An fMRI Study of Emotional engagement in decicion-making

It has been suggested that decisionmaking depends on sensitive feelings associatedwith cognitive processing rather than cognitiveprocessing alone. From human lesions, we knowthe medial anterior inferior-ventral prefrontalcortex processes the sensitivity associated withcognitive processing, it being essentiallyresponsible for decision making.In this fMRI (functional Magnetic ResonanceImage) study 15 subjects were analyzed usingmoral dilemmas as probes to investigate the neuralbasis for painful-emotional sensitivity associatedwith decision making. We found that a networkcomprising the posterior and anterior cingulateand the medial anterior prefrontal cortex wassignificantly and specifically activated by painfulmoral dilemmas, but not by non-painful dilemmas.These findings provide new evidence that thecingulate and medial anterior prefrontal areinvolved in processing painful emotionalsensibility, in particular, when decision makingtakes place. We speculate that decision makinghas a cognitive component processed by cognitivebrain areas and a sensitivity component processedby emotional brain areas. The structures activatedsuggest that decision making depends on painfulemotional feeling processing rather than cognitiveprocessing when painful feeling processinghappens

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

Referral to rehabilitation following traumatic brain injury: practitioners and the process of decision-making

The study aimed to examine the factors influencing referral to rehabilitation following traumatic brain injury (TBI) by using social problems theory as a conceptual model to focus on practitioners and the process of decision-making in two Australian hospitals. The research design involved semi-structured interviews with 18 practitioners and observations of 10 team meetings, and was part of a larger study on factors influencing referral to rehabilitation in the same settings. Analysis revealed that referral decisions were influenced primarily by practitioners' selection and their interpretation of clinical and non-clinical patient factors. Further, practitioners generally considered patient factors concurrently during an ongoing process of decision-making, with the combinations and interactions of these factors forming the basis for interpretations of problems and referral justifications. Key patient factors considered in referral decisions included functional and tracheostomy status, time since injury, age, family, place of residence and Indigenous status. However, rate and extent of progress, recovery potential, safety and burden of care, potential for independence and capacity to cope were five interpretative themes, which emerged as the justifications for referral decisions. The subsequent negotiation of referral based on patient factors was in turn shaped by the involvement of practitioners. While multi-disciplinary processes of decision-making were the norm, allied health professionals occupied a central role in referral to rehabilitation, and involvement of medical, nursing and allied health practitioners varied. Finally, the organizational pressures and resource constraints, combined with practitioners' assimilation of the broader efficiency agenda were central factors shaping referral. (C) 2004 Elsevier Ltd. All rights reserved.

Making Learning Visible: Peer Review and the Scholarship of Teaching

This is the promotional brochure from the March 2004 national conference, Making Learning Visible: Peer Review and the Scholarship of Teaching. This conference was hosted by the UNL Peer Review of Teaching project and the University of Nebraska-Lincoln.

Identifying and enhancing risk thresholds in the detection of elder financial abuse: A signal detection analysis of professionals' decision making

Background: Financial abuse of elders is an under acknowledged problem and professionals' judgements contribute to both the prevalence of abuse and the ability to prevent and intervene. In the absence of a definitive "gold standard" for the judgement, it is desirable to try and bring novice professionals' judgemental risk thresholds to the level of competent professionals as quickly and effectively as possible. This study aimed to test if a training intervention was able to bring novices' risk thresholds for financial abuse in line with expert opinion. Methods: A signal detection analysis, within a randomised controlled trial of an educational intervention, was undertaken to examine the effect on the ability of novices to efficiently detect financial abuse. Novices (n = 154) and experts (n = 33) judged "certainty of risk" across 43 scenarios; whether a scenario constituted a case of financial abuse or not was a function of expert opinion. Novices (n = 154) were randomised to receive either an on-line educational intervention to improve financial abuse detection (n = 78) or a control group (no on-line educational intervention, n = 76). Both groups examined 28 scenarios of abuse (11 "signal" scenarios of risk and 17 "noise" scenarios of no risk). After the intervention group had received the on-line training, both groups then examined 15 further scenarios (5 "signal" and 10 "noise" scenarios). Results: Experts were more certain than the novices, pre (Mean 70.61 vs. 58.04) and post intervention (Mean 70.84 vs. 63.04); and more consistent. The intervention group (mean 64.64) were more certain of abuse post-intervention than the control group (mean 61.41, p = 0.02). Signal detection analysis of sensitivity (Á) and bias (C) revealed that this was due to the intervention shifting the novices' tendency towards saying "at risk" (C post intervention -.34) and away from their pre intervention levels of bias (C-.12). Receiver operating curves revealed more efficient judgments in the intervention group. Conclusion: An educational intervention can improve judgements of financial abuse amongst novice professionals.

Contributos do associativismo na (re)construção da identidade profissional dos professores de matemática do 2º ciclo

Dissertação apresentada na Escola Superior de Educação de Lisboa para obtenção do grau de Mestre em Educação Matemática na Educação Pré-escolar e no 1º e 2º ciclos do Ensino Básico

Nursing Needs Assessment Tool - Users Guide 2002 (PDF 32 KB)

This assessment tool is designed to assess the registered nursing needs of a person needing long-term care. The tool is designed to encapsulate a systematic approach to assessment whilst at the same time embracing professional decision-making that takes place in the relationship between a nurse and another person. For this reason, the tool takes the assessment through a staged approach, moving from a general ‘narrative’ based assessment of ‘domains’ of care need, to a focused assessment of risk and complexity. åÊ

Professor coordenador na formação contínua de professores: um estudo em escolas do município de Limeira

Pós-graduação em Educação - IBRC

Aproximaciones del conjunto eficiente en decisión multicriterio

El conjunto eficiente en la Teoría de la Decisión Multicriterio juega un papel fundamental en los procesos de solución ya que es en este conjunto donde el decisor debe hacer su elección más preferida. Sin embargo, la generación de tal conjunto puede ser difícil, especialmente en problemas continuos y/o no lineales. El primer capítulo de esta memoria, es introductorio a la Decisión Multicriterio y en él se exponen aquellos conceptos y herramientas que se van a utilizar en desarrollos posteriores. El segundo capítulo estudia los problemas de Toma de Decisiones en ambiente de certidumbre. La herramienta básica y punto de partida es la función de valor vectorial que refleja imprecisión sobre las preferencias del decisor. Se propone una caracterización del conjunto de valor eficiente y diferentes aproximaciones con sus propiedades de encaje y convergencia. Varios algoritmos interactivos de solución complementan los desarrollos teóricos. El tercer capítulo está dedicado al caso de ambiente de incertidumbre. Tiene un desarrollo parcialmente paralelo al anterior y utiliza la función de utilidad vectorial como herramienta de modelización de preferencias del decisor. A partir de la consideración de las distribuciones simples se introduce la eficiencia en utilidad, su caracterización y aproximaciones, que posteriormente se extienden a los casos de distribuciones discretas y continuas. En el cuarto capítulo se estudia el problema en ambiente difuso, aunque de manera introductoria. Concluimos sugiriendo distintos problemas abiertos.---ABSTRACT---The efficient set of a Multicriteria Decicion-Making Problem plays a fundamental role in the solution process since the Decisión Maker's preferred choice should be in this set. However, the computation of that set may be difficult, specially in continuous and/or nonlinear problems. Chapter one introduces Multicriteria Decision-Making. We review basic concepts and tools for later developments. Chapter two studies Decision-Making problems under certainty. The basic tool is the vector valué function, which represents imprecisión in the DM's preferences. We propose a characterization of the valué efficient set and different approximations with nesting and convergence properties. Several interactive algorithms complement the theoretical results. We devote Chapter three to problems under uncertainty. The development is parallel to the former and uses vector utility functions to model the DM's preferences. We introduce utility efficiency for simple distributions, its characterization and some approximations, which we partially extend to discrete and continuous classes of distributions. Chapter four studies the problem under fuzziness, at an exploratory level. We conclude with several open problems.

DESCRIBING SLEEP AND SEDATION PRACTICES IN THE ICU: A MULTINATIONAL SURVEY

Introduction Sleep disturbances are common in critically ill patients treated in the intensive care unit (ICU) with the potential for serious consequences and long-term effects on health outcomes and patient morbidity.
Objectives Our aim was to describe sleep management and sedation practices of adult ICUs in ten countries and to evaluate roles and responsibilities of the ICU staff in relation to key sleep and sedation decisions.
Methods A multicenter, self-administered survey sent to nurse managers of adult ICUs across 10 countries. The questionnaire comprised four domains: sleep characteristics of the critically ill; sleep and sedation practices; non-pharmacological and pharmacological interventions used to improve sleep; and the autonomy and influence of nurses on sleeping practices in the ICU.
Results Overall response rate was 66% (range 32% UK to 100% Cyprus), providing data from 522 ICUs. In all countries, the most frequent patient characteristic perceived to identify sleep was lying quietly with closed eyes (N=409, 78%) (range 92% Denmark to 36% Italy). The most commonly used sedation scale was the Richmond Agitation-Sedation Score (RASS) (N=220, 42%) (range 81% UK to 0% Denmark, Cyprus where most ICUs used the Ramsay score). In most ICUs, selection of sleep medication (N=265, 51%) and assessment of effect (N=309, 59%) was performed by physicians and nurses based on collaborative discussion. In a minority of ICUs (N=161, 31%), decisions and assessments were made by physicians alone. The most commonly used (in all countries) non-pharmacological intervention to promote sleep was reducing ICU staff noise (N=473, 91%) (range 100% Denmark, Norway to 78% Canada). Only 95 ICUs (18%) used earplugs on a frequent basis (range 0% Greece, Cyprus, Denmark to 57% Sweden). Propofol was the drug used most commonly for sedation (N=359, 69%) (range 96% Sweden to 29% Canada). Chloral hydrate was used by only 63 (12%) ICUs (range 0% Greece, Cyprus, Denmark, Italy to 56% Germany). Sedation scales were used on a routine basis by 77% of the 522 ICUs. Participants scored nursing autonomy for sleep and sedation management as moderate; median score of 5 (scale of 0 to 10), range 7 (Canada, Greece, Sweden) to 4 (Norway, Poland). Nursing influence on sleep and sedation decisions was perceived considerable; median score 8, range 9 (Denmark) to 5 (Poland).
Conclusions We found considerable across country variation in sleep promotion and sedation management practices though most have adopted a sedation scale as recommended in professional society guidelines. Most ICUs in all countries used a range of pharmacological and non-pharmacological interventions to promote sleep. Most units reported inter-professional decision-making with nurses perceived to have substantial influence on sleep/sedation decisions.

Relatório final de estágio realizado na Escola Secundária da Amadora

O presente relatório visa ilustrar uma reflexão crítica e projetiva sobre as práticas desenvolvidas no estágio pedagógico em Educação Física, realizado na Escola Secundária da Amadora, durante o ano letivo 2015/2016. Este momento de formação carateriza-se pela integração do jovem professor no mundo da docência, possibilitando, por isso, a experimentação de diversas funções relacionadas com esta profissão: a lecionação de aulas de Educação Física, o acompanhamento de um núcleo de Desporto Escolar, o acompanhamento de um Diretor de Turma e a investigação. Ao longo do relatório é dada a conhecer toda a experiência vivida durante o ano letivo, as dificuldades sentidas em cada uma das áreas de intervenção, as estratégias usadas para as ultrapassar e ainda a contribuição destas para o meu desenvolvimento pessoal e profissional. Fazendo o balanço final, as minhas competências enquanto professora, nos vários papeis que a profissão integra, foram sendo melhoradas ao longo do ano, através da experiência, do estudo autónomo, da autorreflexão e da reflexão em grupo, contribuindo, assim, para que me tornasse mais competente na função docente. Contudo, este processo manter-se-á em construção, pois o professor deve estar em contante atualização de forma a potenciar o sucesso educativo dos alunos.

Effective continuing professional development for translating shared decision making in primary care: A study protocol.

Background: Shared decision making (SDM) is a process by which a healthcare choice is made jointly by the healthcare professional and the patient. SDM is the essential element of patient-centered care, a core concept of primary care. However, SDM is seldom translated into primary practice. Continuing professional development (CPD) is the principal means by which healthcare professionals continue to gain, improve, and broaden the knowledge and skills required for patient-centered care. Our international collaboration seeks to improve the knowledge base of CPD that targets translating SDM into the clinical practice of primary care in diverse healthcare systems. Methods: Funded by the Canadian Institutes of Health Research (CIHR), our project is to form an international, interdisciplinary research team composed of health services researchers, physicians, nurses, psychologists, dietitians, CPD decision makers and others who will study how CPD causes SDM to be practiced in primary care. We will perform an environmental scan to create an inventory of CPD programs and related activities for translating SDM into clinical practice. These programs will be critically assessed and compared according to their strengths and limitations. We will use the empirical data that results from the environmental scan and the critical appraisal to identify knowledge gaps and generate a research agenda during a two-day workshop to be held in Quebec City. We will ask CPD stakeholders to validate these knowledge gaps and the research agenda. Discussion: This project will analyse existing CPD programs and related activities for translating SDM into the practice of primary care. Because this international collaboration will develop and identify various factors influencing SDM, the project could shed new light on how SDM is implemented in primary care.

How can continuing professional development better promote shared decision-making? Perspectives from an international collaboration.

ABSTRACT: BACKGROUND: Shared decision-making is not widely implemented in healthcare. We aimed to set a research agenda about promoting shared decision-making through continuing professional development. METHODS: Thirty-six participants met for two days. RESULTS: Participants suggested ways to improve an environmental scan that had inventoried 53 shared decision-making training programs from 14 countries. Their proposed research agenda included reaching an international consensus on shared decision-making competencies and creating a framework for accrediting continuing professional development initiatives in shared decision-making. CONCLUSIONS: Variability in shared decision-making training programs showcases the need for quality assurance frameworks.

Violin-making, as it was and is : being a historical, practical, and theoretical treatise on the science and art of violin-making, for the use of violin makers, and players, amateur and professional.

Mode of access: Internet.

Strategy making process, its content and context in small professional football clubs

This thesis examines the phenomenon of strategy. Making as practised by small professional football clubs. The study was undertaken because football clubs were perceived to have problems with strategy-making and because it was believed that the specific circumstances of football clubs could be outside the range of views covered by conventional views of strategy-making. The characteristics of the club environment are its uncertainty and unpredictability, simultaneous competition and co--operation, strong regulations, and a not-for-profit orientation. Small clubs in particular face a constant struggle for financial viability and survival, due in part to split business and playing objectives. The study was designed to establish the extent and nature of the difficulties clubs experience with a view to preparing the way for creating practical guidance on ways to overcome them. Clearly, in order to survive in the long term, small professional football clubs require very effective strategic decisions. This study has addressed this issue by inquiring into the nature of strategy making for these organisations with the objective to establish the general direction in which the football clubs in question should be moving. As a result, the main research question to guide this investigation was determined as: Why do small professional football clubs have difficulties making strategies. The investigation was based on an analysis the concept of strategy and its elements, the strategic vision and objectives, the process by which strategic action comes about, the strategic action itself, and the context within which this action occurs. Data has been collected, analysed and interpreted in relation to each of these elements. Together with a wide variety of published material, 20 small football clubs have been sampled and personal interviews were conducted with board members of those clubs. The findings indicate that small football clubs do indeed experience considerable difficulties in making strategies, the reasons for which lie both in the characteristics of their competitive environment and their approaches to strategy-making. The competitive environment is characterised by a cartel-like structure with a high degree of regulation, high levels of uncertainty, little control over the core product or the production process, short-term business cycles and a close geographical link between a club with its local market. The management of clubs is characterised by the need to balance conflicting sporting and business objectives. Formal planning techniques are of little use in the small football club context as decision-making processes have a strong political character and the development of novel strategies is hindered by a strong conservative, industry paradigm and a lack of financial and managerial resources. It is concluded that there is no simple advice to be given to clubs, as they must re-examine the relationship between their playing and business objectives to create a unified and workable approach.