Better together: advancing family-centered care

Family-centered care (FCC) is recommended as “best practice” across a variety of pediatric service settings, as it yields better health and wellness outcomes for clients, and greater work satisfaction for practitioners and administrators (American Academy of Pediatrics, 2012). However, providers in multiple health care fields report challenges with translation of FCC concepts into their practice (Bamm & Rosenbaum, 2008; Graham, Rodger, & Ziviani, 2008; Lawlor & Mattingly, 1998; MacKean, Thurston, & Scott, 2005). Therefore, the aim of this doctoral project was to understand the barriers to FCC implementation, and to propose ways for supporting practitioners to enact FCC in their practice. The resulting solution is Better Together, an on-line professional development course designed to empower health care providers to become ambassadors of FCC and effectively enact the FCC practices in their daily interactions with clients and their families. The Better Together course content and structure are based on findings from a review of the literature specific to identifying core skills and knowledge essential for effective FCC practice, as well as best practices for professional development instruction. Methods for course implementation, funding, and dissemination are described, as well as a research plan for program evaluation

Tutela antecipada antecedente: procedimento e estabilização

O trabalho analisa as especificidades e principais características do procedimento atinente à tutela antecipada antecedente. Para tratar do referido instituto jurídico será inicialmente feito um apanhado histórico acerca da evolução das medidas de urgência, desde a caracterização da tutela cautelar até a tutela provisória de urgência antecipada, passando pela nova classificação dada pelo Código de Processo Civil de 2015. A partir daí serão tratadas questões processuais, de forma completa, desde a petição inicial e seus requisitos até as possíveis decisões prolatadas pelo juiz, suas condicionantes e requisitos negativos, bem como as consequências da conduta das partes para os efeitos da decisão. Por fim, será abordado o efeito mais conhecido e controverso desse procedimento, qual seja, a estabilidade. Especificamente em relação a estabilidade, serão analisadas suas diferenças e semelhanças com outros institutos jurídicos semelhantes e principalmente com a coisa julgada, bem como as consequências de eventual colisão entre a decisão estável e a transitada em julgado. O trabalho é concluído no sentido de defender que a decisão estável, uma vez ultrapassado o prazo decadencial de dois anos, apesar de imutável formalmente, pode ter seus efeitos alterados por outra decisão transitada em julgado (de forma material) posterior, proferida em sentido contrário

A Multidisciplinary survey on controversies in the use of EUS-guided FNA: assessing perspectives of surgeons, oncologists and gastroenterologists

<p>Abstract</p> <p>Background</p> <p>EUS-guided FNA can help diagnose and differentiate between various pancreatic and other lesions.</p> <p>The aim of this study was to compare approaches among involved/relevant physicians to the controversies surrounding the use of FNA in EUS.</p> <p>Methods</p> <p>A five-case survey was developed, piloted, and validated. It was collected from a total of 101 physicians, who were all either gastroenterologists (GIs), surgeons or oncologists. The survey compared the management strategies chosen by members of these relevant disciplines regarding EUS-guided FNA.</p> <p>Results</p> <p>For CT operable T2NOM0 pancreatic tumors the research demonstrated variance as to whether to undertake EUS-guided FNA, at p < 0.05. For inoperable pancreatic tumors 66.7% of oncologists, 62.2% of surgeons and 79.1% of GIs opted for FNA (p < 0.05). For cystic pancreatic lesions, oncologists were more likely to send patients to surgery without FNA. For stable simple pancreatic cysts (23 mm), most physicians (66.67%) did not recommend FNA. For a submucosal gastric 19 mm lesion, 63.2% of surgeons recommended FNA, vs. 90.0% of oncologists (p < 0.05).</p> <p>Conclusions</p> <p>Controversies as to ideal application of EUS-FNA persist. Optimal guidelines should reflect the needs and concerns of the multidisciplinary team who treat patients who need EUS-FNA. Multi-specialty meetings assembled to manage patients with these disorders may be enlightening and may help develop consensus.</p

Toward Online Measurement of Decision State

In traditional perceptual decision-making experiments, two pieces of data are collected on each trial: response time and accuracy. But how confident were participants and how did their decision state evolve over time? We asked participants to provide a continuous readout of their decision state by moving a cursor along a sliding scale between a 100% certain left response and a 100% certain right response. Subjects did not terminate the trials; rather, trials were timed out at random and subjects were scored based on the cursor position at that time. Higher rewards for correct responses and higher penalties for errors were associated with extreme responses so that the response with the highest expected value was that which accurately reflected the participant's odds of being correct. This procedure encourages participants to expose the time-course of their evolving decision state. Evidence on how well they can do this will be presented

Pilot Situation Awareness and its Implications for Single Pilot Operations: Analysis of a Human-in-the-Loop Study

AbstractIn 2012, NASA began exploring the feasibility of single pilot/reduced crew operations in the context of scheduled air carrier operations. The current study examined how important it was for ground-based personnel providing support to single piloted aircraft (ground operators) to have opportunities to acquire situation awareness (SA) prior to being called on to assist an aircraft. We looked at two distinct concepts of operation, which varied in how much information was available to ground operators prior to being called on to assist a critical event (no vs. some Situation Preview). Thirty-five commercial pilots participated in the current study. Results suggested that a ground operators’ lack of initial SA when called on for dedicated assistance is not an issue, at least when the ground operator station displays environmental and systems data which are important to gaining overall SA of the specified aircraft. With appropriate displays, ground operators were able to provide immediate assistance, even if they had minimal SA prior to getting a request

Elevating Baseline Activation Does Not Facilitate Reading of Unattended Words

Previous studies have disagreed the extent to which people extract meaning from words presented outside the focus of spatial attention. The present study, examined a possible explanation for such discrepancies, inspired by attenuation theory: unattended words can be read more automatically when they have a high baseline level of activation (e.g., due to frequent repetition or due to being expected in a given context). We presented a brief prime word in lowercase, followed by a target word in uppercase. Participants indicated whether the target word belonged to a particular category (e.g., "sport"). When we drew attention to the prime word using a visual cue, the prime produced substantial priming effects on target responses (i.e., faster responses when the prime and target words were identical or from the same category than when they belonged to different categories). When prime words were not attended, however, they produced no priming effects. This finding replicated even when there were only 4 words, each repeated 160 times during the experiment. Even with a very high baseline level of activation, it appears that very little word processing is possible without spatial attention