Core information sets for informed consent to surgical interventions:baseline information of importance to patients and clinicians

Abstract Background Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. Main body The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. Conclusion The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice

Core information sets for informed consent to surgical interventions:baseline information of importance to patients and clinicians

Abstract Background Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. Main body The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. Conclusion The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice

A conceptual framework of volcanic evacuation simulation of Merapi using agent-based model and GIS

In volcanic crises, the ability of population to evacuate has important role to reduce the risk. Based on two experiences of crisis management of Merapi 2006 and 2010, it was reported that there are problems in this aspect that caused confusion of population during the crises which resulted in fatalities. Therefore, we propose a methodology to develop a simulation model to analyze population risk that can be used to highlight the probabilities of emerged problem during the evacuation. The methodology of this research will be highly relied on the GIS-ABM simulation. The simulation was developed from the relation of the volcano, surrounding population and stakeholder within the environmental system. Those elements are represented as agents with their attributes, roles, behaviour and properties. As an example of the application, we developed a simulation case study using Anylogic

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The Identification and Verification of Hazardous Convective Cells Over Oceans Using Visible and Infrared Satellite Observations

Three algorithms based on geostationary visible and infrared (IR) observations are used to identify convective cells that do (or may) present a hazard to aviation over the oceans. The performance of these algorithms in detecting potentially hazardous cells is determined through verification with Tropical Rainfall Measuring Mission (TRMM) satellite observations of lightning and radar reflectivity, which provide internal information about the convective cells. The probability of detection of hazardous cells using the satellite algorithms can exceed 90% when lightning is used as a criterion for hazard, but the false-alarm ratio with all three algorithms is consistently large (40%), thereby exaggerating the presence of hazardous conditions. This shortcoming results in part from the algorithms’ dependence upon visible and IR observations, and can be traced to the widespread prevalence of deep cumulonimbi with weak updrafts but without lightning over tropical oceans, whose origin is attributed to significant entrainment during ascent

Measuring research impact: a large cancer research funding programme in Australia

Background: Measuring research impact is of critical interest to philanthropic and government funding agencies interested in ensuring that the research they fund is both scientifically excellent and has meaningful impact into health and other outcomes. The Beat Cancer Project (BCP) is a AUD $34 m cancer research funding scheme that commenced in 2011. It was initiated by an Australian charity (Cancer Council SA), and supported by the South Australian Government and the state’s major universities. Methods: This study applied Buxton and Hanney’s Payback Framework to assess research impact generated from the BCP after 3 years of funding. Data sources were an audit of peer-reviewed publications from January 2011 to September 2014 from Web of Knowledge and a self-report survey of investigators awarded BCP research funding during its first 3 years of implementation (2011–2013). Of the 104 surveys, 92 (88 Results: The BCP performed well across all five categories of the Payback Framework. In terms of knowledge production, 1257 peer-reviewed publications were generated and the mean impact factor of publishing journals increased annually. There were many benefits to future research with 21 respondents (23$1 that the cancer charity invested, the BCP gained an additional AUD $6.06. Five projects (5%) had informed policy and 5 (5%) informed product development, with an additional 31 (34%) and 35 (38%) projects, respectively, anticipating doing so. In terms of health and sector and broader economic benefits, 8 (9%) projects had influenced practice or behaviour of health staff and 32 (34%) would reportedly to do so in the future. Conclusions: Research impact was a priority of charity and government funders and led to a deliberate funding strategy. Emphasising research impact while maintaining rigorous, competitive processes can achieve the joint objectives of excellence in research, yielding good research impact and a high rate of leverage for philanthropic and public investment, as indicated by these early results

WET-Roadmap:

The WET-Management Series is a set of integrated tools that can be used to guide well-informed and effective wetland management and rehabilitation. Wetland loss in South Africa has been significant and the need for wetland rehabilitation as part of good wetland stewardship and management is compelling. National policy and legislation provide clear direction and support for rehabilitation, but the very complex links between people and wetlands mean that actions aimed at sustainably rehabilitating and conserving wetlands will depend on the dedication and commitment of all stakeholders, especially landowners and wetland users

Population genetics of the understory fishtail palm Chamaedorea ernesti-augusti in Belize: high genetic connectivity with local differentiation.

BACKGROUND: Developing a greater understanding of population genetic structure in lowland tropical plant species is highly relevant to our knowledge of increasingly fragmented forests and to the conservation of threatened species. Specific studies are particularly needed for taxa whose population dynamics are further impacted by human harvesting practices. One such case is the fishtail or xaté palm (Chamaedorea ernesti-augusti) of Central America, whose wild-collected leaves are becoming progressively more important to the global ornamental industry. We use microsatellite markers to describe the population genetics of this species in Belize and test the effects of climate change and deforestation on its recent and historical effective population size. RESULTS: We found high levels of inbreeding coupled with moderate or high allelic diversity within populations. Overall high gene flow was observed, with a north and south gradient and ongoing differentiation at smaller spatial scales. Immigration rates among populations were more difficult to discern, with minimal evidence for isolation by distance. We infer a tenfold reduction in effective population size ca. 10,000 years ago, but fail to detect changes attributable to Mayan or contemporary deforestation. CONCLUSION: Populations of C. ernesti-augusti are genetically heterogeneous demes at a local spatial scale, but are widely connected at a regional level in Belize. We suggest that the inferred patterns in population genetic structure are the result of the colonization of this species into Belize following expansion of humid forests in combination with demographic and mating patterns. Within populations, we hypothesize that low aggregated population density over large areas, short distance pollen dispersal via thrips, low adult survival, and low fruiting combined with early flowering may contribute towards local inbreeding via genetic drift. Relatively high levels of regional connectivity are likely the result of animal-mediated long-distance seed dispersal. The greatest present threat to the species is the potential onset of inbreeding depression as the result of increased human harvesting activities. Future genetic studies in understory palms should focus on both fine-scale and landscape-level genetic structure

Mudança científica: modelos filosóficos e pesquisa histórica

The authors call for a more thorough testing of the empirical claims of recent theories of scientific change. To facilitate this the empirical claims of Kuhn, Feyerabend, Lakatos and Laudan are listed in nontechnical language, both by author and by topic. A bibliography of case studies is included.Os autores deste ensaio entendem que é preciso testar de forma mais completa as afirmações empíricas das recentes teorias da mudança científica. Tendo em vista facilitar tal empreendimento, apresentam-se em linguagem não-técnica as afirmações empíricas de Kuhn, Feyerabend, Lakatos e Laudan, que estão organizadas por autor e por assunto. Ao final, inclui-se uma bibliografia de estudos de caso