Ethical aspects of children’s perceptions of information-giving in care

The aim of this study was to identify key aspects in the exchange of information and to determine how nurses communicate news to hospitalised children. For this study, we applied the critical incident technique with 30 children aged between 8 and 14 years. Data were collected in paediatric units in a hospital in Alicante (Spain) using participant observation and semi-structured interviews. The analysis yielded three main categories: the children’s reaction to the information, nursing staff behaviour as a key aspect in the exchange of information and communication of news as well as children’s experience. This article emphasises the need to promote children’s consent and participation in nursing interventions. An analysis of these aspects will verify whether children’s rights are being respected and taken into account in order to promote children’s well-being and adaptation to hospitalisation.

List of plant breeders in Canada and the United States of America; a reference list of classified information giving the addresses and activities of plant breeders in these countries.

Supplement; World list of plant breeders. (105 p.) issued in 1952 (Rome, Italy)

Information giving and decision-making in patients with advanced cancer: A systematic review

Patients with advanced, non-curable cancer face difficult decisions on further treatment, where a small increase in survival time must be balanced against: the toxicity of the treatment. If patients want to be involved in these decisions, in keeping with current notions of autonomy and empowerment, they also require to be adequately informed both on the treatments proposed and on their own disease status and prognosis. A systematic review was performed on decision-making and information provision in patients with advanced cancer. Studies of interventions to improve information giving and encourage participation in decision-making were reviewed, including both randomised controlled trials and uncontrolled studies. Almost all patients expressed a desire for full information, but only about two-thirds wished to participate actively in decision-making. Higher educational level, younger age and female sex were predictive of a desire to participate in decision-making. Active decision-making was more common in patients with certain cancers (e.g. breast) than others (e.g. prostate). A number of simple interventions including question prompt sheets, audio-taping of consultations and patient decision aids have been shown to facilitate such involvement. (c) 2005 Elsevier Ltd. All rights reserved.

Nonlinear non-extensive approach for identification of structured information

The problem of separating structured information representing phenomena of differing natures is considered. A structure is assumed to be independent of the others if can be represented in a complementary subspace. When the concomitant subspaces are well separated the problem is readily solvable by a linear technique. Otherwise, the linear approach fails to correctly discriminate the required information. Hence, a non-extensive approach is proposed. The resulting nonlinear technique is shown to be suitable for dealing with cases that cannot be tackled by the linear one.

A systematic review : the effects of orientation programs for cancer patients and their family/carers

Objectives To assess the effects of information interventions which orient patients and their carers/family to a cancer care facility and the services available within the facility. Design Systematic review of randomised controlled trials (RCTs), cluster RCTs and quasi-RCTs. Data sources MEDLINE, CINAHL, PsycINFO, EMBASE and the Cochrane Central Register of Controlled Trials. Methods We included studies evaluating the effect of an orientation intervention, compared with a control group which received usual care, or with trials comparing one orientation intervention with another orientation intervention. Results Four RCTs of 610 participants met the criteria for inclusion. Findings from two RCTs demonstrated significant benefits of the orientation intervention in relation to reduced levels of distress (mean difference (MD): −8.96, 95% confidence interval (95%CI): −11.79 to −6.13), but non-significant benefits in relation to the levels state anxiety levels (MD −9.77) (95%CI: −24.96 to 5.41). There are insufficient data on the other outcomes of interest. Conclusions This review has demonstrated the feasibility and some potential benefits of orientation interventions. There was a low level of evidence to suggest that orientation interventions can reduce distress in patients. However, other outcomes, including patient knowledge recall/satisfaction, remain inconclusive. The majority of trials were subjected to high risk of bias and were likely to be insufficiently powered. Further well conducted and powered RCTs are required to provide evidence for determining the most appropriate intensity, nature, mode and resources for such interventions. Patient and carer-focused outcomes should be included.

Bringing up Children Gran’s Way: Insights from a research project on Indigenous child and youth mental health

Background In 2000, the Mater Child and Youth Mental Health Service Indigenous consultant saw that Indigenous families were isolated from kinship networks following the assimilation policy and clinicians were largely unaware of these socio-cultural histories. Experiences of marginalisation by mainstream society and services were exacerbated by assumptions clinicians made about this population. To enhance Mater’s care the consultant undertook research with Indigenous Elders. The project, “Bringing up Children Gran’s Way”, on which the presenter is the research advisor, was funded by AIATSIS. Aims Increase service quality Improve staff confidence, skills and satisfaction working with this population Promote the wellbeing of Indigenous families Acknowledge the significance of Elders and extended family networks. Methods Over 2006/07 the team used narrative and Indigenous methodologies, (e.g. yarning circles and the use of Indigenous research staff) to arrange and audio-record structured interviews with 19 Aboriginal Elders, on growing up and parenting. The participants were recruited by the Indigenous consultant and gave written consent, following ethical approval and information giving. The team immersed themselves in the material by repeated reading of the transcripts to note recurring themes in Elders’ narratives. Findings The recurring themes included the importance of cultural protocols and extended family; impacts of being ‘under the Act and stories of surviving change; culture, spiritualty and religion; trans-generational impacts; childrearing and the need to reconcile with Elders. Discussion The narratives show Elders resilience in the face of enduring impact of policies of genocide and assimilation. Clinicians need to approach their work with a deeper understanding of the diversity of clients’ social experience and cultural identity. Clinicians need to examine their own cultural assumptions about this population. Conclusion The dissemination of the knowledge and experience of Elders is a matter of social justice and crucial for the well-being of future generations and for improved service access.

The retrieval of structured design knowledge

Design rationale is an effective way of capturing knowledge, since it records the issues addressed, the options considered, and the arguments used when specific decisions are made during the design process. Design rationale is generally captured by identifying elements and their dependencies, i.e. in a structured way. Current retrieval methods focus mainly on either the classification of rationale or on keyword-based searches of records. Keyword-based retrieval is reasonably effective as the information in design rationale records is mainly described using text. However, most of the current keyword-based retrieval methods discard the implicit structures of these records, resulting either in poor precision of retrieval or in isolated pieces of information that are difficult to understand. This ongoing research aims to go beyond keyword-based retrieval by developing methods and tools to facilitate the provision of useful design knowledge in new design projects. Our first step is to understand the structured information derived from the relationship between lumps of text held in different nodes in the design rationale captured via a software tool currently used in industry, and study how this information can be utilised to improve retrieval performance. Specifically, methods for utilising various structured information are developed and implemented on a prototype keyword-based retrieval system developed in our earlier work. The implementation and evaluation of these methods shows that the structured information can be utilised in a number of ways, such as filtering the results and providing more complete information. This allows the retrieval system to present results that are easy to understand, and which closely match designers' queries. Like design rationale, other methods for representing design knowledge also in essence involve structured information and thus the methods proposed can be generalised to be adapted and applied for the retrieval of other kinds of design knowledge. Copyright © 2002-2012 The Design Society. All rights reserved.

A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol

Aim
To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance.

Background
Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy.

Design
A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods.

Methods
Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012).

Discussion
Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.

Estudio de la aplicación de sistemas basados en el conocimiento a la operación de una planta de tratamiento de residuos sólidos urbanos por valorización energética

Una de las actuaciones posibles para la gestión de los residuos sólidos urbanos es la valorización energética, es decir la incineración con recuperación de energía. Sin embargo es muy importante controlar adecuadamente el proceso de incineración para evitar en lo posible la liberación de sustancias contaminantes a la atmósfera que puedan ocasionar problemas de contaminación industrial.Conseguir que tanto el proceso de incineración como el tratamiento de los gases se realice en condiciones óptimas presupone tener un buen conocimiento de las dependencias entre las variables de proceso. Se precisan métodos adecuados de medida de las variables más importantes y tratar los valores medidos con modelos adecuados para transformarlos en magnitudes de mando. Un modelo clásico para el control parece poco prometedor en este caso debido a la complejidad de los procesos, la falta de descripción cuantitativa y la necesidad de hacer los cálculos en tiempo real. Esto sólo se puede conseguir con la ayuda de las modernas técnicas de proceso de datos y métodos informáticos, tales como el empleo de técnicas de simulación, modelos matemáticos, sistemas basados en el conocimiento e interfases inteligentes. En [Ono, 1989] se describe un sistema de control basado en la lógica difusa aplicado al campo de la incineración de residuos urbanos. En el centro de investigación FZK de Karslruhe se están desarrollando aplicaciones que combinan la lógica difusa con las redes neuronales [Jaeschke, Keller, 1994] para el control de la planta piloto de incineración de residuos TAMARA. En esta tesis se plantea la aplicación de un método de adquisición de conocimiento para el control de sistemas complejos inspirado en el comportamiento humano. Cuando nos encontramos ante una situación desconocida al principio no sabemos como actuar, salvo por la extrapolación de experiencias anteriores que puedan ser útiles. Aplicando procedimientos de prueba y error, refuerzo de hipótesis, etc., vamos adquiriendo y refinando el conocimiento, y elaborando un modelo mental. Podemos diseñar un método análogo, que pueda ser implementado en un sistema informático, mediante el empleo de técnicas de Inteligencia Artificial.Así, en un proceso complejo muchas veces disponemos de un conjunto de datos del proceso que a priori no nos dan información suficientemente estructurada para que nos sea útil. Para la adquisición de conocimiento pasamos por una serie de etapas: - Hacemos una primera selección de cuales son las variables que nos interesa conocer. - Estado del sistema. En primer lugar podemos empezar por aplicar técnicas de clasificación (aprendizaje no supervisado) para agrupar los datos y obtener una representación del estado de la planta. Es posible establecer una clasificación, pero normalmente casi todos los datos están en una sola clase, que corresponde a la operación normal. Hecho esto y para refinar el conocimiento utilizamos métodos estadísticos clásicos para buscar correlaciones entre variables (análisis de componentes principales) y así poder simplificar y reducir la lista de variables. - Análisis de las señales. Para analizar y clasificar las señales (por ejemplo la temperatura del horno) es posible utilizar métodos capaces de describir mejor el comportamiento no lineal del sistema, como las redes neuronales. Otro paso más consiste en establecer relaciones causales entre las variables. Para ello nos sirven de ayuda los modelos analíticos - Como resultado final del proceso se pasa al diseño del sistema basado en el conocimiento. El objetivo principal es aplicar el método al caso concreto del control de una planta de tratamiento de residuos sólidos urbanos por valorización energética. En primer lugar, en el capítulo 2 Los residuos sólidos urbanos, se trata el problema global de la gestión de los residuos, dando una visión general de las diferentes alternativas existentes, y de la situación nacional e internacional en la actualidad. Se analiza con mayor detalle la problemática de la incineración de los residuos, poniendo especial interés en aquellas características de los residuos que tienen mayor importancia de cara al proceso de combustión.En el capítulo 3, Descripción del proceso, se hace una descripción general del proceso de incineración y de los distintos elementos de una planta incineradora: desde la recepción y almacenamiento de los residuos, pasando por los distintos tipos de hornos y las exigencias de los códigos de buena práctica de combustión, el sistema de aire de combustión y el sistema de humos. Se presentan también los distintos sistemas de depuración de los gases de combustión, y finalmente el sistema de evacuación de cenizas y escorias.El capítulo 4, La planta de tratamiento de residuos sólidos urbanos de Girona, describe los principales sistemas de la planta incineradora de Girona: la alimentación de residuos, el tipo de horno, el sistema de recuperación de energía, y el sistema de depuración de los gases de combustión Se describe también el sistema de control, la operación, los datos de funcionamiento de la planta, la instrumentación y las variables que son de interés para el control del proceso de combustión.En el capítulo 5, Técnicas utilizadas, se proporciona una visión global de los sistemas basados en el conocimiento y de los sistemas expertos. Se explican las diferentes técnicas utilizadas: redes neuronales, sistemas de clasificación, modelos cualitativos, y sistemas expertos, ilustradas con algunos ejemplos de aplicación.Con respecto a los sistemas basados en el conocimiento se analizan en primer lugar las condiciones para su aplicabilidad, y las formas de representación del conocimiento. A continuación se describen las distintas formas de razonamiento: redes neuronales, sistemas expertos y lógica difusa, y se realiza una comparación entre ellas. Se presenta una aplicación de las redes neuronales al análisis de series temporales de temperatura.Se trata también la problemática del análisis de los datos de operación mediante técnicas estadísticas y el empleo de técnicas de clasificación. Otro apartado está dedicado a los distintos tipos de modelos, incluyendo una discusión de los modelos cualitativos.Se describe el sistema de diseño asistido por ordenador para el diseño de sistemas de supervisión CASSD que se utiliza en esta tesis, y las herramientas de análisis para obtener información cualitativa del comportamiento del proceso: Abstractores y ALCMEN. Se incluye un ejemplo de aplicación de estas técnicas para hallar las relaciones entre la temperatura y las acciones del operador. Finalmente se analizan las principales características de los sistemas expertos en general, y del sistema experto CEES 2.0 que también forma parte del sistema CASSD que se ha utilizado.El capítulo 6, Resultados, muestra los resultados obtenidos mediante la aplicación de las diferentes técnicas, redes neuronales, clasificación, el desarrollo de la modelización del proceso de combustión, y la generación de reglas. Dentro del apartado de análisis de datos se emplea una red neuronal para la clasificación de una señal de temperatura. También se describe la utilización del método LINNEO+ para la clasificación de los estados de operación de la planta.En el apartado dedicado a la modelización se desarrolla un modelo de combustión que sirve de base para analizar el comportamiento del horno en régimen estacionario y dinámico. Se define un parámetro, la superficie de llama, relacionado con la extensión del fuego en la parrilla. Mediante un modelo linealizado se analiza la respuesta dinámica del proceso de incineración. Luego se pasa a la definición de relaciones cualitativas entre las variables que se utilizan en la elaboración de un modelo cualitativo. A continuación se desarrolla un nuevo modelo cualitativo, tomando como base el modelo dinámico analítico.Finalmente se aborda el desarrollo de la base de conocimiento del sistema experto, mediante la generación de reglas En el capítulo 7, Sistema de control de una planta incineradora, se analizan los objetivos de un sistema de control de una planta incineradora, su diseño e implementación. Se describen los objetivos básicos del sistema de control de la combustión, su configuración y la implementación en Matlab/Simulink utilizando las distintas herramientas que se han desarrollado en el capítulo anterior.Por último para mostrar como pueden aplicarse los distintos métodos desarrollados en esta tesis se construye un sistema experto para mantener constante la temperatura del horno actuando sobre la alimentación de residuos.Finalmente en el capítulo Conclusiones, se presentan las conclusiones y resultados de esta tesis.

A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol.

AIM: To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance. BACKGROUND: Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy. DESIGN: A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods. METHODS: Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012). DISCUSSION: Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.

The German business and information technologies project

The Business and Information Technologies (BIT) project strives to reveal new insights into how modern IT impacts organizational structures and business practices using empirical methods. Due to its international scope, it allows for inter-country comparison of empirical results. Germany — represented by the European School of Management and Technologies (ESMT) and the Institute of Information Systems at Humboldt-Universität zu Berlin — joined the BIT project in 2006. This report presents the result of the first survey conducted in Germany during November–December 2006. The key results are as follows: • The most widely adopted technologies and systems in Germany are websites, wireless hardware and software, groupware/productivity tools, and enterprise resource planning (ERP) systems. The biggest potential for growth exists for collaboration and portal tools, content management systems, business process modelling, and business intelligence applications. A number of technological solutions have not yet been adopted by many organizations but also bear some potential, in particular identity management solutions, Radio Frequency Identification (RFID), biometrics, and third-party authentication and verification. • IT security remains on the top of the agenda for most enterprises: budget spending was increasing in the last 3 years. • The workplace and work requirements are changing. IT is used to monitor employees' performance in Germany, but less heavily compared to the United States (Karmarkar and Mangal, 2007).1 The demand for IT skills is increasing at all corporate levels. Executives are asking for more and better structured information and this, in turn, triggers the appearance of new decision-making tools and online technologies on the market. • The internal organization of companies in Germany is underway: organizations are becoming flatter, even though the trend is not as pronounced as in the United States (Karmarkar and Mangal, 2007), and the geographical scope of their operations is increasing. Modern IT plays an important role in enabling this development, e.g. telecommuting, teleconferencing, and other web-based collaboration formats are becoming increasingly popular in the corporate context. • The degree to which outsourcing is being pursued is quite limited with little change expected. IT services, payroll, and market research are the most widely outsourced business functions. This corresponds to the results from other countries. • Up to now, the adoption of e-business technologies has had a rather limited effect on marketing functions. Companies tend to extract synergies from traditional printed media and on-line advertising. • The adoption of e-business has not had a major impact on marketing capabilities and strategy yet. Traditional methods of customer segmentation are still dominating. The corporate identity of most organizations does not change significantly when going online. • Online sales channel are mainly viewed as a complement to the traditional distribution means. • Technology adoption has caused production and organizational costs to decrease. However, the costs of technology acquisition and maintenance as well as consultancy and internal communication costs have increased.

Publishing Orthology and Diseases Information in the Linked Open Data Cloud

The Linked Data initiative offers a straight method to publish structured data in the World Wide Web and link it to other data, resulting in a world wide network of semantically codified data known as the Linked Open Data cloud. The size of the Linked Open Data cloud, i.e. the amount of data published using Linked Data principles, is growing exponentially, including life sciences data. However, key information for biological research is still missing in the Linked Open Data cloud. For example, the relation between orthologs genes and genetic diseases is absent, even though such information can be used for hypothesis generation regarding human diseases. The OGOLOD system, an extension of the OGO Knowledge Base, publishes orthologs/diseases information using Linked Data. This gives the scientists the ability to query the structured information in connection with other Linked Data and to discover new information related to orthologs and human diseases in the cloud.

Processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance

Résumé : Malgré le fait que la vaccination soit reconnue comme l’une des mesures de santé publique les plus efficaces, elle est perçue comme non sécuritaire et non nécessaire par un nombre grandissant de parents. Dans ce contexte, la compréhension du processus décisionnel des parents par rapport à la vaccination de leur enfant serait aidante. Le but de cette étude est d’explorer le processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance, soit la génération X ou Y. Une étude de cas descriptive et comparative a été réalisée avec des entrevues semi-structurées ainsi qu’une analyse des sources d’informations consultées par les participantes. Les mères ont été sélectionnées selon leur intention de vaccination pour leur enfant. Les données ont été codifiées et analysées de façon systématique et rigoureuse au niveau intra-cas et inter-cas, co-analysées et ensuite validées avec les participantes. Quatre mères dans chaque génération ont été interviewées, dont trois participantes par génération à deux reprises. Le processus décisionnel est similaire d’une génération à l’autre. Les composantes du processus sont l’attitude initiale envers la vaccination, le processus cognitif, la recherche d’information, la décision, l’acte et l’évaluation rétrospective de l’expérience vécue. Toutes ces composantes sont influencées par des facteurs intrinsèques et extrinsèques. Certaines trouvailles de cette étude ont peu été documentées dans la littérature telles que la perception positive envers la vaccination, l’inconscience du processus, l’importance du déclencheur et le fait de saisir le moment opportun. Malgré la rigueur de cette étude, la principale limite est la saturation des données qui n’a possiblement pas été atteinte pour tous les aspects du processus décisionnel. Même si la norme sociale est favorable à la vaccination, aucune participante n’avait consciemment réfléchi à l’immunisation de son enfant jusqu’à ce qu’un déclencheur soit introduit. Ceci soulève l’enjeu et l’impact de la transmission de l’information adéquate, au moment opportun, et du soutien donné aux parents qui naviguent dans ce processus.