Discussing uncertainty and risk in primary care: recommendations of a multi-disciplinary panel regarding communication around prostate cancer screening.

BackgroundShared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men.ObjectiveIn July 2011, the Centers for Disease Control and Prevention convened a multidisciplinary expert panel to identify priorities for funding agencies and development groups to promote evidence-based, value-concordant decisions between men at average risk for prostate cancer and their physicians.DesignTwo-day multidisciplinary expert panel in Atlanta, Georgia, with structured discussions and formal consensus processes.ParticipantsSixteen panelists represented diverse specialties (primary care, medical oncology, urology), disciplines (sociology, communication, medical education, clinical epidemiology) and market sectors (patient advocacy groups, Federal funding agencies, guideline-development organizations).Main measuresPanelists used guiding interactional and evaluation models to identify and rate strategies that might improve PrCS discussions and decisions for physicians, patients and health systems/society. Efficacy was defined as the likelihood of each strategy to impact outcomes. Effort was defined as the relative amount of effort to develop, implement and sustain the strategy. Each strategy was rated (1-7 scale; 7 = maximum) using group process software (ThinkTank(TM)). For each group, intervention strategies were grouped as financial/regulatory, educational, communication or attitudinal levers. For each strategy, barriers were identified.Key resultsHighly ranked strategies to improve value-concordant shared decision-making (SDM) included: changing outpatient clinic visit reimbursement to reward SDM; development of evidence-based, technology-assisted, point-of-service tools for physicians and patients; reframing confusing prostate cancer screening messages; providing pre-visit decision support interventions; utilizing electronic health records to promote benchmarking/best practices; providing additional training for physicians around value-concordant decision-making; and using re-accreditation to promote training.ConclusionsConference outcomes present an expert consensus of strategies likely to improve value-concordant prostate cancer screening decisions. In addition, the methodology used to obtain agreement provides a model of successful collaboration around this and future controversial cancer screening issues, which may be of interest to funding agencies, educators and policy makers

Politiques de l'État à l'enseignement supérieur au Québec

Québec Université Laval, Bibliothèque 201

The 'Mistery' of Hobin Hood: A New Social Context for the Texts

The recent debate on the nature and origin of the Robin Hood ballads has been conducted not by literary critics but by social historians; that fact emphasises the importance of these ballads as a register of the popular consciousness of the time. 2 Two major interpretations of the original context of the ballads have emerged. One view, put forward by R.H. Hilton, sees them as a 'by-product of the agrarian social struggle' which took place from the late thirteenth century through to the Peasants' Revolt of1381: this view sees the ballads realising in fiction the discontents ofthe workers and small landholders who were badly affected by agrarian problems and wel·e active in protests against the prevailing system. M.Keen originally presented evidence and argument in support of Hilton, but retracted it and came to agree with a paper by J.C. Holt, which quite contradicted Hilton's position. Holt argued that the ballads 'were designed primarily for a gentle audience' and that they only achieved popularity with the lower orders through performance in the communal and convivial atmosphere of the halls of the gentry. According to Holt, this was an audience concerned not with 'alleged or actual' class conflict, but with 'hospitality and its formalities, and the precedence which arose from service and status.

Perspective d’usagers suivis en clinique externe d’établissements de première, deuxième et troisième lignes

L'étude regroupe les résultats de quatre enquêtes majeures sur la satisfaction de la clientèle de services de consultation externe en santé mentale de Montréal. Elle implique des milieux offrant des services de base, des services spécialisés et des services ultra-spécialisés. Effectuée à l'aide d'entrevues individuelles auprès d'un total de 856 patients, elle a permis de documenter la perspective de ces usagers. Les principales tendances observées indiquent que les patients sont généralement très satisfaits de la façon d'être des intervenants et de l'alliance thérapeutique établie avec eux. L'organisation et le fonctionnement des services génèrent toutefois des taux de satisfaction nettement inférieurs. Ces résultats semblent refléter l'impact des transformations récentes dans le système de services en santé mentale.This study is based on results of four major surveys on the satisfaction of the clientele regarding external consultation of mental health services in Montréal. It covers milieux offering primary care, specialized and ultra-specialized services. Conducted with 856 patients through personal interviews, this study has allowed to document consumers' perspectives. The major tendencies observed indicate that patient are generally highly satisfied with the work of mental health professionals and the therapeutic alliance they establish with them. Organization as well as functioning of services however, generate less satisfaction. These results appear to reflect the impact of recent transformation of the mental health system.El estudio reagrupa los resultados de cuatro grandes encuestas sobre la satisfacción de la clientela de los servicios de consulta externa en salud mental de Montreal. Esta implica los medios que ofrecen servicios de base, servicios especializados y servicios ultra especializados. Efectuada por medio de entrevistas individuales a 856 pacientes, la misma ha permitido documentar la perspectiva de estos usuarios. Las principales tendencias observadas indican que en general los pacientes se encuentran satisfechos de la manera de ser de los trabajadores y de la alianza terapéutica que se ha establecido con ellos. La organización y el funcionamiento de los servicios generan sin embargo algunos porcentajes de satisfacción, netamente inferiores. Estos resultados parecen reflejar el impacto de las recientes transformaciones en el sistema de servicios en salud mental

Fast computing of scattering maps of nanostructures using graphical processing units

Scattering maps from strained or disordered nano-structures around a Bragg reflection can either be computed quickly using approximations and a (Fast) Fourier transform, or using individual atomic positions. In this article we show that it is possible to compute up to 4.10^10 $reflections.atoms/s using a single graphic card, and we evaluate how this speed depends on number of atoms and points in reciprocal space. An open-source software library (PyNX) allowing easy scattering computations (including grazing incidence conditions) in the Python language is described, with examples of scattering from non-ideal nanostructures.Comment: 7 pages, 4 figure

Culture and change blindness

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91933/1/culture_change_blindness.pd