Understanding and Characterizing Shared Decision-Making and Behavioral Intent in Medical Uncertainty

Applying Theoretical Constructs to Address Medical Uncertainty Situations involving medical reasoning usually include some level of medical uncertainty. Despite the identification of shared decision-making (SDM) as an effective technique, it has been observed that the likelihood of physicians and patients engaging in shared decision making is lower in those situations where it is most needed; specifically in circumstances of medical uncertainty. Having identified shared decision making as an effective, yet often a neglected approach to resolving a lack of information exchange in situations involving medical uncertainty, the next step is to determine the way(s) in which SDM can be integrated and the supplemental processes that may facilitate its integration. SDM involves unique types of communication and relationships between patients and physicians. Therefore, it is necessary to further understand and incorporate human behavioral elements - in particular, behavioral intent - in order to successfully identify and realize the potential benefits of SDM. This paper discusses the background and potential interaction between the theories of shared decision-making, medical uncertainty, and behavioral intent. Identifying Shared Decision-Making Elements in Medical Encounters Dealing with Uncertainty A recent summary of the state of medical knowledge in the U.S. reported that nearly half (47%) of all treatments were of unknown effectiveness, and an additional 7% involved an uncertain tradeoff between benefits and harms. Shared decision-making (SDM) was identified as an effective technique for managing uncertainty when two or more parties were involved. In order to understand which of the elements of SDM are used most frequently and effectively, it is necessary to identify these key elements, and understand how these elements related to each other and the SDM process. The elements identified through the course of the present research were selected from basic principles of the SDM model and the “Data, Information, Knowledge, Wisdom” (DIKW) Hierarchy. The goal of this ethnographic research was to identify which common elements of shared decision-making patients are most often observed applying in the medical encounter. The results of the present study facilitated the understanding of which elements patients were more likely to exhibit during a primary care medical encounter, as well as determining variables of interest leading to more successful shared decision-making practices between patients and their physicians. Understanding Behavioral Intent to Participate in Shared Decision-Making in Medically Uncertain Situations Objective: This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent of men between the ages of 45-70 with regard to participating in shared decision-making in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information which may facilitate greater understanding, efficiency and effectiveness of doctor-patient consultations.Design: Qualitative Study using deductive content analysisSetting: Individual semi-structure patient interviews were conducted until data saturation was reached. Researchers read the transcripts and developed a list of codes.Subjects: 25 subjects drawn from the Philadelphia community.Measurements: Qualitative indicators were developed to measure respondents’ experiences and beliefs related to behavioral intent to participate in shared decision-making during medical uncertainty. Subjects were also asked to complete the Krantz Health Opinion Survey as a method of triangulation.Results: Several factors were repeatedly described by respondents as being essential to participate in shared decision-making in medical uncertainty. These factors included past experience with medical uncertainty, an individual’s personality, and the relationship between the patient and his physician.Conclusions: The findings of this study led to the development of a category framework that helped understand an individual’s needs and motivational factors in their intent to participate in shared decision-making. The three main categories include 1) an individual’s representation of medically uncertainty, 2) how the individual copes with medical uncertainty, and 3) the individual’s behavioral intent to seek information and participate in shared decision-making during times of medically uncertain situations.

How I Learned to Stop Worrying and Love the Bits: Archival Motivation in the Digital Age

Why do people become archivists? Historically (and anecdotally) it was a deep love of musty, old records that drew people to the profession. While there have been many other motivating forces that inspired would-be archivists, it is most often that one hears of people seeking jobs in archives for love of “the stuff,” as evidenced in Kate Thiemer’s blog post, Honest tips for wannabe archivists (2012). As a result of the continually advancing presence of digitized and born digital archival collections, the physical nature of archival “stuff” is changing. While there remains the physical imprint of digital information on floppy disks, CDs, DVDs, hard drives, and old computers; the aspects of these physical artifacts might not evoke the same visceral pull to the profession as musty, raspy, paper-based documents. In light of this shift in physical presentation of information, we are faced with the question: how does love of archival “stuff” translate to work in digital archives? What is and/or will be the pull to become a digital archivist? To answer these questions, we will perform a survey-based study where we will invite archivists who work with both traditional and digital archival material to answer questions related to the aspects of their work that inspired or motivated them to join the profession. What motivates people to become archivists? What aspects of digital archives do or can potentially motivate people to seek out a career as an archivist? What, if any, motivational factors for becoming a traditional archivist are the same as those for becoming a digital archivist? What, if any, motivational factors for becoming a traditional archivist are different from those for becoming a digital archivist? By answering these questions, we hope to expand the archival discussion on what it means to be an archivist in the digital age. What compelling intrinsic, evidential, or informational values are present in digital archival content that will draw professionals to the field? Are there other values inherent in digital content that are currently unexplored? In our poster, we will present our discussion of the topic, our survey design, and results we have at the time of the Institute. Thiemer, K. (2012). Honest tips for wannabe archivists. Archivesnext blog. Retrieved from http://www.archivesnext.com/?p=2849

New developments in occupational stress : proceedings of a conference held in Los Angeles, California, 13 November 1978 /

Mode of access: Internet.

Occupational stress : proceedings of the Conference on Occupational Stress, Los Angeles, November 3, 1977.

Mode of access: Internet.

The role of management incentives in successful information systems development and implementation

Because organizations are making large investments in Information systems (IS), efficient IS project management has been found critical to success. This study examines how the use of incentives can improve the project success. Agency theory is used to: identify motivational factors of project success, help the IS owners to understand to what extent management incentives can improve IS development and implementation (ISD/I). The outcomes will help practitioners and researchers to build on theoretical model of project management elements which lead to project success. Given the principal-agent nature of most significant scale of IS development, insights that will allow for greater alignment of the agent’s goals with those of the principal through incentive contracts, will serve to make ISD/I both more efficient and more effective, leading to more successful IS projects.

ESPIRITISMO E CONVERSÃO: FATORES MOTIVACIONAIS DA MIGRAÇÃO RELIGIOSA PARA O ESPIRITISMO, NO BRASIL.

Este trabalho faz um estudo analítico do fenômeno da conversão religiosa. Particularmente, dos fatores que motivam o trânsito de fiéis de uma religião qualquer para o Espiritismo, no Brasil. Os grupos em estudo, dos quais são provenientes os novos espíritas foram divididos em sete blocos: Catolicismo, Protestantismo, afro-brasileiras, Umbanda, orientais, outras e, nenhuma. Essa análise privilegia os fatores sociais e psicológicos que levam um indivíduo a mudar de religião. Ao explorar o caso brasileiro, este trabalho aborda também, a multiplicidade de religiões, seitas, crenças e movimentos religiosos presentes no cenário brasileiro, dentro da dinâmica de forças que envolvem esse campo religioso. Para isso, é apresentado um resumo da história dos principais movimentos religiosos no caso brasileiro. Dá-se ênfase ao Espiritismo no Brasil e no mundo, como forma de caracterizar os processos de evolução da Doutrina Espírita e os argumentos com que a essa Doutrina compete nesse mosaico de convicções religiosas. A pesquisa se apoia em um questionário distribuído em todo território nacional, que coleta dos respondentes, dados que permitem qualificá-los sob diversos aspectos: renda, educação, localização regional, conhecimento e prática da Doutrina Espírita, etc. Dentro dos quesitos de consulta estão sugeridas 18 opções, como razões da mudança da religião para o Espiritismo e, em outros vinte quesitos, um aprofundamento da opção que, no conjunto anterior se apresentou como a mais frequente. As opções iniciais se distribuem entre as razões mais frequentes da mudança de religião observadas pelo autor em sua experiência pessoal e na literatura. Os dados estatísticos foram coletados de mais de 2.300 depoentes, em mais de 400 municípios, em todos os Estados do Brasil.

Diversity and the perceived barriers to participation in volunteer activity by older people

The first chapter introduces the subject from a psychological and sociological perspective emphasising the basic human activity of helping those in need. Governmental prominence for policies that assist this activity is briefly discussed with special mention of the programmes that encourage volunteering. Programmes particularly directed at older people, such as the Age Concern ‘Debate of the Age’ are considered briefly. An extensive review of the extant literature is the subject of the second chapter. The pervious research is explored to discover the formulae used to define a volunteer. A definition relative to this research is created. Volunteering issues aggravated by the demographic situation of older people are explored. Empirical volunteer survey research by mutual organisations is explored to ascertain the extent and nature of the already recorded volunteer population. The penultimate section of this chapter investigates the nature of old age and the strategies that older people adopt to enjoy the benefits and contain the problems. The issue of diversity arises from consideration of the literature suggesting that, although it is an essential voluntary sector strength, it is also a further barrier to recruitment. A model diversity is proposed. Chapter three reviews the theoretical processes, procedures and technologies used to collect and analyse the data required to discover the answer to the research problem. Analysis of the questionnaire survey data received is the subject of chapter four. The discovery of the agency uniqueness of volunteer profiles is the principle finding of this part of the research. The fifth chapter is the qualitative analysis of the oral and written statements received. A content analysis of the scripts and texts provided rich data covering motivational factors. Motivational factors were the same for volunteers in the same organisation, but differed between organisations. Finally, the analysed data is collated and discussed progressively toward a theory of diversity. The individuality of each branch of each agency is progressively described culminating in the creation of a model that infers that diversity is a barrier that aggravates all other barriers. The personal realisations of the researcher are described.

Vállalati döntés egy új információbiztonsági eszköz, a kvantumkulcscsere bevezetéséről (Corporate decision about the installation of a new information security device the quantum key distribution)

A szerzők tanulmányukban az információbiztonság egy merőben új, minőségi változást hozó találmányával, a kvantumkulcscserével (QKD-vel – quantum key distribution) foglalkoznak. Céljuk az, hogy az újdonságra mint informatikai biztonsági termékre tekintsenek, és megvizsgálják a bevezetéséről szóló vállalati döntés során felmerülő érveket, ellenérveket. Munkájuk egyaránt műszaki és üzleti szemléletű. Előbb elkülönítik a kvantumkulcscsere hagyományos eljárásokkal szembeni használatának motiváló tényezőit, és megállapítják, milyen körülmények között szükséges a napi működésben alkalmazni. Ezt követően a forgalomban is kapható QKD-termékek tulajdonságait és gyártóit szemügyre véve megfogalmazzák a termék széles körű elterjedésének korlátait. Végül a kvantumkulcscsere-termék bevezetéséről szóló vállalati döntéshozás különböző aspektusait tekintik át. Információbiztonsági és üzleti szempontból összehasonlítják az új, valamint a hagyományosan használt kulcscsereeszközöket. Javaslatot tesznek a védendő információ értékének becslésére, amely a használatbavétel költség-haszon elemzését támaszthatja alá. Ebből levezetve megállapítják, hogy mely szervezetek alkotják a QKD lehetséges célcsoportját. Utolsó lépésként pedig arra keresik a választ, melyik időpont lehet ideális a termék bevezetésére. _____ This study aims to illuminate Quantum Key Distribution (QKD), a new invention that has the potential to bring sweeping changes to information security. The authors’ goal is to present QKD as a product in the field of IT security, and to examine several pro and con arguments regarding the installation of this product. Their work demonstrates both the technical and the business perspectives of applying QKD. First they identify motivational factors of using Quantum Key Distribution over traditional methods. Then the authors assess under which circumstances QKD could be necessary to be used in daily business. Furthermore, to evaluate the limitations of its broad spread, they introduce the vendors and explore the properties of their commercially available QKD products. Bearing all this in mind, they come out with numerous factors that can influence corporate decision making regarding the installation of QKD. The authors compare the traditional and the new tools of key distribution from an IT security and business perspective. They also take efforts to estimate the value of the pieces of information to be protected. This could be useful for a subsequent cost–benefit analysis. Their findings try to provide support for determining the target audience of QKD in the IT security market. Finally the authors attempt to find an ideal moment for an organization to invest in Quantum Key Distribution.

Munkahelyi motivációk Magyarországon 2013-ban (Workplace motivations in Hungary in 2013)

A motiváció szerepe a szervezetek életében alapvető fontossággal bír. A tanulmány egy friss reprezentatív kutatás eredményeit mutatja be, amelyet a szerzők a magyar munkavállalók körében végeztek annak érdekében, hogy feltárják a hazai motivációs viszonyokat és a munkavállalók számára legfontosabb tényezőket. A korábbi évek felmérései szerint a legfontosabb hazai motivációs tényezők a versenyképes fizetés, a cafeteria, a karrierlehetőség és az előrelépési lehetőségek voltak. A kutatás bizonyította, hogy az elmúlt időszakban átrendeződés figyelhető meg, egyre inkább előtérbe kerülnek olyan tényezők, amelyek a biztonsággal, a stabilitással, a jó munkahelyi légkörrel és a megfelelő kapcsolatokkal függnek össze. A szerzők megvizsgálták egy francia motivációs modell lehetséges magyarországi alkalmazását is, amelynek során szintén megmutatkoztak a magyar sajátosságok. A modell elemei közül bizonyos területek fontosabbak a hazai munkavállalók számára. A modell hazai adaptációja színesítheti a hazai motivációs megoldások kínálatát. ______ Motivation has an essential role in the operation of the organisations. The study represents the results of a recent representative research which was conducted by the authors among Hungarian workers. The aim was to explore the domestic motivational relations and the key motivational factors of employees. According to the surveys of previous years the main Hungarian motivating factors were competitive salary, cafeteria, career opportunities and advancement opportunities. The research has proved that rearrangement could be observed in the last period. Those factors have increasingly come to the forefronts which are related to safety, stability, appropriate work environment and appropriate employee relations. The authors have examined the possible domestic application of a French motivational model, besides the Hungarian specialties were also reflected. Some elements of the model are more important than the others for domestic workers. The adaptation of the model could make the domestic motivational solution offerings more relevant and manifold.

GRE as a predictor of graduate student success at a Hispanic serving institution of higher education

Accurately predicting the success of graduate students is an important aspect of determining which students should be admitted into graduate programs. The GRE is a pivotal factor to examine since it is one of the most widely used criteria for graduate school admission. Even though the GRE is advertised as an accurate tool for predicting first year graduate GPA, there is a lack of research on long term success factors such as time to degree and graduate rate (Luthy, 1996; Powers, 2004). Furthermore, since most studies have low minority sample sizes, the validity of the GRE may not be the same across all groups (ETS, 2008b; Kuncel, Hezlett, & Ones, 2001). Another gap in GRE studies is that few researchers analyze student characteristics, which may alter or moderate the prediction validity of the GRE. Thus, student characteristics such as degree of academic involvement, mentorship interactions, and other academic and social experiences have not been widely examined in this context. These gaps in the analysis of GRE validity are especially relevant given the high attrition rates within of some graduate programs (e.g., an estimated 68% of doctoral student never complete their programs in urban universities; Lovitts, 2001). A sequential mixed methods design was used to answer the research questions in two phases. The quantitative phase used student data files to analyze the relationship of two success variables (graduation rate and graduate GPA) to the GRE scores as well as other academic and demographic graduate student characteristics. The qualitative phase served to complement the first phase by describing a wider range of characteristics from the 11 graduate students who were interviewed. Both proximal and distal moderators influence student behaviors and success in graduate school. In the first phase of the study, the GRE was the distal facilitator under analysis. Findings suggested that both the GRE Quantitative and the GRE Verbal were predictors of success for master’s students, but the GRE Quantitative was not predictive of success for doctoral students. Other student characteristics such as demographic variables and disciplinary area were also predictors of success for the population of students studied. In the second phase of the study, it was inconclusive whether the GRE was predictive of graduate student success; though it did influence access to graduate programs. Furthermore, proximal moderators such as student involvement, faculty/peer interactions, motivational factors, and program structure were perceived to be facilitators and/or detractors for success.

Predictors of client retention in alternative -to -prison substance abuse programs

Increased treatment retention among substance abusing individuals has been associated with reduced drug use, fewer arrests, and decreased unemployment, as well as a reduction in health risk behaviors. This longitudinal study examined the predictors of client retention for alternative to prison substance abuse treatment programs through assessing the roles of motivational factors and the client-worker relationship. The sample was comprised of 141 male felony offenders who were legally mandated to community based long-term residential drug treatment programs. ^ The primary measures used in the study were the consecutive days a participant remained in treatment, Stages of Change Readiness Model and Treatment Eagerness Scale (SOCRATES), the Working Alliance Inventory (WAI), and The Readiness Ruler. Hierarchical multiple regression analysis was conducted for four hypotheses (a) participants who are more motivated to change at the time of entry will remain in treatment longer, (b) participants who have a strong therapeutic alliance will remain in treatment a greater number of consecutive days than participants who have weaker therapeutic alliance, (c) motivation to change, as measured at treatment entry, will be positively related to therapeutic alliance, (d) during the course of treatment variation in motivation to change will be predicted by the therapeutic alliance. ^ Results support the following conclusions: Among clients in alternative-to prison programs the number of days in treatment is positively related to their motivation to change. The therapeutic alliance is not a predictor of the number of days in treatment. Motivation to change, particularly recognition of a drug problem, is positively related to the therapeutic alliance. Changes in motivation to change in response to treatment are positively related to the therapeutic alliance among clients in an alternative to prison substance abuse treatment programs. These results carry forward prior research and have implications for social work practice, research, and social welfare policy. ^

Using the Involvement Construct to Understand the Motivations of Customers of Casual Dining Restaurants in the USA

The purpose of this study was to investigate the motivations that push consumers to dine out and restaurant attributes that pull diners to a specific restaurant. Surveys were administered to a convenience sample of 559 respondents at a large university in the Southwest of the USA. Crosstabs, ANOVA, Correlations, Factor Analysis and Multiple Regression were employed to explore differences and relationships between variables. Findings identified a profile of diners at casual restaurants. Using the involvement construct, the push-pull motivational framework, and the hedonic and utilitarian motivational framework, results of this study indicate two primary reasons behind the decision to dine out at casual restaurants and six principal attributes that draw customers into these types of restaurants. In addition, diners were categorized into high/medium/low involvement categories and the linkages between involvement levels and motivations were explored. Both hedonic and utilitarian motivations were identified. Furthermore, motivational factors and restaurant attributes were found to predict diner loyalty. This paper provides the restaurant industry with insight and understanding as to what attracts diners into an establishment and what influences decisions behind dining out.

Predictors of client retention in alternative to prison substance abuse programs

Increased treatment retention among substance abusing individuals has been associated with reduced drug use, fewer arrests, and decreased unemployment, as well as a reduction in health risk behaviors. This longitudinal study examined the predictors of client retention for alternative to prison substance abuse treatment programs through assessing the roles of motivational factors and the client-worker relationship. The sample was comprised of 141 male felony offenders who were legally mandated to community based long-term residential drug treatment programs. The primary measures used in the study were the consecutive days a participant remained in treatment, Stages of Change Readiness Model and Treatment Eagerness Scale (SOCRATES), the Working Alliance Inventory (WAI), and The Readiness Ruler. Hierarchical multiple regression analysis was conducted for four hypotheses (a) participants who are more motivated to change at the time of entry will remain in treatment longer, (b) participants who have a strong therapeutic alliance will remain in treatment a greater number of consecutive days than participants who have weaker therapeutic alliance, (c) motivation to change, as measured at treatment entry, will be positively related to therapeutic alliance, (d) during the course of treatment variation in motivation to change will be predicted by the therapeutic alliance. Results support the following conclusions: Among clients in alternative-to prison programs the number of days in treatment is positively related to their motivation to change. The therapeutic alliance is not a predictor of the number of days in treatment. Motivation to change, particularly recognition of a drug problem, is positively related to the therapeutic alliance. Changes in motivation to change in response to treatment are positively related to the therapeutic alliance among clients in an alternative to prison substance abuse treatment programs. These results carry forward prior research and have implications for social work practice, research, and social welfare policy.

Key determinants of organisational silence for non-standard workers

Purpose – The purpose of this paper is to identify the key determinants of organisational silence from the perspective of non-standard workers (NSWs). The study focuses on three research themes: first, analysing the experiences motivating NSWs to remain silent; second, analysing the role of the NSW life cycle in the motivation to remain silent, the final theme is evaluation of the impact on organisational voice of an organisation employing a workforce in which NSWs and standard workers (SWs) are blended. Design/methodology/approach – The study utilises a phenomenological approach, as defined by Van Manen (2007), to collect and analyse the phenomenon of organisational silence from the perspective of NSWs. The NSWs are defined as individuals operating via Limited Liability UK registered companies created for the purpose of delivering services to organisations via a contract of services. This study employed a combination of phenomenology and hermeneutics to collect and analyse the data collected from the NSWs using semi-structured interviews (Lindseth and Norberg, 2004). Findings – The study concludes with three core findings. NSWs experience similar motivational factors to silence as experienced by standard workers (SWs). The key differential between a SW and a NSW is the role of defensive silence as a dominant motivator for a start-up NSW. The study identified that the reasons for this is that new NSWs are defensive to protect their reputation for any future contract opportunities. In addition, organisations are utilising the low confidence of new start up NSWs to suppress the ability of NSWs to voice. The research indicates how experienced NSWs use the marketing stage of their life cycle to establish voice mechanisms. The study identified that NSWs, fulfiling management and supervisory roles for organisations, are supporting/creating climates of silence through their transfer of experiences as SWs prior to becoming NSWs. Research limitations/implications – This study is a pilot study, and the findings from this study will be carried forward into a larger scale study through engagement with further participants across a diverse range of sectors. This study has identified that there is a need for further studies on organisational silence and NSWs to analyse more fully the impact of silence on the individuals and the organisation itself. A qualitative phenomenological hermeneutical study is not intended to be extrapolated to provide broad trends. The focus of the phenomenological hermeneutic research methodology is on describing and analysing the richness and depth of the NSW’s experiences of silence in organisational settings. Originality/value – This paper draws together the studies of worker classification, motivators for organisational silence, and the impact of blending SWs and NSWs in an organisational setting. The study demonstrates that academic research to date has focused predominantly on SWs to the exclusion of the 1.5 million, and growing, NSWs in the UK. This study examines these under-represented workers to analyse the participants’ experiences of organisational silence, and its consequences in organisational settings, demonstrating a need for further studies.

Organisaation sisäisessä sosiaalisessa mediassa tapahtuvaan tiedon jakamiseen vaikuttavat tekijät

Aineettoman pääoman, erityisesti tiedon, merkitykseen kiinnitetään organisaatioissa entistä enemmän huomiota. Tiedon jakamisen hyödyt ymmärretään ja siinä hyödynnetään yhä enemmän teknologiaa. Tämän tutkielman tavoitteena on selvittää, mitkä tekijät vaikuttavat asiantuntijoiden tiedon jakamiseen organisaation sisäisessä sosiaalisessa mediassa. Tutkimus on kvalitatiivinen tapaustutkimus, ja sen tavoitteisiin pyritään vastaamaan puolistrukturoitujen haastattelujen (12 kpl) avulla. Tutkimuksen kohdeorganisaatio on innovaatiorahoituskeskus Tekes. Tiedon jakamista sisäisessä sosiaalisessa mediassa tutkittiin yksilön näkökulmasta motivaatioon, kykyyn ja mahdollisuuteen perustuvaa MOA-mallia hyödyntäen. Tutkimuksessa löydettiin sekä motivaatioon, kykyyn että mahdollisuuteen liittyviä tekijöitä, jotka vaikuttavat sisäisessä sosiaalisessa mediassa tapahtuvaan tiedon jakamiseen. Motivaatioon liittyvistä tekijöistä nousivat esiin erityisesti jaetun tiedon hyöty asiantuntijan työssä sekä aktiivisten sosiaalisen median käyttäjien määrä, mahdollisuuteen liittyvistä tekijöistä käytettävissä oleva aika sekä tiedon ja tiedon jakamisen kanavien suuri määrä.