22,266 research outputs found

    Does an Intervention Designed to Improve Self-management, Social Support and Awareness of Palliative-care Address Needs of Persons with Heart Failure, Family Caregivers and Clinicians?

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    Aims and Objectives To conduct a formative evaluation of the iPad‐Enhanced Shared Care Intervention for Partners (iSCIP) among persons with heart failure (HF), family caregivers and clinicians. Together, persons with HF and family caregivers are referred to as partners. Background There is growing awareness of the caregiver\u27s contributions to HF self‐management, social support and reciprocal benefits of interventions that involve both partners. The iSCIP engages both partners in a six‐session psychosocial intervention to address three preventable causes of poor outcomes in a HF population: poor self‐management skills, inadequate social support and underutilisation of palliative care. An iPad app is used to organise the intervention. The goals of the iSCIP are to engage partners in HF self‐management, communication about the HF patient\u27s care values and preferences, and future planning. Design A qualitative focus group design was used. Methods Seven clinicians and eight partners participated in focus groups to explore their experiences, needs and reaction to the iSCIP content and technologies employed. Open‐ended questions and closed‐ended surveys were used to collect data. Deductive content analysis was used to analyse the qualitative data. NVivo software was used for qualitative data analysis. Bayesian statistical models were used to analyse numeric data. Results The iSCIP met partners’ and clinicians’ needs to improve self‐management, communicate about care values and preferences and plan for the future. Quantitative analysis of numeric data supported our qualitative findings, in that both groups rated the intervention components useful to very useful. Implications for practice These findings add to the growing evidence of the feasibility and acceptability of programs that address care values and preferences, and care planning. The iSCIP can be used as a guide for developing interventions and software applications, which involve both partners in care and palliative‐care discussions

    Toward a relational concept of uncertainty: about knowing too little, knowing too differently, and accepting not to know

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    Uncertainty of late has become an increasingly important and controversial topic in water resource management, and natural resources management in general. Diverse managing goals, changing environmental conditions, conflicting interests, and lack of predictability are some of the characteristics that decision makers have to face. This has resulted in the application and development of strategies such as adaptive management, which proposes flexibility and capability to adapt to unknown conditions as a way of dealing with uncertainties. However, this shift in ideas about managing has not always been accompanied by a general shift in the way uncertainties are understood and handled. To improve this situation, we believe it is necessary to recontextualize uncertainty in a broader wayÂżrelative to its role, meaning, and relationship with participants in decision makingÂżbecause it is from this understanding that problems and solutions emerge. Under this view, solutions do not exclusively consist of eliminating or reducing uncertainty, but of reframing the problems as such so that they convey a different meaning. To this end, we propose a relational approach to uncertainty analysis. Here, we elaborate on this new conceptualization of uncertainty, and indicate some implications of this view for strategies for dealing with uncertainty in water management. We present an example as an illustration of these concepts. Key words: adaptive management; ambiguity; frames; framing; knowledge relationship; multiple knowledge frames; natural resource management; negotiation; participation; social learning; uncertainty; water managemen

    Participatory Modelling and Decision Support for Natural Resources Management in Climate Change Research

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    The ever greater role given to public participation by laws and regulations, in particular in the field of environmental management calls for new operational methods and tools for managers and practitioners. This paper analyses the potentials and the critical limitations of current approaches in the fields of simulation modelling (SM), public participation (PP) and decision analysis (DA), for natural resources management within the context of climate change research. The potential synergies of combining SM, PP and DA into an integrated methodological framework are identified and a methodological proposal is presented, called NetSyMoD (Network Analysis – Creative System Modelling – Decision Support), which aims at facilitating the involvement of stakeholders or experts in policy - or decision-making processes (P/DMP). A generic P/DMP is formalised in NetSyMoD as a sequence of six main phases: (i) Actors analysis; (ii) Problem analysis; (iii) Creative System Modelling; (iv) DSS design; (v) Analysis of Options; and (vi) Action taking and monitoring. Several variants of the NetSyMoD approach have been adapted to different contexts such as integrated water resources management and coastal management, and, recently it has been applied in climate change research projects. Experience has shown that NetSyMoD may be a useful framework for skilled professionals, for guiding the P/DMP, and providing practical solutions to problems encountered in the different phases of the decision/policy making process, in particular when future scenarios or projections have to be considered, such as in the case of developing and selecting adaptation policies. The various applications of NetSyMoD share the same approach for problem analysis and communication within the group of selected actors, based upon the use of creative thinking techniques, the formalisation of human-environment relationships through the DPSIR framework, and the use of multi-criteria analysis through a Decision Support System (DSS) software.Modelling, Public Participation, Natural Resource Management, Policy, Decision-Making, Governance, DSS

    Allocating Vote: Biosecurity - Towards an "Economics-Based" Approach for Setting Priorities for the Importation of Risk Goods

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    The New Zealand government (through its agency the Ministry of Agriculture and Forestry, MAF) seeks to mitigate the potential negative impacts of importation through requiring commodities that may pose a risk to New Zealand's primary production systems, human health, indigenous flora, fauna or biodiversity to have an import health standard. Given, potential import opportunities exist in a wide variety of commodities from many different countries, the demand for import health standards far outweighs MAF's available resources to develop them. Therefore MAF must have a framework that prioritises which import health standards will be developed. This paper briefly presents the framework MAF is currently using to undertake the prioritisation of import health standards and then discusses how the current framework could evolve to become more 'economics-based'.Prioritisation, Biosecurity, multiple criteria decision making, Food Consumption/Nutrition/Food Safety, Health Economics and Policy, International Relations/Trade,

    Scientific Method, Anti-Foundationalism, and Public Decision-making

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    An examination of the legitimacy of attacks on lay assessments of environmental or other technological Risk. The case is made that rational policy requires an epistemology in which what we believe about Risk is bootstrapped onto how we should act concerning Risk
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