The need for epistemic reciprocity in person-centred care : a multi-method qualitative study

Background – Person-centred care is a policy priority in the United Kingdom, yet people with long-term conditions report a deficiency in person-centred healthcare relative to their wishes and expectations. Whilst several factors contribute to this problem, recent work recognises a persisting reported failure of healthcare staff to give adequate credence to patients’ knowledge work, which may contribute to worsening person-centred care. Therefore, I set out to answer the following research question: “What does an analysis of the knowledge work done by adults with chronic conditions in the context of their healthcare experiences tell us about changes needed to strengthen person-centred primary care?”Methods – I adopted a multi-method qualitative design. This included a meta-ethnography of published research followed by primary data collection through individual interviews (analysed through interpretive phenomenological analysis) and focus groups (analysed through thematic analysis), which I integrated through an approach that focused on their complementarity.Results – My empirical research described that the participants’ knowledge work involves information seeking, experimentation and reflection, and leads to acquired experiential knowledge that is exclusive, unique and functional. The participants brought this knowledge to primary care settings to negotiate care, and successful negotiations unfolded through moments of active exploration, amplified listening, and reciprocal inquiry.Discussion and conclusions – The person-centred clinical consultation is defined as a negotiated exploration of the patient’s complex experience, grounded in both the patient’s and the doctor’s knowledge work, and that values and enhances the patient’s learning journey. I therefore propose a new concept, epistemic reciprocity, as a principle that guides the clinical negotiation and fosters the co-creation of new knowledge of patient experience and need through the interactive knowledge work of patient and doctor. In considering epistemic reciprocity as a core component of successful person-centred care, I describe the implications for future education, professional practice, and research

La speleologia diffusa “Grotta delle Meraviglie”

Gli autori gestiscono il complesso carsico Grotte delle Meraviglie di Zogno (BG), grotta attrezzata per visite turistiche guidate, in contesto carsico-archeologico (oltre tremila visitatori nel corso del 2010) stimolando l’interesse dei visitatori alla conoscenza del mondo sotterraneo.The authors manage the karst complex Grotte delle Meraviglie in Zogno (BG), a cave equipped for guided tours in the karst-archaeological context (with over 3,000 visitors in 2010), attracting visitors interested in the subterranean world

Design of a high-performance optical tweezer for nanoparticle trapping

Integrated optical nanotweezers offer a novel paradigm for optical trapping, as their ability to confine light at the nanoscale leads to extremely high gradient forces. To date, nanotweezers have been realized either as photonic crystal or as plasmonic nanocavities. Here, we propose a nanotweezer device based on a hybrid photonic/plasmonic cavity with the goal of achieving a very high quality factor-to-mode volume (Q/V) ratio. The structure includes a 1D photonic crystal dielectric cavity vertically coupled to a bowtie nanoantenna. A very high Q/V ~ 107 (λ/n)−3 with a resonance transmission T = 29 % at λR = 1381.1 nm has been calculated by 3D finite element method, affording strong light–matter interaction and making the hybrid cavity suitable for optical trapping. A maximum optical force F = −4.4 pN, high values of stability S = 30 and optical stiffness k = 90 pN/nm W have been obtained with an input power Pin = 1 mW, for a polystyrene nanoparticle with a diameter of 40 nm. This performance confirms the high efficiency of the optical nanotweezer and its potential for trapping living matter at the nanoscale, such as viruses, proteins and small bacteria

The effects of opioids on cognition in older adults with cancer and chronic non-cancer pain: A systematic review

ContextOpioids are prescribed to manage moderate to severe pain and can be used with older adults; however, they may lead to several adverse effects, including cognitive impairment.ObjectiveTo identify, appraise and synthesise evidence on i) the impact of opioids on cognition in older adults with cancer/chronic non-cancer pain, and ii) screening tools/neuropsychological assessments used to detect opioid-induced cognitive impairment.MethodsA systematic literature review following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PROSPERO Registration CRD42018092943). MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and Web of Science were searched up to December 2018. Randomised controlled trials, quasi-experimental studies and observational studies of adults aged ≥65 with cancer/chronic non-cancer pain taking opioids were included. A narrative synthesis was conducted.ResultsFrom 4,036 records, 10 met inclusion criteria. Five studies used one screening tool and five used a range of neuropsychological assessments; assessing 14 cognitive domains. Most studies demonstrated no effect of opioid use on cognitive domains, whilst four studies showed mixed effects. In particular, attention, language, orientation, psychomotor function and verbal working/delayed episodic memory were worsened. Changes to cognitive function were predominantly observed in studies with higher mean doses of opioids (120mg–190.7mg oral morphine equivalent daily dose).ConclusionBoth improvements and impairments to cognition were observed in studies with higher mean opioid doses. In clinical practice, a brief screening tool assessing attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory, may be beneficial to detect worsening cognition in older adults with chronic pain using opioids

Phononic and photonic band gap structures: modelling and applications

AbstractPhotonic crystals (PhCs) are artificial materials with a permittivity which is a periodic function of the position, with a period comparable to the wavelength of light. The most interesting characteristic of such materials is the presence of photonic band gaps (PBGs). PhCs have very interesting properties of light confinement and localization together with the strong reduction of the device size, orders of magnitude less than the conventional photonic devices, allowing a potential very high scale of integration. These structures possess unique characteristics enabling to operate as optical waveguides, high Q resonators, selective filters, lens or superprism. The ability to mould and guide light leads naturally to novel applications in several fields.Band gap formation in periodic structures also pertains to elastic wave propagation. Composite materials with elastic coefficients which are periodic functions of the position are named phononic crystals. They have properties similar to those of photonic crystals and corresponding applications too. By properly choosing the parameters one may obtain phononic crystals (PhnCs) with specific frequency gaps. An elastic wave, whose frequency lies within an absolute gap of a phononic crystal, will be completely reflected by it. This property allows realizing non-absorbing mirrors of elastic waves and vibration-free cavities which might be useful in high-precision mechanical systems operating in a given frequency range. Moreover, one can use elastic waves to study phenomena such as those associated with disorder, in more or less the same manner as with electromagnetic waves.The authors present in this paper an introductory survey of the basic concepts of these new technologies with particular emphasis on their main applications, together with a description of some modelling approaches

The Transportation Engineering Inside the City Structure in the Science Fiction Graphic Novel of the 20th Century

ABSTRACT:Abstract Comic books, graphic novels, bandes dessinées in France, Fumetti in Italy, Tebeos in Spain, etc, are only some of the names given to the ninth art in the world since their first representations in the Ancient Egypt times. In these last decades it has transformed itself, from just a children entertainment of little intellectual value, and now it belongs to the best family of universal literature. Just as the other arts, painting, music, poetry, cinema…, it has become another way of expression of the human being, who often reflects on his master pieces the compendium of the feelings and thoughts of a whole generation, an epoch, or even sublime states of the soul, capable to transmit, in just one masterpiece, the essence of our nature to the next generations. These artists, the comic’s ones, the same as in literature or cinema, have also tried to represent, not only the past and the present, but also the future of the human being. Doing sometimes prodigious imagination efforts, they have constructed utopic, distopic, extra-terrestrial…scenarios, designing realistic or impossible science fiction backgrounds, which will finally influence all of us, as intellectual beings that we are, in all our disciplines, just as the other arts do. And one of these disciplines is, of course, the science of transportation, in all its aspects. Willing to approach all these questions, we began a long investigation journey which will end in a doctoral thesis with the title: “The Civil Engineering in the Science Fiction Graphic Novel”. In this article we anticipate and summarize a small sample of our thesis, including some of the most important aspects of the mentioned investigation as well as the obtained conclusions

Addressing the Importance of Service Attributes in Railways

This research presents a combined qualitative and quantitative method focused on determining the level of importance that users place on different attributes of a railway service. The identification of these preferences will allow the establishment of policies that could increase the quality and demand of this mode. The qualitative analysis is based on a participation process through focus groups and in-depth interviews. From these sources, a diagnosis of the system and the main attributes that may influence the demand have been obtained. The quantitative part of the methodology is grounded on the realization of a stated preference survey using Best?Worst case 1 scaling. This method has made it possible to determine that the attributes related to the fare system, travel time, and intermodality are the most important to increase the quality of rail transport. Instead, the least important attributes were those related to very specific additional services. At the same time, it has been observed that the importance varies depending on the frequency of railway use. Thus, less frequent and nonusers considered the connections with other transport modes and user information more important. Therefore, improving intermodality could be a cost-effective way to attract new users.This research was supported by the Shift2Rail initiative through the financing of the NEAR2050 project (Project Reference: 730838, Call Reference S2R-OC-CCA-01-2015); the Spanish Ministry of Economy and Industry through the Project TRA2015-69903-R (co-funded by ERDF funds); and the Spanish Ministry of Education, Culture, and Sports through the training grant FPU15/02990

Passenger preference analysis: light rail transit or bus versus car

To begin with, his article studies the user's preferences when faced with the introduction of two completely different public transport systems: the bus and the Light Rail Transit (LRT). Also, it examines how the modal distribution varies between the private car and each of the new systems, in particular. In addition, the most important variables for users when travelling in a congested corridor are individualized and a study is made on how these variables influence on the modal distribution. The results of the stated preferences of surveys are modelled using mixed logit models. Values are estimated for user's time and the demand elasticity is determined with respect to the relevant variables. Different situations are created to analyse how user's behaviour changes with the changes in the most important variables. Furthermore, this article quantifies the effects of the more relevant variables and shows that the LRT can attract more demand than a bus service, but it must guarantee a regular and frequent service, at the same time as charging competitive fares. It is also shown that for the introduction to be more successful any taken action should be accompanied by policies that chastise the use of the private car such as increased parking charges or higher fuel taxes

Capturing the conditions that introduce systematic variation in bike-sharing travel behavior using data mining techniques

The potential of smart-card transactions within bike-sharing systems (BSS) is still to be explored. This research proposes an original offline data mining procedure that takes advantage of the quality of these data to analyze the bike usage casuistry within a sharing scheme. A difference is made between usage and travel behavior: the usage is described by the actual trip-chaining gathered with every smart-card transaction and is directly influenced by the limitations of the BSS as a public renting service, whilst the travel behavior relates to the spatio-temporal distribution, the travel time and trip purpose. The proposed approach is based on the hypothesis that there are systematic usage types which can be described through a set of conditions that permit to classify the rentals and reduce the heterogeneity in travel patterns. Hence, the proposed algorithm is a powerful tool to characterize the actual demand for bike-sharing systems. Furthermore, the results show that its potential goes well beyond that since service deficiencies rapidly arise and their impacts can be measured in terms of demand. Consequently, this research contributes to the state of knowledge on cycling behavior within public systems and it is also a key instrument beneficial to both decision makers and operators assisting the demand analysis, the service redesign and its optimization

Using O–D matrices for decision making in road network management

This article uses a real example to demonstrate the importance of mobility modelling (objective criteria) on correctly planned investments in infrastructure. Some radical conclusions are drawn which differ greatly from those suggested by more subjective mental models. Strategic developments on inter-urban networks are evaluated by applying a mobility model including a model for estimating O–D matrices based on traffic counts and a model for the optimal location of traffic counting stations at the same time as a population accessibility model. An important decision making tool is provided for planning investments in road infrastructure by rationalising the high public spending required for this type of work. The models are applied to various possible projects at determined points on a regional road network in the Autonomous Community of Cantabria (Northern Spain) following the proposals and demands of different social and political groups. The models find a 68% reduction in the number of links required to obtain O–D matrices. This provides considerable savings in data collection costs (approximately 50% less) involving future traffic counts on similar and especially regional road networks