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.

Analysis of electronic and telematic voting systems in binding experiences

This paper is about analysis and assess of three experiences on telematic and electronic voting dealing with such aspects as security and achievement of the social requirements. These experiences have been chosen taking into account the deepness of the public documentation and the technological challenge they faces.

Analysis of electronic and telematic voting systems in binding experiences.

This paper is about analysis and assess of three experiences on telematic and electronic voting dealing with such aspects as security and achievement of the social requirements. These experiences have been chosen taking into account the deepness of the public documentation and the technological challenge they faces.

Evaluation of three solar and daylighting control systems based on Calumen II, Ecotect and Radiance simulation programs to obtain an energy efficient and healthy interior in the experimental building prototype SDE10

Evaluation of three solar and daylighting control systems based on Calumen II, Ecotect and Radiance simulation programs to obtain an energy efficient and healthy interior in the experimental building prototype SDE10

Interaction between interconnected and isolated grounding systems: a case study of transferred potentials

The effect caused by ground fault current in a complex system of interacting electrodes is theoretically studied. The calculation applies to a specific case in which a set of interconnected electrodes, which are part of a grounding facility network, are activated by a ground fault current. Transferred potentials to adjacent passive electrodes are calculated and the most relevant parameters of the electrode system are evaluated. Finally, the convenience of connecting the grounding electrodes is discussed.

Tour virtual: una forma eficiente de realizar evaluaciones tempranas en aplicaciones de paciente

Tradicionalmente, los sistemas de ayuda a la decisión (Decision Support Systems, DSS) han estado dirigidos a los profesionales médicos; sin embargo también pueden ayudar a aquellos pacientes que desean tener un papel más activo en el cuidado de su salud. Además, los pacientes quieren ser tratados en el momento en que su estado de salud lo requiera, sin importar el lugar en el que se encuentren. El sistema MobiGuide proporciona un soporte personalizado y basado en evidencia clínica tanto a profesionales médicos como a pacientes en todo momento y en todo lugar. La aplicación móvil del paciente representa el punto de acceso al servicio y, por tanto, es responsable en gran medida del éxito o fracaso del sistema. En MobiGuide, se ha incorporado a los pacientes desde el comienzo en el proceso de diseño y evaluación de la aplicación para garantizar una adecuada funcionalidad y usabilidad del sistema. En este trabajo presentamos la primera evaluación realizada por los pacientes mediante un tour virtual por la Aplicación de Paciente. Los resultados son altamente positivos y útiles para mejorar la aplicación, corregir defectos y conseguir la aplicación final esperada por los pacientes.

Agreement Abstractions in Anonymous and Homonymous Distributed Systems Prone to Failures

The distributed computing models typically assume every process in the system has a distinct identifier (ID) or each process is programmed differently, which is named as eponymous system. In such kind of distributed systems, the unique ID is helpful to solve problems: it can be incorporated into messages to make them trackable (i.e., to or from which process they are sent) to facilitate the message transmission; several problems (leader election, consensus, etc.) can be solved without the information of network property in priori if processes have unique IDs; messages in the register of one process will not be overwritten by others process if this process announces; it is useful to break the symmetry. Hence, eponymous systems have influenced the distributed computing community significantly either in theory or in practice. However, every thing in the world has its own two sides. The unique ID also has disadvantages: it can leak information of the network(size); processes in the system have no privacy; assign unique ID is costly in bulk-production(e.g, sensors). Hence, homonymous system is appeared. If some processes share the same ID and programmed identically is called homonymous system. Furthermore, if all processes shared the same ID or have no ID is named as anonymous system. In homonymous or anonymous distributed systems, the symmetry problem (i.e., how to distinguish messages sent from which process) is the main obstacle in the design of algorithms. This thesis is aimed to propose different symmetry break methods (e.g., random function, counting technique, etc.) to solve agreement problem. Agreement is a fundamental problem in distributed computing including a family of abstractions. In this thesis, we mainly focus on the design of consensus, set agreement, broadcast algorithms in anonymous and homonymous distributed systems. Firstly, the fault-tolerant broadcast abstraction is studied in anonymous systems with reliable or fair lossy communication channels separately. Two classes of anonymous failure detectors AΘ and AP∗ are proposed, and both of them together with a already proposed failure detector ψ are implemented and used to enrich the system model to implement broadcast abstraction. Then, in the study of the consensus abstraction, it is proved the AΩ′ failure detector class is strictly weaker than AΩ and AΩ′ is implementable. The first implementation of consensus in anonymous asynchronous distributed systems augmented with AΩ′ and where a majority of processes does not crash. Finally, a general consensus problem– k-set agreement is researched and the weakest failure detector L used to solve it, in asynchronous message passing systems where processes may crash and recover, with homonyms (i.e., processes may have equal identities), and without a complete initial knowledge of the membership.

Agreement Abstractions in Anonymous and Homonymous Distributed Systems Prone to Failures

The distributed computing models typically assume every process in the system has a distinct identifier (ID) or each process is programmed differently, which is named as eponymous system. In such kind of distributed systems, the unique ID is helpful to solve problems: it can be incorporated into messages to make them trackable (i.e., to or from which process they are sent) to facilitate the message transmission; several problems (leader election, consensus, etc.) can be solved without the information of network property in priori if processes have unique IDs; messages in the register of one process will not be overwritten by others process if this process announces; it is useful to break the symmetry. Hence, eponymous systems have influenced the distributed computing community significantly either in theory or in practice. However, every thing in the world has its own two sides. The unique ID also has disadvantages: it can leak information of the network(size); processes in the system have no privacy; assign unique ID is costly in bulk-production(e.g, sensors). Hence, homonymous system is appeared. If some processes share the same ID and programmed identically is called homonymous system. Furthermore, if all processes shared the same ID or have no ID is named as anonymous system. In homonymous or anonymous distributed systems, the symmetry problem (i.e., how to distinguish messages sent from which process) is the main obstacle in the design of algorithms. This thesis is aimed to propose different symmetry break methods (e.g., random function, counting technique, etc.) to solve agreement problem. Agreement is a fundamental problem in distributed computing including a family of abstractions. In this thesis, we mainly focus on the design of consensus, set agreement, broadcast algorithms in anonymous and homonymous distributed systems. Firstly, the fault-tolerant broadcast abstraction is studied in anonymous systems with reliable or fair lossy communication channels separately. Two classes of anonymous failure detectors AΘ and AP∗ are proposed, and both of them together with a already proposed failure detector ψ are implemented and used to enrich the system model to implement broadcast abstraction. Then, in the study of the consensus abstraction, it is proved the AΩ′ failure detector class is strictly weaker than AΩ and AΩ′ is implementable. The first implementation of consensus in anonymous asynchronous distributed systems augmented with AΩ′ and where a majority of processes does not crash. Finally, a general consensus problem– k-set agreement is researched and the weakest failure detector L used to solve it, in asynchronous message passing systems where processes may crash and recover, with homonyms (i.e., processes may have equal identities), and without a complete initial knowledge of the membership.

Molecular Interaction Map of the Mammalian Cell Cycle Control and DNA Repair Systems

Eventually to understand the integrated function of the cell cycle regulatory network, we must organize the known interactions in the form of a diagram, map, and/or database. A diagram convention was designed capable of unambiguous representation of networks containing multiprotein complexes, protein modifications, and enzymes that are substrates of other enzymes. To facilitate linkage to a database, each molecular species is symbolically represented only once in each diagram. Molecular species can be located on the map by means of indexed grid coordinates. Each interaction is referenced to an annotation list where pertinent information and references can be found. Parts of the network are grouped into functional subsystems. The map shows how multiprotein complexes could assemble and function at gene promoter sites and at sites of DNA damage. It also portrays the richness of connections between the p53-Mdm2 subsystem and other parts of the network.