The very idea of shared decision-making: views from social science

Aim: To examine the ‘idea of shared decision making focusing on assumptions about the concepts ‘choice’ and ‘decision making’; Content: Much of the research literature on shared decision making relies on a prioi assumptions about concepts of ‘choice’; and ‘decision making’. Informed by the writings of French philosopher Michel Foucault on power relations, subjectivity and ethics we examine: the effects of employing ideas of ‘choice’, ‘empowerment’; and ‘autonomy’; the functions of multiple narratives of self management; and, the ideals of ‘shared decision making’ and how these ideals are actually practised. Foucault writes “The exercise of power consists in guiding the possibility of conduct and putting order into practice” (Foucault, 1982, p221). Three papers presented separately at this conference form the empirical background for this workshop. Murtagh, MJ. Forms of freedom? General Practitioner accounts of women’;s decision making at menopause. Hepworth, J. Type II Diabetes self management: a narrative theory of health behaviour change. Rapley, T. et. al. “Well, we’ll come back to that question”: The impact of a computerised decision-support tool on doctor-patient interaction. The theoretical perspectives of these papers are discussed in this workshop: poststructuralism and feminist ethics - Madeleine Murtagh; conversation analysis and ethnomethodology - Tim Rapley; and, social construction and narrative - Julie Hepworth

Analysis of the dynamics of the FT4 powder rheometer

Traditional powder flow measurement devices, such as shear cells, operate in the quasi-static regime of shear strain rate. The FT4 powder rheometer of Freeman Technology, developed over the last two decades, has provided a clearer differentiation of powder flowability in some instances. This has been attributed to the instrument operating in the dynamic regime of shear strain rates, a feature that has yet to be established. We report an analysis of the dynamic behaviour of a bed of glass beads made cohesive by silanisation and subjected to standard FT4 testing procedure, where a rotating blade is driven into a cylindrical bed, using a combination of experimental measurements and numerical simulations by the Distinct Element Method. The DEM analysis underestimates the flow energy measured experimentally, although the agreement is improved when sliding friction is increased. The shear stress of the powder in front of the blade is shown to be roughly constant along the radial direction and increasing as the impeller penetrates the bed, suggesting a characteristic shear stress can be determined for a powder under a given test conditions in the FT4. For ease of simulations large beads were used (1.7 – 2.1 mm). Future work will investigate the influence of particle properties and operational conditions on the prevailing stresses and strain rates

Precipitation regionalization, anomalies and drought occurrence in the Yucatan Peninsula, Mexico

© 2020 The Authors. International Journal of Climatology published by John Wiley & Sons Ltd on behalf of the Royal Meteorological Society. Climate change projections have identified the Yucatan Peninsula as being vulnerable to increasing drought. Understanding spatial and temporal precipitation variability and drought occurrence are therefore important. Drought monitoring in Mexico has been carried out only relatively recently and often without considering the long-term variability in both droughts and precipitation. This research explores the spatio-temporal variability of precipitation and occurrence of droughts at a much finer spatial resolution and over a longer temporal period than previous studies. Using statistical (cluster analysis and standardized precipitation index) and geostatistical (kriging) techniques, maps of precipitation and droughts are generated for the period 1980–2011. These show that whilst many previous studies have regarded the Yucatan Peninsula as a homogenous region with respect to precipitation, there are actually four distinctive clusters of precipitation amount, showing climatic variability across the Peninsula. The analyses also show that droughts in the Peninsula are regionalised. Twelve-month Standardized Precipitation Indices (SPI), calculated for individual stations and for precipitation surfaces, reveal distinct patterns of spatial and temporal variability. SPI surfaces indicate the occurrence of major droughts in 1981, 1986–1987, 1994, 1996, 2003, 2004 and 2009, but these rarely affect the whole Yucatan Peninsula uniformly. Wetter years, such as 1983, 1984, 1988, 1992, 1995, 2002 and 2005 sometimes reflect the impact of individual extreme events, such as hurricane Isidore in 2002. Our results show that drought can be regionalised, thus enhancing the quality of information about droughts in the area and providing evidence and support for future drought mitigation and environmental protection. These methods could usefully be applied elsewhere

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3�6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55 of the global rise in mean BMI from 1985 to 2017�and more than 80 in some low- and middle-income regions�was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing�and in some countries reversal�of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. © 2019, The Author(s)

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries

DataSHIELD – shared individual-level analysis without sharing the data: a biostatistical perspective

Very large sample sizes are required for estimating effects which are known to be small, and for addressing intricate or complex statistical questions. This is often only achievable by pooling data from multiple studies, especially in genetic epidemiology where associations between individual genetic variants and phenotypes of interest are generally weak. However, the physical pooling of experimental data across a consortium is frequently prohibited by the ethico-legal constraints that govern agreements and consents for individual studies. Study level meta-analyses are frequently used so that data from multiple studies need not be pooled to conduct an analysis, though the resulting analysis is necessarily restricted by the available summary statistics. The idea of maintaining data security is also of importance in other areas and approaches to carrying out ‘secure analyses’ that do not require sharing of data from different sources have been proposed in the technometrics literature. Crucially, the algorithms for fitting certain statistical models can be manipulated so that an individual level meta-analysis can essentially be performed without the need for pooling individual-level data by combining particular summary statistics obtained individually from each study. DataSHIELD (Data Aggregation Through Anonymous Summary-statistics from Harmonised Individual levEL Databases) is a tool to coordinate analyses of data that cannot be pooled. In this paper, we focus on explaining why a DataSHIELD approach yields identical results to an individual level meta-analysis in the case of a generalised linear model, by simply using summary statistics from each study. It is also an efficient approach to carrying out a study level meta-analysis when this is appropriate and when the analysis can be pre-planned. We briefly comment on the IT requirements, together with the ethical and legal challenges which must be addressed

New determination of sin/sup 2/theta/sub w/ from ratio of neutrino and anti-neutrino elastic scattering by electrons

Measurements are made of the purely leptonic weak neutral current processes ..nu../sub ..mu../ + e/sup -/ ..-->.. ..nu../sub ..mu../ + e/sup -/ and anti ..nu../sub ..mu../ + e/sup -/ ..-->.. anti ..nu../sub ..mu../ + e/sup -/. Cross sections, the vector and axial vector couplings, and the Standard Model parameters sin/sup 2/theta/sub w/ and rho are determined. Results are: sigma/sub 0//..nu../sub ..mu../) = 1.60 +- 0.29 +- 0.26, sigma/sub 0/(anti ..nu../sub ..mu../) = 1.16 +- 0.20 +- 0.14 (both in units of 10/sup -42/cm/sup 2//GeV), g/sub v//sup e/ = -0.079 +- 0.060, g/sub A//sup e/= -0.483 +- 0.042, rho = 0.967 +- 0.082, sin/sup 2/theta/sub w/ = 0.209 +- 0.029 +- 0.013