Recovery of Sleep or Recovery of Self? A Grounded Theory Study of Residents’ Decision Making Regarding How to Spend Their Nonclinical Postcall Time

Purpose: As resident work hours policies evolve, residents’ off-duty time remains poorly understood. Despite assumptions about how residents should be using their postcall, off-duty time, there is little research on how residents actually use this time and the reasoning underpinning their activities. This study sought to understand residents’ nonclinical postcall activities when they leave the hospital, their decision-making processes, and their perspectives on the relationship between these activities and their well-being or recovery.

Method: The study took place at a Liaison Committee on Medical Education–accredited Canadian medical school from 2012 to 2014. The authors recruited a purposive and convenience sample of postgraduate year 1–5 residents from six surgical and nonsurgical specialties at three hospitals affiliated with the medical school. Using a constructivist grounded theory approach, semistructured interviews were conducted, audio-taped, transcribed, anonymized, and combined with field notes. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking.

Results: Twenty-four residents participated. Residents characterized their predominant approach to postcall decision making as one of making trade-offs between multiple, competing, seemingly incompatible, but equally valuable, activities. Participants exhibited two different trade-off orientations: being oriented toward maintaining a normal life or toward mitigating fatigue.

Conclusions: The authors’ findings on residents’ trade-off orientations suggest a dual recovery model with postcall trade-offs motivated by the recovery of sleep or of self. This model challenges the dominant viewpoint in the current duty hours literature and suggests that the duty hours discussion must be broadened to include other recovery processes.

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.

Changing climate, changing decisions : understanding climate adaptation decision-making and the way science supports it

Tese de doutoramento, Ciências do Ambiente, Universidade de Lisboa, Faculdade de Ciências, Universidade Nova de Lisboa, 2015

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.

School funding and education policy-making models in Ontario /

The purpose of this thesis is to examine various policy implementation models, and to determine what use they are to a government. In order to insure that governmental proposals are created and exercised in an effective manner, there roust be some guidelines in place which will assist in resolving difficult situations. All governments face the challenge of responding to public demand, by delivering the type of policy responses that will attempt to answer those demands. The problem for those people in positions of policy-making responsibility is to balance the competitive forces that would influence policy. This thesis examines provincial government policy in two unique cases. The first is the revolutionary recommendations brought forth in the Hall -Dennis Report. The second is the question of extending full -funding to the end of high school in the separate school system. These two cases illustrate how divergent and problematic the policy-making duties of any government may be. In order to respond to these political challenges decision-makers must have a clear understanding of what they are attempting to do. They must also have an assortment of policy-making models that will insure a policy response effectively deals with the issue under examination. A government must make every effort to insure that all policymaking methods are considered, and that the data gathered is inserted into the most appropriate model. Currently, there is considerable debate over the benefits of the progressive individualistic education approach as proposed by the Hall -Dennis Committee. This debate is usually intensified during periods of economic uncertainty. Periodically, the province will also experience brief yet equally intense debate on the question of separate school funding. At one level, this debate centres around the efficiency of maintaining two parallel education systems, but the debate frequently has undertones of the religious animosity common in Ontario's history. As a result of the two policy cases under study we may ask ourselves these questions: a) did the policies in question improve the general quality of life in the province? and b) did the policies unite the province? In the cases of educational instruction and finance the debate is ongoing and unsettling. Currently, there is a widespread belief that provincial students at the elementary and secondary levels of education are not being educated adequately to meet the challenges of the twenty-first century. The perceived culprit is individual education which sees students progressing through the system at their own pace and not meeting adequate education standards. The question of the finance of Catholic education occasionally rears its head in a painful fashion within the province. Some public school supporters tend to take extension as a personal religious defeat, rather than an opportunity to demonstrate that educational diversity can be accommodated within Canada's most populated province. This thesis is an attempt to analyze how successful provincial policy-implementation models were in answering public demand. A majority of the public did not demand additional separate school funding, yet it was put into place. The same majority did insist on an examination of educational methods, and the government did put changes in place. It will also demonstrate how policy if wisely created may spread additional benefits to the public at large. Catholic students currently enjoy a much improved financial contribution from the province, yet these additional funds were taken from somewhere. The public system had it funds reduced with what would appear to be minimal impact. This impact indicates that government policy is still sensitive to the strongly held convictions of those people in opposition to a given policy.

Making it "click": collaborative perceptions of creative practice in art education /

Making it "Click": Collaborative Perceptions ofCreative Practice in Art Education examined the teaching practice of 6 art educators who conducted their work through the Niagara Falls Art Gallery's (NFAG) in-schools and Children's Museum programmes. These community resources service the elementary levels of participatory Public, Catholic and French schools in the Niagara Peninsula. The goal of this research was to find ways in which these teachers could explore their creative potential as art educators. The "click," a term introduced by participants indicating the coming together of all positive factors towards creativity, became the central theme behind this study. Research revealed that the effective creative process was not merely a singular phase, but rather a series of 4 processes: 1 , gathering knowledge; 2, intuitive and experiential; 3, the informal presentation of information in which creativity as a process was explored; and 4, formal presentation that took the analysis of information to a deeper, holistic level. To examine the ways in which experience and knowledge could be shared and brought together through a collaborative process, this study employed data collection that used literature research, interviews, focus group discussions, and personal journal entries. Follow-up discussions that assessed the effectiveness of action research, took place VA months after the initial meetings. It is hoped that this study might assist in creative educational practices, for myself as a member of the NFAG teaching team, for colleagues in the art programmes, art educators, and other teachers in the broader disciplines of education.

Educational Technology Decision-Making: A Case Study on Technology Acquisition for 746,000 Ontario Students

Very little research has examined K–12 educational technology decision-making in Canada. This collective case study explores the technology procurement process in Ontario’s publicly funded school districts to determine if it is informed by the relevant research, grounded in best practices, and enhances student learning. Using a qualitative approach, 10 senior leaders (i.e., chief information officers, superintendents, etc.) were interviewed. A combination of open-ended and closed-ended questions were used to reveal the most important factors driving technology acquisition, research support, governance procedures, data use, and assessment and return on investment (ROI) measures utilized by school districts in their implementation of educational technology. After participants were interviewed, the data were transcribed, member checked, and then submitted to “Computer-assisted NCT analysis” (Friese, 2014) using ATLAS.ti. The findings show that senior leaders are making acquisitions that are not aligned with current scholarship and not with student learning as the focus. It was also determined that districts struggle to use data-driven decision-making to support the governance of educational technology spending. Finally, the results showed that districts do not have effective assessment measures in place to determine the efficacy or ROI of a purchased technology. Although data are limited to the responses of 10 senior leaders, findings represent the technology leadership for approximately 746,000 Ontario students. The study is meant to serve as an informative resource for senior leaders and presents strategic and research-validated approaches to technology procurement. Further, the study has the potential to refine technology decision-making, policies, and practices in K–12 education.

Du modèle du cercle magique à celui de la place du joueur : un apport de l’esthétique de la réception au design de jeux vidéo

Ce mémoire propose une réflexion sur des modèles permettant de mieux comprendre et concevoir l’expérience esthétique d’un jeu vidéo. Ces modèles traduisent différents idéaux de la place du joueur. Comme on peut le constater à travers une réflexion sur le modèle du cercle magique, jouer est souvent compris comme un acte unilatéral d’entrée en imagination dans un monde étranger au monde actuel – toute sortie marquant la pénalité ou la fin du jeu. De ce point de vue, le designer aurait donc pour rôle de placer et de maintenir le joueur dans le monde virtuel représenté pour qu’il s’y sente immergé et présent. Cela dit, comme en témoignent les critiques qui s’élèvent contre le modèle du cercle magique, d’autres stratégies de mise en place du joueur sont à distinguer et à définir pour faciliter l’analyse et la conception des jeux vidéo. Devant ce modèle, jugé limitatif, ce que nous proposons ici est de recourir à quelques outils méthodologiques et typologiques de l’esthétique de la réception en histoire de l’art pour bâtir un modèle plus englobant, celui de la place du joueur, dont nous testons la validité par l’analyse du jeu vidéo God of War III (2010).

An fMRI Study of Emotional engagement in decicion-making

It has been suggested that decision making depends on sensitive feelings associated with cognitive processing rather than cognitive processing alone. From human lesions, we know the medial anterior inferior-ventral prefrontal cortex processes the sensitivity associated with cognitive processing, it being essentially responsible for decision making. In this fMRI (functional Magnetic Resonance Image) study 15 subjects were analyzed using moral dilemmas as probes to investigate the neural basis for painful-emotional sensitivity associated with decision making. We found that a network comprising the posterior and anterior cingulate and the medial anterior prefrontal cortex was significantly and specifically activated by painful moral dilemmas, but not by non-painful dilemmas. These findings provide new evidence that the cingulate and medial anterior prefrontal are involved in processing painful emotional sensibility, in particular, when decision making takes place. We speculate that decision making has a cognitive component processed by cognitive brain areas and a sensitivity component processed by emotional brain areas. The structures activated suggest that decision making depends on painful emotional feeling processing rather than cognitive processing when painful feeling processing happens

Present simple and continuous: emergence of self-regulation and contextual sophistication in adolescent decision-making

Sophisticated, intentional decision-making is a hallmark of mature, self-aware behaviour. Although neural, psychological, interpersonal, and socioeconomic elements that contribute to such adaptive, foresighted behaviour mature and/or change throughout the life-span, here we concentrate on relevant maturational processes that take place during adolescence, a period of disproportionate developmental opportunity and risk. A brief, eclectic overview is presented of recent evidence, new challenges, and current thinking on the fundamental mechanisms that mature throughout adolescence to support adaptive, self-controlled decision-making. This is followed by a proposal for the putative contribution of frontostriatal mechanisms to the moment-to-moment assembly of evaluative heuristics that mediate increased decision-making sophistication, promoting the maturation of self-regulated behaviour through adolescence and young adulthood.

Telefantasy tower blocks: space, place and social realism shake-ups in Misfits

This article considers the ways in which British youth telefantasy Misfits (E4, 2009–13) takes up and makes strange urban spaces familiar from social-realist narratives. Filmed on the sprawling East London estate, Thamesmead, the programme chronicles a group of young offenders who are given powers by a freak storm, turning them into ‘ASBO superheroes’. Misfits depends on its British urban landscapes for the assertion of its ‘authenticity’ within British youth television, using spaces and landscapes familiar from urban youth exploitation cinema and television's narratives of the underclass. After situating the series within existing cultural discourses and recent developments in social-realist representations, the article explores how Misfits disrupts what have become signifiers for the ‘real’ – the brutalism of housing estates, the grey of the concrete and sky – by making them strange, turning them into telefantasy. The series presents the estate as an uncanny place: the domestic, social-realist world shifted into a fantastical space by the storm. Through close analysis, this article explores how the familiar spaces become skewed and unsettling to match our protagonists' isolation, shifting bodies and scrambled sense of self.

Enchanting resilience: relations of care and people-place connections in agriculture

The practices and decision-making of contemporary agricultural producers are governed by a multitude of different, and sometimes competing, social, economic, regulatory, environmental and ethical imperatives. Understanding how they negotiate and adapt to the demands of this complex and dynamic environment is crucial in maintaining an economically and environmentally viable and resilient agricultural sector. This paper takes a socio-cultural approach to explore the development of social resilience within agriculture through an original and empirically grounded discussion of people-place connections amongst UK farmers. It positions enchantment as central in shaping farmers' embodied and experiential connections with their farms through establishing hopeful, disruptive and demanding ethical practices. Farms emerge as complex moral economies in which an expanded conceptualisation of the social entangles human and non-human actants in dynamic and contextual webs of power and responsibility. While acknowledging that all farms are embedded within broader, nested levels, this paper argues that it is at the micro-scale that the personal, contingent and embodied relations that connect farmers to their farms are experienced and which, in turn, govern their capacity to develop social resilience.

Histological Outcomes on the Development of New Space-making Devices for Maxillary Sinus Floor Augmentation

Background: Previous studies have pointed out that the mere elevation of the maxillary sinus membrane promotes bone formation without the use of augmentation materials. Purpose: This experimental study aimed at evaluating if the two-stage procedure for sinus floor augmentation could benefit from the use of a space-making device in order to increase the bone volume to enable later implant installation with good primary stability. Materials and Methods: Six male tufted capuchin primates (Cebus apella) were subjected to extraction of the three premolars and the first molar on both sides of the maxilla to create an edentulous area. The sinuses were opened using the lateral bone-wall window technique, and the membrane was elevated. One resorbable space-making device was inserted in each maxillary sinus, and the bone window was returned in place. The animals were euthanatized after 6 months, and biopsy blocks containing the whole maxillary sinus and surrounding soft tissues were prepared for ground sections. Results: The histological examination of the specimens showed bone formation in contact with both the schneiderian membrane and the device in most cases even when the device was displaced. The process of bone formation indicates that this technique is potentially useful for two-stage sinus floor augmentation. The lack of stabilization of the device within the sinus demands further improvement of space-makers for predictable bone augmentation. Conclusions: It is concluded that (1) the device used in this study did not trigger any important inflammatory reaction; (2) when the sinus membrane was elevated, bone formation was a constant finding; and (3) an ideal space-making device should be stable and elevate the membrane to ensure a maintained connection between the membrane and the secluded space.

A place preference test in the fish Nile tilapia

The Nile tilapia fish (Oreochromis niloticus) has a high potential to be used as a model in neuroscience studies. In the present study, the preference of the Nile tilapia between a gravel-enriched (GEE), a shelter-enriched (SEE) or a non-enriched (NEE) environment was determined, for developing a place preference model. Nile tilapia had an initial preference for GEE, but after 1 day of observation, the fish stabilized their frequency of visits among compartments. Hence, any stimulus motivating tilapia increase in compartment visiting indicates a positively reinforcing effect. This feature is very useful for the development of new behavioural paradigms for fish in tests using environmental discrimination, such as the conditioning place preference test. © 2006 Elsevier GmbH. All rights reserved.

Youth and social cohesion in Ibero-America: a model in the making. Summary

Includes bibliography