943 resultados para CONSENSUS STUDY
Resumo:
The purpose of this study is to identify the determinants of local officials' preferences of performance measures under the assumption that public officials' consensus on performance measures can enhance the accountability in public service delivery. This research consists of two steps: multiple case studies and a survey. The author conducted the case studies in five general-purpose municipalities in Florida, interviewing 25 local officials, attending community meetings, and reviewing relevant local documents. Based on the case studies and the relevant literature, a survey was developed and sent to 445 local officials in 67 general-purpose municipalities in Dade, Broward, and Palm Beach Counties, Florida. The findings of the case studies and the survey suggest that local officials' preferences of performance measures are influenced by their perception of utilities of performance measures and their desire to measure the achievement of organizational goals. The author concludes that a consensus among local officials for outcome-oriented performance measures is easier to achieve if a prospective performance measurement system is designed for reporting and management purposes rather than for budgeting purposes. ^
Resumo:
This dissertation examines the sociological process of conflict resolution and consensus building in South Florida Everglades Ecosystem Restoration through what I define as a Network Management Coordinative Interstitial Group (NetMIG). The process of conflict resolution can be summarized as the participation of interested and affected parties (stakeholders) in a forum of negotiation. I study the case of the Governor's Commission for a Sustainable South Florida (GCSSF) that was established to reduce social conflict. Such conflict originated from environmental disputes about the Everglades and was manifested in the form of gridlock among regulatory (government) agencies, Indian tribes, as well as agricultural, environmental conservationist and urban development interests. The purpose of the participatory forum is to reduce conflicts of interest and to achieve consensus, with the ultimate goal of restoration of the original Everglades ecosystem, while cultivating the economic and cultural bases of the communities in the area. Further, the forum aim to formulate consensus through envisioning a common sustainable community by providing means to achieve a balance between human and natural systems. ^ Data were gathered using participant observation and document analysis techniques to conduct a theoretically based analysis of the role of the Network Management Coordinative Interstitial Group (NetMIG). I use conflict resolution theory, environmental conflict theory, stakeholder analysis, systems theory, differentiation and social change theory, and strategic management and planning theory. ^ The purpose of this study is to substantiate the role of the Governor's Commission for a Sustainable South Florida (GCSSF) as a consortium of organizations in an effort to resolve conflict rather than an ethnographic study of this organization. Environmental restoration of the Everglades is a vehicle for recognizing the significance of a Network Management Coordinative Interstitial Group (NetMIG), namely the Governor's Commission for a Sustainable South Florida (GCSSF), as a structural mechanism for stakeholder participation in the process of social conflict resolution through the creation of new cultural paradigms for a sustainable community. ^
Resumo:
BACKGROUND: Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization. OBJECTIVES: To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral. SETTING: Focus groups with PCPs practicing in small, medium, and large cities in Wisconsin. METHODS: PCPs were asked to discuss prioritization of treatment for a severely obese patient with multiple co-morbidities and considerations regarding bariatric surgery referral. Focus group sessions were analyzed by using a directed approach to content analysis. A taxonomy of consensus codes was developed. Code summaries were created and representative quotes identified. RESULTS: Sixteen PCPs participated in 3 focus groups. Four treatment prioritization approaches were identified: (1) treat the disease that is easiest to address; (2) treat the disease that is perceived as the most dangerous; (3) let the patient set the agenda; and (4) address obesity first because it is the common denominator underlying other co-morbid conditions. Only the latter approach placed emphasis on obesity treatment. Five factors made PCPs hesitate to refer patients for bariatric surgery: (1) wanting to "do no harm"; (2) questioning the long-term effectiveness of bariatric surgery; (3) limited knowledge about bariatric surgery; (4) not wanting to recommend bariatric surgery too early; and (5) not knowing if insurance would cover bariatric surgery. CONCLUSION: Decision making by PCPs for severely obese patients seems to underprioritize obesity treatment and overestimate bariatric surgery risks. This could be addressed with PCP education and improvements in communication between PCPs and bariatric surgeons.
Resumo:
Monitoring multiple myeloma patients for relapse requires sensitive methods to measure minimal residual disease and to establish a more precise prognosis. The present study aimed to standardize a real-time quantitative polymerase chain reaction (PCR) test for the IgH gene with a JH consensus self-quenched fluorescence reverse primer and a VDJH or DJH allele-specific sense primer (self-quenched PCR). This method was compared with allele-specific real-time quantitative PCR test for the IgH gene using a TaqMan probe and a JH consensus primer (TaqMan PCR). We studied nine multiple myeloma patients from the Spanish group treated with the MM2000 therapeutic protocol. Self-quenched PCR demonstrated sensitivity of >or=10(-4) or 16 genomes in most cases, efficiency was 1.71 to 2.14, and intra-assay and interassay reproducibilities were 1.18 and 0.75%, respectively. Sensitivity, efficiency, and residual disease detection were similar with both PCR methods. TaqMan PCR failed in one case because of a mutation in the JH primer binding site, and self-quenched PCR worked well in this case. In conclusion, self-quenched PCR is a sensitive and reproducible method for quantifying residual disease in multiple myeloma patients; it yields similar results to TaqMan PCR and may be more effective than the latter when somatic mutations are present in the JH intronic primer binding site.
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Objective There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings.
Design Two-round modified Delphi consensus method.
Setting Irish and UK general practice.
Participants A project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel.
Results 47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2).
Conclusions The PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases.
Resumo:
A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. - See more at: http://www.safefood.eu/Publications/Research-reports/The-cost-of-a-healthy-food-basket.aspx#sthash.RiBpj5no.dpuf A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. - See more at: http://www.safefood.eu/Publications/Research-reports/The-cost-of-a-healthy-food-basket.aspx#sthash.RiBpj5no.dpuf A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. - See more at: http://www.safefood.eu/Publications/Research-reports/The-cost-of-a-healthy-food-basket.aspx#sthash.RiBpj5no.dpuf
Resumo:
The adoption of bioregionalism by institutions that are instrumental in river basin management has significant potential to resolve complex water resource management problems. The Westcountry Rivers Trust (WRT) in England provides an example of how localized bioregional institutionalization of adaptive comanagement, consensus decision making, local participation, indigenous technical and social knowledge, and “win-win” outcomes can potentially lead to resilient partnership working. Our analysis of the WRT’s effectiveness in confronting nonpoint source water pollution, previously impervious to centralized agency responses, provides scope for lesson-drawing on institutional design, public engagement, and effective operation, although some evident issues remain.
Resumo:
Stakeholder participation is widely acknowledged as a critical component of post-disaster recovery because it helps create a shared understanding of local hazard risk and vulnerability, improves recovery and mitigation decision efficacy, and builds social capital and local resilience to future disasters. But approaches commonly used to facilitate participation and empower local communities depend on lengthy consensus-building processes which is not conducive to time-constrained post-disaster recovery. Moreover, these approaches are often criticized for being overly technocratic and ignoring existing community power and trust structures. Therefore, there is a need for more nuanced, analytical and applied research on stakeholder participation in planning for post-disaster recovery. This research examines participatory behavior of three stakeholder groups (government agencies, non-local non-government organizations, local community-based organizations) in three coastal village communities of Nagapattinam (India) that were recovering from the 2004 Indian Ocean tsunami. The study found eight different forms of participation and non-participation in the case study communities, ranging from 'transformative' participation to 'marginalized' non-participation. These forms of participation and non-participatory behavior emanated from the negotiation of four factors, namely stakeholder power, legitimacy, trust, and urgency for action. The study also found that the time constraints and changing conditions of recovery pose particular challenges for how these factors operated on the ground and over the course of recovery. Finally, the study uses these insights to suggest four strategies for recovery managers to use in the short- and long-term to facilitate more effective stakeholder participation in post-disaster recovery.
A Comparative Study on the Homeroom Teachers’ Perception of the School guidance in Korea and Finland
Resumo:
This study has four major purposes. First, it compares school guidance of homeroom teachers in Korea and Finland, in order to understand the reality of education, based on the teachers’ perceptions. Secondly, it also considers the topic within its historical, social, and cultural backgrounds, from a critical standpoint. Thirdly, it investigates the direction of the improvement of school guidance, based on the analysis of similarities and differences between Korea and Finland, with regards to the meaning, practice, and environmental factors of the school guidance. Lastly, the influential factors surrounding the school guidance are noted by analysing empirical data from a microscopic approach, and extending the understanding of it into a social context. As for the methods, it employs thematic analysis approach through 10 homeroom teacher interviews in the lower secondary schools. As a result, firstly, the teachers in both countries assumed similarly, that the role of the teacher was not only to teach the subject, but also to care about every aspects of the students’ development in their school life. In addition, they accepted the fact that school guidance became more significant. However, the school guidance became the top priority for the Korean teachers, while teaching subject is the main task for the Finnish teachers. Secondly, the homeroom teachers in both countries hoped to have a better working environment, to perform school guidance concerning education budget for the resources of school guidance, tight curriculum, and increasing the teachers’ tasks. Thirdly, the school guidance in Korea seemed to be influenced by social expectation and government demand, whereas, the Finnish teachers considered school guidance in more aspects of adjustment and academic motivation, rather than resolving the social problems. Fourthly, the Korean teachers perceived that the trust and respect from the society and home became weakened, also expressing doubts about the educational policies and the attitude of the government with regards to school guidance. On the other hand, the Finnish teachers believed that they were trusted and respected by the society. However, blurred lines in the roles and accountability between the homeroom teachers, home, and the society were also controversial among the teachers in both countries. To sum up, Finland needs to ameliorate the system and conditions for school guidance of the homeroom teachers. The consensus on the role and tasks of Finnish homeroom teachers for school guidance seem to be also necessary. Meanwhile, Korea should improve the social system and social consciousness of the teacher, school guidance, and schooling, preceding the reform of the education system or conditions.
Resumo:
The aim of this study was to establish guidelines for the optimization of biologic therapies for health professionals involved in the management of patients with RA, AS and PsA. Recommendations were established via consensus by a panel of experts in rheumatology and hospital pharmacy, based on analysis of available scientific evidence obtained from four systematic reviews and on the clinical experience of panellists. The Delphi method was used to evaluate these recommendations, both between panellists and among a wider group of rheumatologists. Previous concepts concerning better management of RA, AS and PsA were reviewed and, more specifically, guidelines for the optimization of biologic therapies used to treat these diseases were formulated. Recommendations were made with the aim of establishing a plan for when and how to taper biologic treatment in patients with these diseases. The recommendations established herein aim not only to provide advice on how to improve the risk:benefit ratio and efficiency of such treatments, but also to reduce variability in daily clinical practice in the use of biologic therapies for rheumatic diseases
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The background of this study is to assess the accuracy of lung ultrasound (LUS) to diagnose interstitial lung disease (ILD) in Sjögren’s syndrome (Sjs), in patients who have any alterations in pulmonary function tests (PFT) or respiratory symptoms. LUS was correlated with chest tomography (hrCT), considering it as the imaging gold standard technique to diagnose ILD. This is a pilot, multicenter, cross-sectional, and consecutive-case study. The inclusion criteria are ≥18 years old, Signs and symptoms: according to ACEG 2002 criteria, respiratory symptoms (dyspnea, cough), or any alterations in PFR. LUS was done following the International Consensus Conference on Lung Ultrasound protocol for interstitial syndrome (B pattern). Of the 50 patients in follow-up, 13 (26%) met the inclusion criteria. All were women with age 63.62 years (range 39–88). 78.6% of the cases had primary Sjs (SLE, RA, n = 2). The intra-rater reliability k is 1, according to Gwet’s Ac1 and GI index (probability to concordance—e(K)—, by Cohen, of 0.52). LUS has a sensitivity of 1 (95% CI 0.398–1.0), specificity of 0.89 (95% CI 0.518–0.997), and a positive probability reason of 9.00 (95% CI 7.1–11.3) to detect ILD. The correlation of Pearson is r = 0.84 (p < 0.001). To check the accuracy of LUS to diagnose ILD, a completely bilateral criterion of yes/no for interstitial pattern was chosen, AUC reaches significance, 0.94 (0.07) (95% CI 0.81–1.0, p = 0.014). LUS reaches an excellent correlation to hrCT in Sjs affected with ILD, and might be a useful technique in daily clinical practice for the assessment of pulmonary disease in the sicca syndrome. © 2016 SIMI
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In contrast to the definition of metabolic syndrome (MetS) in adults, there is no standard definition of MetS in pediatric populations. We aimed to assess the differences in the prevalence of MetS in children and adolescents aged 9–17 years in the city of Bogota (Colombia) using four different operational definitions for these age groups and to examine the associated variables. A total of 673 children and 1,247 adolescents attending public schools in Bogota (54.4% girls; age range 9–17.9 years) were included. The prevalence of MetS was determined by the definitions provided by the International Diabetes Federation (IDF) and three published studies by Cook et al., de Ferranti et al., and Ford et al. The prevalence of MetS was 0.3%, 6.3%, 7.8%, and 11.0% according to the IDF, Cook et al., Ford et al., and de Ferranti et al. definitions, respectively. The most prevalent components were low high-density lipoprotein cholesterol and high triglyceride levels, whereas the least prevalent components were abdominal obesity and hyperglycemia. Overall, the prevalence of MetS was higher in obese than in non-obese schoolchildren. In conclusion, MetS diagnoses in schoolchildren strongly depend on the definition chosen. These findings may be relevant to health promotion efforts for Colombian youth to develop prospective studies and to define which cut-offs are the best indicators of future morbidity.
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The International FItness Scale (IFIS) is a self-reported measure of physical fitness that could easily. This scale has been validated in children, adolescents, and young adults; however, it is unknown whether the IFIS represents a valid and reliable estimate of physical fitness in Latino-American youth population. In the present study we aimed to examine the validity and reliability of the IFIS on a population-based sample of schoolchildren in Bogota, Colombia. Participants were 1,875 Colombian youth (56.2% girls) aged 9 to 17.9 years old. We measured adiposity markers (body fat, waist-to-height ratio, skinfold thicknesses and BMI), blood pressure, lipids profile, fasting glucose, and physical fitness level (self reported and measured). Also, a validated cardiometabolic risk index was used. An age- and sex-matched sample of 229 Schoolchildren originally not included in the study sample fulfilled IFIS twice for reliability purposes. Our data suggest that both measured and self-reported overall fitness were associated inversely with adiposity indicators and a cardiometabolic risk score. Overall, schoolchildren who self-reported “good” and “very good” fitness had better measured fitness than those who reported “very poor” and “poor” fitness (all p<0.001). Test–retest reliability of IFIS items was also good, with an average weighted Kappa of 0.811. Therefore, our findings suggest that self-reported fitness, as assessed by IFIS, is a valid, reliable, and health-related measure, and it can be a good alternative for future use in large studies with Latin-schoolchildren from Colombia.
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Abstract Objective: Evidence shows an association between muscular strength (MS) and health among youth, however low muscular strength cut-points for the detection of high metabolic risk in Latin-American populations are scarce. The aim of this study was two-fold: to explore potential age- and sex-specific thresholds of MS, for optimal cardiometabolic risk categorization among Colombian children and adolescents; and to investigate if cardiometabolic risk differed by MS group by applying the receiver operating characteristic curve (ROC) cut point. Methods: This is a secondary analysis of a cross-sectional study (the FUPRECOL study), published elsewhere. The FUPRECOL study assessments were conducted during the 2014– 2015 school year. MS was estimated by a handle dynamometer on 1,950 children and adolescents from Colombia, using the MS relative to weight (handgrip strength/body mass). A metabolic risk score was computed from the following components: waist circumference, triglycerides, HDL-c, glucose, systolic and diastolic blood pressure. ROC analysis showed a significant discriminatory accuracy of MS in identifying the low/high metabolic risk in children and adolescents and both gender. Results: In children, handgrip strength/body mass level for a low metabolic risk were 0.359 and 0.376 in girls and boys, respectively. In adolescents, these points were 0.440 and 0.447 in girls and boys, respectively. Conclusion: In conclusion, the results suggest a hypothetical MS level relative to weight for having a low metabolic risk, which could be used to identify youths at risk.