Development of a decision aid to inform patients' and families' renal replacement therapy selection decisions.

BACKGROUND: Few educational resources have been developed to inform patients' renal replacement therapy (RRT) selection decisions. Patients progressing toward end stage renal disease (ESRD) must decide among multiple treatment options with varying characteristics. Complex information about treatments must be adequately conveyed to patients with different educational backgrounds and informational needs. Decisions about treatment options also require family input, as families often participate in patients' treatment and support patients' decisions. We describe the development, design, and preliminary evaluation of an informational, evidence-based, and patient-and family-centered decision aid for patients with ESRD and varying levels of health literacy, health numeracy, and cognitive function. METHODS: We designed a decision aid comprising a complementary video and informational handbook. We based our development process on data previously obtained from qualitative focus groups and systematic literature reviews. We simultaneously developed the video and handbook in "stages." For the video, stages included (1) directed interviews with culturally appropriate patients and families and preliminary script development, (2) video production, and (3) screening the video with patients and their families. For the handbook, stages comprised (1) preliminary content design, (2) a mixed-methods pilot study among diverse patients to assess comprehension of handbook material, and (3) screening the handbook with patients and their families. RESULTS: The video and handbook both addressed potential benefits and trade-offs of treatment selections. The 50-minute video consisted of demographically diverse patients and their families describing their positive and negative experiences with selecting a treatment option. The video also incorporated health professionals' testimonials regarding various considerations that might influence patients' and families' treatment selections. The handbook was comprised of written words, pictures of patients and health care providers, and diagrams describing the findings and quality of scientific studies comparing treatments. The handbook text was written at a 4th to 6th grade reading level. Pilot study results demonstrated that a majority of patients could understand information presented in the handbook. Patient and families screening the nearly completed video and handbook reviewed the materials favorably. CONCLUSIONS: This rigorously designed decision aid may help patients and families make informed decisions about their treatment options for RRT that are well aligned with their values.

Can density functional theory (DFT) be used as an aid to a deeper understanding of tandem mass spectrometric fragmentation pathways?

Prediction of tandem mass spectrometric (MS/MS) fragmentation for non-peptidic molecules based on structure is of immense interest to the mass spectrometrist. If a reliable approach to MS/MS prediction could be achieved its impact within the pharmaceutical industry could be immense. Many publications have stressed that the fragmentation of a molecular ion or protonated molecule is a complex process that depends on many parameters, making prediction difficult. Commercial prediction software relies on a collection of general heuristic rules of fragmentation, which involve cleaving every bond in the structure to produce a list of 'expected' masses which can be compared with the experimental data. These approaches do not take into account the thermodynamic or molecular orbital effects that impact on the molecule at the point of protonation which could influence the potential sites of bond cleavage based on the structural motif. A series of compounds have been studied by examining the experimentally derived high-resolution MS/MS data and comparing it with the in silico modelling of the neutral and protonated structures. The effect that protonation at specific sites can have on the bond lengths has also been determined. We have calculated the thermodynamically most stable protonated species and have observed how that information can help predict the cleavage site for that ion. The data have shown that this use of in silico techniques could be a possible way to predict MS/MS spectra. Copyright (C) 2009 John Wiley & Sons, Ltd.

'An aid to mental health': natural history, alienists and therapeutics in Victorian Scotland

In the nineteenth century natural history was widely regarded as a rational and ‘distracting’ pursuit that countered the ill-effects, physical and mental, of urban life. This familiar argument was not only made by members of naturalists’ societies but was also borrowed and adapted by alienists concerned with the moral treatment of the insane. This paper examines the work of five long-serving superintendents in Victorian Scotland and uncovers the connections made between an interest in natural history and the management of mental disease. In addition to recovering a significant influence on the conduct of several alienists the paper explores arguments made outside the asylum walls in favour of natural history as an aid to mental health. Investigating the promotion of natural history as a therapeutic recreation in Scotland and elsewhere reveals more fully the moral and cultural significance attached to natural history pursuits in the nineteenth century.

Networked tourism: from world destinations to inter-organizations

Na última década, a referência ao conceito de redes cresceu rapidamente entre a literatura sobre turismo, geralmente aplicado a tópicos como as interorganizações, estrutura de multi-destinos, espaços de Turismo online, entre outros. O conceito de rede difundiu-se na natureza e na sociedade, em áreas que vão desde a Biologia à Medicina, ou da Economia à Gestão, e o conhecimento sobre redes tem vindo a impulsionar uma teoria comum para facilitar a compreensão de diferentes sistemas complexos e a representação das ligações entre organizações, acções, bens, proteínas ou pessoas. A tese teve como propósito o encontro de um eixo comum entre dois campos férteis de investigação através de uma revisão teórica sistemática. A investigação sobre redes complexas é um campo recente na Física que tem vindo a desenvolver-se bastante na última década com fortes aplicações interdisciplinares. Por outro lado, a análise de redes sociais é uma área de investigação activa em Sociologia e Economia há bastante tempo. O estudo das implicações das redes complexas para a ciência das redes de turismo é uma área promissora já com resultados fascinantes. A tese tem três resultados principais. Primeiro, traz conhecimento das ricas áreas de conhecimento sobre redes complexas e redes sociais. Em segundo lugar, apresenta modelos evolutivos que melhor se adaptam às chegadas turísticas internacionais. Como se organizam as redes sociais? Como é que os indivíduos escolhem os seus destinos de viagem? Estes são exemplos de questões que serão abordadas na tese. Em terceiro lugar, discute resultados que fazem notar comportamentos comuns entre redes em turismo e outras redes reais. O que é comum a todas as redes na natureza? Adicionalmente, os padrões encontrados entre os destinos turísticos mostram um comportamento não social, com destinos mais característicos de redes económicas e sistemas tecnológicos que questionam a faceta social do sector do turismo. Por acréscimo, a rede de transportes aéreos e a rede de turismo mostram diferenças consideráveis que se podem dever a razões políticas ou outras que provavelmente explicam o aumento da utilização de voos charters.

Red State, Blue State: Examining Federal Transfers to the States, 1983-2004.

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Market Orientation and Organisational Performance of Nonprofit Organizations in Kerala

This study is the concentrates different nature and practice of Marketing in nonprofit organization.How market indication can contribute the organizational performance of nonprofit organizations.