The role of shared decision-making in audiologic rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

Issues of collaboration, representation, meaning and emotions:utilising participant-led visual diaries to capture the everyday lives of people in mid to later life

In recent years there has been an increasing use of visual methods in ageing research. There are, however, limited reflections and critical explorations of the implications of using visual methods in research with people in mid to later life. This paper examines key methodological complexities when researching the daily lives of people as they grow older and the possibilities and limitations of using participant-generated visual diaries. The paper will draw on our experiences of an empirical study, which included a sample of 62 women and men aged 50 years and over with different daily routines. Participant-led photography was drawn upon as a means to create visual diaries, followed by in-depth, photo-elicitation interviews. The paper will critically reflect on the use of visual methods for researching the daily lives of people in mid to later life, as well as suggesting some wider tensions within visual methods that warrant attention. First, we explore the extent to which photography facilitates a ‘collaborative’ research process; second, complexities around capturing the ‘everydayness’ of daily routines are explored; third, the representation and presentation of ‘self’ by participants within their images and interview narratives is examined; and, finally, we highlight particular emotional considerations in visualising daily life.

EPIPOX:immunoinformatic characterization of the shared T-cell epitome between variola virus and related pathogenic orthopoxviruses

Concerns that variola viruses might be used as bioweapons have renewed the interest in developing new and safer smallpox vaccines. Variola virus genomes are now widely available, allowing computational characterization of the entire T-cell epitome and the use of such information to develop safe and yet effective vaccines. To this end, we identified 124 proteins shared between various species of pathogenic orthopoxviruses including variola minor and major, monkeypox, cowpox, and vaccinia viruses, and we targeted them for T-cell epitope prediction. We recognized 8,106, and 8,483 unique class I and class II MHC-restricted T-cell epitopes that are shared by all mentioned orthopoxviruses. Subsequently, we developed an immunological resource, EPIPOX, upon the predicted T-cell epitome. EPIPOX is freely available online and it has been designed to facilitate reverse vaccinology. Thus, EPIPOX includes key epitope-focused protein annotations: time point expression, presence of leader and transmembrane signals, and known location on outer membrane structures of the infective viruses. These features can be used to select specific T-cell epitopes suitable for experimental validation restricted by single MHC alleles, as combinations thereof, or by MHC supertypes.

A linear relational DEA model to evaluate two-stage processes with shared inputs

Two-stage data envelopment analysis (DEA) efficiency models identify the efficient frontier of a two-stage production process. In some two-stage processes, the inputs to the first stage are shared by the second stage, known as shared inputs. This paper proposes a new relational linear DEA model for dealing with measuring the efficiency score of two-stage processes with shared inputs under constant returns-to-scale assumption. Two case studies of banking industry and university operations are taken as two examples to illustrate the potential applications of the proposed approach.

"Quality lives on":quality initiatives and practices in Australia and Britain

Purpose-The purpose of this research is to explore the incidence of innovative approaches to quality in both Australia and Britain, the reasons behind their implementation, the ways in which they were undertaken and the success factors and the pitfalls encountered along the way. Design/methodology/ approach-A structured postal questionnaire was sent to 1,000 quality managers in both Australia and Britain. A response was received from 129 Australian and 175 British companies, who reported on why they did or did not introduce a new quality initiative within the past five years. Findings-A comparative analysis shows trends, similarities and differences, and future directions of quality in both countries. The paper concludes by identifying important lessons for senior management needing to make changes in this important aspect of any business. A high proportion of organisations in both countries are actively undertaking new quality initiatives. The impetus to change and the barriers to successful implementation were common to both countries. The type of initiative differed between the two countries, with a preponderance of ISO 9000 in Australia amongst a much wider choice of approaches than in Britain. There is a low take-up of Six Sigma in both countries, particularly in Australia. Originality/value-The paper offers a recent insight into quality approaches undertaken in both countries and identifies important lessons for senior management. © 2010 Emerald Group Publishing Limited. All rights reserved.

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.

Taiwanese faculty and administrators' perceptions and preferences toward shared governance

This study investigated the perceptions, attitudes, preferences, and actual reported degree of faculty participation in decision-making in Taiwanese universities. It was aimed at exploring possible agreements and disagreements between the faculty and administrators concerning these perceptions, and between the actual and preferred degree of faculty participation in both groups. ^ Seven questions were addressed in this study: (a) What are the most and the least reported areas of faculty involvement in decision making? (b) What are the most and the least preferred areas of faculty involvement in decision-making? (c) Is there a difference between faculty and administrators' reports of faculty involvement in decision-making? (d) Is there a difference between faculty and administrators in their preference for faculty involvement in decision-making? (e) Among the faculty, is reported involvement different from preferred involvement in decision-making? (f) Among the administrators, is their reported faculty involvement different from their preferred faculty involvement? and (g) Do faculty and administrators hold different attitudes toward faculty participation in decision-making? ^ The results indicated that: (a) Faculty had the highest level of involvement in academic decisions, and had the lowest level of involvement in developing general policies. (b) Both faculty and administrators had the highest preference for faculty involvement in academic decisions, and both of them had the lowest preference for faculty involvement in general policies. (c) Administrators reported a level of involvement for the faculty that was higher than the level that the faculty themselves reported. (d) Faculty desired a higher level of involvement than they currently have, and administrators also agreed that faculty should have greater involvement. ^ The interview results indicated that the presidents believed that faculty should participate in decision-making, but they also had negative feelings towards faculty who were enthusiastic about participating. The presidents showed their support of faculty participation in academic decisions, but not in other areas. ^ The results reflected the traditional Taiwanese social expectations of the role of faculty. When the range of decisions was narrowed to the academic context, the disagreements between the faculty, administrators, and university presidents disappeared. However, when the range of decisions was expanded, the agreement declined. ^

Autonomy and authority in the lives of children who work as domestic servants in Ghana

Limited literature exists on Ghana's child domestic servants, and researchers have found it difficult to locate and study these children. The research for this dissertation used qualitative research methodologies and non-probabilistic sampling techniques to make it possible to interview child domestic servants, their parents, employers and recruiters in Ghana. The findings from the qualitative analyses informed the second part of this study, which was quantitative and tested hypotheses using crosstabulations and logistic regression analyses that were based on survey data from the Ghana Statistical Service. Explanatory variables in the quantitative analyses included lineage, level of education and relationships to the household head. ^ This study located findings about the processes of children's recruitment into domestic servitude, their working conditions and methods of remuneration in theories of slavery to answer the question of whether or not child domestic servants are slaves. According to the findings, elite households in Ghana exploit children from rural regions because they have taken advantage of a historical practice that allowed children to live with older members of their extended families to provide domestic services and in return, be given the chance to receive formal education or to learn a trade. The participants in the qualitative part of this research described the treatments that they receive from their employers as slavery. Nevertheless, the processes of their recruitment and the age at which most of them accepted such job offers made it difficult to categorize a majority of them as contemporary slaves. ^

A youth vision of the city: The socio-spatial lives and exclusion of street girls in Bogota, Colombia

This dissertation documents the everyday lives and spaces of a population of youth typically constructed as out of place, and the broader urban context in which they are rendered as such. Thirty-three female and transgender street youth participated in the development of this youth-based participatory action research (YPAR) project utilizing geo-ethnographic methods, auto-photography, and archival research throughout a six-phase, eighteen-month research process in Bogotá, Colombia. ^ This dissertation details the participatory writing process that enabled the YPAR research team to destabilize dominant representations of both street girls and urban space and the participatory mapping process that enabled the development of a youth vision of the city through cartographic images. The maps display individual and aggregate spatial data indicating trends within and making comparisons between three subgroups of the research population according to nine spatial variables. These spatial data, coupled with photographic and ethnographic data, substantiate that street girls’ mobilities and activity spaces intersect with and are altered by state-sponsored urban renewal projects and paramilitary-led social cleansing killings, both efforts to clean up Bogotá by purging the city center of deviant populations and places. ^ Advancing an ethical approach to conducting research with excluded populations, this dissertation argues for the enactment of critical field praxis and care ethics within a YPAR framework to incorporate young people as principal research actors rather than merely voices represented in adultist academic discourse. Interjection of considerations of space, gender, and participation into the study of street youth produce new ways of envisioning the city and the role of young people in research. Instead of seeing the city from a panoptic view, Bogotá is revealed through the eyes of street youth who participated in the construction and feminist visualization of a new cartography and counter-map of the city grounded in embodied, situated praxis. This dissertation presents a socially responsible approach to conducting action-research with high-risk youth by documenting how street girls reclaim their right to the city on paper and in practice; through maps of their everyday exclusion in Bogotá followed by activism to fight against it.^

Living positive: Life in community among Puerto Rican men living with HIV in Boston

Negative experiences of stigmatization, discrimination, and rejection are common among people living with HIV in the United States, and particularly when they are also members of a minority group. Some three decades after the first cases of AIDS were identified, people infected with HIV continue to be perceived and characterized negatively. While an HIV/AIDS diagnosis is typically associated with negativity, this study investigates the extent to which collective experiences among HIV-positive people result in healthy responses and positive social adjustment. This study is focused on the ways in which HIV-positive Puerto Rican men in Boston live positive despite being diagnosed with HIV. Rather than wrapping themselves in the social stigma of HIV and the isolation that entails, they participate in processes that affirm themselves and their peers. In so doing, they help generate both healthy and meaningful lives for themselves and others. The study examines the process in which Puerto Rican men living with HIV in Boston participate, promote, and reaffirm an HIV community, la comunidad, as a social entity with a unique culture and identity. This study also investigates how this community influences, supports, and encourages the adoption of positive transformations for living long term with HIV. On the basis of nine months of field research, this qualitative study employed both focus groups and interviews with fifty HIV-positive Puerto Rican men in Boston. These men were recruited, using convenience sampling, from different community-based organizations (CBOs) that provide HIV/AIDS services in Boston. The study finds that HIV-positive Puerto Rican men in Boston build community, not in response to social exclusion, but built on shared positive practices and strategies for living healthy with HIV. These men come together to negotiate and form a unique cultural community expressed in norms, beliefs, and practices that, although centered on HIV, are designed for living healthy. These expressions reaffirm a sense of community in everyday settings and transform the lives of these men with positive behaviors and healthy lifestyles. The findings reveal that this transformation takes place in the context of a community, with the support, encouragement, and at times, policing of others. La comunidad is where the lives of these men are transformed as they learn, adopt, and experience living positive with HIV.