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1.
J Environ Manage ; 304: 114277, 2022 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-35021586

RESUMEN

Ecological compensation (EC) has been proposed as an important tool for stopping the loss of biodiversity and natural values. However, there are few studies on its actual operationalisation and there is high uncertainty about how it should be designed and implemented to be an effective way of performing nature conservation. In this study we focus on ecological compensation in Sweden, a country where it is in the process of being implemented more broadly. Using interviews and a workshop we investigate how the work with the implementation is carried out and what challenges exist. The results show that implementation of EC is at an early stage of development and there are many practical obstacles, linked to both legislation and routines in the planning processes. There is a lack of holistic perspective and large-scale thinking, a quite strong focus on a small number of individual species, and an overall attitude that anything is better than nothing, all of which can have negative consequences for biodiversity conservation overall. Based on the results we discuss the need for better integration of EC into the entire decision-making process and for a holistic approach to preservation of biodiversity and ecosystem services, by increasing the focus on landscape perspective and considering delays in compensation outcomes. There is also a need for a national level standard for EC, making good and worse examples of compensation measures available and systematic monitoring of EC projects. Finally, a spatially explicit database to document all EC areas should be introduced both to ensure consistency in protection from future development plans and to enable long-term monitoring of EC outcomes.


Asunto(s)
Conservación de los Recursos Naturales , Ecosistema , Biodiversidad , Proyectos de Investigación , Incertidumbre
2.
Clin Nucl Med ; 47(2): 123-129, 2022 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-35006106

RESUMEN

PURPOSE: The aim of this study was to evaluate brain FDG PET for short- to medium-term prediction of cognitive decline, need for assisted living, and survival in acutely hospitalized geriatric patients with newly detected clinically uncertain cognitive impairment (CUCI). MATERIALS AND METHODS: The study included 96 patients (62 females, 81.4 ± 5.4 years) hospitalized due to (sub)acute admission indications with newly detected CUCI (German Clinical Trials Register DRKS00005041). FDG PET was categorized as "neurodegenerative" (DEG+) or "nonneurodegenerative" (DEG-) based on visual inspection by 2 independent readers. In addition, each individual PET was tested voxel-wise against healthy controls (P < 0.001 uncorrected). The resulting total hypometabolic volume (THV) served as reader-independent measure of the spatial extent of neuronal dysfunction/degeneration. FDG PET findings at baseline were tested for association with the change in living situation and change in vital status 12 to 24 months after PET. The association with the annual change of the CDR-SB (Clinical Dementia Rating Sum of Boxes) after PET was tested in a subsample of 72 patients. RESULTS: The mean time between PET and follow-up did not differ between DEG+ and DEG- patients (1.37 ± 0.27 vs 1.41 ± 0.27 years, P = 0.539). Annual change of CDR-SB was higher in DEG+ compared with DEG- patients (2.78 ± 2.44 vs 0.99 ± 1.81, P = 0.001), and it was positively correlated with THV (age-corrected Spearman ρ = 0.392, P = 0.001). DEG+ patients moved from at home to assisted living significantly earlier than DEG- patients (P = 0.050). Survival was not associated with DEG status or with THV. CONCLUSIONS: In acutely hospitalized geriatric patients with newly detected CUCI, the brain FDG PET can contribute to the prediction of further cognitive/functional decline and the need for assisted living within 1 to 2 years.


Asunto(s)
Enfermedad de Alzheimer , Disfunción Cognitiva , Anciano , Anciano de 80 o más Años , Encéfalo , Femenino , Fluorodesoxiglucosa F18 , Humanos , Masculino , Tomografía de Emisión de Positrones , Incertidumbre
3.
J Neurosci Nurs ; 54(1): 23-29, 2022 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-35007260

RESUMEN

ABSTRACT: BACKGROUND: By 2030, there will be approximately 7.6 million stroke survivors (SSs) in the United States, yet comprehensive transitional care (TC) for stroke is not widely available. Stroke strikes without warning and leaves in its wake a "storm" of uncertainty for SSs and caregivers (CGs) as they encounter a myriad of unmet physical, mental, emotional, and financial needs that are not wholly addressed by passive healthcare delivery systems. Needed is a stroke-specific TC model that bridges this storm to active delivery of SS and CG postacute care. Naylor's Transitional Care Model (NTCM) has not been examined for how it can frame comprehensive stroke care. The purpose of this study was to solicit SS and CG descriptions of TC experiences to inform the NTCM with refined operational definitions and exemplars specific to stroke. METHODS: Focus groups conducted for this qualitative descriptive study were guided by interview questions based on the 8 NTCM operational definitions. Data were analyzed using inductive and deductive qualitative content analysis methods. RESULTS: Post-acute-stroke care does not comprehensively meet the needs of SSs and CGs. Participants described TC deficits across all 8 NTCM components. Two new subcomponents that could be applied for a stroke-specific NTCM emerged: psychological and transportation challenges. CONCLUSION: Unmet needs identified by SSs and CGs were used to extend NTCM specific to the stroke population and to develop the Recommendations and Exemplars for Stroke Specific Comprehensive Transitional Care Delivery (see Supplementary Digital Content, available at http://links.lww.com/JNN/A385). Researchers and practitioners can use the findings to develop and deliver more comprehensive TC to SSs and CGs.


Asunto(s)
Accidente Cerebrovascular , Cuidado de Transición , Cuidadores , Humanos , Sobrevivientes , Incertidumbre
4.
Rev Esc Enferm USP ; 56: e20210303, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35007317

RESUMEN

OBJECTIVE: To test the explanatory power of coping strategies and intolerance of uncertainty on men's perceived stress levels and test the moderating role of coping strategies in the relationship between intolerance of uncertainty and perceived stress during the Covid-19 pandemic. METHOD: This was an online cross-sectional study in which 1,006 men living in Brazil during the Covid-19 pandemic participated. Participants were recruited using a snowball sampling technique and completed a questionnaire containing measures of all study variables. Data were examined using a correlation and a regression analysis. RESULTS: Intolerance of uncertainty (ß = .51) and refusal (ß = .15) positively predicted perceived stress, whereas control (ß = -.31) and isolation (ß = -.06) negatively predicted it. Together, these variables explained 52% of men's perceived stress (p < .001). Isolation and social support lessened the relationship between intolerance of uncertainty and stress (p < .001). CONCLUSION: Men high in intolerance of uncertainty and refusal were more vulnerable to stress during the pandemic. However, coping helped mitigate the relationship between intolerance of uncertainty and perceived stress, thus being a promising psychosocial intervention in this context.


Asunto(s)
COVID-19 , Pandemias , Adaptación Psicológica , Estudios Transversales , Humanos , Masculino , SARS-CoV-2 , Incertidumbre
5.
Proc Natl Acad Sci U S A ; 119(2)2022 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-34983870

RESUMEN

Pooled testing increases efficiency by grouping individual samples and testing the combined sample, such that many individuals can be cleared with one negative test. This short paper demonstrates that pooled testing is particularly advantageous in the setting of pandemics, given repeated testing, rapid spread, and uncertain risk. Repeated testing mechanically lowers the infection probability at the time of the next test by removing positives from the population. This effect alone means that increasing frequency by x times only increases expected tests by around [Formula: see text] However, this calculation omits a further benefit of frequent testing: Removing infections from the population lowers intragroup transmission, which lowers infection probability and generates further efficiency. For this reason, increasing testing frequency can paradoxically reduce total testing cost. Our calculations are based on the assumption that infection rates are known, but predicting these rates is challenging in a fast-moving pandemic. However, given that frequent testing naturally suppresses the mean and variance of infection rates, we show that our results are very robust to uncertainty and misprediction. Finally, we note that efficiency further increases given natural sampling pools (e.g., workplaces, classrooms) that induce correlated risk via local transmission. We conclude that frequent pooled testing using natural groupings is a cost-effective way to provide consistent testing of a population to suppress infection risk in a pandemic.


Asunto(s)
Tamizaje Masivo/economía , Tamizaje Masivo/métodos , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/prevención & control , Prueba de COVID-19 , Análisis Costo-Beneficio , Humanos , Vigilancia de la Población , Prevalencia , SARS-CoV-2/aislamiento & purificación , Incertidumbre
6.
8.
Comput Intell Neurosci ; 2022: 2092313, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35047030

RESUMEN

Neutrosophic set (NS) is an extensively used framework whenever the imprecision and uncertainty of an event is described based on three possible aspects. The association, neutral, and nonassociation degrees are the three unique aspects of an NS. More importantly, these degrees are independent which is a great plus point. On the contrary, neutrosophic graphs (NGs) and single-valued NGs (SVNGs) are applicable to deal with events that contain bulks of information. However, the concept of degrees in NGs is a handful tool for solving the problems of decision-making (DM), pattern recognition, social network, and communication network. This manuscript develops various forms of edge irregular SVNG (EISVNG), highly edge irregular SVNG (HEISVNG), strongly (EISVNG), strongly (ETISVNG), and edge irregularity on a cycle and a path in SVNGs. All these novel notions are supported by definitions, theorems, mathematical proofs, and illustrative examples. Moreover, two types of DM problems are modelled using the proposed framework. Furthermore, the computational processes are used to confirm the validity of the proposed graphs. Furthermore, the results approve that the decision-making problems can be addressed by the edge irregular neutrosophic graphical structures. In addition, the comparison between proposed and the existing methodologies is carried out.


Asunto(s)
Inversiones en Salud , Incertidumbre
9.
Sensors (Basel) ; 22(1)2022 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-35009912

RESUMEN

This paper considers the physical layer security (PLS) of a simultaneous wireless information and power transfer (SWIPT) relay communication system composed of a legitimate source-destination pair and some eavesdroppers. Supposing a disturbance of channel status information (CSI) between relay and eavesdroppers in a bounded ellipse, we intend to design a robust beamformer to maximum security rate in the worst case on the constraints of relay energy consumption. To handle this non-convex optimization problem, we introduce a slack variable to transform the original problem into two sub-problems firstly, then an algorithm employing a semidefinite relaxation (SDR) technique and S-procedure is proposed to tackle above two sub-problems. Although our study was conducted in the scene of a direct link among source, destination, and eavesdroppers that is non-existing, we demonstrate that our conclusions can be easily extended to the scene for which a direct link among source, destination and eavesdroppers exist. Numerical simulation results compared with the benchmark scheme are provided to prove the effectiveness and superior performance of our algorithm.


Asunto(s)
Redes de Comunicación de Computadores , Tecnología Inalámbrica , Algoritmos , Simulación por Computador , Incertidumbre
10.
BMC Psychol ; 10(1): 6, 2022 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-34986890

RESUMEN

BACKGROUND: Test anxiety has a detrimental effect on test performance but current interventions for test anxiety have limited efficacy. Therefore, examination of newer psychological models of test anxiety is now required. Two transdiagnostic psychological models of emotional disorders that can account for anxiety are the intolerance of uncertainty model (IUM) and the Self-Regulatory Executive Function (S-REF) model. Intolerance of uncertainty, the stable disposition to find uncertainty distressing, is central to the IUM, while beliefs about thinking, metacognition, are central to the S-REF model. We tested for the first time the role of both intolerance of uncertainty and metacognitive beliefs in test anxiety. METHODS: A cross-sectional design was used, with college students (n = 675) completing questionnaires assessing their test anxiety, intolerance of uncertainty, and metacognitive beliefs. Hierarchical linear regressions examined if intolerance of uncertainty and metacognitive beliefs were associated with test anxiety, after controlling for age and gender. RESULTS: Females reported significantly more test anxiety than males. Partial correlations, controlling for gender, found intolerance of uncertainty and metacognitive beliefs were significantly and positively correlated with test anxiety. Hierarchical linear regressions found metacognitive beliefs explained an additional 13% of variance in test anxiety, after controlling for intolerance of uncertainty. When the order of entry was reversed, intolerance of uncertainty was only able to explain an additional 2% of variance, after controlling for metacognitive beliefs. In the final regression model, gender, intolerance of uncertainty and the metacognitive belief domains of 'negative beliefs about the uncontrollability and danger of worry' and 'cognitive confidence' were all significantly associated test anxiety, with 'negative beliefs about the uncontrollability and danger of worry' having the largest association. CONCLUSIONS: Both intolerance of uncertainty and metacognitive beliefs are linked to test anxiety, but results suggest metacognitive beliefs have more explanatory utility, providing greater support for the S-REF model. Modification of intolerance of uncertainty and metacognitive beliefs could alleviate test anxiety and help students fulfil their academic potential.


Asunto(s)
Metacognición , Ansiedad , Estudios Transversales , Femenino , Humanos , Masculino , Estudiantes , Encuestas y Cuestionarios , Ansiedad ante los Exámenes , Incertidumbre
11.
ALTEX ; 39(1): 3-29, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35034131

RESUMEN

Safety sciences must cope with uncertainty of models and results as well as information gaps. Acknowledging this uncer-tainty necessitates embracing probabilities and accepting the remaining risk. Every toxicological tool delivers only probable results. Traditionally, this is taken into account by using uncertainty / assessment factors and worst-case / precautionary approaches and thresholds. Probabilistic methods and Bayesian approaches seek to characterize these uncertainties and promise to support better risk assessment and, thereby, improve risk management decisions. Actual assessments of uncertainty can be more realistic than worst-case scenarios and may allow less conservative safety margins. Most importantly, as soon as we agree on uncertainty, this defines room for improvement and allows a transition from traditional to new approach methods as an engineering exercise. The objective nature of these mathematical tools allows to assign each methodology its fair place in evidence integration, whether in the context of risk assessment, sys-tematic reviews, or in the definition of an integrated testing strategy (ITS) / defined approach (DA) / integrated approach to testing and assessment (IATA). This article gives an overview of methods for probabilistic risk assessment and their application for exposure assessment, physiologically-based kinetic modelling, probability of hazard assessment (based on quantitative and read-across based structure-activity relationships, and mechanistic alerts from in vitro studies), indi-vidual susceptibility assessment, and evidence integration. Additional aspects are opportunities for uncertainty analysis of adverse outcome pathways and their relation to thresholds of toxicological concern. In conclusion, probabilistic risk assessment will be key for constructing a new toxicology paradigm - probably!


Asunto(s)
Toxicología , Teorema de Bayes , Medición de Riesgo , Incertidumbre
12.
J Environ Manage ; 302(Pt B): 114077, 2022 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-34768038

RESUMEN

Diffuse solar radiation (Rd), known as an important component of global solar radiation (Rg), is a key parameter for solar energy related applications and ecosystem photosynthesis. Some meteorological models have been developed to estimate Rd with acceptable accuracy, but their spatial scales are often small due to the limited meteorological station number. Satellite-based models provide accurate and large-scale Rg estimates. However, remote sensing estimations of Rd are often with low spatial resolutions and large uncertainties, because their methods were based on inaccurate surface and atmospheric parameters. To address these challenges, the high-spatiotemporal-resolution (half-hourly and 1-km) Rd in the United States was estimated using the top-of-atmosphere (TOA) data from the new-generation geostationary satellite Geostationary Operational Environmental Satellites (GOES-16) and the method iterative random forest (RF). The results showed that the iterative RF model had higher accuracy than the simple RF and artificial neural network (ANN) models, and using TIR (thermal infrared) bands can improve models' accuracy. The best model can estimate half-hourly Rd with the accuracy R2 = 0.88, RMSE = 37.81 W/m2, and MBE = 0.01 W/m2. Compared with the previous 0.01-degree (∼11-km) Rd product Earth Polychromatic Imaging Camera (EPIC), the GOES-16 estimated 1-km Rd had similar spatial patterns. Moreover, based on the GOES-16 estimated half-hourly and 1-km Rd in the United States, the spatiotemporal heterogeneity of Rd was quantitatively observed. The proposed approach can be used to produce more high-spatiotemporal-resolution Rd products, and these products are very helpful for many solar-related research topics and industrial applications.


Asunto(s)
Monitoreo del Ambiente , Energía Solar , Atmósfera , Ecosistema , Incertidumbre , Estados Unidos
13.
Neural Netw ; 145: 199-208, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34768090

RESUMEN

Variational autoencoders (VAEs) are influential generative models with rich representation capabilities from the deep neural network architecture and Bayesian method. However, VAE models have a weakness that assign a higher likelihood to out-of-distribution (OOD) inputs than in-distribution (ID) inputs. To address this problem, a reliable uncertainty estimation is considered to be critical for in-depth understanding of OOD inputs. In this study, we propose an improved noise contrastive prior (INCP) to be able to integrate into the encoder of VAEs, called INCPVAE. INCP is scalable, trainable and compatible with VAEs, and it also adopts the merits from the INCP for uncertainty estimation. Experiments on various datasets demonstrate that compared to the standard VAEs, our model is superior in uncertainty estimation for the OOD data and is robust in anomaly detection tasks. The INCPVAE model obtains reliable uncertainty estimation for OOD inputs and solves the OOD problem in VAE models.


Asunto(s)
Redes Neurales de la Computación , Teorema de Bayes , Incertidumbre
14.
J Environ Manage ; 302(Pt A): 114009, 2022 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-34872175

RESUMEN

Green infrastructure (GI) is becoming a common solution to mitigate stormwater-related problems. Given the uncertain costs of GI relative to other stormwater management strategies, stakeholders investing in GI need performance-analysis tools that consider the full suite of benefits and the impacts of uncertainty to help justify GI expenditures. This study provides a quantitative and comparative analysis of GI benefits, including nutrient uptake from stormwater and air pollutant deposition. Economic costs and benefits of GI are assessed using two metrics, benefit-cost ratios (BCRs) and nutrient removal costs, at three scales: household, subwatershed, and watershed scale. Results from a case study in the state of Maryland show that the costs of nutrient uptake at the subwatershed scale can be lower than those at either the watershed or household scales. Moreover, rain gardens are far more efficient in stormwater treatment at the household scale in comparison to watershed scale, for which large-scale dry or wet basins are more efficient. Using a BCR metric, smaller subwatersheds show more promise, while using a nutrient removal cost metric indicates that upstream subwatersheds are more suitable for stormwater treatment. The results also show that implementation of GI at all potential pervious locations does not necessarily increase nutrient removal costs and that self-installation of rain gardens greatly reduces nutrient removal costs. Finally, the results show that using numerous small-sized rain garden practices in front of residential buildings yields lower nutrient removal costs in comparison to permeable pavements placed in parking lots and commercial buildings.


Asunto(s)
Lluvia , Purificación del Agua , Análisis Costo-Beneficio , Incertidumbre , Abastecimiento de Agua
15.
Sci Total Environ ; 806(Pt 1): 150504, 2022 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-34583072

RESUMEN

The results of a global sensitivity and uncertainty analysis of a microalgae model applied to a Membrane Photobioreactor (MPBR) pilot plant were assessed. The main goals of this study were: (I) to identify the sensitivity factors of the model through the Morris screening method, i.e. the most influential factors; (II) to calibrate the influential factors online or offline; and (III) to assess the model's uncertainty. Four experimental periods were evaluated, which encompassed a wide range of environmental and operational conditions. Eleven influential factors (e.g. maximum specific growth rate, light intensity and maximum temperature) were identified in the model from a set of 34 kinetic parameters (input factors). These influential factors were preferably calibrated offline and alternatively online. Offline/online calibration provided a unique set of model factor values that were used to match the model results with experimental data for the four experimental periods. A dynamic optimization of these influential factors was conducted, resulting in an enhanced set of values for each period. Model uncertainty was assessed using the uncertainty bands and three uncertainty indices: p-factor, r-factor and ARIL. Uncertainty was dependent on both the number of influential factors identified in each period and the model output analyzed (i.e. biomass, ammonium and phosphate concentration). The uncertainty results revealed a need to apply offline calibration methods to improve model performance.


Asunto(s)
Microalgas , Purificación del Agua , Biomasa , Fotobiorreactores , Incertidumbre , Aguas Residuales
16.
Sci Total Environ ; 806(Pt 1): 150128, 2022 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-34583084

RESUMEN

Atmospheric dispersion models are crucial for nuclear risk assessment and emergency response systems since they rapidly predict air concentrations and deposition of released radionuclides, providing a basis for dose estimations and countermeasure strategies. Atmospheric dispersion models are associated with relatively large and often unknown uncertainties that are mostly attributed to meteorology, source terms and parametrisation of the dispersion model. By developing methods that can provide reliable uncertainty ranges for model outputs, decision makers have an improved basis for handling nuclear emergency situations. In the present work, model skill of the Severe Nuclear Accident Programme (SNAP) model was quantified by employing an ensemble method in which 51 meteorological realisations from a numerical weather prediction model were combined with 9 source term descriptions for the accidental 137Cs releases from Fukushima Daiichi Nuclear Power Plant during 14th-17th March 2011. The meteorological forecast was compared to observations of wind speed from 30 meteorological stations. The 459 dispersion realisations were compared with hourly observations of activity concentrations from 100 air filter stations. Exclusive use of deterministic meteorology resulted in most members of the dispersion ensemble showing too low concentration values, however this was mitigated by applying ensemble meteorology. Ensemble predictions, including both the meteorological and source term ensemble, show an overall higher prediction skill compared to individual meteorology and source term runs, with true predictive rate accuracy increasing from 30%-50% to 70%-90%, with a decrease in positive predictive rate accuracy from 75%-80% to 65%-75%. Skill scores and other ensemble indicators also showed improvements in using ensembles of source terms and meteorology. From the present study on the Fukushima accident there are strong indications that ensemble predictions improve the basis for decision making in the early phase after a nuclear accident, which emphasises the importance of including ensemble prediction in nuclear preparedness tools of the future.


Asunto(s)
Contaminantes Radiactivos del Aire , Accidente Nuclear de Fukushima , Monitoreo de Radiación , Contaminantes Radiactivos del Aire/análisis , Radioisótopos de Cesio/análisis , Japón , Plantas de Energía Nuclear , Incertidumbre
17.
J Environ Manage ; 301: 113900, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34638041

RESUMEN

This paper introduces a new framework to evaluate the resilience of lakes under climatic and anthropogenic droughts. The proposed hierarchical structure of criteria for assessing lake's resilience has four levels. The first level includes several indices such as long-term resilience, reliability, and implementation cost. In the second to fourth levels, four main resilience-based criteria (i.e. robustness, resourcefulness, redundancy, and rapidity) and some qualitative and quantitative sub-criteria are defined considering the factors affecting the ecological condition of lakes. To quantify the time series of the sub-criteria, a coupled SWAT-MODSIM-based simulation model has been applied. Also, the values of criteria and sub-criteria have been aggregated using the Evidential Reasoning (ER) approach. After estimating the annual resilience time series, three resilience indices, namely the recovery time (Tr), loss of resilience (LOR), and final resilience (Resf), have been calculated. The normalized values of these indices and reliability criteria have been aggregated to evaluate the overall performance of lake restoration scenarios. To show the applicability of the proposed methodology, the Zarrinehrud river basin and Lake Urmia have been selected as the case study. As one of the largest hypersaline lakes globally, Lake Urmia suffers from drastic changes in its water body and a high level of salinization. Also, the Zarrinehrud river basin, located in the southeastern of Urmia Lake, is the most significant sub-basin of the lake and is responsible for supplying 41% of the total annual inflow of the lake. The restoration scenarios of Lake Urmia have been assessed from 2019 to 2049. Eventually, the most effective scenario, which has an average overall performance of 0.72, the implementation cost of 17.1 million dollars, and the uncertainty band of 0.05, has been selected.


Asunto(s)
Sequías , Lagos , Monitoreo del Ambiente , Reproducibilidad de los Resultados , Ríos , Incertidumbre
18.
Am J Hosp Palliat Care ; 39(1): 4-8, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33910380

RESUMEN

Discussions involving racial health disparities must include pathways for engaging in shared decision-making with racial/ethnic minorities. Research demonstrates glaring racial and ethnic disparities when it comes to hematologic malignancies from the time of diagnosis to treatment and even at the end of life. Unfortunately, decision-making in these circumstances may be streamlined, given the urgency of the disease, prognostic uncertainty, and varying treatment options. Being diagnosed with cancer is undoubtedly a traumatic experience and a patient's race and/or ethnicity add an important dimension to their experience. The tenets of trauma-informed care (TIC) are anchored in recognizing that trauma can manifest in several ways and acknowledging the impact of past trauma on a patient's present and future behaviors. We argue that using a TIC approach may help hematologists create a space for decision-making while minimizing the risk of re-traumatization and perpetuating racial disparities. Using the foundation of TIC, an interprofessional team can begin addressing manifestations of trauma and hopefully mitigate racial and ethnic disparities.


Asunto(s)
Neoplasias Hematológicas , Disparidades en Atención de Salud , Neoplasias Hematológicas/terapia , Humanos , Incertidumbre
19.
Am J Hosp Palliat Care ; 39(1): 79-85, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34002621

RESUMEN

BACKGROUND: There are multiple factors that may cause end-of-life conflict in the critical care setting. These include severe illness, family distress, lack of awareness about a patient's wishes, prognostic uncertainty, and the participation of multiple providers in goals-of-care discussions. METHODS: Case report and discussion of the associated ethical issues. RESULTS: We present a case of a patient with a pontine stroke, in which the family struggled with decision-making about goals-of-care, leading to fluctuation in code status from Full Code to Do Not Resuscitate-Comfort Care, then back to Full Code, and finally to Do Not Resuscitate-Do Not Intubate. We discuss factors that contributed to this situation and methods to avoid conflict. Additionally, we review the effects of discord at the end-of-life on patients, families, and the healthcare team. CONCLUSION: It is imperative that healthcare teams proactively collaborate with families to minimize end-of-life conflict by emphasizing decision-making that prioritizes the best interest and autonomy of the patient.


Asunto(s)
Cuidados Críticos , Cuidado Terminal , Muerte , Toma de Decisiones , Humanos , Incertidumbre
20.
Soc Stud Sci ; 52(1): 53-78, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34963397

RESUMEN

This article presents a preliminary analysis of the advice provided by the UK government's Scientific Advisory Group for Emergencies (SAGE) held between 22 January and 23 March 2020 in response to the emerging coronavirus pandemic. Drawing on the published minutes of the group's meetings, the article examines what was known and not known, the assumptions and working practices that shaped their work, and how this knowledge was reflected in the decisions made by the government. In doing so, the article critically examines what it means for policy making to be 'led by the science' when the best available science is provisional and uncertain. Using ideas of 'externality' and 'evidential significance', the article argues that the apparent desire for high levels of certainty by both scientists and political decision-makers made early action impossible as the data needed were not, and could not be, available in time. This leads to an argument for changes to the institutions that provide scientific advice based on sociologically informed expectations of science in which expert judgement plays a more significant role.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Infecciones por Coronavirus/epidemiología , Gobierno , Humanos , Formulación de Políticas , Incertidumbre
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