A qualitative study of professional and client perspectives on information flows and decision aid use

<p>Abstract</p> <p>Background</p> <p>This paper explores the meanings given by a diverse range of stakeholders to a decision aid aimed at helping carers of people in early to moderate stages of dementia (PWD) to select community based respite services. Decision aids aim to empower clients to share decision making with health professionals. However, the match between health professionals' perspectives on decision support needs and their clients' perspective is an important and often unstudied aspect of decision aid use.</p> <p>Methods</p> <p>A secondary analysis was undertaken of qualitative data collected as part of a larger study. The data included twelve interviews with carers of people with dementia, three interviews with expert advisors, and three focus groups with health professionals. A theoretical analysis was conducted, drawing on theories of 'positioning' and professional identity.</p> <p>Results</p> <p>Health professionals are seen to hold varying attitudes and beliefs about carers' decision support needs, and these appeared to be grounded in the professional identity of each group. These attitudes and beliefs shaped their attitudes towards decision aids, the information they believed should be offered to dementia carers, and the timing of its offering. Some groups understood carers as needing to be protected from realistic information and consequently saw a need to filter information to carer clients.</p> <p>Conclusion</p> <p>Health professionals' beliefs may cause them to restrict information flows, which can limit carers' ability to make decisions, and limit health services' ability to improve partnering and shared decision making. In an era where information is freely available to those with the resources to access it, we question whether health professionals should filter information.</p

Gerhardt EBELING, Lutherstudien. Band II. Disputatio de homine. Dritter Teil: Die theologische Definition des Menschen. Kommentar zu These 20-40, Tübingen, J. C. Mohr (Paul Siebeck), 1989, XXIII + 698 pp., 23,5 x 16. [RECENSIÓN]

One of the key activities during the initial phase of the international GEOTRACES program was an extensive international intercalibration effort, to ensure that results for a range of trace elements and isotopes (TEIs) from different cruises and from different laboratories can be compared in a meaningful way. Here we present the results from the intercalibration efforts on neodymium isotopes and rare earth elements in seawater and marine particles. Fifteen different laboratories reported results for dissolved 143Nd/144Nd ratios in seawater at three different locations (BATS 15 m, BATS 2000 m, SAFe 3000 m), with an overall agreement within 47 to 57 ppm (2? standard deviation of the mean). A similar agreement was found for analyses of an unknown pure Nd standard solution carried out by 13 laboratories (56 ppm), indicating that mass spectrometry is the main variable in achieving accurate and precise Nd isotope ratios. Overall, this result is very satisfactory, as the achieved precision is a factor of 40 better than the range of Nd isotopic compositions observed in the global ocean. Intercalibration for dissolved rare earth element concentrations (REEs) by six laboratories for two water depths at BATS yielded a reproducibility of 15% or better for all REE except Ce, which seems to be the most blank-sensitive REE. Neodymium concentrations from 12 laboratories show an agreement within 9%, reflecting the best currently possible reproducibility. Results for Nd isotopic compositions and REE concentrations on marine particles are inconclusive, and should be revisited in the future

Chemostratigraphy Across the Triassic-Jurassic Boundary

The Triassic-Jurassic transition (~201.5 Ma) is marked by one of the largest mass extinctions in Earth's history. This was accompanied by significant perturbations in ocean and atmosphere geochemistry, including the global carbon cycle, as expressed by major fluctuations in carbon isotope ratios. Central Atlantic Magmatic Province (CAMP) volcanism triggered environmental changes and played a key role in this biotic crisis. Biostratigraphic and chronostratigraphic studies link the end-Triassic mass extinction with the early phases of CAMP volcanism, and notable mercury enrichments in geographically distributed marine and continental strata are shown to be coeval with the onset of the extrusive emplacement of CAMP. Sulfuric acid induced atmospheric aerosol clouds from subaerial CAMP volcanism can explain a brief, relatively cool seawater temperature pulse in the mid-paleolatitude Pan-European seaway across the T–J transition. The occurrence of CAMP-induced carbon degassing may explain the overall long-term shift toward much warmer conditions. The effect of CAMP volcanism on seawater 87Sr/86Sr values might have been indirect by driving enhanced continental weathering intensity. Changes in ocean-atmosphere geochemistry and associated (causative) effects on paleoclimatic, paleoenvironmental, and paleoceanographic conditions on local, regional, and global scales are however not yet fully constrained