Prior family communication and consent to organ donation: Using intensive care physicians' perception to model decision processes

Generally, the Swiss hold favourable attitudes to organ donation, but only few carry a donor card. If no card is found on a potential donor, families have to be approached about donation. The aim of this paper is to model the role that some family communication factors play in the family decision to consent or not to organ donation by a brain dead relative. Information was gathered in face-to-face interviews, using a questionnaire and recording open answers and comments. Eight heads of intensive care units (ICU) of Swiss hospitals and one representative from Swisstransplant were interviewed. Questions asked respondents to estimate the prevalence and effect of communication factors in families facing a decision to consent to donation. Answers were averaged for modelling purposes. Modelling also relies on a previous representative population survey for cross-validation. The family of the deceased person is almost always approached about donation. Physicians perceive that prior thinking and favourable predisposition to donation are correlated and that the relatives' predisposition is the most important factor for the consent to donation, up to the point that a negative predisposition may override an acknowledged wish of the deceased to donate. Donor cards may trigger family communication and ease the physicians' approach to family about donation. Campaigns should encourage donate-willing people to talk to their families about it, make people think about organ donation and try to change unfavourable predispositions

Development of a 3D dynamic flood web GIS visualisation tool

Low elevation coastal areas are vulnerable to the effects of sea level rise and to an increase in the frequency and severity of storm surge events due to climate change.Coastal urban areas are at risk because coastal flooding causes extensive damage to energy and transportation infrastructure, disruptions to the delivery of services, devastating tolls on the public’s health and,occasionally, significant loss of life. Although scientists widely stress the compelling need to mitigate and adapt to climate change, public awareness lags behind. Because WebGIS maps (web-based geographic information systems) quickly convey strong messages, condense complex information, engage people on issues of environmental change, and motivate personal actions, this paper focuses on searching the ideal flood assessment WebGIS method to encourage people to mitigate and adapt to climate change. Surveys demonstrated that 3D visualisations have an enormous added value because they are more vivid and therefore more understandable and make it easier to imagine the consequences of a flood than2D visualisations. In this research, the WebGIS will be created using Ol3-Cesium and openlayers to visualise a flood event by dynamic layers in a 2D/3D environment

Using system dynamics for collaborative design: a case study

<p>Abstract</p> <p>Background</p> <p>In order to facilitate the collaborative design, system dynamics (SD) with a group modelling approach was used in the early stages of planning a new stroke unit. During six workshops a SD model was created in a multiprofessional group.</p> <p>Aim</p> <p>To explore to which extent and how the use of system dynamics contributed to the collaborative design process.</p> <p>Method</p> <p>A case study was conducted using several data sources.</p> <p>Results</p> <p>SD supported a collaborative design, by facilitating an explicit description of stroke care process, a dialogue and a joint understanding. The construction of the model obliged the group to conceptualise the stroke care and experimentation with the model gave the opportunity to reflect on care.</p> <p>Conclusion</p> <p>SD facilitated the collaborative design process and should be integrated in the early stages of the design process as a quality improvement tool.</p

Workflow in Clinical Trial Sites & Its Association with Near Miss Events for Data Quality: Ethnographic, Workflow & Systems Simulation

10.1371/journal.pone.0039671PLoS ONE76

Clubs as status symbol: Would you belong to a club that accepts you as a member

We present a stylised model that goes beyond traditional analyses involving crowding and exclusiveness, and addresses the status issue by asking 'Do I want to be associated with those individuals?' rather than 'Do I want to be associated with that many individuals?'. As the population cares more about status, exclusion from well-defined groups/clubs occurs: less desirable individuals are refused. Inability to exclude induces the most desirable individuals to leave, and the club collapses. Offering honorary membership to the most desirable potential members is not only a commercially optimal strategy when exclusion is not allowed, it even outperforms exclusion as a revenue maximisation strategy

Security of Supply in the Swiss Electricity Market: A System Dynamics Approach

Guaranteeing the security of supply (SoS) has become more complex since the liberalization of electricity markets started in the 90's. Liberalization and the ever larger share of intermittent sources (photovoltaic [PV] and wind energy), combined with increasingly interconnected markets, have a direct impact on SoS. Given the large number of elements and stakeholders involved, actions to enhance security may conflict with economic efficiency and/or environmental protection, thus increasing problem complexity. We develop a SD model that allows us to analyse the investment decision process and, understand, how the presence of PV and wind energy affects the reliability of the system. We focus on the Swiss electricity market, which is currently undergoing a liberalization process, and has simultaneously decided to encourage the implementation of renewable energies and to phase out nuclear energy. Results of the simulation show that nuclear production is replaced mainly by PV, CCGT and imports, which impacts the SoS negatively. Although installed capacity increases, the decreasing de-rated margin indicates a drop of the system's reliability. This reveals a problem of capacity adequacy that is partially "solved" by increasing imports. Regardless of the increasing share of inexpensive sources, this large dependency drives prices up, especially in winter, and to a lower extend in autumn

From Nuclear phase-out to renewable energies in the Swiss Electricity Market

Liberalisation and the ever larger share of variable renewable energies (VRES), e.g. photovoltaic (PV) and wind energy, affect security of supply (SoS). We develop a system dynamics model to analyse the impact of VRES on the investment decision process and to understand how SoS is affected. We focus on the Swiss electricity market, which is currently undergoing a liberalisation process, and simultaneously faces the encouragement of VRES and a nuclear phase out. Our results show that nuclear production is replaced mainly by PV and imports; the country becomes a net importer. This evolution points to a problem of capacity adequacy. The resulting price rise, together with the subsidies needed to support VRES, lead to a rise in tariffs. In the presence of a high share of hydro, the de-rated margin may give a misleading picture of the capacity adequacy. We thus propose a new metric, the annual energy margin, which considers the energy available from all sources, while acknowledging that hydro-storage can function as a battery. This measure shows a much less reassuring picture of the country's capacity adequacy