A critical narrative analysis of shared decision-making in acute, inpatient mental health care

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients? care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

A Slow March from Social Evil to Harm Reduction: Drugs and Drug Policy in Vietnam

The suppression of drug consumption and trade is high on the Government of Vietnam’s agenda. To accomplish this goal, Vietnam employs repressive policies that often contravene international human rights law. Among the most detrimental and problematic policies are the incarceration of drug users in compulsory treatment centers, and the stigmatization and abuse of consumers by the police. That said, Vietnamese drug policy is slowly changing in the face of one of Asia’s worst ongoing HIV epidemics. While the Communist Government of the early-1990s designated illicit drugs as a “social evil” to be eradicated through punitive and often repressive means, the recent implementation of harm reduction approaches have reduced the level of needle sharing, and thus HIV transmission. This briefing will explore the current trends in drug consumption, production, and trafficking before looking at the key harms and threats associated with drugs in Vietnam. This will be followed by a summary of Vietnam’s drug policies, including the country’s approach to drug treatment, harm reduction, and illicit opium suppression—Vietnam is one of a small number of states to have suppressed illicit opium production, an intervention that centred upon coercive negotiations with limited alternative development. The briefing will conclude with some tentative recommendations for reform and thoughts on what could be expected from Vietnam during the Special Session of the United Nations General Assembly on the World Drug Problem (UNGASS 2016).

LifeSpeeder: a web and mobile platform for events location

The use of smartphones and tablets as become almost banal in these days. Smartphones, besides serving their main purpose of making and receiving calls, come to be one of the main equipments to obtain information from the Internet, using the commonly installed browsers or through the use of dedicated applications. Furthermore, several other devices are also very frequent to the majority of the modern smartphones and tablets in the market (e.g., GPS - Global Positioning System). This devices give the current systems a very high potential of usage. One example of applicability, comes from the wish to find and navigate to events or activities which are or will soon be occurring near the user. The LifeSpeeder platform is one of the first applications in the mobile equipment market of applications which take into consideration exactly what we have just outlined, i.e., a mobile and desktop application which allows the users to locate events according with their preferences and to get help navigating to them. In this paper we briefly describe the LifeSpeeder's front and back-end. © 2014 Springer International Publishing.

Exercise Prescription for Patients with Non-specific Chronic Low Back Pain: a Qualitative Exploration of Decision Making in Physiotherapy Practice

Background: Providing an effective exercise prescription process for patients with non-specific chronic low back pain (NSCLBP) is a challenging task. Emerging research has indicated that partnership in care and shared decision making are important for people with NSCLBP and calls for further investigation into the approaches used to prescribe exercise. Objective: To explore how shared decision making and patient partnership are addressed by physiotherapists in the process of exercise prescription for patients with NSCLBP. Design: A qualitative study using a philosophical hermeneutic approach. Methods: Eight physiotherapists were each observed on three occasions undertaking their usual clinical activities (total n=24 observations). They conducted brief interviews after each observation and a later in depth semi-structured interview. Iterative hermeneutic strategies were used to interpret the texts and identify the characteristics and processes of exercise prescription for patients with NSCLBP. Findings: The findings revealed how physiotherapy practice often resulted in unequal possibilities for patient participation which were in turn linked to the physiotherapists? assumptions about the patients, clinical orientation, cognitive and decision making processes. Three linked themes emerged: (1) I want them to exercise, (2) Which exercise? - the tension between evidence and everyday practice and (3) Compliance-orientated more than concordance based. Conclusions: This research, by focusing on a patient-centred approach, makes an important contribution to the body of evidence relating to the management of NSCLBP. It challenges physiotherapists to critically appraise their approaches to the prescription of exercise therapy in order to improve outcomes for these patients.

Evaluation and Evaluating the Community Initiative "URBAN"

The relevance of the relationship between evaluation and learning is widely acknowledged; as well as the importance of this learning process to support policy decision making and to judge the value of “what was done”, “how” and “with what results”. Although the activity of evaluation is not something new, but a field of knowledge with its own theories and practices, it is important to notice that there is great variability in the tradition and cultures of evaluation between countries. This paper presents and compares different conceptual and methodological frameworks created for the assessment of the European initiative Urban II, including the one that was used by the author in the context of an academic evaluation in the city of Porto. The comparative analysis of the results leads us to the recommendation for more democratic processes of evaluation and intervention, in order to improve their quality and accountability and promote the important goal of learning with this type of experimental initiatives.

Embracing difference and the deferral of self-government: a critical analysis of the framing and practice of contemporary peace building

This thesis analyses how dominant policy approaches to peacebuilding have moved away from a single and universalised understanding of peace to be achieved through a top-down strategy of democratisation and economic liberalisation, prevalent at the beginning of 1990s. Instead, throughout the 2000s, peacebuilders have increasingly adopted a commitment to cultivating a bottom-up and hybrid peace building process that is context-sensitive and intended to be more respectful of the needs and values of post-war societies. The projects of statebuilding in Kosovo and, to a lesser extent, in Bosnia are examined to illustrate the shift. By capturing this shift, I seek to argue that contemporary practitioners of peace are sharing the sensibility of the theoretical critics of liberalism. These critics have long contended that post-war societies cannot be governed from ‘above’ and have advocated the adoption of a bottom-up approach to peacebuilding. Now, both peace practitioners and their critics share the tendency to embrace difference in peacebuilding operations, but this shift has failed to address meaningfully the problems and concerns of post-conflict societies. The conclusion of this research is that, drawing on the assumption that these societies are not capable of undertaking sovereign acts because of their problematic inter-subjective frames, the discourses of peacebuilding (in policy-making and academic critique) have increasingly legitimised an open-ended role of interference by external agencies, which now operate from ‘below’. Peacebuilding has turned into a long-term process, in which international and local actors engage relationally in the search for ever-more emancipatory hybrid outcomes, but in which self-government and self-determination are constantly deferred. Processes of emphasising difference have thus denied the political autonomy of post-war societies and have continuously questioned the political and human equality of these populations in a hierarchically divided world.

What’s in a surname? Physique, aptitude, and sports type comparisons between Tailors and Smiths

Combined heredity of surnames and physique, coupled with past marriage patterns and trade-specific physical aptitude and selection factors, may have led to differential assortment of bodily characteristics among present-day men with specific trade-reflecting surnames (Tailor vs. Smith). Two studies reported here were partially consistent with this genetic-social hypothesis, first proposed by Bäumler (1980). Study 1 (N = 224) indicated significantly higher self-rated physical aptitude for prototypically strength-related activities (professions, sports, hobbies) in a random sample of Smiths. The counterpart effect (higher aptitude for dexterity-related activities among Tailors) was directionally correct, but not significant, and Tailor-Smith differences in basic physique variables were not significant. Study 2 examined two large datasets (Austria/Germany combined, and UK: N = 7001 and 20532) of men’s national high-score lists for track-and-field events requiring different physiques. In both datasets, proportions of Smiths significantly increased from light-stature over medium-stature to heavy-stature sports categories. The predicted counterpart effect (decreasing prevalences of Tailors along these categories) was not supported. Related prior findings, implicit egotism as an alternative interpretation of the evidence, and directions for further inquiry are discussed in conclusion.

Rethinking gossip and scandal in healthcare organizations

Purpose – The purpose of this viewpoint paper is to argue that gossip is a neglected aspect of organizational communication and knowledge, and an under-used management resource. Design/methodology/approach – The paper challenges mainstream managerial assumptions that gossip is trivial or tainted talk which should be discouraged in the workplace. Instead, gossip is re-framed at an organizational level of analysis, which provides the opportunity for relational knowledge about systemic failure and poor practice in healthcare to surface. Findings – Rather than simply viewing gossip as an individual behaviour and interpersonal process, it is claimed that organizational gossip is also a valuable early warning indicator of risk and failure in healthcare systems. There is potentially significant value in re-framing gossip as an aspect of organizational communication and knowledge. If attended to (rather than neglected or silenced) gossip can provide fresh insights into professional practice, decision-making and relational leadership. Originality/value – This paper offers a provocative challenge to mainstream health organization and management thinking about gossip in the workplace. It offers new ways of thinking to promote patient safety, and prevent the scandals that have plagued healthcare organizations in recent years.

Dispachability improvement of wind generation by the virtual power producers

Nowadays, there is a growing environmental concern about were the energy that we use comes from, bringing the att ention on renewable energies. However, the use and trade of renewable e nergies in the market seem to be complicated because of the lack of guara ntees of generation, mainly in the wind farms. The lack of guarantees is usually addressed by using a reserve generation. The aggregation of DG p lants gives place to a new concept: the Virtual Power Producer (VPP). VPPs can reinforce the importance of wind generation technologies, making them valuable in electricity markets. This paper presents some resul ts obtained with a simulation tool (ViProd) developed to support VPPs in the analysis of their operation and management methods and of their strat egies effects.

Application of different heuristic classes in memory-based and stimulus-based decisions

This paper studies the drivers of heuristic application in different decision types. The study compares differences in frequencies of heuristic classes' such as recognition, one-reason choice and trade-off applied in, respectively, memory-based and stimulus-based choices as well as in high and low involvement decisions. The study has been conducted online among 205 participants from 28 countries.

Drivers and Barriers of Collaboration in the Value Chain of Paperboard-Packed Consumer Goods

Value chain collaboration has been a prevailing topic for research, and there is a constantly growing interest in developing collaborative models for improved efficiency in logistics. One area of collaboration is demand information management, which enables improved visibility and decrease of inventories in the value chain. Outsourcing of non-core competencies has changed the nature of collaboration from intra-enterprise to cross-enterprise activity, and this together with increasing competition in the globalizing markets have created a need for methods and tools for collaborative work. The retailer part in the value chain of consumer packaged goods (CPG) has been studied relatively widely, proven models have been defined, and there exist several best practice collaboration cases. The information and communications technology has developed rapidly, offering efficient solutions and applications to exchange information between value chain partners. However, the majority of CPG industry still works with traditional business models and practices. This concerns especially companies operating in the upstream of the CPG value chain. Demand information for consumer packaged goods originates at retailers' counters, based on consumers' buying decisions. As this information does not get transferred along the value chain towards the upstream parties, each player needs to optimize their part, causing safety margins for inventories and speculation in purchasing decisions. The safety margins increase with each player, resulting in a phenomenon known as the bullwhip effect. The further the company is from the original demand information source, the more distorted the information is. This thesis concentrates on the upstream parts of the value chain of consumer packaged goods, and more precisely the packaging value chain. Packaging is becoming a part of the product with informative and interactive features, and therefore is not just a cost item needed to protect the product. The upstream part of the CPG value chain is distinctive, as the product changes after each involved party, and therefore the original demand information from the retailers cannot be utilized as such – even if it were transferred seamlessly. The objective of this thesis is to examine the main drivers for collaboration, and barriers causing the moderate adaptation level of collaborative models. Another objective is to define a collaborative demand information management model and test it in a pilot business situation in order to see if the barriers can be eliminated. The empirical part of this thesis contains three parts, all related to the research objective, but involving different target groups, viewpoints and research approaches. The study shows evidence that the main barriers for collaboration are very similar to the barriers in the lower part of the same value chain; lack of trust, lack of business case and lack of senior management commitment. Eliminating one of them – the lack of business case – is not enough to eliminate the two other barriers, as the operational model in this thesis shows. The uncertainty of the future, fear of losing an independent position in purchasing decision making and lack of commitment remain strong enough barriers to prevent the implementation of the proposed collaborative business model. The study proposes a new way of defining the value chain processes: it divides the contracting and planning process into two processes, one managing the commercial parts and the other managing the quantity and specification related issues. This model can reduce the resistance to collaboration, as the commercial part of the contracting process would remain the same as in the traditional model. The quantity/specification-related issues would be managed by the parties with the best capabilities and resources, as well as access to the original demand information. The parties in between would be involved in the planning process as well, as their impact for the next party upstream is significant. The study also highlights the future challenges for companies operating in the CPG value chain. The markets are becoming global, with toughening competition. Also, the technology development will most likely continue with a speed exceeding the adaptation capabilities of the industry. Value chains are also becoming increasingly dynamic, which means shorter and more agile business relationships, and at the same time the predictability of consumer demand is getting more difficult due to shorter product life cycles and trends. These changes will certainly have an effect on companies' operational models, but it is very difficult to estimate when and how the proven methods will gain wide enough adaptation to become standards.

Partnership, politics and public administration: a case study of the Ontario Ministry of Natural Resources

Efforts to reform the public sector reflect the social, political and economic environment within which government must function. The recent demands by the public for more consensual decision-making, as well as more efficient, effective and responsive public service, have resulted in a number of reform initiatives, including an emphasis on partnership development. The purpose of this thesis is to examine partnership arrangements within the public sector. Specifically, the thesis will assess the value of partnerships and their impact on government by examining six partnership arrangements involving the Ontario Ministry of Natural Resources (OMNR). The OMNR, having recently been awarded the 1992 Institute of Public Administration of Canada Award for Innovative Management, on the theme of partnership development, is being lauded as an example for other government agencies considering similar alliances. The thesis begins by introducing the concept and practice of partnership within the public sector in general and the OMNR specifically. Descriptive analysis of six OMNR partnerships is provided and a number of criteria are used to determine the success of each of these arrangements. Special attention is paid to the political implications of partnerships and to those attributes which appear to contribute to the successful establishment and iii maintenance of partnership arrangements. The conclusion is drawn that partnerships provide the government with an opportunity to address public demands for greater involvement in decision-making while accommodating government's limited financial resources. However, few truly collaborative partnerships exist within the public sector. There are also significant political implications associated with partnerships which must be dealt with both at the political and bureaucratic levels of government. Lastly, it is argued that while partnerships within the OMNR are experiencing some difficulties, they constitute a genuine attempt to broaden the base of decision-making and to incorporate the concerns of stakeholders into resource management.

Individual differences in risk-taking and associated characteristics : a test of specificity in executive functions /

Multiple measures have been devised by clinicians and theorists from many different backgrounds for the purpose of assessing the influence of the frontal lobes on behaviour. Some utilize self-report measures to investigate behavioural characteristics such as risktaking, sensation seeking, impulsivity, and sensitivity to reward and punishment in an attempt to understand complex human decision making. Others rely more on neuroimaging and electrophysiological investigation involving experimental tasks thought to demonstrate executive functions in action, while other researchers prefer to study clinical populations with selective damage. Neuropsychological models of frontal lobe functioning have led to a greater appreciation of the dissociations among various aspects of prefrontal cortex function. This thesis involves (1) an examination of various psychometric and experimental indices of executive functions for coherence as one would predict on the basis of highly developed neurophysiological models of prefrontal function, particularly those aspects of executive function that involve predominantly cognitive abilities versus processes characterized by affect regulation; and (2) investigation of the relations between risk-taking, attentional abilties and their associated characteristics using a neurophysiological model of prefrontal functions addressed in (1). Late adolescence is a stage in which the prefrontal cortices undergo intensive structural and functional maturational changes; this period also involves increases in levels of risky and sensation driven behaviours, as well as a hypersensitivity to reward and a reduction in inhibition. Consequently, late adolescence spears to represent an ideal developmental period in which to examine these decision-making behaviours due to the maximum variability of behavioural characteristics of interest. Participants were 45 male undergraduate 18- to 19-year olds, who completed a battery of measures that included self-report, experimental and behavioural measures designed to assess particular aspects of prefrontal and executive functioning. As predicted, factor analysis supported the grouping of executive process by type (either primarily cognitive or affective), conforming to the orbitofrontal versus dorsolateral typology; risk-taking and associated characteristics were associated more with the orbitofrontal than the dorsolateral factor, whereas attentional and planning abilities tended to correlate more strongly with the dorsolateral factor. Results are discussed in light of future assessment, investigation and understanding of complex human decision-making and executive functions. Implications, applications and suggestions for future research are also proposed.

The Welland Canals Foundation, Honourable William Hamilton Merritt and the St. Catharines Historical Society and Museum, 1971-1990, n.d.

‘The Father of Canadian Transportation’ is a term commonly associated with William Hamilton Merritt. Although he is most known for being one of the driving forces behind the building of the first Welland Canal, he was many things throughout his life; a soldier, merchant, promoter, entrepreneur and politician to name a few. Born on July 3, 1793 at Bedford, Westchester County, N.Y. to Thomas Merritt and Mary Hamilton, Merritt’s family relocated to Canada shortly after in 1796. The move came after Merritt’s father petitioned John Graves Simcoe for land in Upper Canada after serving under him in the Queen’s Rangers during the American Revolution. The family quickly settled into their life at Twelve Mile Creek in St. Catharines. Merritt’s father became sheriff of Lincoln County in 1803 while Merritt began his education in mathematics and surveying. After some brief travel and further education Merritt returned to Lincoln County, in 1809 to help farm his father’s land and open a general store. While a farmer and merchant, Merritt turned his attention to military endeavours. A short time after being commissioned as a Lieutenant in the Lincoln militia, the War of 1812 broke out. Fulfilling his duty, Merritt fought in the Battle of Queenston Heights in October of 1812, and numerous small battles until the Battle of Lundy’s Lane in July 1814. It was here that Merritt was captured and held in Cheshire, Massachusetts until the war ended. Arriving back in the St. Catharines area upon his release, Merritt returned to being a merchant, as well as becoming a surveyor and mill owner. Some historians hypothesize that the need to draw water to his mill was how the idea of the Welland Canals was born. Beginning with a plan to connect the Welland River with the Twelve mile creek quickly developed into a connection between the Lakes Erie and Ontario. Its main purpose was to improve the St. Lawrence transportation system and provide a convenient way to transport goods without having to go through the Niagara Falls portage. The plan was set in motion in 1818, but most living in Queenston and Niagara were not happy with it as it would drive business away from them. Along with the opposition came financial and political restraints. Despite these factors Merritt pushed on and the Welland Canal Company was chartered by the Upper Canadian Assembly on January 19, 1824. The first sod was turned on November 30, 1824 almost a year after the initial chartering. Many difficulties arose during the building of the canal including financial, physical, and geographic restrictions. Despite the difficulties two schooners passed through the canal on November 30, 1829. Throughout the next four years continual work was done on the canal as it expended and was modified to better accommodate large ships. After his canal was underway Merritt took a more active role in the political arena, where he served in various positions throughout Upper Canada. In 1851, Merritt withdrew from the Executive Council for numerous reasons, one of which being that pubic interest had diverted from the canals to railways. Merritt tried his hand at other public works outside transportation and trade. He looked into building a lunatic asylum, worked on behalf of War of 1812 veterans, aided in building Brock’s monument, established schools, aided refugee slaves from the U.S. and tried to establish a National Archives among many other feats. He was described by some as having “policy too liberal – conceptions too vast – views too comprehensive to be comprehensible by all”, but he still made a great difference in the society in which he lived. After his great contributions, Merritt died aboard a ship in the Cornwall canal on July 5, 1862. Dictionary of Canadian Biography Online http://www.biographi.ca/EN/ShowBio.asp?BioId=38719 retrieved October 2006 Today numerous groups carry on the legacy of Merritt and the canals both in the past and present. One such group is the Welland Canals Foundation. They describe themselves as: “. . . a volunteer organization which strives to promote the importance of the present and past Welland Canals, and to preserve their history and heritage. The Foundation began in 1980 and carries on events like William Hamilton Merritt Day. The group has strongly supported the Welland Canals Parkway initiative and numerous other activities”. The Welland Canals Foundation does not work alone. They have help from other local groups such as the St. Catharines Historical Society. The Society’s main objective is to increase knowledge and appreciation of the historical aspects of St. Catharines and vicinity, such as the Welland Canals. http://www.niagara.com/~dmdorey/hssc/dec2000.html - retrieved Oct. 2006 http://www.niagara.com/~dmdorey/hssc/feb2000.html - retrieved Oct. 2006

London Gazette, 1812

The London Gazette, originally called The Oxford Gazette, was first published in 1665, making it the world's oldest continuously published newspaper. This government paper, which contains official dispatches of Great Britain during peace time and war, provides a mix of State intelligence, government notices and trade/business news. Articles also discussed anything from naval operations, royal appointments, state visits, to military reports from Generals. The paper was and still is said to be published "with Authority". This issue was printed by Robert George Clarke, Cannon-Row, Parliament-Street.