Utilizing a New Graphical Elicitation Technique to Collect Emotional Narratives Describing Disease Trajectories

Elicitation techniques in connection with semi-structured interviews are scantily used, but reported to be beneficial to research. We developed and tested a new visual technique to be utilized in the latter part of semi-structured interviews. It has proved to be feasible and beneficial to use, and it could possibly be used by others. This way of extending the interviews generates more data in a visual form, as well as in a verbal form, by supporting the participants in remembering nearly forgotten parts of their experiences and in expressing emotions associated with those significant experiences. As a contribution to qualitative research, our study showed that the visual data, created by the participants, also contributed to getting the elaborated narratives

Benefits and challenges perceived by patients with cancer when offered a nurse navigator

<p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Introduction: </span></strong><span style="font-family: " lang="EN-US">Lack of communication, care and respect from healthcare professionals can be challenges for patients in trajectories of cancer, possibly accompanied by experienced fragmentation of the care, anxiety and worries. One way to try to improve delivery of care is additional help from Nurse Navigators (NN) offered in a predefined shorter or longer period, but patients´ experiences with this have seldom been investigated.</span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Aims: </span></strong><span style="font-family: " lang="EN-US">To explore patients´ experiences of an NN offered in a short period of a longer trajectory of cancer. </span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Methods: </span></strong><span style="font-family: " lang="EN-US">NN worked from the hospital side in the transition between primary care and a university hospital before admission. A phenomenological-hermeneutical longitudinal study was performed from referral and until two months after discharge from the hospital. Semi-structured interviews provided data for the analysis, which started open-minded.</span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Results: </span></strong><span style="font-family: " lang="EN-US"><span style="mso-spacerun: yes;"> </span>Affectional bonds were made to NN and patients felt that they benefited from her presence and her help,<strong style="mso-bidi-font-weight: normal;"> </strong>which they requested until one month after discharge. They were deeply disappointed and felt rejected when the contact to the NN stopped. </span></span></p><p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="font-family: " lang="EN-US">Conclusion:</span></strong><span style="font-family: " lang="EN-US"> In efforts to increase quality of care for patients with cancer we recommend paying special attention to critical periods in their trajectories, as well as to the theory of attachment to supplement thoughts of continuity of care and coordination in the care for women. In short, it is fine to offer additional help to those who can use it, but in practice as well as in research we call attention to awareness on how and when to stop the help, to prevent patients from feeling hurt.</span></span></p

Precautionary principle or evidence-based conservation? Assessing the information content of threat data for the Yangtze finless porpoise

Conservation management requires evidence, but robust data on key parameters such as threats are often unavailable. Conservation-relevant insights might be available within datasets collected for other reasons, making it important to determine the information content of available data for threatened species and identify remaining data-gaps before investing time and resources in novel data collection. The Yangtze finless porpoise (Neophocaena asiaeorientalis asiaeorientalis) has declined severely across the middle-lower Yangtze, but multiple threats exist in this system and the relative impact of different anthropogenic activities is unclear, preventing identification of appropriate mitigation strategies. Several datasets containing information on porpoises or potential threats are available from past boat-based and fishing community surveys, which might provide novel insights into causes of porpoise mortality and decline. We employed multiple analytical approaches to investigate spatial relationships between live and dead porpoises and different threats, reproductive trends over time, and sustainable offtake levels, to assess whether evidence-based conservation is feasible under current data availability. Our combined analyses provide new evidence that mortality is spatially associated with increased cargo traffic; observed mortality levels (probably a substantial underestimate of true levels) are unsustainable; and population recruitment is decreasing, although multiple factors could be responsible (pollutants, declining fish stocks, anthropogenic noise, reduced genetic diversity). Available data show little correlation between patterns of mortality and fishing activity even when analyzed across multiple spatial scales; however, interview data can be affected by multiple biases that potentially complicate attempts to reconstruct levels of bycatch, and new data are required to understand dynamics and sustainability of porpoise-fisheries interactions. This critical assessment of existing data thus suggests that in situ porpoise conservation management must target multiple co-occurring threats. Even limited available datasets can provide new insights for understanding declines, and we demonstrate the importance of an integrative approach for investigating complex conservation problems and maximizing evidence in conservation planning for poorly known taxa

Comparison between the degree of motor unit short-term synchronization and recurrence quantification analysis of the surface EMG in two human muscles

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Type of atrial fibrillation and clinical outcomes in patients with heart failure and reduced ejection fraction

Background: Atrial fibrillation (AF) is common in heart failure (HF), but the outcome by type of AF is largely unknown. Objectives: This study investigated outcomes related to type of AF (paroxysmal, persistent or permanent, or new onset) in 2 recent large trials in patients with HF with reduced ejection fraction. Methods: The study analyzed patients in the PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure) trials. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for outcomes related to AF type. Results: Of 15,415 patients, 5,481 (35.6%) had a history of AF at randomization, and of these, 1,645 (30.0%) had paroxysmal AF. Compared with patients without AF, patients with paroxysmal AF at randomization had a higher risk of the primary composite endpoint of cardiovascular death or HF hospitalization (HR: 1.20; 95% confidence interval [CI]: 1.09 to 1.32; p &#60; 0.001), HF hospitalization (HR: 1.34; 95% CI: 1.19 to 1.51; &#60; 0.001), and stroke (HR: 1.34; 95% CI: 1.02 to 1.76; p = 0.037), whereas the corresponding risks in patients with persistent or permanent AF were not elevated. Neither type of AF was associated with higher mortality. New onset AF was associated with the greatest risk of adverse outcomes: primary endpoint (HR: 2.21; 95% CI: 1.80 to 2.71), HF hospitalization (HR: 2.11; 95% CI: 1.58 to 2.81), stroke (HR: 2.20; 95% CI: 1.25 to 3.88), and all-cause mortality (HR: 2.26; 95% CI: 1.86 to 2.74), all p values &#60; 0.001, compared with patients without AF. Anticoagulants were used less often in patients with paroxysmal (53%) and new onset (16%) AF than in patients with persistent or permanent AF (71%). Conclusions: Among HF patients with a history of AF, those with paroxysmal AF were at greater risk of HF hospitalization and stroke than were patients with persistent or permanent AF, underlining the importance of anticoagulant therapy. New onset AF was associated with increased risk of all outcomes. (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255) (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure [ATMOSPHERE]; NCT00853658

Detecting Determinacy in Prolog Programs: 22nd International Conference, ICLP 2006, Seattle, WA, USA, August 17-20, 2006. Proceedings

In program development it is useful to know that a call to a Prolog program will not inadvertently leave a choice-point on the stack. Determinacy inference has been proposed for solving this problem yet the analysis was found to be wanting in that it could not infer determinacy conditions for programs that contained cuts or applied certain tests to select a clause. This paper shows how to remedy these serious deficiencies. It also addresses the problem of identifying those predicates which can be rewritten in a more deterministic fashion. To this end, a radically new form of determinacy inference is introduced, which is founded on ideas in ccp, that is capable of reasoning about the way bindings imposed by a rightmost goal can make a leftmost goal deterministic