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The importance of shared decision making (SDM) for informed consent has been emphasised in the updated regulatory guidelines. Errors of completion, legibility and omission have been associated with paper-based consent forms. We introduced a digital consent process and compared it against a paper-based process for quality and patient reported involvement in shared decision making. 223 patients were included in this multi-site, single centre study. Patient consent documentation was by either a paper consent form or the Concentric digital consent platform. Consent forms were assessed for errors of legibility, completion and accuracy of content. Core risks for 20 orthopaedic operations were pre-defined by a Delphi round of experts and forms analysed for omission of these risks. SDM was determined via the 'collaboRATE Top Score', a validated measure for gold-standard SDM. 72% (n = 78/109) of paper consent forms contained ≥1 error compared to 0% (n = 0/114) of digital forms (P < 0.0001). Core risks were unintentionally omitted in 63% (n = 68/109) of paper-forms compared to less than 2% (n = 2/114) of digital consent forms (P < 0.0001). 72% (n = 82/114) of patients giving consent digitally reported gold-standard SDM compared to 28% (n = 31/109) with paper consent (P < 0.001). Implementation of a digital consent process has been shown to reduce both error rate and the omission of core risks on consent forms whilst increasing the quality of SDM. This novel finding suggests that using digital consent can improve both the quality of informed consent and the patient experience of SDM. • The paper consent process is associated with errors and omissions of core risks. • A digital consent process improved error rate and omission rate of core risks. • Patients reported a higher level of shared decision making with a digital process. • Documentation of consent can be reliably standardised with an electronic record. [ABSTRACT FROM AUTHOR]

The objective of this paper is to show the added value of using tools such as eyetracking, galvanic skin response, facial coding and others in the field of market research and user experience research. We will present 3 case studies in which these tools have been used successfully. We will give an overview of the background, the objectives, methods and results and how the neuro-tools provided additional insights into consumer behaviour, which would otherwise not have been possible. In this paper we will specifically show cases from packaging design, advertising research and user experience research thus only covering a small part of possible application areas. [ABSTRACT FROM AUTHOR]

This discussion paper highlights the importance of Australian nursing and midwifery students' lack of exposure to electronic medical records during their undergraduate programs. There is pressure on universities offering nursing and midwifery programs to provide students with opportunities to learn to use patient electronic medical records. This will provide authentic rehearsal with the digital technology prior to clinical placements and increase graduate work readiness. Informed by contemporary literature, we describe the benefits of implementing electronic medical records (eMR) in health organisations and identify the challenges and barriers to implementing and integrating the education of electronic records into undergraduate nursing and midwifery programs. Undergraduate students who had not experienced eMR as part of on-campus learning felt unprepared and lacked confidence when commencing clinical practice. Some international nursing and midwifery programs have found that student's skills improve in decision-making and documenting patient observations when eMR is integrated into their university education program. Successful integration of an eMR program should consider academic/teaching staff skills and confidence in technology use, initial and ongoing costs and technical support required to deliver the program. In conclusion, Australian universities need to embed eMR learning experiences into the nursing and midwifery undergraduate curricula to increase students work-readiness with a focus on patient safety. [ABSTRACT FROM AUTHOR]

Abstract This conceptual paper provides a brief review of hospitality consumers' information search behavior and the factors that are likely to influence their information search behavior and their utilization and processing of online reviews. This study focuses on the factors such as information overload, confusion, information processing, information presentation format, trust and evaluation mode that has not received much attention from hospitality scholars in addition to discussing the impacts of perceived risk and familiarity on information search and information processing approaches utilized by hospitality consumers. This study also discusses opportunities for hospitality researchers to empirically examine the extent to which each of the factors discussed might influence hospitality consumers information search, information processing and especially their utilization of online reviews in their decision making process. [ABSTRACT FROM AUTHOR]

The incidence of differentiated thyroid cancer (DTC) has been increasing worldwide, mostly, as an increase in the incidental detection of micro papillary thyroid carcinomas (microPTCs), many of which are potentially overtreated, as suggested by the unchanged mortality. Several international guidelines have suggested a less aggressive approach. More recently, it has been shown that active surveillance or minimally invasive treatments (MIT) are good alternatives for the management of these patients. In this context, patient participation in the decision-making process is paramount. The Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) has undertaken the task to establish consensus and define its position based on the scientific evidence concerning, 1) the current state of diagnostic and management options in microPTCs, including the current opinion of physicians about shared decision making (SDM), 2) the available evidence concerning patients' needs and the available decision instruments, and 3) to provide practical suggestions for implementation of SDM in this context. To improve SDM and patients' participation, knowledge gaps and research directions were highlighted. • New management approaches for patients with low-risk microPTC have been introduced. • For all available options, scientific evidence is weak, resulting in clinical equipoise. • SDM to carefully discuss these treatment options with patients is paramount. [ABSTRACT FROM AUTHOR]

In recent years, the pulp and paper industry has changed a lot and products have been constructed in quite different methods using new technologies. It can be due to the emergence of challenges and constraints such as shortage of raw materials, energy consumption (fossil fuels, electric, etc.), management of the resulting pollutants, environmental issues, ongoing legal requirements and cleaner production strategies. In Iran, the pulp and paper industry's technological development is not keeping pace with global growth. Iran's pulp and paper mills supply a small fraction of domestic market. The reasons can be due to old technologies being used in factories, aging machinery, low productivity of production systems and lack of coordination with modern technologies. It leads to low-quality of paper products and willingness to buy local products. The aim of this study is to select the most appropriate technologies in the pulp section, due to high impact of pulp quality on the quality of final paper. Using a 2-filterd fuzzy decision-making, hierarchical structure of research is designed to assess technological alternatives according to the selected criteria. Findings show that after passing through two filters, Kraft method was chosen as the most appropriate method. The Kraft process has still many advantages like the high quality of the produced pulp and self-sufficiency in energy supply. This framework offers an appropriate procedure for identifying and selecting technologies that has not been used in past researches. Using this framework facilitates using a clear procedure for evaluating and selecting technology and prevents future losses for organizations. [ABSTRACT FROM AUTHOR]

[Display omitted] • Fibre transfer from unconstrained physical assaults involving human subjects. • More fibres transfer in person-person contact than previous data suggests. • Realistic fibre transfer quantities to inform better decision making. • Care must be taken in assigning 'roles' in physical assaults using fibre evidence. • Broad fibre distribution maps evident despite garments stored in paper bags. Knowledge of the number of fibres transferred during a particular activity is essential for the interpretation of findings in similar criminal cases. In this regard, violent contacts and physical assaults still present a challenge, due to a lack of robust published data. Hereby, we present the outcome of an empirical study where different assault activities were simulated by a Jiu Jitsu team and participants were asked to play either the role of an aggressive 'assailant' or a defensive 'victim', wearing cotton garments (i.e., Gi's). Four different scenarios were simulated in replicates (n = 5), each of them involving different intensity levels (low and high) and duration times (30 and 60 s). Results showed that approximately 1,000 to 44,000 fibres were cross-transferred between the participants' garments, with noticeable differences between the different scenarios. These values were significantly larger than those published in previous studies and, therefore, suggested the possibility of a current underestimation of the number of fibres transferred in physical assaults. Furthermore, statistical analysis by ANOVA indicated that the all the variables tested (i.e., intensity level, duration time, and participants role) had a significant effect on the number of transferred fibres (p < 0.001) and, consequently, that some knowledge of the case circumstances may be important to make more educated estimations. This is the first time that such a methodology has been applied for the quantitative assessment of fibre transfer between participants in assault activities. Data are expected to help practitioners with the interpretation of findings in real casework and lead to a more robust evidential assessment. [ABSTRACT FROM AUTHOR]

Improvement In Shared Decision-Making SDM-Q-9 survey scores with concentric digital consent compared to paper-based consent. P149. [Extracted from the article]

Summary: The Anatomische Gesellschaft (anatomical society, AG) was founded in Germany in 1886 as an international society and remains the main organizing body of German anatomists to this day. A previous study of the history of the AG during National Socialism (NS) was based on the published proceedings of the AG and drew the preliminary conclusion that the “AG did not follow the path of preemptive obedience toward the new rulers” in contrast to some other professional societies. However, it was noted that archival sources were needed to support this conclusion and to illustrate the decision process within the society. Such sources are now available in the estate papers of Alfred Benninghoff, a leading anatomist at the time. His correspondence supports the previous finding that the AG was able to maintain its international character, thereby enabling it to avoid the active exclusion of “non-Aryan” members. The papers also confirm that the AG did not defend its vulnerable members as valiantly as the official narrative suggests, a fact illustrated in a controversy surrounding Martin Heidenhain. The interactions and conflicts between the leaders of the AG can now be reconstructed, i.e. between the secretary of the AG Heinrich von Eggeling, Benninghoff and Hermann Stieve. The Benninghoff documents also refer to a meeting of a subsection of the AG in November 1942, at which a disturbing radicalization of some anatomists developed. Finally, the papers reflect the political realities for German professionals trying to re-establish their science in a country divided into four occupation zones. [ABSTRACT FROM AUTHOR]

Objective The aims of this quasi-experimental before-and-after study were to first determine whether the use of eye tracking technology combined with video debriefing techniques has the potential to improve the quality of feedback and enhance situation awareness (SA) in simulated settings and second to determine students' satisfaction towards simulated learning. Methods Nursing and paramedicine students from three universities participated in three 8-minute simulation scenarios of acutely deteriorating patients. Eye tracking glasses video recorded the scenarios and tracked right eye movement. On completion, participants were questioned using the Situation Awareness Global Assessment Technique, completed the Satisfaction with Simulation Experience Scale (SSES), and provided textual feedback and received video-based verbal feedback. Results Participants lacked awareness of presenting medical conditions and patient environments and had poor recall of patient vital signs. Significant improvements in SA scores were demonstrated between the first and third scenarios ( P  = 0.04). Participants reported greater insight into their performance and were satisfied with simulated learning. Conclusions Use of visual field review techniques appears to enhance the use of realistic simulated practice as a means of addressing significant performance deficits. Eye tracking and point of view recording techniques are feasible and with applicable debriefing techniques could enhance clinical and situated performance. [ABSTRACT FROM AUTHOR]

Abstract: We propose an intelligent sensor system based on a new sensing methodology, relying also on 3D map reconstruction techniques, for computing with high precision, in real-time and without human intervention the parameters needed for stream-flow computa- tion: water levels, morphology of the streams of all potentially flooded areas by each controlled stream. The collected data will be continuously transmitted, through a communication infrastructure, to software agents designed to compute the stream-flow and to quantify the spatial distribution of flood risk for each controlled watershed. The computed risks, together with other data coming from other sources (barometric sensors, camera operators of public organizations, emergency agencies, private citizens), will be analyzed by a diagnostic decision system implementing a risk-alert scheduling strategy. This system will be able to diagnose the health state of the controlled environment and to define specialized alarm levels for each potentially interested area that will be used to alert all citizens (ubiquity) locally present (alerting locality). [Copyright &y& Elsevier]

Abstract: Bibliometric studies at the micro level are increasingly requested by science managers and policy makers to support research decisions. Different measures and indices have been developed at this level of analysis. One type of indices, such as the h-index and g-index, describe the most productive core of the output of a researcher and inform about the number of papers in the core. Other indices, such as the a-index and m-index, depict the impact of the papers in the core. In this paper, we present a new index which relates two different dimensions in a researcher’s productive core: a quantitative one (number of papers) and a qualitative one (impact of papers). In such a way, we could obtain a more balanced and global view of the scientific production of researchers. This new index, called -index, is based on the geometric mean of h-index and the median number of citations received by papers in the h-core, i.e., the m-index, which allows us to combine the advantages of both kind of indices. [Copyright &y& Elsevier]

LCA studies on waste management have been promoted as they can help policy makers choose the best environmental options. However, the increasing globalization of raw materials and waste makes the optimization of waste management strategies and policies quite challenging. Therefore, new approaches are needed in order to identify the consequences of markets on the waste management systems. This paper concentrates on the quantification of greenhouse gas (GHG) emissions of recycling processes. The aim is to generate a comprehensive assessment of GHG emissions as a consequence of increasing the amount of material collected for recycling. Consequential life cycle assessment (CLCA) is an effective methodological framework for addressing GHG quantifications within market, but to properly perform and assess all of the market links between raw materials and waste, it is necessary to determine the cause-effect chains made up of physical flows. Thus, we propose integrating the methodologies of material flow analysis (MFA) and CLCA. We applied these methodologies to the paper and cardboard recycling system in Spain. The GHG results varied between −36 kg CO 2 eq. and −317 kg CO 2 eq. per ton of waste paper collected, depending on the quantity of waste paper exported and the source of marginal pulp considered. The cumulative energy demand (CED) was also calculated as complementary indicator. Similar trends as for GHG emissions were obtained. The future GHG quantifications should be based on the flows described by MFA analysis and should be quantified using CLCA because methodologies that accurately account for GHG are necessary for decision-making. [ABSTRACT FROM AUTHOR]

Numerous socio-legal factors make the process of surrogate decision-making for people living in dementia very complicated in Japan. In this discussion paper, we argue that the lack of early consultation between patients, surrogate decision-makers and healthcare providers and the overreliance of patients and their families on doctors to assume the decision-making role lead to healthcare practices that may not align with the patient's wishes. Further, we argue that lack of laws on surrogate decision-making, changing family structure and the liabilities associated with the care of people living with dementia contribute to the complexity of the decision-making process in Japan. Finally, given the rapidly changing social and healthcare norms in Japan, we call for greater involvement of nurses and care workers in the decision-making process to ensure patient-centric treatment and care are adopted. [ABSTRACT FROM AUTHOR]

The design of a high-volume printer for professional use is rather complex. The design of the paper path and the timing of sheets is frequently reengineered as the design of the printer components progresses. This paper presents an optimization model for the combined paper path and timing design problem. The paper path is an optimal physical dimensioning problem, while the timing is an open-loop optimal control problem. The coupled optimization problem is formulated as a simultaneous analysis and design (SAND) problem using a direct transcription of the optimal control problem. Benefits of the chosen formulation for industrial application are the ease of setting up the optimization model for arbitrary printer configurations, and the short computation times. Results of an industrial case are presented. [ABSTRACT FROM AUTHOR]

Evidence-based published data is the prime source used for clinical decision making, the issuance of guidelines and the drafting new policies. A number of different study designs are used to perform and publish research studies, corresponding to the research question being investigated. Over the decades, a hierarchical system of evidence has been established. This provides an indication of the level of evidence each study design contributes to the research community. Policies and clinical guidelines should naturally be based on the highest level of evidence data available. However, the highest level of evidence study designs may not always provide an adequate answer to a research question. Thus, when utilising published evidence-based data, one should first understand the clinical question that needs to be answered, and then critically appraise the published data accordingly. [ABSTRACT FROM AUTHOR]

Modern day societies and economies are becoming increasingly vulnerable to the continued erosion of the stocks and flows of essential ecosystem services. Thus, the management of complex socio-economic systems to effectively provide these essential services has become a global priority policy and academic research area. Understanding how underlying processes and functions contribute towards the provision of final ecosystem services can facilitate improved dissemination of credible, legitimate and salient information to decision-makers. This paper presents an ecosystem service value chain analysis framework that applies basic system dynamics modelling in the form of causal loop diagrams to facilitate an alternative analysis of ecosystem service value chains. A scoping application of the framework is applied to a case study for flood attenuation services in the Baviaanskloof catchment in South Africa. The framework enables the identification of forward linkages and ripple effects in individual value chains of final ecosystem services as well as the identification and assessment of challenges and opportunities within individual causal pathways. Ultimately, providing the potential to advance strategies for improving the efficiency and effectiveness of final ecosystem service provision. [ABSTRACT FROM AUTHOR]

Digital twins have emerged as novel technology in the wind energy sector that enables the design, monitoring and prediction of wind turbine performance. Despite growing attention on their potential, little is known about how digital twins are designed, by whom and how their design choices affect multiple aspects of decision making in the development of wind energy. Using a framework of co-production, this paper examines digital twins as boundary objects and the role of twinning as boundary work that involves an active process of design and affects multiple aspects of decision making in the development of wind energy. Our results demonstrate how the design of digital twins evolves throughout the twinning process, affected by regulation, choices of expert twinners on data and models, and what constitutes a matter of concern. We shed light on the role of these twinners in influencing which actors and their matters of concern are included and excluded during the twinning process. Our understanding of twinning as an active process of governance by design more clearly reveals how digital twins are not objective representations of reality, but a function of boundary work. We conclude that more transparency is needed over how digital twins are designed to enhance their role as technologies that foster a transition towards more sustainable energy systems and decision-making over wind energy technologies and their integration in landscapes. • There is limited understanding of how digital twins are designed • We focus on wind energy and 'twinning' as an act of governance • We unpack twinning as boundary work and digital twins as boundary objects • Twinning involves choices about data, models, concerns and regulation • Priorities and focus in twinning may steer wind energy transitions [ABSTRACT FROM AUTHOR]

Abstract: Recycling activities have demonstrated a remarkable increase over the last decade due to the economic and environmental dimensions of sustainability. In particular, capacity planning in production facilities has become a strategic issue of key importance affecting the profitability of the recycling industry. By integrating the simulation discipline and the feedback control theory into a dynamic consideration of recycling networks, this paper proposes a System Dynamics (SD) model for strategic capacity planning in the recycling industry. The decision-making process is based on a balanced tradeoff between profit and capacity utilization for a single producer with closed-loop recycling activities. The SD model captures physical stocks and flows apparent in real-world recycling networks and includes the feedback mechanisms which regulate these flows. When used as an “experimental tool”, the model tests alternative capacity planning policies and demonstrates policy suggestions for the forward and reverse channels, which maximize profitability over a strategic planning horizon. This experimentation is illustrated by using data from a paper producer with recycling activities, as a real-world test case. Extensive simulation runs, investigate the efficiency of a wide range capacity acquisition decisions, using total company profit as the measure of performance. Although such an analysis may differ from one recycling network to another, it has been kept as generic as possible to facilitate its applicability to a wide-spectrum of real-world local, regional or global networks. [Copyright &y& Elsevier]