810 resultados para Procedural sedation


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Procedural knowledge is the knowledge required to perform certain tasks, and forms an important part of expertise. A major source of procedural knowledge is natural language instructions. While these readable instructions have been useful learning resources for human, they are not interpretable by machines. Automatically acquiring procedural knowledge in machine interpretable formats from instructions has become an increasingly popular research topic due to their potential applications in process automation. However, it has been insufficiently addressed. This paper presents an approach and an implemented system to assist users to automatically acquire procedural knowledge in structured forms from instructions. We introduce a generic semantic representation of procedures for analysing instructions, using which natural language techniques are applied to automatically extract structured procedures from instructions. The method is evaluated in three domains to justify the generality of the proposed semantic representation as well as the effectiveness of the implemented automatic system.

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This paper applies the concept of procedural justice to one of the most important focal points of interorganizational relations: the purchaser-supplier relationship. The few extant studies of the concept in the purchaser-supplier domain have overlooked an important aspect of this key relationship: that is, inclusiveness in procurement. This is despite the fact that interest in the specific empirical context of supply chain links between large purchasing organizations (LPOs) and ethnic minority suppliers (EMSs) from disadvantaged communities proceeds apace on both sides of the Atlantic. Institutional theory is used to examine the form that procedural justice takes in eight case studies of LPOs from the private and public sectors, which actively engage with inclusive procurement management initiatives in England. The guiding question is twofold: 'What may LPO approaches to installing procedural justice in procurement management entail?' and 'How are these approaches shaped?' This paper identifies specific approaches to installing procedural justice for inclusive procurement and submits theoretical propositions about how these are shaped. The study contributes to a macro-level assessment of procedural justice, i.e. interorganizational procedural justice, as a significant aspect of inclusive interorganizational relationships, which is a domain in need of theoretical development.

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In the article, we have reviewed the means for visualization of syntax, semantics and source code for programming languages which support procedural and/or object-oriented paradigm. It is examined how the structure of the source code of the structural and object-oriented programming styles has influenced different approaches for their teaching. We maintain a thesis valid for the object-oriented programming paradigm, which claims that the activities for design and programming of classes are done by the same specialist, and the training of this specialist should include design as well as programming skills and knowledge for modeling of abstract data structures. We put the question how a high level of abstraction in the object-oriented paradigm should be presented in simple model in the design stage, so the complexity in the programming stage stay low and be easily learnable. We give answer to this question, by building models using the UML notation, as we take a concrete example from the teaching practice including programming techniques for inheritance and polymorphism.

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Магдалина Василева Тодорова - В статията е описан подход за верификация на процедурни програми чрез изграждане на техни модели, дефинирани чрез обобщени мрежи. Подходът интегрира концепцията “design by contract” с подходи за верификация от тип доказателство на теореми и проверка на съгласуваност на модели. За целта разделно се верифицират функциите, които изграждат програмата относно спецификации според предназначението им. Изгражда се обобщен мрежов модел, специфициащ връзките между функциите във вид на коректни редици от извиквания. За главната функция на програмата се построява обобщен мрежов модел и се проверява дали той съответства на мрежовия модел на връзките между функциите на програмата. Всяка от функциите на програмата, която използва други функции се верифицира и относно спецификацията, зададена чрез мрежовия модел на връзките между функциите на програмата.

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The civil jury has been under attack in recent years for being unreliable and incompetent. Considering the myriad causes for poor civil juror decision-making, the current investigation explores both procedural and evidentiary issues that impact juror's decisions. Specifically, the first phase of this dissertation examines how jurors (mis)use evidence pertaining to the litigants when determining liability and awarding damages. After investigating how jurors utilize evidence, the focus shifts to exploring the utility of procedural reforms designed to improve decision-making (specifically revising the instructions on the laws in the case and bifurcating the damage phases of the trial). Using the results from the first two phases of the research, the final study involves manipulating pieces of evidence related to the litigants while exploring the effects that revising the judicial instructions have on the utilization of evidence in particular and on decision-making in general. ^ This dissertation was run on-line, allowing participants to access the study materials at their convenience. After giving consent, participants read the scenario of a fictitious product liability case with the litigant manipulations incorporated into the summary. Participants answered several attitudinal, case-specific, and comprehension questions, and were instructed to find in favor of one side and award any damages they felt warranted. Exploratory factor analyses, Probit and linear regressions, and path analyses were used to analyze the data (M-plus and SPSS were the software packages used to conduct the analyses). Results indicated that misuse of evidence was fairly frequent, though the mock jurors also utilized evidence appropriately. Although the results did not support bifurcation as a viable procedural reform, revising the judicial instructions did significantly increase comprehension rates. Trends in the data suggested that better decision-making occurred when the revised instructions were used, thus providing empirical support for this procedural reform as a means of improving civil jury decision-making. Implications for actual trials and attorneys are discussed. ^

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Previous research has established that relationships with authority figures and procedural justice perceptions are important in terms of the way in which employees react to organizational procedures that affect them. What is less clear are the reasons why exchange quality with authorities is related to perceptions of process fairness and the role of procedural justice climate in this process. Results indicate that individual-level perceptions of procedural justice, but not performance ratings, partially mediate the relationship between exchange quality and reactions to performance appraisals, and that procedural justice climate is positively related to perceptions of procedural justice and appraisal reactions. These results support a more relational than instrumental view of justice perceptions in organizational procedures bound by exchange quality with an authority figure. Our study suggests that it is essential for managers to actively monitor and manage employee perceptions of process fairness at the group and individual levels. © 2015 Wiley Periodicals, Inc.

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Attitudes towards legal authorities based on theories of procedural justice have been explored extensively in the criminal and civil justice systems. This has provided considerable empirical evidence concerning the importance of trust and legitimacy in generating cooperation, compliance and decision acceptance. However, not enough attention has been paid to attitudes towards institutions of informal dispute resolution. This paper asks whether the theory of procedural justice applies to the alternative dispute resolution (ADR) context, focusing on ombuds services. What are the predictors of perceptions of procedural justice during the process of dealing with an ombuds, and what factors shape outcome acceptance? These questions are analyzed using a sample of recent ombuds users. The results indicate that outcome favorability is highly correlated with perceived procedural justice, and both predict decision acceptance.

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As the number of high profile cases of institutional child abuse mounts internationally, and the demands of victims for justice are heard, state responses have ranged from prosecution, apology, and compensation schemes, to truth commissions or public inquiries. Drawing on the examples of Australia and Northern Ireland as two jurisdictions with a recent and ongoing history of statutory inquiries into institutional child abuse, the article utilises the restorative justice paradigm to critically evaluate the strengths and limitations of the inquiry framework in providing ‘justice’ for victims. It critically explores the normative and pragmatic implications of a hybrid model as a more effective route to procedural justice and suggests that an appropriately designed restorative pathway may augment the legitimacy and utility of the public inquiry model for victims chiefly via improving offender accountability and ‘voice’ for victims. The article concludes by offering some thoughts on the broader implications for other jurisdictions in responding to large-scale historical abuses and seeking to come to terms with the legacy of institutional child abuse.

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Introduction Sleep disturbances are common in critically ill patients treated in the intensive care unit (ICU) with the potential for serious consequences and long-term effects on health outcomes and patient morbidity.
Objectives Our aim was to describe sleep management and sedation practices of adult ICUs in ten countries and to evaluate roles and responsibilities of the ICU staff in relation to key sleep and sedation decisions.
Methods A multicenter, self-administered survey sent to nurse managers of adult ICUs across 10 countries. The questionnaire comprised four domains: sleep characteristics of the critically ill; sleep and sedation practices; non-pharmacological and pharmacological interventions used to improve sleep; and the autonomy and influence of nurses on sleeping practices in the ICU.
Results Overall response rate was 66% (range 32% UK to 100% Cyprus), providing data from 522 ICUs. In all countries, the most frequent patient characteristic perceived to identify sleep was lying quietly with closed eyes (N=409, 78%) (range 92% Denmark to 36% Italy). The most commonly used sedation scale was the Richmond Agitation-Sedation Score (RASS) (N=220, 42%) (range 81% UK to 0% Denmark, Cyprus where most ICUs used the Ramsay score). In most ICUs, selection of sleep medication (N=265, 51%) and assessment of effect (N=309, 59%) was performed by physicians and nurses based on collaborative discussion. In a minority of ICUs (N=161, 31%), decisions and assessments were made by physicians alone. The most commonly used (in all countries) non-pharmacological intervention to promote sleep was reducing ICU staff noise (N=473, 91%) (range 100% Denmark, Norway to 78% Canada). Only 95 ICUs (18%) used earplugs on a frequent basis (range 0% Greece, Cyprus, Denmark to 57% Sweden). Propofol was the drug used most commonly for sedation (N=359, 69%) (range 96% Sweden to 29% Canada). Chloral hydrate was used by only 63 (12%) ICUs (range 0% Greece, Cyprus, Denmark, Italy to 56% Germany). Sedation scales were used on a routine basis by 77% of the 522 ICUs. Participants scored nursing autonomy for sleep and sedation management as moderate; median score of 5 (scale of 0 to 10), range 7 (Canada, Greece, Sweden) to 4 (Norway, Poland). Nursing influence on sleep and sedation decisions was perceived considerable; median score 8, range 9 (Denmark) to 5 (Poland).
Conclusions We found considerable across country variation in sleep promotion and sedation management practices though most have adopted a sedation scale as recommended in professional society guidelines. Most ICUs in all countries used a range of pharmacological and non-pharmacological interventions to promote sleep. Most units reported inter-professional decision-making with nurses perceived to have substantial influence on sleep/sedation decisions.


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Procedural justice advocates argue that fair procedures in decision making processes can increase participant satisfaction with legal institutions. Little critical work has been done however to explore the power of such claims in the context of mass violence and international criminal justice. This article critically examines some of the key claims of procedural justice by exploring the perceptions of justice held by victims participating as Civil Parties in the Extraordinary Chambers in the Courts of Cambodia (ECCC). The ECCC has created one of the most inclusive and extensive victim participation regimes within international criminal law. It therefore provides a unique case study to examine some of claims of ‘victim-centred’ transitional justice through a procedural justice lens. It finds that while procedural justice influenced civil parties’ overall perceptions of the Court, outcomes remained of primary importance. It concludes by analysing the possible reasons for this prioritisation.

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Background. Excessive sedation is associated with adverse patient outcomes during critical illness, and a validated monitoring technology could improve care. We developed a novel method, the responsiveness index (RI) of the frontal EMG. We compared RI data with Ramsay clinical sedation assessments in general and cardiac intensive care unit (ICU) patients. Methods. We developed the algorithm by iterative analysis of detailed observational data in 30 medical–surgical ICU patients and described its performance in this cohort and 15 patients recovering from scheduled cardiac surgery. Continuous EMG data were collected via frontal electrodes and RI data compared with modified Ramsay sedation state assessments recorded regularly by a blinded trained observer. RI performance was compared with EntropyTM across Ramsay categories to assess validity. Results. RI correlated well with the Ramsay category, especially for the cardiac surgery cohort (general ICU patients r¼0.55; cardiac surgery patients r¼0.85, both P,0.0001). Discrimination across all Ramsay categories was reasonable in the general ICU patient cohort [PK¼0.74 (SEM 0.02)] and excellent in the cardiac surgery cohort [PK¼0.92 (0.02)]. Discrimination between ‘lighter’ vs ‘deeper’ (Ramsay 1–3 vs 4–6) was good for general ICU patients [PK¼0.80 (0.02)] and excellent for cardiac surgery patients [PK¼0.96 (0.02)]. Performance was significantly better than EntropyTM. Examination of individual cases suggested good face validity. Conclusions. RI of the frontal EMG has promise as a continuous sedation state monitor in critically ill patients. Further investigation to determine its utility in ICU decision-making is warranted.

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Background: There are limited data concerning endoscopist-directed endoscopic retrograde cholangiopancreatography deep sedation. The aim of this study was to establish the safety and risk factors for difficult sedation in daily practice. Patients and methods: Hospital-based, frequency matched case-control study. All patients were identified from a database of 1,008 patients between 2014 and 2015. The cases were those with difficult sedations. This concept was defined based on the combination of the receipt of high-doses of midazolam or propofol, poor tolerance, use of reversal agents or sedation-related adverse events. The presence of different factors was evaluated to determine whether they predicted difficult sedation. Results: One-hundred and eighty-nine patients (63 cases, 126 controls) were included. Cases were classified in terms of high-dose requirements (n = 35, 55.56%), sedation-related adverse events (n = 14, 22.22%), the use of reversal agents (n = 13, 20.63%) and agitation/discomfort (n = 8, 12.7%). Concerning adverse events, the total rate was 1.39%, including clinically relevant hypoxemia (n = 11), severe hypotension (n = 2) and paradoxical reactions to midazolam (n = 1). The rate of hypoxemia was higher in patients under propofol combined with midazolam than in patients with propofol alone (2.56% vs. 0.8%, p < 0.001). Alcohol consumption (OR: 2.674 [CI 95%: 1.098-6.515], p = 0.030), opioid consumption (OR: 2.713 [CI 95%: 1.096-6.716], p = 0.031) and the consumption of other psychoactive drugs (OR: 2.015 [CI 95%: 1.017-3.991], p = 0.045) were confirmed to be independent risk factors for difficult sedation. Conclusions: Endoscopist-directed deep sedation during endoscopic retrograde cholangiopancreatography is safe. The presence of certain factors should be assessed before the procedure to identify patients who are high-risk for difficult sedation.