Many of these studies have focused on constructing discriminative semi-parametric models and as such are also subject to the issue of random correlations of sparse model selection in high dimensional spaces. In this work we outline a different approach based around an unsupervised patient-specific nonlinear topographic projection in predictive gene lists. Methods: We construct nonlinear topographic projection maps based on inter-patient gene-list relative dissimilarities. The Neuroscale, the Stochastic Neighbor Embedding(SNE) and the Locally Linear Embedding(LLE) techniques have been used to construct two-dimensional projective visualisation plots of 70 dimensional PGLs per patient, classifiers are also constructed to identify the prognosis indicator of each patient using the resulting projections from those visualisation techniques and investigate whether a-posteriori two prognosis groups are separable on the evidence of the gene lists. A literature-proposed predictive gene list for breast cancer is benchmarked against a separate gene list using the above methods. Generalisation ability is investigated by using the mapping capability of Neuroscale to visualise the follow-up study, but based on the projections derived from the original dataset. Results: The results indicate that small subsets of patient-specific PGLs have insufficient prognostic dissimilarity to permit a distinction between two prognosis patients. Uncertainty and diversity across multiple gene expressions prevents unambiguous or even confident patient grouping. Comparative projections across different PGLs provide similar results. Conclusion: The random correlation effect to an arbitrary outcome induced by small subset selection from very high dimensional interrelated gene expression profiles leads to an outcome with associated uncertainty. This continuum and uncertainty precludes any attempts at constructing discriminative classifiers. However a patient's gene expression profile could possibly be used in treatment planning, based on knowledge of other patients' responses. We conclude that many of the patients involved in such medical studies are intrinsically unclassifiable on the basis of provided PGL evidence. This additional category of 'unclassifiable' should be accommodated within medical decision support systems if serious errors and unnecessary adjuvant therapy are to be avoided.

An exploratory study of the role of trust in medication management within mental health services

Objective - To develop understandings of the nature and influence of trust in the safe management of medication within mental health services. Setting - Mental health services in the UK. Method - Qualitative methods were applied through focus groups across three different categories of service user—older adult, adults living in the community and forensic services. An inductive thematic analysis was carried out, using the method of constant comparison derived from grounded theory. Main Outcome - Measure Participants’ views on the key factors influencing trust and the role of trust in safe medication management. Results - The salient factors impacting trust were: the therapeutic relationship; uncertainty and vulnerability; and social control. Users of mental health services may be particularly vulnerable to adverse events and these can damage trust. Conclusion - Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust.

Minimizing nasty surprises with better informed decision-making in self-adaptive systems

Designers of self-adaptive systems often formulate adaptive design decisions, making unrealistic or myopic assumptions about the system's requirements and environment. The decisions taken during this formulation are crucial for satisfying requirements. In environments which are characterized by uncertainty and dynamism, deviation from these assumptions is the norm and may trigger 'surprises'. Our method allows designers to make explicit links between the possible emergence of surprises, risks and design trade-offs. The method can be used to explore the design decisions for self-adaptive systems and choose among decisions that better fulfil (or rather partially fulfil) non-functional requirements and address their trade-offs. The analysis can also provide designers with valuable input for refining the adaptation decisions to balance, for example, resilience (i.e. Satisfiability of non-functional requirements and their trade-offs) and stability (i.e. Minimizing the frequency of adaptation). The objective is to provide designers of self adaptive systems with a basis for multi-dimensional what-if analysis to revise and improve the understanding of the environment and its effect on non-functional requirements and thereafter decision-making. We have applied the method to a wireless sensor network for flood prediction. The application shows that the method gives rise to questions that were not explicitly asked before at design-time and assists designers in the process of risk-aware, what-if and trade-off analysis.

A method for systematic artifact selection decision making

Artifact selection decisions typically involve the selection of one from a number of possible/candidate options (decision alternatives). In order to support such decisions, it is important to identify and recognize relevant key issues of problem solving and decision making (Albers, 1996; Harris, 1998a, 1998b; Jacobs & Holten, 1995; Loch & Conger, 1996; Rumble, 1991; Sauter, 1999; Simon, 1986). Sauter classifies four problem solving/decision making styles: (1) left-brain style, (2) right-brain style, (3) accommodating, and (4) integrated (Sauter, 1999). The left-brain style employs analytical and quantitative techniques and relies on rational and logical reasoning. In an effort to achieve predictability and minimize uncertainty, problems are explicitly defined, solution methods are determined, orderly information searches are conducted, and analysis is increasingly refined. Left-brain style decision making works best when it is possible to predict/control, measure, and quantify all relevant variables, and when information is complete. In direct contrast, right-brain style decision making is based on intuitive techniques—it places more emphasis on feelings than facts. Accommodating decision makers use their non-dominant style when they realize that it will work best in a given situation. Lastly, integrated style decision makers are able to combine the left- and right-brain styles—they use analytical processes to filter information and intuition to contend with uncertainty and complexity.

Do stressful times call for team-based working? A study of psychiatric nurses in UK mental healthcase

Background: Team-based working is now an inherent part of effective health care delivery. Previous research has identified that team working is associated with positive mental health and well-being outcomes for individuals operating in an effective team environment. This is a particularly important topic in the health services context, although little empirical attention has been paid to mental-health services. Psychiatric nurses work on a day-to-day basis with a particularly stressful and demanding client group in an environment which is characterised by high demands, uncertainty, and limited resources. This paper specifically focuses on psychiatric nurses working in National Health Service (NHS) and casts some light on the ways in which effective team-based working can help to alleviate a number of occupational stressors and strains. Method: A questionnaire method (2005 NHS Staff Survey) was employed to collect data from 6655 psychiatric nurses from 64 different NHS Trusts. The hypotheses were concerned with four overall measures from the survey; effective team working, occupational stress, work pressure and social support. Hypothesis 1 stated that effective team working will have a significant negative relationship with occupational stress and work pressure. Further, Hypothesis 2 stated that social support from supervisors and co-workers will moderate this relationship. Findings: Data was treated with a series of regression analyses. For Hypothesis 1, working in a real team did have main effects on work pressure and accounted for 1.6 per cent of the variance. Using the Nagelkerke R square value, working in a real team also had main effects on occupational stress an accounted for approximately 2.8 per cent of the variance. Further, the Exp (B) value of 0.662 suggests that the odds of suffering from occupational stress are cut by 33.8 per cent when a psychiatric nurse works in a real team. Results failed to provide support for Hypothesis 2. The analysis then went on to adopt a unique approach for assessing the extent of real team-based working, distinguishing between real teams, and a number of pseudo team typologies, as well as the absence of teamwork all together. As was hypothesised, results demonstrated that psychiatric nurses working in real teams (ones with clear objectives, where-by team members work closely with one another to achieve team objectives and meet regularly to discuss team effectiveness and how it can be improved) experienced the lowest levels of stress and work pressure of the sample. However, contrary to prediction, results indicated that psychiatric nurses working in any type of pseudo team actually experienced significantly higher levels of stress and work pressure than those who did not report as working in a team at all. Discussion: These findings have serious implications for NHS Mental Health Trusts, which may not be implementing, structuring and managing their nursing teams adequately. Indeed, results suggest that poorly-structured team work may actually facilitate stress and pressure in the workplace. Conversely, well-structured real teams serve to reduce stress and work pressure, which in turn not only enhances the working lives and well-being of psychiatric nurses, but also greatly improves the service that the NHS provides to its users.

Stressful times call for team-based measures:psychiatric nursing in the UK National Health Service

Background: Team-based working is now an inherent part of effective health care delivery. Previous research has identified that team working is associated with positive mental health and well-being outcomes for individuals operating in an effective team environment. This is a particularly important topic in the health services context, although little empirical attention has been paid to mental-health services. Psychiatric nurses work on a day-to-day basis with a particularly stressful and demanding client group in an environment which is characterised by high demands, uncertainty, and limited resources. This paper specifically focuses on psychiatric nurses working in National Health Service (NHS) and casts some light on the ways in which effective team-based working can help to alleviate a number of occupational stressors and strains. Method: A questionnaire method (2005 NHS Staff Survey) was employed to collect data from 6655 psychiatric nurses from 64 different NHS Trusts. The hypotheses were concerned with four overall measures from the survey; effective team working, occupational stress, work pressure and social support. Hypothesis 1 stated that effective team working will have a significant negative relationship with occupational stress and work pressure. Further, Hypothesis 2 stated that social support from supervisors and co-workers will moderate this relationship. Findings: Data was treated with a series of regression analyses. For Hypothesis 1, working in a real team did have main effects on work pressure and accounted for 1.6 per cent of the variance. Using the Nagelkerke R square value, working in a real team also had main effects on occupational stress an accounted for approximately 2.8 per cent of the variance. Further, the Exp (B) value of 0.662 suggests that the odds of suffering from occupational stress are cut by 33.8 per cent when a psychiatric nurse works in a real team. Results failed to provide support for Hypothesis 2. The analysis then went on to adopt a unique approach for assessing the extent of real team-based working, distinguishing between real teams, and a number of pseudo team typologies, as well as the absence of teamwork all together. As was hypothesised, results demonstrated that psychiatric nurses working in real teams (ones with clear objectives, where-by team members work closely with one another to achieve team objectives and meet regularly to discuss team effectiveness and how it can be improved) experienced the lowest levels of stress and work pressure of the sample. However, contrary to prediction, results indicated that psychiatric nurses working in any type of pseudo team actually experienced significantly higher levels of stress and work pressure than those who did not report as working in a team at all. Discussion: These findings have serious implications for NHS Mental Health Trusts, which may not be implementing, structuring and managing their nursing teams adequately. Indeed, results suggest that poorly-structured team work may actually facilitate stress and pressure in the workplace. Conversely, well-structured real teams serve to reduce stress and work pressure, which in turn not only enhances the working lives and well-being of psychiatric nurses, but also greatly improves the service that the NHS provides to its users.

Dynamic decision networks for decision-making in self-adaptive systems:a case study

Bayesian decision theory is increasingly applied to support decision-making processes under environmental variability and uncertainty. Researchers from application areas like psychology and biomedicine have applied these techniques successfully. However, in the area of software engineering and speci?cally in the area of self-adaptive systems (SASs), little progress has been made in the application of Bayesian decision theory. We believe that techniques based on Bayesian Networks (BNs) are useful for systems that dynamically adapt themselves at runtime to a changing environment, which is usually uncertain. In this paper, we discuss the case for the use of BNs, speci?cally Dynamic Decision Networks (DDNs), to support the decision-making of self-adaptive systems. We present how such a probabilistic model can be used to support the decision making in SASs and justify its applicability. We have applied our DDN-based approach to the case of an adaptive remote data mirroring system. We discuss results, implications and potential bene?ts of the DDN to enhance the development and operation of self-adaptive systems, by providing mechanisms to cope with uncertainty and automatically make the best decision.

A method for systematic artifact selection decision making

Artifact selection decisions typically involve the selection of one from a number of possible/candidate options (decision alternatives). In order to support such decisions, it is important to identify and recognize relevant key issues of problem solving and decision making (Albers, 1996; Harris, 1998a, 1998b; Jacobs & Holten, 1995; Loch & Conger, 1996; Rumble, 1991; Sauter, 1999; Simon, 1986). Sauter classifies four problem solving/decision making styles: (1) left-brain style, (2) right-brain style, (3) accommodating, and (4) integrated (Sauter, 1999). The left-brain style employs analytical and quantitative techniques and relies on rational and logical reasoning. In an effort to achieve predictability and minimize uncertainty, problems are explicitly defined, solution methods are determined, orderly information searches are conducted, and analysis is increasingly refined. Left-brain style decision making works best when it is possible to predict/control, measure, and quantify all relevant variables, and when information is complete. In direct contrast, right-brain style decision making is based on intuitive techniques—it places more emphasis on feelings than facts. Accommodating decision makers use their non-dominant style when they realize that it will work best in a given situation. Lastly, integrated style decision makers are able to combine the left- and right-brain styles—they use analytical processes to filter information and intuition to contend with uncertainty and complexity.

Humidity responsivity of poly(methyl methacrylate)-based optical fiber Bragg grating sensors

The humidity response of poly(methyl methacrylate) (PMMA)-based optical fiber Bragg gratings (POFBGs) has been studied. The characteristic wavelength of the grating is modulated by water absorption-induced swelling and refractive index change in the fiber. This work indicates that anisotropic expansion may exist in PMMA optical fiber, reducing the humidity responsivity of the grating and introducing uncertainty in the responsivity from fiber to fiber. By pre-straining a grating, one can get rid of this uncertainty and simultaneously improve the POFBG response time. © 2014 Optical Society of America.

Building bank brands:how leadership behavior influences employee commitment

Front line employees are critical to service brand success, as their performance brings brand promises to life. Banking employees, like others, must remain committed to their employers, to live the brand, particularly during periods of economic uncertainty and customer frustration. Employees' commitment influences their brand adoption and brand-supporting behavior during service encounters. Effective leadership fosters employee commitment and brand supporting behaviors. This study examines the nature of employee commitment in banking, distinguishing between affective, continuance and normative commitment. The study explores bank leaders, examining whether initiating structure leader behavior or considerate leader behavior is most effective in encouraging employee commitment. Data from a sample of 438 employees in a leading Irish bank reveals the optimal leadership style for employee commitment. © 2012 Elsevier Inc.

Fuzzy Membership Functions in a Fuzzy Decision Making Problem

Authors analyses questions of the subjective uncertainty and inexactness situations in the moment of using expert information and another questions which are connected with expert information uncertainty by fuzzy sets with rough membership functions in this article. You can find information about integral problems of individual expert marks and about connection among total marks “degree of inexactness” with sensibility of measurement scale. A lot of different situation which are connected with distribution of the function accessory significance and orientation of the concrete take to task decision making are analyses here.

'In reality it's almost impossible':CLT-oriented curriculum change

Curriculum innovation is challenging and, as several commentators have reported, moves to introduce communicative language teaching in many contexts internationally have resulted in mixed outcomes, or even failure. In an effort to shed some light on this complex problem, this article focuses on curriculum change through the introduction of new communicative textbooks in an engineering college (kosen) in Japan. First, three key factors that inhibit change are considered and then other factors that specifically hindered change in the kosen environment are identified. A study investigating the attitudes and classroom practices of four Japanese teachers of English highlighted a culture of pedagogical uncertainty and lack of professional support. Suggestions for supporting teachers to implement curriculum change more effectively, both in Japan and elsewhere, are drawn out.

Economical analysis for investment on measuring systems

Metrology processes contribute to entire manufacturing systems that can have a considerable impact on financial investment in coordinate measuring systems. However, there is a lack of generic methodologies to quantify their economical value in today’s industry. To solve this problem, a mathematical model is proposed in this paper by statistical deductive reasoning. This is done through defining the relationships between Process Capability Index, measurement uncertainty and tolerance band. The correctness of the mathematical model is proved by a case study. Finally, several comments and suggestions on evaluating and maximizing the benefits of metrology investment are given.

Plaintext Recovery in DES-like Cryptosystems Based on S-boxes with Embedded Parity Check

We describe an approach for recovering the plaintext in block ciphers having a design structure similar to the Data Encryption Standard but with improperly constructed S-boxes. The experiments with a backtracking search algorithm performing this kind of attack against modified DES/Triple-DES in ECB mode show that the unknown plaintext can be recovered with a small amount of uncertainty and this algorithm is highly efficient both in time and memory costs for plaintext sources with relatively low entropy. Our investigations demonstrate once again that modifications resulting to S-boxes which still satisfy some design criteria may lead to very weak ciphers. ACM Computing Classification System (1998): E.3, I.2.7, I.2.8.