Investigating a training supporting shared decision making (IT'S SDM 2011): study protocol for a randomized controlled trial

<p/> <p>Background</p> <p>Shared Decision Making (SDM) is regarded as the best practice model for the communicative challenge of decision making about treatment or diagnostic options. However, randomized controlled trials focusing the effectiveness of SDM trainings are rare and existing measures of SDM are increasingly challenged by the latest research findings. This study will 1) evaluate a new physicians' communication training regarding patient involvement in terms of SDM, 2) validate SDM_MASS, a new compound measure of SDM, and 3) evaluate the effects of SDM on the perceived quality of the decision process and on the elaboration of the decision.</p> <p>Methods</p> <p>In a multi-center randomized controlled trial with a waiting control group, 40 physicians from 7 medical fields are enrolled. Each physician contributes a sequence of four medical consultations including a diagnostic or treatment decision.</p> <p>The intervention consists of two condensed video-based individual coaching sessions (15min.) supported by a manual and a DVD. The interventions alternate with three measurement points plus follow up (6 months).</p> <p>Realized patient involvement is measured using the coefficient SDM_MASSdrawn from the Multifocal Approach to the Sharing in SDM (MAPPIN'SDM) which includes objective involvement, involvement as perceived by the patient, and the doctor-patient concordance regarding their judges of the involvement. For validation purposes, all three components of SDM_MASSare supplemented by similar measures, the OPTION observer scale, the Shared Decision Making Questionnaire (SDM-Q) and the dyadic application of the Decisional Conflict Scale (DCS). Training effects are analyzed using t-tests. Spearman correlation coefficients are used to determine convergent validities, the influence of involvement (SDM_MASS) on the perceived decision quality (DCS) and on the elaboration of the decision. The latter is operationalised by the ELAB coefficient from the UP24 (Uncertainty Profile, 24 items version).</p> <p>Discussion</p> <p>Due to the rigorous blinded randomized controlled design, the current trial promises valid and reliable results. On the one hand, we expect this condensed time-saving training to be adopted in clinical routine more likely than previous trainings. On the other hand, the exhaustivity of the MAPPIN'SDM measurement system qualifies it as a reference measure for simpler instruments and to deepen understanding of decision-making processes.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN78716079">ISRCTN78716079</a></p

Constrained optimal control: an application to semiactive suspension systems

This article applies three different control techniques to the design of a quarter-car semiactive suspension system. The three techniques, originally developed to solve a constrained optimal control problem, are optimal gain switching, discontinuous variable structure control and explicit model predictive control. All of them divide the state space into convex regions and assign a linear or affine state feedback controller to each region. The partition of the state space is computed off-line. During the on-line phase, the controller switches between the subcontrollers according to the current state. All the above techniques gave satisfactory results when applied to the design of semiactive suspension systems. A detailed comparison in terms of computational complexity, performance and simplicity of the design is proposed in the article

Modelling of Active Distribution Networks for Power System Restoration Studies

This paper presents an aggregated model of Active Distribution Networks (ADNs) appropriate for power system restoration studies. The ADN considers aggregated loads and inverter based generation, such as wind and photovoltaic generation. The load model incorporates: i) time series data for consumption; ii) voltage and frequency dependency; iii) under frequency load shedding; iv) disconnection behavior; and v) cold load pick-up. The generation model considers: i) time series data for generation; ii) over frequency active power reduction; iii) disconnection; and iv) reconnection behavior. The ADN model covers dynamic phenomena in the time scale of tens of seconds up to several minutes with the focus on frequency dynamics. Moreover, the model was tested in several case studies and shows adequate dynamic behavior

Pulsed ENDOR at 95 GHz on the primary acceptor ubisemiquinone Q in photosynthetic bacterial reaction centers and related model systems

Davies-type pulsed H electron nuclear double resonance (ENDOR) measurements were performed at a magnetic field of 3.4 T and a microwave (MW) frequency of 95 GHz (W-band). By taking advantage of the increased electron Zeeman interaction at high field, the small g-anisotropy of the semiquinone anion radicals could be resolved in frozen solutions. Hence, the W-band ENDOR spectra could be taken at the well-separated canonical peaks of the powder electron paramagnetic resonance (EPR) spectra, thereby becoming highly orientation-selective with respect to the relative orientation of the radicals to the external magnetic field. The measurements were performed on various randomly oriented semiquinone anion radicals in frozen alcoholic solution and on the primary ubiquinone anion radical, Q, frozen photosynthetic bacterial reaction centers (RCs) of Rhodobacter sphaeroides in which the Fe was replaced by Zn (ZnRC). A simulation program was used to obtain magnitudes and orientations of the hyperfine tensors. The W-band ENDOR spectra of the immobilized radicals show not only hyperfine couplings (HFC) of local protons of the semiquinones, but also those of protons from the environment. These are, for example, involved in hydrogen bonds between the amino acid surrounding and the quinone carbonyl groups. For Q in ZnRCs, a particularly large H-bond HFC was obtained from which direction and distance of the H-bond could be estimated. These data were compared with those measured for the respective ubisemiquinone radical, UQ-10, in protonated and deuterated 2-propanol, where two H-bonds of comparable strength but different directions could be detected. Comparison of H ENDOR spectra of the 2,3,5,6-tetra-methyl-1,4-benzoquinone anion radical in frozen solution, performed both at W-band and at X-band frequency, demonstrated the limitations of achieving orientation selected ENDOR spectra from X-band experiments on systems with small g-anisotropy

Islamic Finance Between Intentionalism And Consequentialism: Critical Perspectives On The Normative Operational Construct Of Islamic Finance

This paper presents the status of the APEmille project, which is essentially completed, as far as machine development and construction is concerned. Several large installations of APEmille are in use for physics production runs leading to many new results presented at this conference. This paper briefly summarizes the APEmille architecture, reviews the status of the installations and presents some performance figures for physics codes

Resonances: Noise and Contemporary Music

Noise seems to stand for a lack of aesthetic grace, to alienate or distract rather than enrapture. And yet the drones of psychedelia, the racket of garage rock and punk, the thudding of rave, the feedback of shoegaze and post-rock, the bombast of thrash and metal, the clatter of jungle and the stuttering of electronica, together with notable examples of avant-garde noise art, have all found a place in the history of contemporary musics, and are recognised as representing key evolutionary moments. Noise therefore is the untold story of contemporary popular music, and in a critical exploration of noise lies the possibility of a new narrative – one that is wide-ranging, connects the popular to the underground and avant-garde, fully posits the studio as a musical instrument, and demands new critical and theoretical paradigms of those seeking to write about music. Resonances is a compelling collection of new essays by scholars, writers and musicians – all seeking to explore and enlighten this field of study

APE computers--past, present and future

International audienc