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.

Hydroinformatics based decision.making integrating modelling, sampling and profiling: the Ria Formosa case

A Waste Water monitoring program aiming to help decision making is presented. The program includes traditional and inboard sensor sampling, hydrodynamic and water quality modeling and a GIS based database to help the decision making of manager authorities. The focus is in the quality of waters receiving discharges from Waste Water Treatment Plants. Data was used to feed model simulations and produce hydrodynamic, effluent dispersion and ecological results. The system was then used to run different scenarios of discharge flow, concentration and location. The results enable to access the current water quality state of the lagoon and are being used as a decision making tool by the waste water managers in the evaluation phase of the treatment plant project to decide the location and the level of treatment of the discharge.

Nuclear and mitochondrial control of the apoptosis machinery regulates neural stem cell fate

Tese de doutoramento, Farmácia (Bioquímica), Universidade de Lisboa, Faculdade de Farmácia, 2014

Application of Decision-Making Theory to the Regulation of Muscular Work Rate During Self-Paced Competitive Endurance Activity.

Successful participation in competitive endurance activities requires continual regulation of muscular work rate in order to maximise physiological performance capacities, meaning that individuals must make numerous decisions with regards to the muscular work rate selected at any point in time. Decisions relating to the setting of appropriate goals and the overall strategic approach to be utilised are made prior to the commencement of an event, whereas tactical decisions are made during the event itself. This review examines current theories of decision-making in an attempt to explain the manner in which regulation of muscular work is achieved during athletic activity. We describe rational and heuristic theories, and relate these to current models of regulatory processes during self-paced exercise in an attempt to explain observations made in both laboratory and competitive environments. Additionally, we use rational and heuristic theories in an attempt to explain the influence of the presence of direct competitors on the quality of the decisions made during these activities. We hypothesise that although both rational and heuristic models can plausibly explain many observed behaviours in competitive endurance activities, the complexity of the environment in which such activities occur would imply that effective rational decision-making is unlikely. However, at present, many proposed models of the regulatory process share similarities with rational models. We suggest enhanced understanding of the decision-making process during self-paced activities is crucial in order to improve the ability to understand regulation of performance and performance outcomes during athletic activity.

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.

Understanding what drives the purchase decision in pension and investment products

The aims of this paper are to first seek an understanding of consumer decision-making when purchasing pension and investment products, and second to ascertain how this decision-making affects the consumer's choice of distribution route. The study employed both focus groups and postal questionnaire survey methods based on the framework of a classical decision-making model that investigated problem recognition, information search, evaluation tools used and post-purchase. The findings show that the decision-making process experience differed to a lesser or greater degree depending on the distribution route. The majority of respondents had recognised the need to make a purchase decision long before seeking information. Younger respondents on all incomes believed that they must make some pension provision for themselves as opposed to relying on the government's retirement provision. Many changed channels for information searches, but tended to settle with the Independent Financial Adviser (IFA). The two main evaluation tools for pension and investment were found to be the ‘charges’ and ‘historic fund performance’. The vast majority of respondents reiterated their worry that the outcomes would not be known until retirement. In terms of analysis by the level of ‘financial literacy’, respondents who scored in the upper quartile were more inclined to be on a higher income, less inclined to evaluate on charges and more proactive in discussing the investment strategy of their pension fund. Respondents who scored in the lower quartile had opposite results. One of the implications of these findings is that the younger respondents’ recognition of pension savings favours the government's intention to reverse the existing balance of pension distribution. The other main implication is that the findings will be of help to managers in appreciating the dominance of the IFA channel by providing an explanation of why consumers choose this route, and, additionally, can assist direct marketing managers in identifying customers who will be more likely to use multichannel or single-channel shoppers. It can also help the marketing manager increase the usage of different channels by addressing the factors driving the purchase decision and distribution choice.

The east of Suez decision

A witness seminar on Britain's decision to withdraw from East of Suez was held by the Institute of Contemporary British History at King's College London on 16 November 1990. It was introduced by a short paper by David Greenwood of the Centre for the Study of Defence Economics, University of Aberdeen. Those participating were Professor Lawrence Freedman (Chairman), David Greenwood, Sir Frank Cooper, C.W. Wright, Sir Patrick Nairne, Richard Hastie‐Smith, J.K. Wright, Sir Ewen Broadbent, Peter Hudson, Sir Robert Andrew, Sir George Leitch, Sir Arthur Drew, Lord Thomson of Monifieth, Lord Zuckerman, Lord Mayhew and Field Marshal Lord Carver. The Institute of Contemporary British History would like to record its thanks to BP for its sponsorship of this event.

Utilização do método Multicritério AHP, na aquisição de um sistema ERP

The selection of an Enterprise Resource Planning (ERP) system is one of the most sensitive and highest impact processes in the area of information systems and technologies, because it supports and integrates the whole business of an organization. Hence the importance of deciding the best solution in order to contribute to the organization's competitiveness in a global and increasingly demanding market. Therefore, it is essential to provide tools to support decision making, turning complex and often intangible decisions into simple and quantifiable scenarios. This study addressed the adoption of the Analytical Hierarchy Process (AHP) multicriteria decision method to support the selection of an ERP system. The literature review was the source used to obtain the set of the most relevant criteria to be considered in this decision, which were subsequently validated through systematic application of various surveys of experts and people related to the field of ERP systems. To support the application of AHP, according to the model obtained in the study, it was developed a web application that will be available to the general public. The responsible for the acquisition of ERP systems can use it to easily apply the AHP method based on validated decision model. On the other hand, the web application can be used as a validation tool, allowing collecting data for future developments of the decision model.

Virtual power players demand response programs management based on locational marginal prices

Power systems have been suffering huge changes mainly due to the substantial increase of distributed generation and to the operation in competitive environments. Virtual power players can aggregate a diversity of players, namely generators and consumers, and a diversity of energy resources, including electricity generation based on several technologies, storage and demand response. Resource management gains an increasing relevance in this competitive context, while demand side active role provides managers with increased demand elasticity. This makes demand response use more interesting and flexible, giving rise to a wide range of new opportunities.This paper proposes a methodology for managing demand response programs in the scope of virtual power players. The proposed method is based on the calculation of locational marginal prices (LMP). The evaluation of the impact of using demand response specific programs on the LMP value supports the manager decision concerning demand response use. The proposed method has been computationally implemented and its application is illustrated in this paper using a 32 bus network with intensive use of distributed generation.

Intelligent decision making in electricity markets: simulated annealing Q-Learning

Electricity markets are complex environments, involving a large number of different entities, playing in a dynamic scene to obtain the best advantages and profits. MASCEM is a multi-agent electricity market simulator to model market players and simulate their operation in the market. Market players are entities with specific characteristics and objectives, making their decisions and interacting with other players. MASCEM is integrated with ALBidS, a system that provides several dynamic strategies for agents’ behavior. This paper presents a method that aims at enhancing ALBidS competence in endowing market players with adequate strategic bidding capabilities, allowing them to obtain the higher possible gains out of the market. This method uses a reinforcement learning algorithm to learn from experience how to choose the best from a set of possible actions. These actions are defined accordingly to the most probable points of bidding success. With the purpose of accelerating the convergence process, a simulated annealing based algorithm is included.

Agent-based simulation of electronic marketplaces with decision support

This paper presents a Multi-Agent Market simulator designed for analyzing agent market strategies based on a complete understanding of buyer and seller behaviors, preference models and pricing algorithms, considering user risk preferences and game theory for scenario analysis. The system includes agents that are capable of improving their performance with their own experience, by adapting to the market conditions, and capable of considering other agents reactions.

A decision-support system based on particle swarm optimization for multiperiod hedging in electricity markets

This paper proposes a particle swarm optimization (PSO) approach to support electricity producers for multiperiod optimal contract allocation. The producer risk preference is stated by a utility function (U) expressing the tradeoff between the expectation and variance of the return. Variance estimation and expected return are based on a forecasted scenario interval determined by a price range forecasting model developed by the authors. A certain confidence level is associated to each forecasted scenario interval. The proposed model makes use of contracts with physical (spot and forward) and financial (options) settlement. PSO performance was evaluated by comparing it with a genetic algorithm-based approach. This model can be used by producers in deregulated electricity markets but can easily be adapted to load serving entities and retailers. Moreover, it can easily be adapted to the use of other type of contracts.

A study on the authentication method for TAmI in ambient intelligence (secure group decision making toolkit)

It is difficult to get the decision about an opinion after many users get the meeting in same place. It used to spend too much time in order to find solve some problem because of the various opinions of each other. TAmI (Group Decision Making Toolkit) is the System to Group Decision in Ambient Intelligence [1]. This program was composed with IGATA [2], WebMeeting and the related Database system. But, because it is sent without any encryption in IP / Password, it can be opened to attacker. They can use the IP / Password to the bad purpose. As the result, although they make the wrong result, the joined member can’t know them. Therefore, in this paper, we studied the applying method of user’s authentication into TAmI.

Modelling group decision simulation through argumentation

Group decision making plays an important role in today’s organisations. The impact of decision making is so high and complex, that rarely the decision making process is made individually. In Group Decision Argumentation, there is a set of participants, with different profiles and expertise levels, that exchange ideas or engage in a process of argumentation and counter-argumentation, negotiate, cooperate, collaborate or even discuss techniques and/or methodologies for problem solving. In this paper, it is proposed a Multi-Agent simulator for the behaviour representation of group members in a decision making process. Agents behave depending on rational and emotional intelligence and use persuasive argumentation to convince and make alternative choices.