What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations

Objective: To understand the variability and nature of shared decision making (SDM) regarding a uniform type of serious medical decision, and to make normative judgments about how these conversations might be improved. Methods: This was a mixed-methods sub-analysis of the Improving Patient Outcomes with Respect and Trust (IMPORT) study. We used the Braddock framework to identify and describe seven elements of SDM in audio-recorded encounters regarding initiation of hydroxyurea, and used data from medical records and patient questionnaires to understand whether and how these tasks were achieved. Results: Physicians covered a spectrum of SDM behaviors: all dialogues contained discussion regarding the clinical issue and the pros and cons of treatment; the patient's understanding and role were not explicitly assessed or stated in any encounter. Yet no patient agreed to start hydroxyurea who did not already prefer it. There was no uniform approach to how physicians presented risk; many concerns expressed by patients in a pre-visit questionnaire were not discussed. Conclusion: In this analysis, patients seemed to understand their role in the decision-making process, suggesting that a patient's role may not always need to be explicitly stated. However, shared decision making might be improved with more routine assessment of patient understanding and concerns. Standardized decision aids might help fully inform patients of risks and benefits

Silicon Pad Detectors for the PHOBOS Experiment at RHIC

The PHOBOS experiment is well positioned to obtain crucial information about relativistic heavy ion collisions at RHIC, combining a multiplicity counter with a multi-particle spectrometer. The multiplicity arrays will measure the charged particle multiplicity over the full solid angle. The spectrometer will be able to identify particles at mid-rapidity. The experiment is constructed almost exclusively of silicon pad detectors. Detectors of nine different types are configured in the multiplicity and vertex detector (22,000 channels) and two multi-particle spectrometers (120,000 channels). The overall layout of the experiment, testing of the silicon sensors and the performance of the detectors during the engineering run at RHIC in 1999 are discussed.Comment: 7 pages, 7 figures, 1 table, Late

Fibrations on four-folds with trivial canonical bundles

Four-folds with trivial canonical bundles are divided into six classes according to their holonomy group. We consider examples that are fibred by abelian surfaces over the projective plane. We construct such fibrations in five of the six classes, and prove that there is no such fibration in the sixth class. We classify all such fibrations whose generic fibre is the Jacobian of a genus two curve.Comment: 28 page