Increasing Scientific Confidence in Adverse Outcome Pathways: Application of Tailored Bradford-Hill Considerations for Evaluating Weight of Evidence.

Systematic consideration of scientific support is a critical element in developing and, ultimately, using adverse outcome pathways (AOPs) for various regulatory applications. Though weight of evidence (WoE) analysis has been proposed as a basis for assessment of the maturity and level of confidence in an AOP, methodologies and tools are still being formalized. The Organization for Economic Co-operation and Development (OECD) Users' Handbook Supplement to the Guidance Document for Developing and Assessing AOPs (OECD 2014a; hereafter referred to as the OECD AOP Handbook) provides tailored Bradford-Hill (BH) considerations for systematic assessment of confidence in a given AOP. These considerations include (1) biological plausibility and (2) empirical support (dose-response, temporality, and incidence) for Key Event Relationships (KERs), and (3) essentiality of key events (KEs). Here, we test the application of these tailored BH considerations and the guidance outlined in the OECD AOP Handbook using a number of case examples to increase experience in more transparently documenting rationales for assigned levels of confidence to KEs and KERs, and to promote consistency in evaluation within and across AOPs. The major lessons learned from experience are documented, and taken together with the case examples, should contribute to better common understanding of the nature and form of documentation required to increase confidence in the application of AOPs for specific uses. Based on the tailored BH considerations and defining questions, a prototype quantitative model for assessing the WoE of an AOP using tools of multi-criteria decision analysis (MCDA) is described. The applicability of the approach is also demonstrated using the case example aromatase inhibition leading to reproductive dysfunction in fish. Following the acquisition of additional experience in the development and assessment of AOPs, further refinement of parameterization of the model through expert elicitation is recommended. Overall, the application of quantitative WoE approaches hold promise to enhance the rigor, transparency and reproducibility for AOP WoE determinations and may play an important role in delineating areas where research would have the greatest impact on improving the overall confidence in the AOP.

Mathematical models for the arrangement and the cleaning of the river basin and surroundings of the river sandy grounds to its passage by the city of Salta (Argentina)

The province of Salta is located the Northwest of Argentina in the border with Bolivia, Chile and Paraguay. Its Capital is the city of Salta that concentrates half of the inhabitants of the province and has grown to 600000 hab., from a small active Spanish town well founded in 1583. The city is crossed by the Arenales River descending from close mountains at North, source of water and end of sewers. But with actual growing it has become a focus of infection and of remarkable unhealthiness. It is necessary to undertake a plan for the recovery of the river, directed to the attainment of the well-being and to improve the life?s quality of the Community. The fundamental idea of the plan is to obtain an ordering of the river basin and an integral management of the channel and its surroundings, including the cleaning out. The improvement of the water?s quality, the healthiness of the surroundings and the improvement of the environment, must go hand by hand with the development of sport activities, of relaxation, tourism, establishment of breeding grounds, kitchen gardens, micro enterprises with clean production and other actions that contribute to their benefit by the society, that being a basic factor for their care and sustainable use. The present pollution is organic, chemical, industrial, domestic, due to the disposition of sweepings and sewer effluents that affects not only the flora and small fauna, destroying the biodiversity, but also to the health of people living in their margins. Within the plan it will be necessary to consider, besides hydric and environmental cleaning and the prevention of floods, the planning of the extraction of aggregates, the infrastructure and consolidation of margins works and the arrangement of all the river basin. It will be necessary to consider the public intervention at state, provincial and local level, and the private intervention. In the model it has been necessary to include the sub-model corresponding to the election of the entity to be the optimal instrument to reach the proposed objectives, giving an answer to the social, environmental and economic requirements. For that the authors have used multi-criteria decision methods to qualify and select alternatives, and for the programming of their implementation. In the model the authors have contemplated the short, average and long term actions. They conform a Paretooptimal alternative which secures the ordering, integral and suitable management of the basin of the Arenales River, focusing on its passage by the city of Salta.

Dominance Measuring Method Performance under Incomplete Information about Weights.

In multi-attribute utility theory, it is often not easy to elicit precise values for the scaling weights representing the relative importance of criteria. A very widespread approach is to gather incomplete information. A recent approach for dealing with such situations is to use information about each alternative?s intensity of dominance, known as dominance measuring methods. Different dominancemeasuring methods have been proposed, and simulation studies have been carried out to compare these methods with each other and with other approaches but only when ordinal information about weights is available. In this paper, we useMonte Carlo simulation techniques to analyse the performance of and adapt such methods to deal with weight intervals, weights fitting independent normal probability distributions orweights represented by fuzzy numbers.Moreover, dominance measuringmethod performance is also compared with a widely used methodology dealing with incomplete information on weights, the stochastic multicriteria acceptability analysis (SMAA). SMAA is based on exploring the weight space to describe the evaluations that would make each alternative the preferred one.

Drivers in adopting adaptation strategies to face increased water scarcity in agriculture. A case study in Do��ana (Spain) and Makueni (Kenya)

La agricultura es uno de los sectores m��s afectados por el cambio clim��tico. A pesar de haber demostrado a lo largo de la historia una gran capacidad para adaptarse a nuevas situaciones, hoy en d��a la agricultura se enfrenta a nuevos retos tales como satisfacer un elevado crecimiento en la demanda de alimentos, desarrollar una agricultura sostenible con el medio ambiente y reducir las emisiones de gases de efecto invernadero. El potencial de adaptaci��n debe ser definido en un contexto que incluya el comportamiento humano, ya que ��ste juega un papel decisivo en la implementaci��n final de las medidas. Por este motivo, y para desarrollar correctamente pol��ticas que busquen influir en el comportamiento de los agricultores para fomentar la adaptaci��n a estas nuevas condiciones, es necesario entender previamente los procesos de toma de decisiones a nivel individual o de explotaci��n, as�� como los efectos de los factores que determinan las barreras o motivaciones de la implementaci��n de medidas. Esta Tesis doctoral trata de profundizar en el an��lisis de factores que influyen en la toma de decisiones de los agricultores para adoptar estrategias de adaptaci��n al cambio clim��tico. Este trabajo revisa la literatura actual y desarrolla un marco metodol��gico a nivel local y regional. Dos casos de estudio a nivel local (Do��ana, Espa��a y Makueni, Kenia) han sido llevados a cabo con el fin de explorar el comportamiento de los agricultores hacia la adaptaci��n. Estos casos de estudio representan regiones con notables diferencias en climatolog��a, impactos del cambio clim��tico, barreras para la adaptaci��n y niveles de desarrollo e influencia de las instituciones p��blicas y privadas en la agricultura. Mientras el caso de estudio de Do��ana representa un ejemplo de problemas asociados al uso y escasez del agua donde se espera que se agraven en el futuro, el caso de estudio de Makueni ejemplifica una zona fuertemente amenazada por las predicciones de cambio clim��tico, donde adicionalmente la falta de infraestructura y la tecnolog��a juegan un papel crucial para la implementaci��n de la adaptaci��n. El caso de estudio a nivel regional trata de generalizar en ��frica el comportamiento de los agricultores sobre la implementaci��n de medidas. El marco metodol��gico que se ha seguido en este trabajo abarca una amplia gama de enfoques y m��todos para la recolecci��n y an��lisis de datos. Los m��todos utilizados para la toma de datos incluyen la implementaci��n de encuestas, entrevistas, talleres con grupos de inter��s, grupos focales de discusi��n, revisi��n de estudios previos y bases de datos p��blicas. Los m��todos anal��ticos incluyen m��todos estad��sticos, an��lisis multi���criterio para la toma de decisiones, modelos de optimizaci��n de uso del suelo y un ��ndice compuesto calculado a trav��s de indicadores. Los m��todos estad��sticos se han utilizado con el fin de evaluar la influencia de los factores socio���econ��micos y psicol��gicos sobre la adopci��n de medidas de adaptaci��n. Dentro de estos m��todos se incluyen regresiones log��sticas, an��lisis de componentes principales y modelos de ecuaciones estructurales. Mientras que el an��lisis multi���criterio se ha utilizado con el fin de evaluar las opciones de adaptaci��n de acuerdo a las opiniones de las diferentes partes interesadas, el modelo de optimizaci��n ha tenido como fin analizar la combinaci��n ��ptima de medidas de adaptaci��n. El ��ndice compuesto se ha utilizado para evaluar a nivel regional la implementaci��n de medidas de adaptaci��n en ��frica. En general, los resultados del estudio ponen de relieve la gran importancia de considerar diferentes escalas espaciales a la hora de evaluar la implementaci��n de medidas de adaptaci��n al cambio clim��tico. El comportamiento de los agricultores es diferente entre lugares considerados a una escala local relativamente peque��a, por lo que la generalizaci��n de los patrones del comportamiento a escalas regionales o globales resulta relativamente compleja. Los resultados obtenidos han permitido identificar factores determinantes tanto socioecon��micos como psicol��gicos y calcular su efecto sobre la adopci��n de medidas de adaptaci��n. Adem��s han proporcionado una mejor comprensi��n del distinto papel que desempe��an los cinco tipos de capital (natural, f��sico, financiero, social y humano) en la implementaci��n de estrategias de adaptaci��n. Con este trabajo se proporciona informaci��n de gran inter��s en los procesos de desarrollo de pol��ticas destinadas a mejorar el apoyo de la sociedad a tomar medidas contra el cambio clim��tico. Por ��ltimo, en el an��lisis a nivel regional se desarrolla un ��ndice compuesto que muestra la probabilidad de adoptar medidas de adaptaci��n en las regiones de ��frica y se analizan las causas que determinan dicha probabilidad de adopci��n de medidas. ABSTRACT Agriculture is and will continue to be one of the sectors most affected by climate change. Despite having demonstrated throughout history a great ability to adapt, agriculture today faces new challenges such as meeting growing food demands, developing sustainable agriculture and reducing greenhouse gas emissions. Adaptation policies planned on global, regional or local scales are ultimately implemented in decision���making processes at the farm or individual level so adaptation potentials have to be set within the context of individual behaviour and regional institutions. Policy instruments can play a formative role in the adoption of such policies by addressing incentives/disincentives that influence farmer���s behaviour. Hence understanding farm���level decision���making processes and the influence of determinants of adoption is crucial when designing policies aimed at fostering adoption. This thesis seeks to analyse the factors that influence decision���making by farmers in relation to the uptake of adaptation options. This work reviews the current knowledge and develops a methodological framework at local and regional level. Whilst the case studies at the local level are conducted with the purpose of exploring farmer���s behaviour towards adaptation the case study at the regional level attempts to up���scale and generalise theory on adoption of farmlevel adaptation options. The two case studies at the local level (Do��ana, Spain and Makueni, Kenya) encompass areas with different; climates, impacts of climate change, adaptation constraints and limits, levels of development, institutional support for agriculture and influence from public and private institutions. Whilst the Do��ana Case Study represents an area plagued with water���usage issues, set to be aggravated further by climate change, Makueni Case study exemplifies an area decidedly threatened by climate change where a lack of infrastructure and technology plays a crucial role in the uptake of adaptation options. The proposed framework is based on a wide range of approaches for collecting and analysing data. The approaches used for data collection include the implementation of surveys, interviews, stakeholder workshops, focus group discussions, a review of previous case studies, and public databases. The analytical methods include statistical approaches, multi criteria analysis for decision���making, land use optimisation models, and a composite index based on public databases. Statistical approaches are used to assess the influence of socio���economic and psychological factors on the adoption or support for adaptation measures. The statistical approaches used are logistic regressions, principal component analysis and structural equation modelling. Whilst a multi criteria analysis approach is used to evaluate adaptation options according to the different perspectives of stakeholders, the optimisation model analyses the optimal combination of adaptation options. The composite index is developed to assess adoption of adaptation measures in Africa. Overall, the results of the study highlight the importance of considering various scales when assessing adoption of adaptation measures to climate change. As farmer���s behaviour varies at a local scale there is elevated complexity when generalising behavioural patterns for farmers at regional or global scales. The results identify and estimate the effect of most relevant socioeconomic and psychological factors that influence adoption of adaptation measures to climate change. They also provide a better understanding of the role of the five types of capital (natural, physical, financial, social, and human) on the uptake of farm���level adaptation options. These assessments of determinants help to explain adoption of climate change measures and provide helpful information in order to design polices aimed at enhancing societal support for adaptation policies. Finally the analysis at the regional level develops a composite index which suggests the likelihood of the regions in Africa to adopt farm���level adaptation measures and analyses the main causes of this likelihood of adoption.

A novel motion tracking system for evaluation of functional rehabilitation of the upper limbs

Upper limb function impairment is one of the most common sequelae of central nervous system injury, especially in stroke patients and when spinal cord injury produces tetraplegia. Conventional assessment methods cannot provide objective evaluation of patient performance and the tiveness of therapies. The most common assessment tools are based on rating scales, which are inefficient when measuring small changes and can yield subjective bias. In this study, we designed an inertial sensor-based monitoring system composed of five sensors to measure and analyze the complex movements of the upper limbs, which are common in activities of daily living. We developed a kinematic model with nine degrees of freedom to analyze upper limb and head movements in three dimensions. This system was then validated using a commercial optoelectronic system. These findings suggest that an inertial sensor-based motion tracking system can be used in patients who have upper limb impairment through data integration with a virtual reality-based neuroretation system.

Building resilience to water scarcity in Southern Spain: A case study of rice farming in Do��ana protected wetlands

Agricultural water management needs to evolve in view of increased water scarcity, especially when farming and natural protected areas are closely linked. In the study site of Don?ana (southern Spain), water is shared by rice producers and a world heritage biodiversity ecosystem. Our aim is to contribute to defining adaptation strategies that may build resilience to increasing water scarcity and minimize water conflicts among agricultural and natural systems. The analytical framework links a participatory process with quantitative methods to prioritize the adaptation options. Bottom-up proposed adaptation measures are evaluated by a multi-criteria analysis (MCA) that includes both socioeconomic criteria and criteria of the ecosystem services affected by the adaptation options. Criteria weights are estimated by three different methods?analytic hierarchy process, Likert scale and equal weights?that are then compared. Finally, scores from an MCA are input into an optimization model used to determine the optimal land-use distribution in order to maximize utility and land-use diversification according to different scenarios of funds and water availability. While our results show a spectrum of perceptions of priorities among stakeholders, there is one overriding theme that is to define a way to restore part of the rice fields to natural wetlands. These results hold true under the current climate scenario and evenmore so under an increased water scarcity scenario.

Towards mitigation of greenhouse gases by small changes in farming practices: understanding local barriers in Spain.

Small changes in agricultural practices have a large potential for reducing greenhouse gas emissions. However, the implementation of such practices at the local level is often limited by a range of barriers. Understanding the barriers is essential for defining effective measures, the actual mitigation potential of the measures, and the policy needs to ensure implementation. Here we evaluate behavioural, cultural, and policy barriers for implementation of mitigation practices at the local level that imply small changes to farmers. The choice of potential mitigation practices relevant to the case study is based on a literature review of previous empirical studies. Two methods that include the stakeholders? involvement (experts and farmers) are undertaken for the prioritization of these potential practices: (a) Multi-criteria analysis (MCA) of the choices of an expert panel and (b) Analysis of barriers to implementation based on a survey of farmers. The MCA considers two future climate scenarios ? current climate and a drier and warmer climate scenario. Results suggest that all potential selected practices are suitable for mitigation considering multiple criteria in both scenarios. Nevertheless, if all the barriers for implementation had the same influence, the preferred mitigation practices in the case study would be changes in fertilization management and use of cover crops. The identification of barriers for the implementation of the practices is based on the econometric analysis of surveys given to farmers. Results show that farmers? environmental concerns, financial incentives and access to technical advice are the main factors that define their barriers to implementation. These results may contribute to develop effective mitigation policy to be included in the 2020 review of the European Union Common Agricultural Policy.

Exploring strategic farming choices to respond to mitigation and adaptation to climate change

Las alteraciones del sistema clim��tico debido al aumento de concentraciones de gases de efecto invernadero (GEI) en la atm��sfera, tendr��n implicaciones importantes para la agricultura, el medio ambiente y la sociedad. La agricultura es una fuente importante de emisiones de gases de efecto invernadero (globalmente contribuye al 12% del total de GEI), y al mismo tiempo puede ser parte de la soluci��n para mitigar las emisiones y adaptarse al cambio clim��tico. Las acciones frente al desaf��o del cambio clim��tico deben priorizar estrategias de adaptaci��n y mitigaci��n en la agricultura dentro de la agenda para el desarrollo de pol��ticas. La agricultura es por tanto crucial para la conservaci��n y el uso sostenible de los recursos naturales, que ya est��n sometidos a impactos del cambio clim��tico, al mismo tiempo que debe suministrar alimentos para una poblaci��n creciente. Por tanto, es necesaria una coordinaci��n entre las actuales estrategias de pol��tica clim��tica y agr��cola. El concepto de agricultura clim��ticamente inteligente ha surgido para integrar todos estos servicios de la producci��n agraria. Al evaluar opciones para reducir las amenazas del cambio clim��tico para la agricultura y el medio ambiente, surgen dos preguntas de investigaci��n: ��� ��Qu�� informaci��n es necesaria para definir pr��cticas agrarias inteligentes? ��� ��Qu�� factores influyen en la implementaci��n de las pr��cticas agrarias inteligentes? Esta Tesis trata de proporcionar informaci��n relevante sobre estas cuestiones generales con el fin de apoyar el desarrollo de la pol��tica clim��tica. Se centra en sistemas agr��colas Mediterr��neos. Esta Tesis integra diferentes m��todos y herramientas para evaluar las alternativas de gesti��n agr��cola y pol��ticas con potencial para responder a las necesidades de mitigaci��n y adaptaci��n al cambio clim��tico. La investigaci��n incluye enfoques cuantitativos y cualitativos e integra variables agron��micas, de clima y socioecon��micas a escala local y regional. La investigaci��n aporta una recopilaci��n de datos sobre evidencia experimental existente, y un estudio integrado sobre el comportamiento de los agricultores y las posibles alternativas de cambio (por ejemplo, la tecnolog��a, la gesti��n agr��cola y la pol��tica clim��tica). Los casos de estudio de esta Tesis - el humedal de Do��ana (S Espa��a) y la regi��n de Arag��n (NE Espa��a) - permiten ilustrar dos sistemas Mediterr��neos representativos, donde el uso intensivo de la agricultura y las condiciones semi��ridas son ya una preocupaci��n. Por este motivo, la adopci��n de estrategias de mitigaci��n y adaptaci��n puede desempe��ar un papel muy importante a la hora de encontrar un equilibrio entre la equidad, la seguridad econ��mica y el medio ambiente en los escenarios de cambio clim��tico. La metodolog��a multidisciplinar de esta tesis incluye una amplia gama de enfoques y m��todos para la recopilaci��n y el an��lisis de datos. La toma de datos se apoya en la revisi��n bibliogr��fica de evidencia experimental, bases de datos p��blicas nacionales e internacionales y datos primarios recopilados mediante entrevistas semi-estructuradas con los grupos de inter��s (administraciones p��blicas, responsables pol��ticos, asesores agr��colas, cient��ficos y agricultores) y encuestas con agricultores. Los m��todos de an��lisis incluyen: meta-an��lisis, modelos de gesti��n de recursos h��dricos (modelo WAAPA), an��lisis multicriterio para la toma de decisiones, m��todos estad��sticos (modelos de regresi��n log��stica y de Poisson) y herramientas para el desarrollo de pol��ticas basadas en la ciencia. El meta-an��lisis identifica los umbrales cr��ticos de temperatura que repercuten en el crecimiento y el desarrollo de los tres cultivos principales para la seguridad alimentaria (arroz, ma��z y trigo). El modelo WAAPA eval��a el efecto del cambio clim��tico en la gesti��n del agua para la agricultura de acuerdo a diferentes alternativas pol��ticas y escenarios clim��ticos. El an��lisis multicriterio eval��a la viabilidad de las pr��cticas agr��colas de mitigaci��n en dos escenarios clim��ticos de acuerdo a la percepci��n de diferentes expertos. Los m��todos estad��sticos analizan los determinantes y las barreras para la adopci��n de pr��cticas agr��colas de mitigaci��n. Las herramientas para el desarrollo de pol��ticas basadas en la ciencia muestran el potencial y el coste para reducir GEI mediante las pr��cticas agr��colas. En general, los resultados de esta Tesis proporcionan informaci��n sobre la adaptaci��n y la mitigaci��n del cambio clim��tico a nivel de explotaci��n para desarrollar una pol��tica clim��tica m��s integrada y ayudar a los agricultores en la toma de decisiones. Los resultados muestran las temperaturas umbral y la respuesta del arroz, el ma��z y el trigo a temperaturas extremas, siendo estos valores de gran utilidad para futuros estudios de impacto y adaptaci��n. Los resultados obtenidos tambi��n aportan una serie de estrategias flexibles para la adaptaci��n y la mitigaci��n a escala local, proporcionando a su vez una mejor comprensi��n sobre las barreras y los incentivos para su adopci��n. La capacidad de mejorar la disponibilidad de agua y el potencial y el coste de reducci��n de GEI se han estimado para estas estrategias en los casos de estudio. Estos resultados podr��an ayudar en el desarrollo de planes locales de adaptaci��n y pol��ticas regionales de mitigaci��n, especialmente en las regiones Mediterr��neas. ABSTRACT Alterations in the climatic system due to increased atmospheric concentrations of greenhouse gas emissions (GHG) are expected to have important implications for agriculture, the environment and society. Agriculture is an important source of GHG emissions (12 % of global anthropogenic GHG), but it is also part of the solution to mitigate emissions and to adapt to climate change. Responses to face the challenge of climate change should place agricultural adaptation and mitigation strategies at the heart of the climate change agenda. Agriculture is crucial for the conservation and sustainable use of natural resources, which already stand under pressure due to climate change impacts, increased population, pollution and fragmented and uncoordinated climate policy strategies. The concept of climate smart agriculture has emerged to encompass all these issues as a whole. When assessing choices aimed at reducing threats to agriculture and the environment under climate change, two research questions arise: ��� What information defines smart farming choices? ��� What drives the implementation of smart farming choices? This Thesis aims to provide information on these broad questions in order to support climate policy development focusing in some Mediterranean agricultural systems. This Thesis integrates methods and tools to evaluate potential farming and policy choices to respond to mitigation and adaptation to climate change. The assessment involves both quantitative and qualitative approaches and integrates agronomic, climate and socioeconomic variables at local and regional scale. The assessment includes the collection of data on previous experimental evidence, and the integration of farmer behaviour and policy choices (e.g., technology, agricultural management and climate policy). The case study areas -- the Do��ana coastal wetland (S Spain) and the Arag��n region (NE Spain) ��� illustrate two representative Mediterranean regions where the intensive use of agriculture and the semi-arid conditions are already a concern. Thus the adoption of mitigation and adaptation measures can play a significant role for reaching a balance among equity, economic security and the environment under climate change scenarios. The multidisciplinary methodology of this Thesis includes a wide range of approaches for collecting and analysing data. The data collection process include revision of existing experimental evidence, public databases and the contribution of primary data gathering by semi-structured interviews with relevant stakeholders (i.e., public administrations, policy makers, agricultural advisors, scientist and farmers among others) and surveys given to farmers. The analytical methods include meta-analysis, water availability models (WAAPA model), decision making analysis (MCA, multi-criteria analysis), statistical approaches (Logistic and Poisson regression models) and science-base policy tools (MACC, marginal abatement cost curves and SOC abatement wedges). The meta-analysis identifies the critical temperature thresholds which impact on the growth and development of three major crops (i.e., rice, maize and wheat). The WAAPA model assesses the effect of climate change for agricultural water management under different policy choices and climate scenarios. The multi-criteria analysis evaluates the feasibility of mitigation farming practices under two climate scenarios according to the expert views. The statistical approaches analyses the drivers and the barriers for the adoption of mitigation farming practices. The science-base policy tools illustrate the mitigation potential and cost effectiveness of the farming practices. Overall, the results of this Thesis provide information to adapt to, and mitigate of, climate change at farm level to support the development of a comprehensive climate policy and to assist farmers. The findings show the key temperature thresholds and response to extreme temperature effects for rice, maize and wheat, so such responses can be included into crop impact and adaptation models. A portfolio of flexible adaptation and mitigation choices at local scale are identified. The results also provide a better understanding of the stakeholders oppose or support to adopt the choices which could be used to incorporate in local adaptation plans and mitigation regional policy. The findings include estimations for the farming and policy choices on the capacity to improve water supply reliability, abatement potential and cost-effective in Mediterranean regions.

A multidisciplinary reference framework to support innovative design, implementation and assessment of chronic care models

Hoy en d��a, por primera vez en la historia, la mayor parte de la poblaci��n podr�� vivir hasta los sesenta a��os y m��s (United Nations, 2015). Sin embargo, todav��a existe poca evidencia que demuestre que las personas mayores, est��n viviendo con mejor salud que sus padres, a la misma edad, ya que la mayor��a de los problemas de salud en edades avanzadas est��n asociados a las enfermedades cr��nicas (WHO, 2015). Los sistemas sanitarios de los pa��ses desarrollados funcionan adecuadamente cuando se trata del cuidado de enfermedades agudas, pero no son lo suficientemente eficaces en la gesti��n de las enfermedades cr��nicas. Durante la ��ltima d��cada, se han realizado esfuerzos para mejorar esta gesti��n, por medio de la utilizaci��n de estrategias de prevenci��n y de reenfoque de la provisi��n de los servicios de atenci��n para la salud (Kane et al. 2005). Seg��n una revisi��n sistem��tica de modelos de cuidado de salud, comisionada por el sistema nacional de salud Brit��nico, pocos modelos han conceptualizado cu��les son los componentes que hay que utilizar para proporcionar un cuidado cr��nico efectivo, y estos componentes no han sido suficientemente estructurados y articulados. Por lo tanto, no hay suficiente evidencia sobre el impacto real de cualquier modelo existente en la actualidad (Ham, 2006). Las innovaciones podr��an ayudar a conseguir mejores diagn��sticos, tratamientos y gesti��n de pacientes cr��nicos, as�� como a dar soporte a los profesionales y a los pacientes en el cuidado. Sin embargo, la forma en las que estas innovaciones se proporcionan no es lo suficientemente eficiente, efectiva y amigable para el usuario. Para mejorar esto, hace falta crear equipos de trabajo y estrategias multidisciplinares. En conclusi��n, hacen falta actividades que permitan conseguir que las innovaciones sean utilizadas en los sistemas de salud que quieren mejorar la gesti��n del cuidado cr��nico, para que sea posible: 1) traducir la ���atenci��n sanitaria basada en la evidencia��� en ���conocimiento factible���; 2) hacer frente a la complejidad de la atenci��n sanitaria a trav��s de una investigaci��n multidisciplinaria; 3) identificar una aproximaci��n sistem��tica para que se establezcan intervenciones innovadoras en el cuidado de salud. El marco de referencia desarrollado en este trabajo de investigaci��n es un intento de aportar estas mejoras. Las siguientes hip��tesis han sido propuestas: Hip��tesis 1: es posible definir un proceso de traducci��n que convierta un modelo de cuidado cr��nico en una descripci��n estructurada de objetivos, requisitos e indicadores clave de rendimiento. Hip��tesis 2: el proceso de traducci��n, si se ejecuta a trav��s de elementos basados en la evidencia, multidisciplinares y de orientaci��n econ��mica, puede convertir un modelo de cuidado cr��nico en un marco descriptivo, que define el ciclo de vida de soluciones innovadoras para el cuidado de enfermedades cr��nicas. Hip��tesis 3: es posible definir un m��todo para evaluar procesos, resultados y capacidad de desarrollar habilidades, y asistir equipos multidisciplinares en la creaci��n de soluciones innovadoras para el cuidado cr��nico. Hip��tesis 4: es posible dar soporte al desarrollo de soluciones innovadoras para el cuidado cr��nico a trav��s de un marco de referencia y conseguir efectos positivos, medidos en indicadores clave de rendimiento. Para verificar las hip��tesis, se ha definido una aproximaci��n metodol��gica compuesta de cuatro Fases, cada una asociada a una hip��tesis. Antes de esto, se ha llevado a cabo una ���Fase 0���, donde se han analizado los antecedentes sobre el problema (i.e. adopci��n sistem��tica de la innovaci��n en el cuidado cr��nico) desde una perspectiva multi-dominio y multi-disciplinar. Durante la fase 1, se ha desarrollado un Proceso de Traducci��n del Conocimiento, elaborado a partir del JBI Joanna Briggs Institute (JBI) model of evidence-based healthcare (Pearson, 2005), y sobre el cual se han definido cuatro Bloques de Innovaci��n. Estos bloques consisten en una descripci��n de elementos innovadores, definidos en la fase 0, que han sido a��adidos a los cuatros elementos que componen el modelo JBI. El trabajo llevado a cabo en esta fase ha servido tambi��n para definir los materiales que el proceso de traducci��n tiene que ejecutar. La traducci��n que se ha llevado a cabo en la fase 2, y que traduce la mejor evidencia disponible de cuidado cr��nico en acci��n: resultado de este proceso de traducci��n es la parte descriptiva del marco de referencia, que consiste en una descripci��n de un modelo de cuidado cr��nico (se ha elegido el Chronic Care Model, Wagner, 1996) en t��rminos de objetivos, especificaciones e indicadores clave de rendimiento y organizada en tres ciclos de innovaci��n (dise��o, implementaci��n y evaluaci��n). Este resultado ha permitido verificar la segunda hip��tesis. Durante la fase 3, para demostrar la tercera hip��tesis, se ha desarrollado un m��todo-mixto de evaluaci��n de equipos multidisciplinares que trabajan en innovaciones para el cuidado cr��nico. Este m��todo se ha creado a partir del m��todo mixto usado para la evaluaci��n de equipo multidisciplinares translacionales (Wooden, 2013). El m��todo creado a��ade una dimensi��n procedural al marco. El resultado de esta fase consiste, por lo tanto, en una primera versi��n del marco de referencia, lista para ser experimentada. En la fase 4, se ha validado el marco a trav��s de un caso de estudio multinivel y con t��cnicas de observaci��n-participante como m��todo de recolecci��n de datos. Como caso de estudio se han elegido las actividades de investigaci��n que el grupo de investigaci��n LifeStech ha desarrollado desde el 2008 para mejorar la gesti��n de la diabetes, actividades realizadas en un contexto internacional. Los resultados demuestran que el marco ha permitido mejorar las actividades de trabajo en distintos niveles: 1) la calidad y cantidad de las publicaciones; 2) se han conseguido dos contratos de investigaci��n sobre diabetes: el primero es un proyecto de investigaci��n aplicada, el segundo es un proyecto financiado para acelerar las innovaciones en el mercado; 3) a trav��s de los indicadores claves de rendimiento propuestos en el marco, una prueba de concepto de un prototipo desarrollado en un proyecto de investigaci��n ha sido transformada en una evaluaci��n temprana de una intervenci��n eHealth para el manejo de la diabetes, que ha sido recientemente incluida en Repositorio de pr��cticas innovadoras del Partenariado de Innovaci��n Europeo en Envejecimiento saludable y activo. La verificaci��n de las 4 hip��tesis ha permitido demonstrar la hip��tesis principal de este trabajo de investigaci��n: es posible contribuir a crear un puente entre la atenci��n sanitaria y la innovaci��n y, por lo tanto, mejorar la manera en que el cuidado cr��nico sea procurado en los sistemas sanitarios. ABSTRACT Nowadays, for the first time in history, most people can expect to live into their sixties and beyond (United Nations, 2015). However, little evidence suggests that older people are experiencing better health than their parents, and most of the health problems of older age are linked to Chronic Diseases (WHO, 2015). The established health care systems in developed countries are well suited to the treatment of acute diseases but are mostly inadequate for dealing with CDs. Healthcare systems are challenging the burden of chronic diseases by putting more emphasis on the prevention of disease and by looking for new ways to reorient the provision of care (Kane et al., 2005). According to an evidence-based review commissioned by the British NHS Institute, few models have conceptualized effective components of care for CDs and these components have been not structured and articulated. ���Consequently, there is limited evidence about the real impact of any of the existing models��� (Ham, 2006). Innovations could support to achieve better diagnosis, treatment and management for patients across the continuum of care, by supporting health professionals and empowering patients to take responsibility. However, the way they are delivered is not sufficiently efficient, effective and consumer friendly. The improvement of innovation delivery, involves the creation of multidisciplinary research teams and taskforces, rather than just working teams. There are several actions to improve the adoption of innovations from healthcare systems that are tackling the epidemics of CDs: 1) Translate Evidence-Based Healthcare (EBH) into actionable knowledge; 2) Face the complexity of healthcare through multidisciplinary research; 3) Identify a systematic approach to support effective implementation of healthcare interventions through innovation. The framework proposed in this research work is an attempt to provide these improvements. The following hypotheses have been drafted: ������Hypothesis 1: it is possible to define a translation process to convert a model of chronic care into a structured description of goals, requirements and key performance indicators. ������Hypothesis 2: a translation process, if executed through evidence-based, multidisciplinary, holistic and business-oriented elements, can convert a model of chronic care in a descriptive framework, which defines the whole development cycle of innovative solutions for chronic disease management. ������Hypothesis 3: it is possible to design a method to evaluate processes, outcomes and skill acquisition capacities, and assist multidisciplinary research teams in the creation of innovative solutions for chronic disease management. ������Hypothesis 4: it is possible to assist the development of innovative solutions for chronic disease management through a reference framework and produce positive effects, measured through key performance indicators. In order to verify the hypotheses, a methodological approach, composed of four Phases that correspond to each one of the stated hypothesis, was defined. Prior to this, a ���Phase 0���, consisting in a multi-domain and multi-disciplinary background analysis of the problem (i.e.: systematic adoption of innovation to chronic care), was carried out. During phase 1, in order to verify the first hypothesis, a Knowledge Translation Process (KTP) was developed, starting from the JBI Joanna Briggs Institute (JBI) model of evidence-based healthcare was used (Pearson, 2005) and adding Four Innovation Blocks. These blocks represent an enriched description, added to the JBI model, to accelerate the transformation of evidence-healthcare through innovation; the innovation blocks are built on top of the conclusions drawn after Phase 0. The background analysis gave also indication on the materials and methods to be used for the execution of the KTP, carried out during phase 2, that translates the actual best available evidence for chronic care into action: this resulted in a descriptive Framework, which is a description of a model of chronic care (the Chronic Care Model was chosen, Wagner, 1996) in terms of goals, specified requirements and Key Performance Indicators, and articulated in the three development cycles of innovation (i.e. design, implementation and evaluation). Thanks to this result the second hypothesis was verified. During phase 3, in order to verify the third hypothesis, a mixed-method to evaluate multidisciplinary teams working on innovations for chronic care, was created, based on a mixed-method used for the evaluation of Multidisciplinary Translational Teams (Wooden, 2013). This method adds a procedural dimension to the descriptive component of the Framework, The result of this phase consisted in a draft version of the framework, ready to be tested in a real scenario. During phase 4, a single and multilevel case study, with participant-observation data collection, was carried out, in order to have a complete but at the same time multi-sectorial evaluation of the framework. The activities that the LifeStech research group carried out since 2008 to improve the management of diabetes have been selected as case study. The results achieved showed that the framework allowed to improve the research activities in different directions: the quality and quantity of the research publications that LifeStech has issued, have increased substantially; 2 project grants to improve the management of diabetes, have been assigned: the first is a grant funding applied research while the second is about accelerating innovations into the market; by using the assessment KPIs of the framework, the proof of concept validation of a prototype developed in a research project was transformed into an early stage assessment of innovative eHealth intervention for Diabetes Management, which has been recently included in the repository of innovative practice of the European Innovation Partnership on Active and Health Ageing initiative. The verification of the 4 hypotheses lead to verify the main hypothesis of this research work: it is possible to contribute to bridge the gap between healthcare and innovation and, in turn, improve the way chronic care is delivered by healthcare systems.

Estudio de un modelo multicriterio para estudiar la viabilidad de un cultivo energ��tico en la Pen��nsula Ib��rica. Aplicaci��n a la comarca de Navalmoral de la Mata

En el presente estudio se propone una metodolog��a para la evaluaci��n de proyectos de implantaci��n de cultivos energ��ticos, integrando una serie de factores de inter��s en un modelo de decisi��n, basado en un enfoque multicriterio. Mediante este modelo se pretende evaluar tanto los territorios m��s adecuados para la introducci��n un cultivo energ��tico, como la especie m��s apropiada a los condicionantes que presenta el lugar elegido. Para este estudio se ha realizado una selecci��n previa de cuatro especies forestales, cuyas caracter��sticas de crecimiento y producci��n las hace adecuadas para su aplicaci��n en un proyecto de este tipo. Las cuatro especies escogidas han sido chopo, sauce, eucalipto y paulonia. La metodolog��a propuesta ha consistido primero en un estudio ecol��gico en el ��mbito de la Pen��nsula Ib��rica y Baleares, con el fin de identificar aquellas regiones ��ptimas para cada una de las cuatro especies estudiadas. En este proceso se han seleccionado una serie de factores clim��ticos, que vendr��n definidos a partir de los condicionantes ecol��gicos de dichas especies. Posteriormente se ha propuesto un modelo multicriterio, basado en t��cnicas conocidas y de aplicaci��n sencilla, donde se integran aspectos ambientales, econ��micos y sociales, que vendr��n a completar la informaci��n ecol��gica trabajada previamente. Este modelo incluye la t��cnica de comparaci��n por pares propuesta por el Dr. Saaty en el a��o 1980, para la ponderaci��n de los factores o criterios seleccionados. Posteriormente, y tras su valoraci��n, se utiliza la suma lineal ponderada como t��cnica de decisi��n final. Una vez definido el modelo, se ha aplicado a una comarca en particular, la comarca agraria de Navalmoral de la Mata. A partir de la informaci��n recopilada referente a todos los criterios seleccionados previamente en el modelo, se ha procedido a valorar cada uno de ellos. Con estos valores y tras la ponderaci��n de criterios, se ha aplicado el modelo, para obtener finalmente los territorios dentro de la comarca, y las especies forestales con mayor aptitud para el desarrollo de un proyecto de implantaci��n de cultivos energ��ticos. ABSTRACT A methodology has been proposed for the evaluation of projects to implement energy crops; this includes a number of factors of interest in a decision model based on a multi-criteria approach. This model is to evaluate both the most suitable territories for introducing an energy crop, as the most appropriate species to the conditions presented by the place chosen For this study has made a preliminary selection of four species, with characteristics of growth and production, what making them suitable for use in a project of this type. The four species selected were poplar, willow, eucalyptus and paulownia. The proposed methodology consists first in an ecological study in the context of the Iberian Peninsula and the Balearic Islands, in order to identify those best regions for each of the four species studied. In this process has selected a series of climatic factors, which will be defined from the ecological conditions of these species. Then we have proposed a multi-criteria model based on known techniques and simple application where are integrated environmental, economic and social aspects, which will complement the ecological information previous. This model includes the technique proposed by Dr. Saaty in 1980, the weighting by pairs of factors or criteria selected. Then, after valuation, the weighted linear sum as final decision technique is used. After defining the model has been applied to a particular region, the agrarian region of Navalmoral de la Mata. From the information collected concerning to the criteria previously selected in the model, we proceeded to value each. With these values and assigned weights, the model has been applied to finally get the territories and forest species with greater aptitude for the development of a project to implement energy crops.

Why do health economists promote technology adoption rather than the search for efficiency? A proposal for a change in our approach to economic evaluation in health care

Acknowledgments Financial Support: HERU and HSRU receive a core grant from the Chief Scientist���s Office of the Scottish Government Health and Social Care Directorates, and the Centre for Clinical epidemiology & Evaluation is funded by Vancouver Coastal Health Authority. The model used for the illustrative case study in this paper was developed as part of a NHS Technology Assessment Review, funded by the National Institute for Health Research (NIHR) Health Technology Assessment Program (project number 09/146/01). The views and opinions expressed in this paper are those of the authors and do not necessarily reflect those of the Scottish Government, NHS, Vancouver Coastal Health, NIHR HTA Program or the Department of Health. The authors wish to thank Kathleen Boyd and members of the audience at the UK Health Economists Study Group, for comments received on an earlier version of this paper. We also wish to thank Cynthia Fraser (University of Aberdeen) for literature searches undertaken to inform the manuscript, and Mohsen Sadatsafavi (University of British Columbia) for comments on an earlier draft

The evaluation of highway traffic safety programs. A manual for managers.

Mode of access: Internet.

An evaluation of warning and regulatory signs for curves on rural roads. Final report.

Federal Highway Administration, Office of Research and Development, Washington, D.C.

Program evaluation support for the motor vehicle diagnostic inspection demonstration projects. Volume III: Final evaluation report.

National Highway Traffic Safety Administration, Office of State Vehicle Programs, Washington, D.C.

Design for the evaluation of FMVSS 208 using police bi-level accident investigation. Final report.

National Highway Traffic Safety Administration, National Center for Statistics and Analysis, Washington, D.C.