Working with interpreters: the challenges of introducing Option Grid patient decision aids

Objective We aimed to observe how an Option GridTM decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. Methods Data were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. Results Analysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. Conclusion Patients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. Practice Implications Option Grid decision aids are not being used as intended in interpreted consultations

Downtown Winnipeg: Developments and Investments, 2005 - 2013

This IUS In-Brief explores the rapid upswing in investment in Winnipeg's downtown over the last eight years by collecting and mapping the changes that have taken place during this frenzied period of development

Ethical aspects of risk communication

Clinical decision-making is becoming increasingly complex because of greater patient access to information, more clinical options and the emphasis on patient-centred care with informed decision-making. Risk communication should form part of evidence-based clinical practice, and it is important to think about what happens when clinicians adopt different consultation approaches. In this article, the ethical consequences of risk communication are analysed by looking at how the paternalistic and shared decision-making models of consultation demonstrate different ethical implications, based around a clinical scenario. To do this, we have applied the ethical principles of autonomy, utility and justice to these models. We show that the different models of consultation place varying degrees of emphasis on risk communication, patient autonomy and biomedical utility. This has implications for the way care is delivered both for the individual patient and for the population as a whole

The LEAD trial - the effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: study protocol for a randomized controlled trial

Background: Colorectal cancer screening participation is a preference-sensitive choice, in which trade-offs between benefits and harms must be made by individual citizens. Often the decision is made without any contact with healthcare professionals. Citizens with lower educational attainment tend to participate less in colorectal cancer screening than citizens with average educational attainment. Further, they tend to have lower levels of knowledge about colorectal cancer screening. Providing lower educational attainment citizens with a targeted decision aid embracing their diverse information needs might increase these citizens’ ability to make informed decisions. The aim of this trial is to test the effectiveness of such a newly developed self-administered decision aid. Methods: The LEAD (Lower Educational Attainment Decision aid) trial will be conducted as a two-arm randomized controlled trial among 10,000 50–74-year-old citizens, resident in the Central Denmark Region not yet invited to take up colorectal cancer screening. Citizens will receive a baseline questionnaire. Respondents will be allocated into the intervention or the control groups. Citizens in the intervention group will receive the decision aid whereas the control group will not. Those who return a stool sample within 45 days after receiving the screening invitation and those with medium or higher educational attainment are excluded. Both groups will receive a follow-up questionnaire 90 days after being invited to colorectal cancer screening. A historic cohort consisting of 5000 50–74-year-old citizens resident in the Central Denmark Region, having received their screening invitation in the beginning of 2017 will be included. This cohort will receive a follow-up questionnaire 6–9 months after they received the screening invitation. Informed choice will be evaluated by assessing levels of knowledge, attitudes, and screening uptake. Analyses will be conducted as intention-to-treat analyses. Additionally, differences between levels of worry and decisional conflict between groups will be assessed as secondary outcomes

The transition to secondary progressive multiple sclerosis: an exploratory qualitative study of health professionals' experiences

Background: Identifying the transition from relapsing-remitting to secondary progressive multiple sclerosis (SPMS) can be challenging for clinicians. Little previous research has explored how professionals experience working with patients during this specific stage of the disease. We explored the experiences of a group of multidisciplinary professionals who support patients in the transition to SPMS, to describe this stage from a professional perspective. Methods: Qualitative semistructured interview study with 11 professionals (medical, nursing, and allied professionals; both specialists and generalists) working with patients with MS in South Wales, United Kingdom. Thematic analysis of the interview data was performed. Results: Two overarching themes were identified: the transition and providing support. The theme “transition” comprised issues related to recognizing and communicating about SPMS. Uncertainty influenced both recognizing the transition and knowing how to discuss it with patients. “Providing support” included descriptions of challenging aspects of patient care, providing support for carers, utilizing the multidisciplinary team, and working within service constraints. Providing adequate psychological support and engaging patients with self-management approaches were seen as particularly challenging. Conclusions: Caring for patients in the transition to SPMS generates specific challenges for professionals. Further research on health-care interactions and patients'/professionals' experiences around the transition phase may help to identify strategies for professional development and learning, and how to optimize patient experience at this difficult stage of disease

A Dual-polarized Broadband Planar Antenna and Channelizing Filter Bank for Millimeter Wavelengths

We describe the design, fabrication, and testing of a broadband log-periodic antenna coupled to multiple cryogenic bolometers. This detector architecture, optimized here for astrophysical observations, simultaneously receives two linear polarizations with two octaves of bandwidth at millimeter wavelengths. The broad bandwidth signal received by the antenna is divided into sub-bands with integrated in-line frequency-selective filters. We demonstrate two such filter banks: a diplexer with two sub-bands and a log-periodic channelizer with seven contiguous sub-bands. These detectors have receiver efficiencies of 20-40% and percent level polarization isolation. Superconducting transition-edge sensor bolometers detect the power in each sub-band and polarization. We demonstrate circularly symmetric beam patterns, high polarization isolation, accurately positioned bands, and high optical efficiency. The pixel design is applicable to astronomical observations of intensity and polarization at millimeter through sub-millimeter wavelengths. As compared with an imaging array of pixels measuring only one band, simultaneous measurements of multiple bands in each pixel has the potential to result in a higher signal-to-noise measurement while also providing spectral information. This development facilitates compact systems with high mapping speeds for observations that require information in multiple frequency bands.Comment: 4 pages, 4 figures, accepted for publication in Applied Physics Letter

Nonuniformity of the 1/N1/N Expansion for Two-Dimensional O(N)O(N) Models

We point out that the $1/N$ expansion, which is widely invoked to infer properties of the $2D$ $O(N)$ models, is nonuniform in the temperature, i.e. with decreasing temperature the $1/N$ expansion truncated at a fixed order deviates more and more from the true answer. This fact precludes the use of the expansion to deduce low temperature properties such as asymptotic scaling for those models. By contrast, in the $1D$ $O(N)$ chains, there are no signs of such a nonuniformity.Comment: 10 pages, MPI-PhT/94-4

Quantitative analysis of regulatory flexibility under changing environmental conditions

The circadian clock controls 24-h rhythms in many biological processes, allowing appropriate timing of biological rhythms relative to dawn and dusk. Known clock circuits include multiple, interlocked feedback loops. Theory suggested that multiple loops contribute the flexibility for molecular rhythms to track multiple phases of the external cycle. Clear dawn- and dusk-tracking rhythms illustrate the flexibility of timing in Ipomoea nil. Molecular clock components in Arabidopsis thaliana showed complex, photoperiod-dependent regulation, which was analysed by comparison with three contrasting models. A simple, quantitative measure, Dusk Sensitivity, was introduced to compare the behaviour of clock models with varying loop complexity. Evening-expressed clock genes showed photoperiod-dependent dusk sensitivity, as predicted by the three-loop model, whereas the one- and two-loop models tracked dawn and dusk, respectively. Output genes for starch degradation achieved dusk-tracking expression through light regulation, rather than a dusk-tracking rhythm. Model analysis predicted which biochemical processes could be manipulated to extend dusk tracking. Our results reveal how an operating principle of biological regulators applies specifically to the plant circadian clock

Erosion patterns in a sediment layer

We report here on a laboratory-scale experiment which reproduces a rich variety of natural patterns with few control parameters. In particular, we focus on intriguing rhomboid structures often found on sandy shores and flats. We show that the standard views based on water surface waves come short to explain the phenomenon and we evidence a new mechanism based on a mud avalanche instability.Comment: 4 pages, 4 figures, to appear as Phys. Rev. E rapid com