922 resultados para Expert Opinions
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K. Rasmani and Q. Shen. Data-driven fuzzy rule generation and its application for student academic performance evaluation. Applied Intelligence, 25(3):305-319, 2006.
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K. Rasmani and Q. Shen. Subsethood-based Fuzzy Rule Models and their Application to Student Performance Classification. Proceedings of the 14th International Conference on Fuzzy Systems, pages 755-760, 2005.
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Abstract
BACKGROUND:
Glaucoma is a leading cause of blindness. Early detection is advocated but there is insufficient evidence from randomized controlled trials (RCTs) to inform health policy on population screening. Primarily, there is no agreed screening intervention. For a screening programme, agreement is required on the screening tests to be used, either individually or in combination, the person to deliver the test and the location where testing should take place. This study aimed to use ophthalmologists (who were experienced glaucoma subspecialists), optometrists, ophthalmic nurses and patients to develop a reduced set of potential screening tests and testing arrangements that could then be explored in depth in a further study of their feasibility for evaluation in a glaucoma screening RCT.
METHODS:
A two-round Delphi survey involving 38 participants was conducted. Materials were developed from a prior evidence synthesis. For round one, after some initial priming questions in four domains, specialists were asked to nominate three screening interventions, the intervention being a combination of the four domains; target population, (age and higher risk groups), site, screening test and test operator (provider). More than 250 screening interventions were identified. For round two, responses were condensed into 72 interventions and each was rated by participants on a 0-10 scale in terms of feasibility.
RESULTS:
Using a cut-off of a median rating of feasibility of =5.5 as evidence of agreement of intervention feasibility, six interventions were identified from round 2. These were initiating screening at age 50, with a combination of two or three screening tests (varying combinations of tonometry/measures of visual function/optic nerve damage) organized in a community setting with an ophthalmic trained technical assistant delivering the tests. An alternative intervention was a 'glaucoma risk score' ascertained by questionnaire. The advisory panel recommended that further exploration of the feasibility of screening higher risk populations and detailed specification of the screening tests was required.
CONCLUSIONS:
With systematic use of expert opinions, a shortlist of potential screening interventions was identified. Views of users, service providers and cost-effectiveness modeling are now required to identify a feasible intervention to evaluate in a future glaucoma screening trial.
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OBJECTIVE: Delirium is highly prevalent in general hospitals but remains underrecognized and undertreated despite its association with increased morbidity, mortality, and health services utilization. To enhance its management, we developed guidelines covering all aspects, from risk factor identification to preventive, diagnostic, and therapeutic interventions in adult patients. METHODS: Guidelines, systematic reviews, randomized controlled trials (RCT), and cohort studies were systematically searched and evaluated. Based on a synthesis of retrieved high-quality documents, recommendation items were submitted to a multidisciplinary expert panel. Experts scored the appropriateness of recommendation items, using an evidence-based, explicit, multidisciplinary panel approach. Each recommendation was graded according to this process' results. RESULTS: Rated recommendations were mostly supported by a low level of evidence (1.3% RCT and systematic reviews, 14.3% nonrandomized trials vs. 84.4% observational studies or expert opinions). Nevertheless, 71.1% of recommendations were considered appropriate by the experts. Prevention of delirium and its nonpharmacological management should be fostered. Haloperidol remains the first-choice drug, whereas the role of atypical antipsychotics is still uncertain. CONCLUSIONS: While many topics addressed in these guidelines have not yet been adequately studied, an explicit panel and evidence-based approach allowed the proposal of comprehensive recommendations for the prevention and management of delirium in general hospitals.
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La majorité des personnes atteintes de démence en soins de longue durée (SLD) souffre d’une détérioration de la cognition, des interactions sociales, de la santé mentale et de la qualité de vie (QdV). Par conséquent, les proches aidants et les soignants de cette population peuvent éprouver des difficultés, tel que le stress, en raison de la complexité du syndrome. Il s’avère essentiel de valider des interventions psychosociales adaptées à la population atteinte de démence et à ses aidants. La réminiscence, une intervention psychosociale misant sur les capacités résiduelles des personnes atteintes de démence, se fonde sur la remémoration des souvenirs anciens agréables. L’objectif général du mémoire était de valider la mise en œuvre d’une intervention de réminiscence menée par le personnel soignant auprès des personnes atteintes de démence et leurs familles dans un centre de SLD, en faisant appel aux avis experts des soignants et des familles des personnes atteintes de démence dans le contexte d’entrevues. Une évaluation pré-post intervention a permis de mesurer la santé mentale et la QdV des personnes atteintes de démence avant l’intervention, une semaine après et trois mois après l’intervention. Les résultats indiquent que la réminiscence a été bien appréciée par les soignants, les personnes atteintes de démence et leurs familles, et valident sa mise en œuvre en SLD. Des améliorations significatives (Wilcoxon p < 0,025) à court et à long terme ont été observées au niveau de la santé mentale et la QdV des personnes atteintes de démence.
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Im Zuge der Novellierung der Gasnetzzugangsverordnung sowie des Erneuerbare-Energien-Gesetzes entwickelte sich die Einspeisung von Biomethan in das Erdgasnetz als alternative Investitionsmöglichkeit der Erneuerbare-Energien-Branche. Als problematisch erweist sich dabei die Identifikation und Strukturierung einzelner Risikofaktoren zu einem Risikobereich, sowie die anschließende Quantifizierung dieser Risikofaktoren innerhalb eines Risikoportfolios. Darüber hinaus besteht die Schwierigkeit, diese Risikofaktoren in einem cashflowbasierten und den Ansprüchen der Investoren gewachsenem Risikomodell abzubilden. Zusätzlich müssen dabei Wechselwirkungen zwischen einzelnen Risikofaktoren berücksichtigt werden. Aus diesem Grund verfolgt die Dissertation das Ziel, die Risikosituation eines Biomethanprojektes anhand aggregierter und isolierter Risikosimulationen zu analysieren. Im Rahmen einer Diskussion werden Strategien und Instrumente zur Risikosteuerung angesprochen sowie die Implementierungsfähigkeit des Risikomodells in das Risikomanagementsystem von Investoren. Die Risikomaße zur Beschreibung der Risikoauswirkung betrachten die Shortfälle einer Verteilung. Dabei beziehen sich diese auf die geplanten Ausschüttungen sowie interne Verzinsungsansprüche der Investoren und die von Kreditinstituten geforderte minimale Schuldendienstdeckungsrate. Im Hinblick auf die Risikotragfähigkeit werden liquiditätsorientierte Kennzahlen hinzugezogen. Investoren interessieren sich vor dem Hintergrund einer gezielten Risikosteuerung hauptsächlich für den gefahrvollsten Risikobereich und innerhalb dessen für den Risikofaktor, der die größten Risikoauswirkungen hervorruft. Zudem spielt der Zeitpunkt maximaler Risikoauswirkung eine große Rolle. Als Kernaussage dieser Arbeit wird festgestellt, dass in den meisten Fällen die Aussagefähigkeit aggregierter Risikosimulationen durch Überlagerungseffekte negativ beeinträchtigt wird. Erst durch isoliert durchgeführte Risikoanalysen können diese Effekte eliminiert werden. Besonders auffällig gestalten sich dabei die Ergebnisse der isoliert durchgeführten Risikoanalyse des Risikobereichs »Politik«. So verursacht dieser im Vergleich zu den übrigen Risikobereichen, wie »Infrastruktur«, »Rohstoffe«, »Absatzmarkt« und »Finanzmarkt«, die geringsten Wahrscheinlichkeiten avisierte Planwerte der Investoren zu unterschreiten. Kommt es jedoch zu einer solchen Planwert-Unterschreitung, nehmen die damit verbundenen Risikoauswirkungen eine überraschende Position im Risikoranking der Investoren ein. Hinsichtlich der Aussagefähigkeit des Risikomodells wird deutlich, dass spezifische Risikosichtweisen der Investoren ausschlaggebend dafür sind, welche Strategien und Instrumente zur Risikosenkung umgesetzt werden. Darüber hinaus wird festgestellt, dass die Grenzen des Risikomodells in der Validität der Expertenmeinungen und dem Auffinden einer Optimallösung zu suchen sind.
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Developed in response to the new challenges of the social Web, this study investigates how involvement with brand-related user-generated content (UGC) affects consumers’ perceptions of brands. The authors develop a model that provides new insights into the links between drivers of UGC creation, involvement, and consumer-based brand equity. Expert opinions were sought on a hypothesized model, which further was tested through data from an online survey of 202 consumers. The results provide guidance for managerial initiatives involving UGC campaigns for brand building. The findings indicate that consumer perceptions of co-creation, community, and self-concept have a positive impact on UGC involvement that, in turn, positively affects consumer based brand equity. These empirical results have significant implications for avoiding problems and building deeper relationships between consumers and brands in the age of social media.
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A avaliação de risco sísmico, fundamental para as decisões sobre as estruturas de obras de engenharia e mitigação de perdas, envolve fundamentalmente a análise de ameaça sísmica. Calcular a ameaça sísmica é o mesmo que calcular a probabilidade de que certo nível de determinada medida de intensidade em certo local durante um certo tempo seja excedido. Dependendo da complexidade da atividade geológica essas estimativas podem ser bas- tante sofisticadas. Em locais com baixa sismicidade, como é o caso do Brasil, o pouco tempo (geológico) de observação e a pouca quantidade de informação são fontes de muitas incer- tezas e dificuldade de análise pelos métodos mais clássicos e conhecidos que geralmente consideram, através de opiniões de especialistas, determinadas zonas sísmicas. Serão discutidas algumas técnicas de suavização e seus fundamentos como métodos al- ternativos ao zoneamento, em seguida se exemplifica suas aplicações no caso brasileiro.
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How have shocks to supply and demand affected global oil prices; and what are key policy implications following the resurgence of oil production in the United States? Highlights: − The recent collapse in global oil prices was dominated by oversupply. − The future of tight oil in the United States is vulnerable to obstacles beyond oil prices. − Opinions on tight oil from the Top 25 think tank organizations are considered. Global oil prices have fallen more than fifty percent since mid-2014. While price corrections in the global oil markets resulted from multiple factors over the past twelve months, surging tight oil production from the United States was a key driver. Tight oil is considered an unconventional or transitional oil source due to its location in oil-bearing shale instead of conventional oil reservoirs. These qualities make tight oil production fundamentally different from regular crude, posing unique challenges. This case study examines these challenges and explores how shocks to supply and demand affect global oil prices while identifying important policy considerations. Analysis of existing evidence is supported by expert opinions from more than one hundred scholars from top-tier think tank organizations. Finally, implications for United States tight oil production as well as global ramifications of a new low price environment are explored.
Microscopic evaluation of induced tooth movement in traumatized teeth: an experimental study in rats
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The clinical management of orthodontic patients with dental trauma before or during the treatment is mainly founded on clinical experience, expert opinions, and individual case reports. It is proposed in the literature that teeth sustaining mild trauma with minor damage to the periodontium (e.g. subluxation) should be followed for a period of time before being subjected to orthodontic forces. A minimum period of 3 months has been proposed. In this study, we used an animal model to investigate whether shorter observation periods could be established in case of mild trauma. The periradicular region of rat molars was examined microscopically to determine the biological events of tooth movement started 15 and 30 days after intentional subluxation using an experimental method to induce dentoalveolar trauma. Thirty adult male Wistar rats were assigned to 6 groups (n = 5): Group 1 (control no trauma/orthodontic movement); Group 2: the animals received an orthodontic device and were sacrificed after 7 days; Groups 3 and 4: dentoalveolar trauma (subluxation) was experimentally induced by the application of an axial force of 900 cN on the occlusal surface of the maxillary right first molar, and the animals were sacrificed after 22 and 37 days, respectively; and Groups 5 and 6: 15 and 30 days, respectively, after force application, an orthodontic device was installed and the rats were sacrificed 7 days later. In G5 and G6, the periodontal ligament and pulp tissue were rich in cellular elements and blood vessels, the alveolar bone was preserved, and the root surface presented only very small areas of surface resorption (cementum), maintaining the characteristics of normality. In conclusion, the microscopic alterations in the gingival and periodontal tissues in response to an experimentally induced mild dentoalveolar trauma simulating subluxation were not sufficient to contraindicate starting the orthodontic movement 15 and 30 days after trauma.
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Aim: To use published literature and experts' opinion to investigate the clinical meaning and magnitude of changes in the Quality of Life (QOL) of groups of patients measured with the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Methods: An innovative method combining systematic review of published studies, expert opinions and meta-analysis was used to estimate large, medium, and small mean changes over time for QLQ-C30 scores. Results: Nine hundred and eleven papers were identified, leading to 118 relevant papers. One thousand two hundred and thirty two mean changes in QOL over time were combined in the meta-analysis, with timescales ranging from four days to five years. Guidelines were produced for trivial, small, and medium size classes, for each subscale and for improving and declining scores separately. Estimates for improvements were smaller than respective estimates for declines. Conclusions: These guidelines can be used to aid sample size calculations and interpretation of mean changes over time from groups of patients. Observed mean changes in the QLQ-C30 scores are generally small in most clinical situations, possibly due to response shift. Careful consideration is needed when planning studies where QOL changes over time are of primary interest; the timing of follow up, sample attrition, direction of QOL changes, and subscales of primary interest are key considerations. (C) 2012 Elsevier Ltd. All rights reserved.
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OBJECTIVE: This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy. METHODS: A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard. RESULTS: According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy. CONCLUSION: The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment.
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Background: Communication in cancer care has become a major topic of interest. Since there is evidence that ineffective communication affects both patients and oncology clinicians (physicians and nurses), so-called communication skills trainings (CSTs) have been developed over the last decade. While these trainings have been demonstrated to be effective, there is an important heterogeneity with regard to implementation and with regard to evidence of different aspects of CST. Methods: In order to review and discuss the scientific literature on CST in oncology and to formulate recommendations, the Swiss Cancer League has organised a consensus meeting with European opinion leaders and experts in the field of CST, as well as oncology clinicians, representatives of oncology societies and patient organisations. On the basis of a systematic review and a meta-analysis, recommendations have been developed and agreed upon. Results: Recommendations address (i) the setting, objectives and participants of CST, (ii) its content and pedagogic tools, (iii) organisational aspects, (iv) outcome and (v) future directions and research. Conclusion: This consensus meeting, on the basis of European expert opinions and a systematic review and meta-analysis, defines key elements for the current provision and future development and evaluation of CST in oncology.
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BACKGROUND: In order to optimise the cost-effectiveness of active surveillance to substantiate freedom from disease, a new approach using targeted sampling of farms was developed and applied on the example of infectious bovine rhinotracheitis (IBR) and enzootic bovine leucosis (EBL) in Switzerland. Relevant risk factors (RF) for the introduction of IBR and EBL into Swiss cattle farms were identified and their relative risks defined based on literature review and expert opinions. A quantitative model based on the scenario tree method was subsequently used to calculate the required sample size of a targeted sampling approach (TS) for a given sensitivity. We compared the sample size with that of a stratified random sample (sRS) with regard to efficiency. RESULTS: The required sample sizes to substantiate disease freedom were 1,241 farms for IBR and 1,750 farms for EBL to detect 0.2% herd prevalence with 99% sensitivity. Using conventional sRS, the required sample sizes were 2,259 farms for IBR and 2,243 for EBL. Considering the additional administrative expenses required for the planning of TS, the risk-based approach was still more cost-effective than a sRS (40% reduction on the full survey costs for IBR and 8% for EBL) due to the considerable reduction in sample size. CONCLUSIONS: As the model depends on RF selected through literature review and was parameterised with values estimated by experts, it is subject to some degree of uncertainty. Nevertheless, this approach provides the veterinary authorities with a promising tool for future cost-effective sampling designs.
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Switzerland is about to implement a completely new patent litigation system, following the establishment of a new specialized federal patent trial court and the replacement of twenty-six cantonal codes of civil procedure with a single uniform federal code of civil procedure. This article provides an overview of the general structure and the most important features of the new patent litigation system that may be of interest to international patent litigants and litigators.