Search

This chapter looks at the production of data visualizations (dataviz) in newsrooms and audiences’ everyday engagements with them.

Background:Advance directives are legal documents that include living wills and durable health care power of attorney documents. They are critical components of care for seriously ill patients which are designed to be implemented when a patient is terminally ill and incapacitated. We sought to evaluate potential reasons for why advance directives were not appropriately implemented, by reviewing the electronic health record (EHR) in patients with terminal cancer.Methods:A retrospective analysis of the EHR of 500 cancer patients from 1/1/2013 to 12/31/2016 was performed. Data points were manually collected and entered in a central database.Results:Of the 500 patients, 160 (32%) had an advance directive (AD). The most common clinical terminology used by physicians indicating a terminal diagnosis was progressive (36.6%) and palliative (31%). The most common clinical terminology indicating incapacity was altered mental status (25.6%), and not oriented (14%). 34 (6.8%) patients met all criteria of having a terminal diagnosis, a documented AD, and were deemed incapacitated. Of these patients who met all of these data points, their ADs were implemented on average 1.7 days (SD: 4.4 days) after which they should have been. This resulted in a total of 58 days of additional care provided.Discussion:This study provided insight on to how ADs are managed in day to day practice in the hospital. From our analysis it appears that physicians are able to identify when a patient is terminal, however, it is typically later than it should have been recognized. Further studies should be performed focusing on harnessing the power of the EHR and providing physicians formative and evaluative feedback of practice patterns to ensure that ADs are honored when appropriate.

I review ethical and legal challenges for end of life (EOL) care in dementia. Is access to hospice care for dementia patients impacted by Medicare’s terminal prognosis requirement? Are dementia-specific advance directives warranted? How does state legislation affect dementia patients’ EOL options? Should dementia patients’ be able to refuse orally ingested food and fluids by advance directive? The difficulty of predicting time to death in dementia inhibits access to Medicare hospice benefits. Efforts have been made to create dementia-specific advance directives. Advance refusal of artificial nutrition and hydration are common, but the issue of oral ingestion of food and fluids by dementia patients remains controversial. Medicare’s hospice benefit should be made more accessible to dementia patients. State advance directive threshold definitions should be broadened to include dementia, and capacitated persons who refuse in advance orally ingested food and fluids should have their choices honored.

This research was supported by the National Science Foundation EPSCoR Grant No.IIA-1301765.

Civil society organisations increasingly mediate the creation and exchange of evidence in their activities with policy-makers and practitioners. This article extends knowledge on evidence in policy-making settings to civil society contexts. As an exploratory and qualitative study, it shows how nine UK-based organisations working on issues including migration and social welfare hold different perceptions of evidence and its usefulness. A range of related factors involving individuals, organisations, sectors, and issue areas emerge as contingent contributors to these variations. The results suggest that researchers and practitioners seeking to engage with civil society using evidence should consider context-specific values, skills, motivations, and timeliness.

This chapter addresses how research and public debate about migration interact with and inform each other, focusing on public perceptions and media coverage as important aspects. Factors including generalized public innumeracy about migration levels, effects of emotions on perceptions, and variation in the perceived credibility of different messengers make communicating information— of which research evidence is an important type—a complex process with multiple points of potential resistance. Meanwhile, the demands and expectations of public users and policy-makers can influence how research happens and the types of questions that are seen to be more meaningful. These interrelationships exist within wider social, political, and economic contexts that, in certain circumstances, are likely to favour some outcomes over others. In total, the chapter argues that the pathway from generating research evidence to impacting public debates is not only uncertain, it is also more complex than is often presumed. Research on migration often aims to influence not only relatively specialized research communities, but also broader society including political institutions, policy processes, and media and public debates. Whether motivated by the intrinsic value of relating their work to the wider world, or prodded by shifting financial and professional incentives, academic researchers increasingly find themselves being asked to demonstrate how their work has impact beyond universities—especially when that research is publicly funded. Yet, defining and generating that impact is often elusive. Public debate and major policy decisions often seem to fly in the face of the evidence base accumulated by researchers in the academy, civil society, and even in government agencies themselves. Despite escalating pressure to produce impactful research, evidence-based public debate seems as far off as ever—particularly on the issue of immigration, where public discussion is often polarized, emotive, and based on perceptions rather than reality (Duffy 2014). In this chapter, we explore the relationships between research and public debate, two aspects of the tripartite model proposed in the Introduction to this volume. We argue that the idea of ‘research impact’ is often based on a naive model of one-way effects that does not reflect the multifaceted relationships between research and elements of public debate. The pathway from research evidence to public debate is not only uncertain, it is also inevitably bidirectional: media and public discussions affect research as well as being affected by it. As academics aim to have impact on public debate, they should acknowledge even further how their research—comprising the questions they ask, the methods they employ, and the modes and venues in which they present their (p.51) findings—relates to the contours of public debate. Therefore, despite growing expectations that research can and should influence public debate, the implicit model of impact underlying such expectations is misleading and simplistic.

The goal of this paper is to present a methodology for professional evaluation, comparison and selection of alternatives in conservation planning and related areas. Our decision methodology is based on soft computing and consistent with observable properties of human reasoning. Main topics that we cover include the presentation of the LSP (Logic Scoring of Preference) decision method, the analysis of benefits that soft computing graded logic provides in comparison to traditional oversimplified additive weighted scoring models, and a detailed presentation of the Upper Neuse Clean Water Initiative in North Carolina, which is a real-life decision project in landscape planning and strategic conservation, based on our proposed methodology. In addition, we also present results of using decision support software tools that are necessary for the development and use of decision criteria. Our methodology and results are applicable in a wide variety of areas, including ecology, open space management, urban planning, geographic information systems, and decision making in agriculture. Keywords LSP method Strategic conservation Suitability analysis Multi-criteria decision making Graded logic Simple additive scoring Landscape planning Water quality protection GIS

A consensus exists among academics that cost-effective land preservation should involve both benefits and costs. In reality, the vast majority of programs do a poor job at being cost-effective. Few studies have examined why conservation professionals have failed to adopt cost-effective approaches. This study reports on a survey conducted with conservation professionals associated with the Maryland Agricultural Land Preservation Foundation, a leading program in the United States where county program administrators have experience with both traditional benefit targeting approaches and optimization approaches. Results show that conservation professionals place lower importance on cost-effectiveness than transparency and fairness, which are the most critical elements. Administrators also report a lack of incentives as a major obstacle for them to adopt cost-effective selection processes, but are more likely to adopt cost-effective conservation techniques if training and software is provided. These findings provide economists with valuable insights when designing cost-effective mechanisms that could be adopted and used in the future.

e24011 Background: Advanced care planning and living wills are critical components of caring for patients at the end of their lives. Advance directives are designed to be implemented when a patient meets the legal definition of terminal and is deemed incapacitated. By reviewing the electronic health record (EHR) in patients with terminal cancer, we sought to evaluate whether advance directives were appropriately implemented. Methods: A retrospective analysis of the EHR of 500 cancer patients from 1/1/2013 to 12/31/2016 was performed. Data points were manually collected and entered in a central database, and data analysis was completed using SAS. Results: Of the 500 patients, 160 (32%) had an advance directive (AD). The most common clinical terminology used by physicians indicating a terminal diagnosis was “progressive” (36.6%) and “palliative” (31%). The most common clinical terminology indicating incapacity was “altered mental status” (25.6%), and “not oriented” (14%). 34 patients (6.8%) met all criteria of having a terminal diagnosis, a documented AD, and deemed incapacitated. Of these patients who met all of these data points, their ADs were implemented on average 1.7 days (SD: 4.4 days) after which they should have been. This resulted in a total of 58 days of additional care provided to these patients. Conclusions: End-of-life care is a challenging albeit vital part of the practice of medicine. This study provided insight on to how ADs are managed in day to day practice in a hospital. From our analysis, it is clear that physicians are able to identify when a patient is terminal; however, it is typically later than it should have been recognized (and thereby, leading to delays in the implementation of the patient’s AD). Further studies should be performed focusing on harnessing the power of the EHR and providing physicians formative and evaluative feedback of practice patterns to ensure that ADs are honored when appropriate.

As data become increasingly ubiquitous, so too do data visualisations, which are the main means through which non-experts get access to data. Most visualizations circulate and are shared online, and many of them are produced by Internet researchers. For these reasons, data visualization is an important object of study for Internet research. This paper proposes that Internet research should engage critically with data visualization, and it does so by focusing on how people engage with them. Drawing on qualitative, empirical research with users, in this paper we identify six factors that affect engagement, which we define as socio-cultural: subject matter; source/media location; beliefs and opinions; time; emotions; and confidence and skills. We argue that our findings have implications for how effectiveness is defined in relation to data visualizations: such definitions vary depending on how, by whom, where and for what purpose visualizations are encountered. Our research also suggests that research into visualization engagement can benefit from adopting qualitative approaches developed within media audience research.

This research note reflects on the gaps and limitations confronting the development of ethical principles regarding the accessibility of large-scale data for civil society organisations (CSOs). Drawing upon a systematic scoping study on the use of data in UK civil society, it finds that there are twin needs to conceptualise accessibility as more than mere availability of data, as well as examine the use of data among CSOs more generally. In order to deal with the apparent ‘digital divide’ in UK civil society—where, despite extensive government rhetoric about data openness, organisations face not only the barriers of limited time, funds, and expertise to harness data but also the lack of representation within existing data—we present a working model in which ethical risks accompanying data utilisation by civil society may be better accounted. This suggests there is a need for further research into the nexus of civil society and data upon which interdisciplinary discussion about the ethical dimensions of engagement with data, particularly informed by insight from the social sciences, can be predicated.

Critical researchers in anthropology, politics, and history have profited from the spatial turn, or the idea that spaces produced through practices and perceptions influence observable social action, in showing how people at borders derive specific economic and social benefits from their unique location. This is especially relevant in African border contexts where state presence is often modified or resisted by local agendas. However, less work examines how cross-border activities, locally-held perceptions, and geographic location interact to generate different versions of what it means to “be at” a border for border-crossers and residents themselves. This paper, in responding to calls for interdisciplinary and multiperspectival approaches to border studies, argues that theorizing border towns as dynamic “places” clarifies how individuals impact and construct different meanings at and across borders. It empirically develops this idea by examining two spheres of everyday activity occurring at the Kenya-Uganda border: cross-border trade and health service provision.

This paper argues that visualisation conventions work to make the data represented within visualisations seem objective, that is, transparent and factual. Interrogating the work that visualisation conventions do helps us to make sense of the apparent contradiction between criticisms of visualisations as doing persuasive work and visualisation designers’ belief that through visualisation, it is possible to ‘do good with data’ [Periscopic. 2014. Home page. Retrieved from http://www.periscopic.com/]. We focus on four conventions which imbue visualisations with a sense of objectivity, transparency and facticity. These include: (a) two-dimensional viewpoints; (b) clean layouts; (c) geometric shapes and lines; (d) the inclusion of data sources. We argue that thinking about visualisations from a social semiotic standpoint, as we do in this paper by bringing together what visualisation designers say about their intentions with a semiotic analysis of the visualisations they produce, advances understanding of the ways that data visualisations come into being, how they are imbued with particular qualities and how power operates in and through them. Thus, this paper contributes nuanced understanding of data visualisations and their production, by uncovering the ways in which power is at work within them. In turn, it advances debate about data in society and the emerging field of data studies.

Over the past decade, green infrastructure has evolved from a novel buzzword into a recognized planning practice. Definitions of green infrastructure inevitably have been tailored to appeal to dive...

In 2007, the American Society of Human Genetics issued recommendations for what the new and largely self-regulating industry offering genetic tests directly to consumers should disclose to potential customers. Websites for every DTC company offering health-related genetic tests as identified by a public policy group were evaluated for compliance with those transparency recommendations. The results showed that only six of the 25 companies studied met even 70% of the standards and that overall, the industry complied with the disclosure standards just 44% of the time. Further, the study revealed that even when companies met the letter of the law, they often failed to disclose to consumers the shortcomings associated with the tests and thus promoted genetic determinism. By failing to meet the spirit of the ASHG transparency recommendations, the DTC genetic testing industry demonstrates disdain toward the ethical principle of informed consent.

Using agricultural preservation priorities derived from an analytical hierarchy process by 23 conservation experts from 18 agencies in the state of Delaware, this research uses weighted benefit measures to evaluate the historical success of Delaware's agricultural protection fund, which spent nearly $100 million in its first decade. This research demonstrates how these operation research techniques can be used in concert to address relevant conservation questions. Results suggest that the state's sealed-bid-offer auction, which determines the yearly conservation selections, is superior to benefit-targeting approaches frequently employed by conservation organizations, but is inferior to the optimization technique of binary linear programming that could have provided additional benefits to the state, such as 12,000 additional acres worth an estimated $25 million. Key Words: conservation optimization, farmland protection, analytic hierarchy process, binary linear programming (ProQuest: ... denotes formulae omitted.) In the United States, conservation groups spend an estimated $3.2 billion annually (Lerner, Mackey, and Casey 2007). While operations research techniques are frequently used in a wide variety of areas, yielding substantial success, such techniques have rarely been applied to on-theground conservation efforts despite the promise of providing more conservation benefits for the same budget constraint (Prendergast, Quinn, and Lawton 1999, Rodrigues and Gaston 2002, Azzaino, Conrad, and Ferraro 2002, Messer 2006). A partial explanation for this lack of adoption is that many of the initial analyses in operations research have focused on problem setups-such as covering problems that identify the minimum number of preserves necessary to protect a set number of endangered species or the maximum number of species that could be protected with a set of protected areas (e.g., Ando et al. 1998, Balmford et al. 2001, Polasky, Camm, and Garber- Yonts 2001, Moore et al. 2004, Strange et al. 2006, Cabeza and Moilanen 2001, ReVelle, Williams, and Boland 2002)-that have little relationship to the actual priorities and problems faced by conservation organizations. Secondly, conservation objectives and goals tend to be difficult to characterize, identify, and measure, and lack a common metric for success, such as profit in business applications. Furthermore, other obstacles exist for the use of these techniques for conservation, including how to identify the true decision-space for the conservation group, which must first locate willing sellers, develop the meaning of the measures of conservation benefit, assess the relative importance of one environmental characteristic over another, and provide reliable, arm's-length estimates of the costs involved (Strager and Rosenberger 2006). In this research, we show the benefits of applying operations research techniques in a setting where these latter obstacles have already been essentially overcome given the existing program priorities of the Delaware Agricultural Lands Preservation Foundation (DALPF) and its historical data of willing sellers' offers, parcels' market appraisals, GIS information on parcels' agricultural and ecological value, and a gathering of conservation experts to help determine the relative value of different agricultural and ecological measures. The most common approach in the economics literature for evaluating the benefits of agricultural land preservation is willingness-to-pay (WTP) surveys of the public (e.g., Bergstrom, Dillman, and Stoll 1985, Halstead 1984, Kline and Wichelns, 1996, 1998, Duke and Ilvento 2004, Ozdemir et al. 2004, Johnston and Duke 2009, Duke and Johnston 2010).1 However, other studies have explicitly examined the public's preferences for different attribute trade-offs inevitably involved in conservation settings by employing the technique of analytic hierarchy process (AHP) (e.g., Duke and Aull-Hyde 2002, Strager and Rosenberger 2006). …

Federal, state, and local governments construct thousands of kilometers of roads each year in the U.S.A., as well as undertaking widening, rerouting or repair projects. Under the National Environmental Policy Act (NEPA), environmental impacts from such construction must be offset by mitigation measures (e.g., stream or wetland restoration). Unfortunately, restoration projects often are opportunistic, do not consider a broad landscape context, and have a low benefit–cost ratio. In 2007, the Maryland State Highway Administration asked The Conservation Fund, the Maryland Department of Natural Resources, and the U.S. Fish and Wildlife Service to help identify and evaluate natural resource stewardship opportunities in four Maryland watersheds that could potentially be affected by construction of a highway bypass. Stewardship activities, including conservation, restoration, or management of natural resources, would go above and beyond required mitigation. After soliciting feedback from stakeholders and reviewing pertinent literature, we modeled and validated a conservation network of high-quality wildlife and plant habitat (core areas), large contiguous natural areas (hubs), and linkages to facilitate wildlife movement and gene flow (corridors). We then ranked elements of this network at multiple scales, and identified high priority areas for conservation and restoration. Finally, we developed and tested protocols for field assessment and benefit–cost optimization. We hope that this approach can be adapted and improved by highway agencies and other entities for environmental planning and protection, and have a report available upon request with full details.

Careful investigation of the form of animal signals can offer novel insights into their function. Here, we deconstruct the face patterns of a tribe of primates, the guenons (Cercopithecini), and examine the information that is potentially available in the perceptual dimensions of their multicomponent displays. Using standardized colour-calibrated images of guenon faces, we measure variation in appearance both within and between species. Overall face pattern was quantified using the computer vision ‘eigenface’ technique, and eyebrow and nose-spot focal traits were described using computational image segmentation and shape analysis. Discriminant function analyses established whether these perceptual dimensions could be used to reliably classify species identity, individual identity, age and sex, and, if so, identify the dimensions that carry this information. Across the 12 species studied, we found that both overall face pattern and focal trait differences could be used to categorize species and individuals reliably, whereas correct classification of age category and sex was not possible. This pattern makes sense, as guenons often form mixed-species groups in which familiar conspecifics develop complex differentiated social relationships but where the presence of heterospecifics creates hybridization risk. Our approach should be broadly applicable to the investigation of visual signal function across the animal kingdom.

This study examined facilitators and barriers to effective patient and caregiver communication with providers with emphasis on communication related to cancer pain management. Focus groups and personal interviews were conducted with cancer patients and family caregivers of patients. Communication experiences of subjects as well as suggestions for ways to improve the communication process were elicited. Twenty-two cancer patients and 16 family caregivers participated in the study. Seven themes emerged suggesting improvements that are needed in the communication process. These include: 1) improving the process of information exchange, 2) increasing active participation of patient and caregiver in the care process, 3) improving provider relationship-building skills, 4) overcoming time barriers, 5) addressing fears regarding use of pain management medications, 6) fostering appropriate involvement of family and caregivers in the communication process, and 7) improving coordination of care among providers. Specific suggestions and their practice implications for health care providers are highlighted.

Primate trichromatic colour vision has been hypothesized to be well tuned for detecting variation in facial coloration, which could be due to selection on either signal wavelengths or the sensitivities of the photoreceptors themselves. We provide one of the first empirical tests of this idea by asking whether, when compared with other visual systems, the information obtained through primate trichromatic vision confers an improved ability to detect the changes in facial colour that female macaque monkeys exhibit when they are proceptive. We presented pairs of digital images of faces of the same monkey to human observers and asked them to select the proceptive face. We tested images that simulated what would be seen by common catarrhine trichromatic vision, two additional trichromatic conditions and three dichromatic conditions. Performance under conditions of common catarrhine trichromacy, and trichromacy with narrowly separated LM cone pigments (common in female platyrrhines), was better than for evenly spaced trichromacy or for any of the dichromatic conditions. These results suggest that primate trichromatic colour vision confers excellent ability to detect meaningful variation in primate face colour. This is consistent with the hypothesis that social information detection has acted on either primate signal spectral reflectance or photoreceptor spectral tuning, or both.

The Port Allen grain terminal on the west bank of the Mississippi was designed and constructed to operate at varying water levels and in changing river currents. Each year, the level of the Mississippi River fluctuates approximately 45 feet (nearly 14 meters) and wind speeds can reach 110 mph (177 kmh). This paper discusses the design, detailing, and construction of three fender systems that will enable the facility to continue to operate in this challenging environment. Each fender system designed for the terminal has a specific purpose. The first serves fully loaded barge berthing operations. This system uses timber beams spanning to driven-steel fender piles. This system absorbs the berthing energy of the tugboat-delivered barge. The second consists of barge slipway fenders located along opposing faces of the two support platforms. This system uses timber beams spanning to wide flange vertical strong backs supported by structural plumb piles and the support platforms. This system guides the barge through the unloading process. The third system provides berthing energy and mooring force resistance for the export vessel. This system is constructed of ultra-high molecular weight material fastened to a steel plate spanning to a pair of fender piles. Traditionally, when platforms are constructed or fender systems are assembled in this region, projects use barge-mounted cranes, man lifts, and in-water divers. Because all of three of these fender systems use panelized design and detailing techniques, the contractor can assemble their components on land or on a barge and attach them to the concrete support platform in large sections. This method all but eliminates inwater work by divers and minimizes the time required to erect the nearly 1,200 linear feet (365.7 linear meters) of the fender systems. All in all, this is an innovative way to deliver a constructible, cost-effective solution.

The statutory language of the Americans with Disabilities Act (ADA) affords antidiscrimination protection to persons who have a physical or mental impairment that substantially limits one or more of the major life activities. The ADA comprises two major aspects: (1) whether one has a disability that qualifies for protection, and (2) if one does have a protected disability, whether the accommodations requested by the person with a disability are reasonable or unreasonable. Historically, many students who have challenged an institution's denial of accommodations in a court of law have been unsuccessful because they have been determined not to qualify as legally disabled. However, recent amendments to the ADA will affect how accommodation issues are handled by courts and, therefore, how medical colleges and other institutions make strategic decisions involving persons requesting special accommodations for learning disabilities under the ADA.In this article, the authors examine how the amendments to the ADA will affect the cases of persons with learning impairments who request special accommodations in medical education. This article focuses primarily on the issue of what constitutes a protected disability rather than on the reasonableness of accommodations. To examine this issue, the authors consider the narrow interpretations of the ADA that led to Congress enacting the amendments. The authors then discuss how the amendments might have influenced Wong v Regents of the University of California (2004). Finally, they examine the implications of the amendments for medical education and consider how they may affect a current case.

OBJECTIVE: To describe a legal structure for the accommodation of pharmacists' rights of conscience in the dispensing of drugs for pharmaceutically assisted death. BACKGROUND: Pharmacists have indicated that there is disagreement in the profession regarding the appropriateness of a practice known as “pharmaceutically assisted death”, in which lethal medications are prescribed for terminally ill patients who want to end their lives. Pharmacists who object to pharmaceutically assisted death may be asserting a conscientious objection that threatens to create a conflict with their employers. In addition, pharmacists who support pharmaceutically assisted death, but whose employers forbid the dispensing of medications for this purpose, may face a similar conflict. Current laws and principles of professional ethics fail to adequately address the resolution of either of these conflicts. DISCUSSION: We propose a system within which the pharmacy profession could accommodate the right to conscientious objection without sacrificing the quality of patient care. At the heart of our proposal is the understanding that employers must respect an employee's right to beliefs that differ from those of the employer and, correspondingly, the understanding that employees must respect the employer's duty to provide products and services to those who seek them from the employer. CONCLUSIONS: Pharmacy associations can adopt policies for conscientious objection and have those policies become law through action of the state legislature or the state board of pharmacy. This approach could lead to the development of a clear policy and procedure for resolving the issue of conscientious objection within the pharmacy community, making it far less likely that institutions outside pharmacy would be required to develop a solution for pharmacy.