Hope for a peaceful death and organ donation

The therapeutic, social and economic benefits of organ transplantation are irrefutable; however, organ shortages contribute to avoidable patient deaths and burgeoning health care costs. This problem can be addressed by increasing family consent to deceased organ donation. There are high levels of community support for deceased organ donation in Australia and yet, almost fifty percent of families decline the request to donate. Increasing the number of families who agree to deceased organ donation is key to increasing national and international transplantation rates. The purpose of this study was to identify the major factors that influence a family to agree or decline deceased organ donation during the process of decision-making. The aims of the study were three-fold: to identify the key stages and the major influencers’ in the decisionmaking process; to determine if hope, deep hope and trust played a role in the decision, and to explore families’ perceptions of their decision-making experience. The study utilised an exploratory case study approach to examine the family decisionmaking process of deceased organ donation. Following ethics approval, recruitment was conducted utilising a qualitative purposive snowball strategy across Australia. A pilot study was conducted to test the study procedures prior to the main data collection, and 22 participants who had been involved in a deceased organ donation decision from nine families were interviewed. In five deaths family members had agreed to organ donation, and in four deaths the family declined. A theoretical framework based on the Precaution Adoption Process Model of decision-making was applied to propose trust, hope and deep hope underpin family organ donation decisions. Thematic analysis was conducted and three key themes comprising ‘In the fog drowning’, ‘Harvesting humanity’, and ‘It’s all up to Mum’ were revealed. The study found women, and in particular mothers, played a significant role in organ donation decision-making, and that the decision-making is bounded by family needs of trust, hope and deep hope across the continuum of time. It also found families who had their trust, hope and deep hope needs met expressed satisfaction about their decision-making experience and agreed to organ donation. Some families perceived that organ donation was a sacrifice that was too great to endure, even if the deceased had previously indicated intent to donate, and therefore declined donation. This study found that families’ ideas of a peaceful death and organ donation are not mutually exclusive. It concludes that when decision-makers’ trust and deep hope needs are met they are more willing to agree to donation. This study recommends that the idea of a ‘right’ to a peaceful death should be aligned with deceased organ donation practices and normalised.

SEQUENTIAL DECISIONS AND PREDICTIONS IN NATURAL LANGUAGE PROCESSING

Natural language processing has achieved great success in a wide range of ap- plications, producing both commercial language services and open-source language tools. However, most methods take a static or batch approach, assuming that the model has all information it needs and makes a one-time prediction. In this disser- tation, we study dynamic problems where the input comes in a sequence instead of all at once, and the output must be produced while the input is arriving. In these problems, predictions are often made based only on partial information. We see this dynamic setting in many real-time, interactive applications. These problems usually involve a trade-off between the amount of input received (cost) and the quality of the output prediction (accuracy). Therefore, the evaluation considers both objectives (e.g., plotting a Pareto curve). Our goal is to develop a formal understanding of sequential prediction and decision-making problems in natural language processing and to propose efficient solutions. Toward this end, we present meta-algorithms that take an existent batch model and produce a dynamic model to handle sequential inputs and outputs. Webuild our framework upon theories of Markov Decision Process (MDP), which allows learning to trade off competing objectives in a principled way. The main machine learning techniques we use are from imitation learning and reinforcement learning, and we advance current techniques to tackle problems arising in our settings. We evaluate our algorithm on a variety of applications, including dependency parsing, machine translation, and question answering. We show that our approach achieves a better cost-accuracy trade-off than the batch approach and heuristic-based decision- making approaches. We first propose a general framework for cost-sensitive prediction, where dif- ferent parts of the input come at different costs. We formulate a decision-making process that selects pieces of the input sequentially, and the selection is adaptive to each instance. Our approach is evaluated on both standard classification tasks and a structured prediction task (dependency parsing). We show that it achieves similar prediction quality to methods that use all input, while inducing a much smaller cost. Next, we extend the framework to problems where the input is revealed incremen- tally in a fixed order. We study two applications: simultaneous machine translation and quiz bowl (incremental text classification). We discuss challenges in this set- ting and show that adding domain knowledge eases the decision-making problem. A central theme throughout the chapters is an MDP formulation of a challenging problem with sequential input/output and trade-off decisions, accompanied by a learning algorithm that solves the MDP.

Towards Automated Business Process Deduction through a Social and Collaborative Platform

Part 12: Collaboration Platforms

Gestão de Informação e do Conhecimento

Nos últimos anos, a Gestão de Informação e do Conhecimento (GIC) tem despertado um interesse cada vez maior por parte da comunidade científica e de prestigiadas organizações empresariais e governamentais. A incorporação organizacional desta disciplina possibilitou a correção de lacunas de informação e de conhecimento, contribuindo eficazmente para a superioridade de informação. Desta maneira, este estudo tem por objetivo determinar as opções que permitirão ao Exército Português maximizar a sua eficácia no âmbito da GIC. Posto isto, analisar-se-á primeiramente o impacto da “era da informação” na atual gestão organizacional. Em seguida, proceder-se-á à avaliação do modelo de GIC que melhor servirá uma organização tipo Exército Português, verificando-se, numa fase final, quais os aspetos que caracterizam o atual modelo em vigor no Exército e qual o seu impacto na sua gestão estratégica. Por último, conclui-se com o presente estudo que se encontra em curso uma transformação ao nível de toda a cultura organizacional do Exército, uma vez que a mesma passa a centralizar o seu processo de decisão em rede. Para isso, torna-se essencial a implementação eficaz da GIC, o que é apenas é praticável com a definição de uma estratégia e de um plano de ação para a sua eficaz materialização. Abstract: The Information and Knowledge Management (IKM) is beginning to awaken a growing interest in the academic world as well as in large organizations globally. The implementation of this type of capability allows bridging the information and knowledge gaps contributing to achieve in organizational terms the information superiority. This study focuses on determining the options that will allow the Portuguese Army in order to maximize its effectiveness within the IKM. To achieve this purpose, it begins by analyzing how the "information age" influences the management of organizations. Next, we evaluate which model of IKM that could best serve an organization like the Portuguese Army and finally we analyze which aspects characterizing the current IKM model in the Army and its impact on its Strategic Management. We conclude that the Army is crossing a transformation of the whole organizational culture passing this to centralize its decision process through the network changing the whole paradigm of sharing and obligation to share. For this, it is essential to the implementation of the IKM capacity and this is only possible with the definition of a strategy and action plan for the implementation of this strategy.

l'importanza della modellazione dei processi applicata ad un caso aziendale

La pianificazione e la gestione dei processi è diventata un elemento critico a causa della crescente complessità delle attività all’interno delle organizzazioni. Nell’era dell’impresa digitale, la gestione dei processi di businesss viene coadiuvata mediante l’utilizzo di sistemi software che sono in grado di gestire una grande quantità di informazioni ovvero i sistemi BPM. Il Business Performance Management è una disciplina gestionale che si occupa di descrivere e gestire i processi di business di una organizzazione. L’obiettivo della seguente tesi è verificare se il modello del processo realizzato precedentemente all’implementazione del sistema reale possa permettere una più dettagliata analisi del sistema e anticipare relative problematiche che talvolta si evincono solamente durante il mero sviluppo. Inoltre si vuole verificare se il modello realizzato in fase di discussione di un nuovo progetto cliente possa poi migliorare anche lo scambio di informazioni nel team di sviluppo. A supporto di questa tesi è stato sviluppato un caso di studio reale in una società di gestione del risparmio specializzata in fondi di investimento immobiliare. Inizialmente si è proceduto con una prima fase di raccolta dei requisiti dell’applicativo che si è conclusa con la realizzazione dei modelli creati utilizzando due linguaggi che sono il Business Process Model and Notation (BPMN) e il Decision Model and Notation (DMN); il medesimo applicativo è stato successivamente implementato seguendo i modelli realizzati. I tempi globali di sviluppo del sistema e la migliore comprensione del modello da parte del team di sviluppo hanno fatto evincere l’utilità della modellazione a fronte di maggiori giornate uomo. Inoltre è stata riscontata maggiore manutenibilità complessiva del sistema.

Análisis de la toma de decisiones a nivel del alto gobierno, durante la crisis del Palacio de Justicia en noviembre de 1985.

El objetivo de este estudio, consiste en el análisis de la toma de decisiones del gabinete ministerial del presidente Belisario Betancur, durante la crisis de la toma del Palacio de Justicia por parte del M-19, durante los días 6 y 7 de noviembre de 1985. Para ello, se utilizará un enfoque histórico sociológico e institucional, realizando una revisión documental para describir los hechos previos a la toma del Palacio de Justicia, examinar el escalamiento de la crisis y explicar el proceso de toma de decisiones a nivel del alto gobierno, durante el desarrollo de la toma militar del Palacio. De esta forma se busca comprobar, utilizando principalmente el modelo de políticas gubernamentales de Graham T. Allison, que durante el proceso de toma de decisiones no se realizó un adecuado análisis del contexto, no se tuvo en cuenta los factores psicológicos de cada actor del conflicto, ni hubo claridad sobre el rol que desempeñó cada uno dentro de la mencionada crisis, creando las condiciones para el desenlace violento que generó el conocido Holocausto del Palacio de Justicia.

A estrutura organizacional das bibliotecas universitárias em Portugal

Este estudo tem como objetivo definir linhas orientadoras para as estruturas organizacionais em bibliotecas universitárias portuguesas e baseia-se numa investigação que fez uso de métodos diversificados, tanto quantitativos (em extensão), como qualitativos (em profundidade), e cotejou os dados assim obtidos com as práticas mais inovadoras em bibliotecas de diversos países do mundo. Foi feito o enquadramento teórico, para temas relacionados com os da investigação, como as teorias da gestão, as estruturas organizacionais, a liderança, a motivação, a comunicação e o processo de mudança nas organizações. Considerando o meio onde se integram estas bibliotecas, identificaram-se os principais aspetos da política educativa no ensino superior europeu e português. A revisão da literatura permitiu recolher informação sobre algumas tendências mais recentes nas bibliotecas universitárias, em geral e em Portugal. Foram identificadas as tipologias de estruturas organizacionais, as transformações que as mesmas têm sofrido noutros países e que soluções foram encontradas. A partir dos dados recolhidos com o questionário, caracterizaram-se estas bibliotecas portuguesas e os resultados indicam que há uma grande diversidade e que, em grande parte as suas estruturas organizacionais foram alteradas. Com o estudo de caso, detalharam-se aspetos dessas alterações. Concluiu-se que, com as alterações no ensino superior, as bibliotecas podem ter um papel mais ativo no processo de ensino-aprendizagem. As alterações em estruturas organizacionais de bibliotecas universitárias portuguesas ocorreram, na sua grande parte, por razões legais e houve participação das chefias das bibliotecas e dos técnicos superiores especializados em ciências da informação. As novas estruturas organizacionais procuram adaptar-se às transformações externas e internas, optando por estruturas mais flexíveis que incentivam a participação de todos os funcionários na inovação e tomadas de decisão. Como linhas orientadoras, foram indicados um conjunto de princípios por não ser possível um modelo ideal a aplicar em todas as bibliotecas. Cada caso encontrará uma solução que deverá ser continuamente analisada e adaptada à realidade; Organizational structure of university libraries in Portugal Abstract: The purpose of this study is to define guidelines for the organizational structures of Portuguese university libraries and it is based on a research that used as quantitative (in range) as qualitative (in depth) methods and compared the findings with the most innovative practices in libraries all over the world. An approach was made to the theoretical areas of management, organizational structures, leadership, motivation, communication and the process of change in organizations. Considering that these libraries act in higher education institutions it was referred the education policy for higher education, in Europe and in Portugal. The literature review allowed collecting information about the more recent tendencies of the university libraries in general and in Portugal. The organizational structures models were identified as their changes and solutions. From the data from the questionnaire the Portuguese university libraries were described and the results show there is a great variety among them and most of them have transformed their organizational structures. The case study allowed obtaining more information about the process of change in the three selected libraries. It was concluded that, with the changes of higher education, the libraries can play a more active role in the teaching and learning process. The changes of the organizational structures in the Portuguese university libraries occurred mostly for legal reasons and the top of the libraries hierarchy and librarians participated. With the new organizational structures libraries have made all the efforts to adapt to the external and internal transformations with more flexible structures encouraging all staff to participate with ideas and to take part in the decision process. For the guidelines it was pointed out a set of principles to follow as it is not possible to have an ideal model to apply to all the libraries. Each library must find a solution that will be continually analyzed and adapted.

Comparison of multitemporal MODIS-EVI smoothing algorithms and its contribution to crop monitoring.

Crop monitoring and more generally land use change detection are of primary importance in order to analyze spatio-temporal dynamics and its impacts on environment. This aspect is especially true in such a region as the State of Mato Grosso (south of the Brazilian Amazon Basin) which hosts an intensive pioneer front. Deforestation in this region as often been explained by soybean expansion in the last three decades. Remote sensing techniques may now represent an efficient and objective manner to quantify how crops expansion really represents a factor of deforestation through crop mapping studies. Due to the special characteristics of the soybean productions' farms in Mato Grosso (area varying between 1000 hectares and 40000 hectares and individual fields often bigger than 100 hectares), the Moderate Resolution Imaging Spectroradiometer (MODIS) data with a near daily temporal resolution and 250 m spatial resolution can be considered as adequate resources to crop mapping. Especially, multitemporal vegetation indices (VI) studies have been currently used to realize this task [1] [2]. In this study, 16-days compositions of EVI (MODQ13 product) data are used. However, although these data are already processed, multitemporal VI profiles still remain noisy due to cloudiness (which is extremely frequent in a tropical region such as south Amazon Basin), sensor problems, errors in atmospheric corrections or BRDF effect. Thus, many works tried to develop algorithms that could smooth the multitemporal VI profiles in order to improve further classification. The goal of this study is to compare and test different smoothing algorithms in order to select the one which satisfies better to the demand which is classifying crop classes. Those classes correspond to 6 different agricultural managements observed in Mato Grosso through an intensive field work which resulted in mapping more than 1000 individual fields. The agricultural managements above mentioned are based on combination of soy, cotton, corn, millet and sorghum crops sowed in single or double crop systems. Due to the difficulty in separating certain classes because of too similar agricultural calendars, the classification will be reduced to 3 classes : Cotton (single crop), Soy and cotton (double crop), soy (single or double crop with corn, millet or sorghum). The classification will use training data obtained in the 2005-2006 harvest and then be tested on the 2006-2007 harvest. In a first step, four smoothing techniques are presented and criticized. Those techniques are Best Index Slope Extraction (BISE) [3], Mean Value Iteration (MVI) [4], Weighted Least Squares (WLS) [5] and Savitzky-Golay Filter (SG) [6] [7]. These techniques are then implemented and visually compared on a few individual pixels so that it allows doing a first selection between the five studied techniques. The WLS and SG techniques are selected according to criteria proposed by [8]. Those criteria are: ability in eliminating frequent noises, conserving the upper values of the VI profiles and keeping the temporality of the profiles. Those selected algorithms are then programmed and applied to the MODIS/TERRA EVI data (16-days composition periods). Tests of separability are realized based on the Jeffries-Matusita distance in order to see if the algorithms managed in improving the potential of differentiation between the classes. Those tests are realized on the overall profile (comprising 23 MODIS images) as well as on each MODIS sub-period of the profile [1]. This last test is a double interest process because it allows comparing the smoothing techniques and also enables to select a set of images which carries more information on the separability between the classes. Those selected dates can then be used to realize a supervised classification. Here three different classifiers are tested to evaluate if the smoothing techniques as a particular effect on the classification depending on the classifiers used. Those classifiers are Maximum Likelihood classifier, Spectral Angle Mapper (SAM) classifier and CHAID Improved Decision tree. It appears through the separability tests on the overall process that the smoothed profiles don't improve efficiently the potential of discrimination between classes when compared with the original data. However, the same tests realized on the MODIS sub-periods show better results obtained with the smoothed algorithms. The results of the classification confirm this first analyze. The Kappa coefficients are always better with the smoothing techniques and the results obtained with the WLS and SG smoothed profiles are nearly equal. However, the results are different depending on the classifier used. The impact of the smoothing algorithms is much better while using the decision tree model. Indeed, it allows a gain of 0.1 in the Kappa coefficient. While using the Maximum Likelihood end SAM models, the gain remains positive but is much lower (Kappa improved of 0.02 only). Thus, this work's aim is to prove the utility in smoothing the VI profiles in order to improve the final results. However, the choice of the smoothing algorithm has to be made considering the original data used and the classifier models used. In that case the Savitzky-Golay filter gave the better results.

Motor Nerve-Conduction Studies in Obstetric Brachial Plexopathy for a Selection of Patients with a Poor Outcome

Background: The criteria and timing for nerve surgery in infants with obstetric brachial plexopathy remain controversial. Our aim was to develop a new method for early prognostic assessment to assist this decision process. Methods: Fifty-four patients with unilateral obstetric brachial plexopathy who were ten to sixty days old underwent bilateral motor-nerve-conduction studies of the axillary, musculocutaneous, proximal radial, distal radial, median, and ulnar nerves. The ratio between the amplitude of the compound muscle action potential of the affected limb and that of the healthy side was called the axonal viability index. The patients were followed and classified in three groups according to the clinical outcome. We analyzed the receiver operating characteristic curve of each index to define the best cutoff point to detect patients with a poor recovery. Results: The best cutoff points on the axonal viability index for each nerve (and its sensitivity and specificity) were <10% (88% and 89%, respectively) for the axillary nerve, 0% (88% and 73%) for the musculocutaneous nerve, <20% (82% and 97%) for the proximal radial nerve, <50% (82% and 97%) for the distal radial nerve, and <50% (59% and 97%) for the ulnar nerve. The indices from the proximal radial, distal radial, and ulnar nerves had better specificities compared with the most frequently used clinical criterion: absence of biceps function at three months of age. Conclusions: The axonal viability index yields an earlier and more specific prognostic estimation of obstetric brachial plexopathy than does the clinical criterion of biceps function, and we believe it may be useful in determining surgical indications in these patients.

Spatial portability of numerical models of leaf wetness duration based on empirical approaches

Leaf wetness duration (LWD) models based on empirical approaches offer practical advantages over physically based models in agricultural applications, but their spatial portability is questionable because they may be biased to the climatic conditions under which they were developed. In our study, spatial portability of three LWD models with empirical characteristics - a RH threshold model, a decision tree model with wind speed correction, and a fuzzy logic model - was evaluated using weather data collected in Brazil, Canada, Costa Rica, Italy and the USA. The fuzzy logic model was more accurate than the other models in estimating LWD measured by painted leaf wetness sensors. The fraction of correct estimates for the fuzzy logic model was greater (0.87) than for the other models (0.85-0.86) across 28 sites where painted sensors were installed, and the degree of agreement k statistic between the model and painted sensors was greater for the fuzzy logic model (0.71) than that for the other models (0.64-0.66). Values of the k statistic for the fuzzy logic model were also less variable across sites than those of the other models. When model estimates were compared with measurements from unpainted leaf wetness sensors, the fuzzy logic model had less mean absolute error (2.5 h day(-1)) than other models (2.6-2.7 h day(-1)) after the model was calibrated for the unpainted sensors. The results suggest that the fuzzy logic model has greater spatial portability than the other models evaluated and merits further validation in comparison with physical models under a wider range of climate conditions. (C) 2010 Elsevier B.V. All rights reserved.

Spelling in adults: The role of reading skills and experience

One hundred university students completed tests of spelling production, vocabulary, reading comprehension, reading experience, and reading accuracy (ability to distinguish a previously read word from a similar distractor). Reading experience, as measured by an adaptation of the Author Recognition Test, and reading accuracy contributed to the prediction of spelling beyond the joint contribution of reading comprehension and vocabulary. The results are more consistent with a uni-process model of spelling based on the quality of word-specific orthographic learning, rather than with a dual-process account relying on both word-specific knowledge and rules.

Dual processes in recognition: Does a focus on measurement operations provide a sufficient foundation?

Current theoretical thinking about dual processes in recognition relies heavily on the measurement operations embodied within the process dissociation procedure. We critically evaluate the ability of this procedure to support this theoretical enterprise. We show that there are alternative processes that would produce a rough invariance in familiarity (a key prediction of the dual-processing approach) and that the process dissociation procedure does not have the power to differentiate between these alternative possibilities. We also show that attempts to relate parameters estimated by the process dissociation procedure to subjective reports (remember-know judgments) cannot differentiate between alternative dual-processing models and that there are problems with some of the historical evidence and with obtaining converging evidence. Our conclusion is that more specific theories incorporating ideas about representation and process are required.

Using a combination of MLPA kits to detect chromosomal imbalances in patients with multiple congenital anomalies and mental retardation is a valuable choice for developing countries

Conventional karyotyping detects anomalies in 3-15% of patients with multiple congenital anomalies and mental retardation (MCA/MR). Whole-genome array screening (WGAS) has been consistently suggested as the first choice diagnostic test for this group of patients, but it is very costly for large-scale use in developing countries. We evaluated the use of a combination of Multiplex Ligation-dependent Probe Amplification (MLPA) kits to increase the detection rate of chromosomal abnormalities in MCA/MR patients. We screened 261 MCA/MR patients with two subtelomeric and one microdeletion kits. This would theoretically detect up to 70% of all submicroscopic abnormalities. Additionally we scored the de Vries score for 209 patients in an effort to find a suitable cut-off for MLPA screening. Our results reveal that chromosomal abnormalities were present in 87 (33.3%) patients, but only 57 (21.8%) were considered causative. Karyotyping detected 15 abnormalities (6.9%), while MLPA identified 54 (20.7%). Our combined MLPA screening raised the total detection number of pathogenic imbalances more than three times when compared to conventional karyotyping. We also show that using the de Vries score as a cutoff for this screening would only be suitable under financial restrictions. A decision analytic model was constructed with three possible strategies: karyotype, karyotype + MLPA and karyotype + WGAS. Karyotype + MLPA strategy detected anomalies in 19.8% of cases which account for 76.45% of the expected yield for karyotype + WGAS. Incremental Cost Effectiveness Ratio (ICER) of MLPA is three times lower than that of WGAS, which means that, for the same costs, we have three additional diagnoses with MLPA but only one with WGAS. We list all causative alterations found, including rare findings, such as reciprocal duplications of regions deleted in Sotos and Williams-Beuren syndromes. We also describe imbalances that were considered polymorphisms or rare variants, such as the new SNP that confounded the analysis of the 22q13.3 deletion syndrome. (C) 2011 Elsevier Masson SAS. All rights reserved.

Cost-effectiveness analysis of routine rotavirus vaccination in Brazil

Objective. The objective of this study was to conduct a cost-effectiveness analysis of a universal rotavirus vaccination program among children : 5 years of age in Brazil. Methods. Considering a hypothetical annual cohort of approximately 3 300 000 newborns followed over 5 years, a decision-tree model was constructed to examine the possible clinical and economic effects of rotavirus infection with and without routine vaccination of children. Probabilities and unit costs were derived from published research and national administrative data. The impact of different estimates for key parameters was studied using sensitivity analysis. The analysis was conducted from both healthcare system and societal perspectives. Results. The vaccination program was estimated to prevent approximately 1735 351 (54%) of the 3 210 361 cases of rotavirus gastroenteritis and 703 (75%) of 933 rotavirus-associated deaths during the 5-year period. At a vaccine price of 18.6 Brazilian reais (R$) per dose, this program would cost R$121 673 966 and would save R$38 536 514 in direct costs to the public healthcare system and R$71 778 377 in direct and indirect costs to society. The program was estimated to cost R$1 028 and R$1 713 per life-years saved (LYS)from the societal and healthcare system perspectives, respectively. Conclusions. Universal rotavirus vaccination was a cost-effective strategy for both perspectives. However, these findings are highly sensitive to diarrhea incidence rate, proportion of severe cases, vaccine coverage, and vaccine price.

Public sector change in Australia: Are managers' ideals being realized?

Public sector organizations traditionally have been associated with the internal process (bureaucratic) model of organizational culture. Public choice and management theory have suggested that public sector managers can learn from the experience of private sector management, and need to change from the Internal process model of organizational culture. Due to these Influences an managers, the current research proposes that managers' perceptions of Ideal organizational culture would no longer reflect the Internal process model. Public sector managers' perceptions of the current culture, as well as their perceptions of the Ideal culture, were measured. A mail-out survey was conducted In the Queensland (a state of Australia) public sector. Responses to a competing values culture Inventory were received from 222 managers. Results Indicated that a reliance on the Internal process model persists, while managers had a desire for cultural models other than the Internal process model, as hypothesized.