Shared decision making: what do clinicians need to know and why should they bother?

Shared decision making enables a clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient's values, preferences and circumstances. It is not a single step to be added into a consultation, but a process that can be used to guide decisions about screening, investigations and treatments. The benefits of shared decision making include enabling evidence and patients' preferences to be incorporated into a consultation; improving patient knowledge, risk perception accuracy and patient-clinician communication; and reducing decisional conflict, feeling uninformed and inappropriate use of tests and treatments. Various approaches can be used to guide clinicians through the process. We elaborate on five simple questions that can be used: What will happen if the patient waits and watches? What are the test or treatment options? What are the benefits and harms of each option? How do the benefits and harms weigh up for the patient? Does the patient have enough information to make a choice? Although shared decision making can occur without tools, various types of decision support tools now exist to facilitate it. Misconceptions about shared decision making are hampering its implementation. We address the barriers, as perceived by clinicians. Despite numerous international initiatives to advance shared decision making, very little has occurred in Australia. Consequently, we are lagging behind many other countries and should act urgently.

Establishment and preliminary outcomes of a palliative care research network

Objective: The difficulties in conducting palliative care research have been widely acknowledged. In order to generate the evidence needed to underpin palliative care provision, collaborative research is considered essential. Prior to formalizing the development of a research network for the state of Victoria, Australia, a preliminary study was undertaken to ascertain interest and recommendations for the design of such a collaboration. Method:: Three data-collection strategies were used: a cross-sectional questionnaire, interviews, and workshops. The questionnaire was completed by multidisciplinary palliative care specialists from across the state (n = 61); interviews were conducted with senior clinicians and academics (n = 21) followed by two stakeholder workshops (n = 29). The questionnaire was constructed specifically for this study, measuring involvement of and perceptions of palliative care research. Results:: Both the interview and the questionnaire data demonstrated strong support for a palliative care research network and aided in establishing a research agenda. The stakeholder workshops assisted with strategies for the formation of the Palliative Care Research Network Victoria (PCRNV) and guided the development of the mission and strategic plan. Significance of results:: The research and efforts to date to establish the PCRNV are encouraging and provide optimism for the evolution of palliative care research in Australia. The international implications are highlighted.

Our Sherlockian eyes: the surveillance of vision

or this inter-disciplinary article, we undertook a pilot case study that eye-tracked the ‘Holmes Saves Mrs. Hudson’ sequence from the episode, A Scandal in Belgravia (Sherlock, BBC, 2012). This small-scale empirical study involved a total of 13 participants (3 males and 10 females, mean age was: 27 years), comprised of a mixture of academics and undergraduate students at La Trobe University in Melbourne, Australia. The article examines its findings through a range of threaded frames – neuroscience, forensics, surveillance, haptics, memory, performance-movement, and relationality – and uniquely draws upon the interests of the authors to set the examination in context. The article is both a reading of Sherlock and a dialogue between its authors. We discover that the codes and conventions of Sherlock have a direct impact on where viewers look but we also discover eyes emerging in the periphery of the frame, and we account for these ways of seeing in different ways.

A monster that lives in our lives: experiences of caregivers of people with motor neuron disease and identifying avenues for support

BACKGROUND: A developing body of evidence has provided valuable insight into the experiences of caregivers of people with motor neuron disease; however, understandings of how best to support caregivers remain limited. AIM: This study sought to understand concepts related to the motor neuron disease caregiver experience which could inform the development of supportive interventions.

DESIGN: A qualitative thematic analysis of a one-off semistructured interview with caregivers was undertaken.

SETTING/PARTICIPANTS: Caregivers of people with motor neuron disease were recruited from a progressive neurological diseases clinic in Melbourne, Australia.

RESULTS: 15 caregivers participated. Three key themes were identified: (1) The Thief: the experience of loss and grief across varied facets of life; (2) The Labyrinth: finding ways to address ever changing challenges as the disease progressed; (3) Defying fate: being resilient and hopeful as caregivers tried to make the most of the time remaining.

CONCLUSIONS: Caregivers are in need of more guidance and support to cope with experiences of loss and to adapt to changeable care giving duties associated with disease progression. Therapeutic interventions which target these experiences of loss and change are worth investigation.

1988 Yearbook

Vol. 7; Sept. 1988; 109 p. b&w, color photographs TOC: Life at LaGuardia…2 / Activities and Events…17 / Faculty and Staff…33 / Activities at LaGuardia…49 / Graduation…71 Yearbook Committee Credits: Faculty Advisor, Vincent Banrey; Project Director, Catherine Whan; Editors: Alexandra Gomez, Juan Jimenez, GloryAnn Torres; Asst. Editor, Kenny Rosa; LAYOUT: Vincent Banrey, Marino "Tito" Cabrera, Shirley Chance, George Condors, Milton Ferreira, Maria Flores, Alexandra Gomez, Ana Lisa Gonzalez, Bernadette Henry, Juan Jimenez, Alejandro Meneses, Richard Provost, Kenny Rosa, Maria Sanchez, GloryAnn Torres, Catherine Whan, Alan O. Young; PHOTOGRAPHY: Peter Abbate, Sandra Acres, Young Baek Choi, Randy Fader Smith, Milton Ferriera, Alexandra Gomez, Juan Jimenez, Seymour Lerman, Chuck Lindsey, Victoria Pamias, Richard Provost, Alan Scribner, Frank Tocco, GloryAnn Torres, Catherine Whan. ART: Jose Marti (Cover Design and Division Pages); Martin Carrichner, Jose Marti (Endsheet Design), Arnold Escalera, Jacqui Fernandez, Richard Massey, Alejandro Meneses; WRITING: Anthony Archer, Alexandra Bastidas, Joie Fadde, Alexandra Gomez, Ana Lisa Gonzalez, Doreen Hansen, Bernadette Henry, Sarah Hudson, Juan Jimenez, Donna Libert, Cathy Passiglia, Jody Pincus, Richard Provost, Kenny Rosa, Maria Sanchez, Alan Scribner, Christiana Sommerville, GloryAnn Torres, Catherine Whan, Alan O. Young; SPECIAL THANKS: Blanca Arbito, Classic Studios, Edward Hollins, Umoja Kwanguvu, Kelly Johnson and the LaGuardia Archives, Andrew Saluga and Recreation Staff, Ted Schiffman of Taylor Publishing.

Identificação de falhas em engrenagens na transmissão de trator agrícola por meio de análise de vibrações

Neste trabalho é apresentado o desenvolvimento de um método de análise de falhas, por meio de análise de vibrações, para a bancada de final de linha das transmissões dos tratores linha 5000 da John Deere Brasil, o qual tem como finalidade diferenciar transmissões aprovadas de transmissões com defeito em engrenagens na caixa de marchas, e também auxiliar na identificação da engrenagem com defeito. Para o desenvolvimento deste método foram utilizados equipamentos de medição e aquisição de dados disponíveis na John Deere Brasil. Os testes foram realizados na bancada de final da linha de transmissões, possibilitando a aplicação do método sem a necessidade de alteração na bancada de testes. Os sinais padrões da transmissão em cada uma das quatro marchas foram levantados através da medição de quatro transmissões boas. De posse destes padrões, (assinatura em cada marcha), partiu-se para a identificação de como estes são alterados por diferentes defeitos em diversas engrenagens da caixa de marchas, sendo para isto induzidos defeitos em diferentes engrenagens da caixa de marchas de transmissões boas. Os sinais em todas as marchas nestas transmissões com defeito induzido foram medidos e analisado as alterações em relação aos padrões, resultando a conclusão de que a aplicação do método de análise de vibrações no final de linha de transmissões da John Deere Brasil é possível, tanto para a diferenciação entre transmissões boas e transmissões com defeito em engrenagens da caixa de marchas, quanto como auxiliar na identificação de qual engrenagem da caixa de marchas está com defeito.

Avaliação de opções sob consideração de volatilidades históricas, implícitas e condicionadas: o caso TELEBRÁS na BOVESPA

Buscamos aferir ganhos na precificação de opções lançadas sobre a ação Telebrás PN, com a utilização de modelos auto regressivos de volatilidade· condicionada, cujos resultados foram comparados àqueles gerados pelos procedimentos numéricos de volatilidades históricas e implícitas. Nesta tarefa, a dinâmica do estudo levou ao estabelecimento de novos objetivos, que destacamos: a) identificação de modelos mais eficientes para filtragem da média do processo sobre retornos de Telebrás PN, que eventualmente pudessem otimizar o emprego dos modelos da classe ARCH; b) aferir anomalias de mercadodevidas a negociaçõesem dias específicos da semana; c) esclarecer influências exercidas pela sensibilidade dos preços das opções sobre a eficiência dos modelos de volatilidade condicionada, com vista a definir condições para o alcance de resultados práticos no campo da precificação de opções.

Um estudo sobre a persistência de performance positiva dos fundos IBOVESPA ativos

O objetivo desta dissertação é identificar se persistência de performance positiva um fenômeno presente entre os fundos de investimento ativos em relação ao índice da bolsa de valores de São Paulo (IBOVESPA). Para tanto, foram utilizadas informações em bases diárias, para período de janeiro de 1997 dezembro de 2001, de 191 fundos que tiveram para cada ano sua performance calculada. Em cada ano sob estudo definiu-se, pelo menos, dois grupos: um em que se alinhavam os fundos que apresentavam os melhores indicadores outro em que estavam presentes aqueles cujos desempenhos foram considerados piores. Os fundos que lograram sucesso em permanecer no primeiro grupo em pares de anos consecutivos foram denominados persistentes. Para que se pudesse medir significância dos resultados apurados, fez-se uso do instrumental de testes estatísticos, testes de hipóteses, que buscaram identificar se as proporções de fundos persistentes forneciam evidências suficientes para que se garantisse ocorrência do fenômeno no mercado brasileiro para período pesquisado.

Eventos raros e volatilidade de ações, taxa de câmbio e taxa de juros

O objetivo dessa pesquisa foi testar a relação entre a volatilidade da variação real de índices de ações e eventos raros (positivos e negativos) no PIB real e, adicionalmente, a relação entre a volatilidade das taxas de juros reais e da variação das taxas de câmbio real efetiva e a ocorrência de tais eventos. Para testar essas relações foi utilizado o modelo GARCH, com o objetivo de modelar a volatilidade das variáveis consideradas (índices de ações, taxas de câmbio real efetiva e taxas de juros), inclusive regredindo a volatilidade contra variáveis dummy que indicassem a ocorrência de eventos raros. O teste foi realizado para os seguintes países: Estados Unidos, Canadá, Reino Unido, Coréia do Sul, Japão e Brasil. Foram encontradas evidências de que a ocorrência de eventos raros negativos (desastres raros) impacta positivamente a volatilidade tanto da variação real de índices de ações quanto da variação da taxa de câmbio real efetiva. Entretanto, os resultados não indicaram que existe um impacto de eventos raros positivos na volatilidade dessas variáveis. Para a volatilidade da taxa de juros real, os testes não indicaram a existência de relação com eventos raros, porém esses resultados podem ter sido influenciados pelo fato da amostra ser pequena.

Os conflitos de competência normativa do estado regulador brasileiro no setor administrado pela ANP

The dissertation has by objective describe the administrative activity of regulation exercised by independent regulatory agencies, observing that this activity was already done before this structures creation, however, after a really deep administrative reform that had as objective built a Public Administration with more efficiency, it passed to be done with some own peculiarities of these new structures of regulation. The work gave especial attention to what concern the conflicts of normative competency that really often happen between ANP (Agência Nacional do Petróleo, Gás Natural e Biocombustíveis) and the legislatives organs of the Republic Federative of Brazil, because energetic area has unbelievable mater to any country, and the fact of some juridical norm be against the law and be accepted is very dangerous, it affronts the constitutional principle of the legality e may put in risk the democratic Estate of law, them, regulatory dogmatic must be scientifically knows, and developed, thought and especially there are so many doctrinaires divergences about regulation constitutionality. As a theorist point, the investigation got the Logical nocontradiction principle, according Hans Kelsen and Lourival Vilanova thought, doing a philosophical reflection about the system of positive law, in which there are many antinomies, or conflicts of norms, what include the conflicts of the administrative acts expedited by ANP and the legislation of the brazilian regulatory Estate. For a better understanding and exemplify some perplexities treated by the doctrinaire angle, this work did a lucubration about a possibility of a normative conflict between a ANP resolution and the municipal legislation in a specific case, also, brought several jurisprudences for the brazilians courts of justice, that confirm the empiric existence of normative conflicts among ANP s administrative norms and federal legislation. Finally, concludes observing that the regulation is not a legislative competency delegation to regulatory agencies, is just a new exercise of the administrative function, it is a technical specialization of the public administration, that using this know-how can acting with more efficiency, however the normative power of regulatory agencies must respect the empire of law, so in this terms, the dissertation suggests the ponderation of the constitutionals principles of efficiency and legality how form to harmonizing the democratic legitimate inherent to legal norm supremacy, with the perspective of an efficient economic and institutional development

Corpo e saúde: reflexões sobre o quadro "Medida Certa"

The present scenario is permeated by different comprehensions about the body and health. These are the result of a historical process experienced by men in different times and social contexts through which were being built. Faced this scenario, we emphasize the media as a powerful means of information and training ideas regarding the body and health of theses. The media also as a means of mediating information we present characteristics of the social scenario where is inserted. In our research we bring reflects about the comprehensions, knowledge and practices propagated by the way the body and health under "Medida Certa" of the program Fantastico the broadcaster Globo Telecommunications, in order to identify how Physical Education, has contributed the construction of knowledge disseminated. Therefore, we focus our analysis to the table "Medida Certa" exhibited by Fantastico in the months of April, May and June of 2011.The data for analysis were collected through the videos shown live in Fantastic and the information provided in the blog that table. Thus, we had 14 videos shown live, 16 videos posted on the blog, 97 posts in blog. As technique of analysis of the datas used of content analysis of the Bardin (2011). About body obtained as analytical categories: body as operating system; biological body; fragmented body exterior to the subject; body trailer quantified to patterns; subject body. How to health we analyze the categories of health existential: health existential based in biological indices of normality; health existential associated with weight loss and aesthetic patterns; health existential associated with physical activity and nutritional control; and finally we propose a comprehension of health existential. Therefore, from the analysis of the data evidenced a predominance of comprehensions, knowledge and practices about the body and health guided the biological constituents of the body, quantification and classification in medium and normal patterns on pervasive forms of care, in the linear association among physical activity and nutritional control with health, evidenced that Physical Education has contributed to these constructions, through some of his discourses with emphasis on biological aspects. Thus, in our study we advocate an understanding of not only the body as object, but also as a subject clipped by organic, cultural, historical and social elements, a living body, feeling, desire and above all expresses itself, and health viewed as something body, interlaced through the biological, cultural, historical and emotional aspects of this body that coexist in this society

A contextualização e a interdisplinaridade no ensino de Química: uma analise de livros didáticos ACIDO-BASE e das propostas pedagógicas realizadas pelos docentes diante da temática

Nowadays, chemistry contents taught in high school continue to be presented in a fragmented and decontextualized manner by the teachers and the textbooks. Even though it is known that contextualization and interdisciplinary exchange play an important role in the process of Chemistry teaching/learning. Therefore, the present study aims at enlightening the importance of these methodological foundations in the learning of chemistry. The data acquisition about the subject Contextualization and Interdisciplinary Exchange involved in Chemistry Teaching was developed through bibliographical researches on chemistry textbooks, which focused on the analysis of the topics acid and base , since it is a theme studied throughout all three years of high school. The present study also developed questionnaires which were applied to analyze to what extent chemistry teachers are working in a contextualized and interdisciplinary manner throughout the process of Chemistry teaching/learning. The results obtained in the researches show that a contextualized and interdisciplinary teaching contributes to a more meaningful acquisition of chemistry knowledge, in a dynamic and interactive way, but there are still many roadblocks towards the achievement of this kind of Chemistry teaching/learning process

Refluxo gastroesofágico: estudo comparativo da receptividade e sensibilidade entre seriografia e ultrassonografia

OBJETIVO: Estudo comparativo da receptividade (colaboração) e sensibilidade da seriografia do esôfago, estômago e duodeno em relação à ultrassonografia do esôfago intra-abdominal em pacientes com suspeita de refluxo gastroesofágico. MATERIAIS E MÉTODOS: Foram incluídos no estudo 42 pacientes pediátricos (26 masculinos, com idade média de 33,64 ± 34,33 meses, e 16 femininos, com idade média de 31,02 ± 35,56 meses) com suspeita de refluxo gastroesofágico, os quais foram submetidos, inicialmente, a seriografia do esôfago, estômago e duodeno, e posteriormente, a ultrassonografia do esôfago intra-abdominal. RESUL-TADOS: A análise estatística comparativa entre os sexos e as idades sugere não haver evidência de associação com a colaboração, tanto para a seriografia do esôfago, estômago e duodeno como para a ultrassonografia do esôfago intra-abdominal. Entretanto, na classificação quanto ao tipo de colaboração, a técnica de seriografia do esôfago, estômago e duodeno apresentou menos de 50% de colaboração, enquanto 80,49% dos pacientes colaboraram com a ultrassonografia do esôfago intra-abdominal. Quanto à sensibilidade do diagnóstico de refluxo gastroesofágico, a técnica de ultrassonografia do esôfago intra-abdominal (85,7%) foi significativamente superior à de seriografia do esôfago, estômago e duodeno (47,6%). CONCLUSÃO: O presente estudo sugere que se proceda a ultrassonografia do esôfago intra-abdominal, mesmo na ausência de refluxo gastroesofágico na seriografia do esôfago, estômago e duodeno.