906 resultados para case outcomes
Resumo:
The environment affects our health, livelihoods, and the social and political institutions within which we interact. Indeed, nearly a quarter of the global disease burden is attributed to environmental factors, and many of these factors are exacerbated by global climate change. Thus, the central research question of this dissertation is: How do people cope with and adapt to uncertainty, complexity, and change of environmental and health conditions? Specifically, I ask how institutional factors, risk aversion, and behaviors affect environmental health outcomes. I further assess the role of social capital in climate adaptation, and specifically compare individual and collective adaptation. I then analyze how policy develops accounting for both adaptation to the effects of climate and mitigation of climate-changing emissions. In order to empirically test the relationships between these variables at multiple levels, I combine multiple methods, including semi-structured interviews, surveys, and field experiments, along with health and water quality data. This dissertation uses the case of Ethiopia, Africa’s second-most populous nation, which has a large rural population and is considered very vulnerable to climate change. My fieldwork included interviews and institutional data collection at the national level, and a three-year study (2012-2014) of approximately 400 households in 20 villages in the Ethiopian Rift Valley. I evaluate the theoretical relationships between households, communities, and government in the process of adaptation to environmental stresses. Through my analyses, I demonstrate that water source choice varies by individual risk aversion and institutional context, which ultimately has implications for environmental health outcomes. I show that qualitative measures of trust predict cooperation in adaptation, consistent with social capital theory, but that measures of trust are negatively related with private adaptation by the individual. Finally, I describe how Ethiopia had some unique characteristics, significantly reinforced by international actors, that led to the development of an extensive climate policy, and yet with some challenges remaining for implementation. These results suggest a potential for adaptation through the interactions among individuals, communities, and government in the search for transformative processes when confronting environmental threats and climate change.
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The Convention on Biodiversity (CBD) was created in 1992 to coordinate global governments to protect biological resources. The CBD has three goals: protection of biodiversity, achievement of sustainable use of biodiversity and facilitation of equitable sharing of the benefits of biological resources. The goal of protecting biological resources has remained both controversial and difficult to implement. This study focused more on the goal of biodiversity protection. The research was designed to examine how globally constructed environmental policies get adapted by national governments and then passed down to local levels where actual implementation takes place. Effectiveness of such policies depends on the extent of actual implementation at local levels. Therefore, compliance was divided and examined at three levels: global, national and local. The study then developed various criteria to measure compliance at these levels. Both qualitative and quantitative methods were used to analyze compliance and implementation. The study was guided by three questions broadly examining critical factors that most influence the implementation of biodiversity protection policies at the global, national and local levels. Findings show that despite an overall biodiversity deficit of 0.9 hectares per person, global compliance with the CBD goals is currently at 35%. Compliance is lowest at local levels at 14%, it is slightly better at national level at 50%, and much better at the international level 64%. Compliance appears higher at both national and international levels because compliance here is paper work based and policy formulation. If implementation at local levels continues to produce this low compliance, overall conservation outcomes can only get worse than what it is at present. There are numerous weaknesses and capacity challenges countries are yet to address in their plans. In order to increase local level compliance, the study recommends a set of robust policies that build local capacity, incentivize local resource owners, and implement biodiversity protection programs that are akin to local needs and aspirations.
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The Development Permit System has been introduce with minimal directives for establishing a decision making process. This is in opposition to the long established process for minor variances and suggests that the Development Permit System does not necessarily incorporate all of Ontario’s fundamental planning principles. From this concept, the study aimed to identify how minor variances are incorporated into the Development Permit System. In order to examine this topic, the research was based around the following research questions: • How are ‘minor variance’ applications processed within the DPS? • To what extent do the four tests of a minor variance influence the outcomes of lower level applications in the DPS approval process? A case study approach was used for this research. The single-case design employed both qualitative and quantitative research methods including a review of academic literature, court cases, and official documents, as well as a content analysis of Class 1, 1A, and 2 Development Permit application files from the Town of Carleton Place that were decided between 2011 and 2015. Upon the completion of the content analysis, it was found that minor variance issues were most commonly assigned to Class 1 applications. Planning staff generally met approval timelines and embraced their delegated approval authority, readily attaching conditions to applications in order to mitigate off-site impacts. While staff met the regulatory requirements of the DPS, ‘minor variance’ applications were largely decided on impact alone, demonstrating that the principles established by the four tests, the defining quality of the minor variance approval process, had not transferred to the Development Permit System. Alternatively, there was some evidence that the development community has not fully adjusted to the requirements of the new approvals process, as some applications were supported using a rationale containing the four tests. Subsequently, a set of four recommendations were offered which reflect the main themes established by the findings. The first two recommendations are directed towards the Province, the third to municipalities and the fourth to developers and planning consultants: 1) Amend Ontario Regulation 608/06 so that provisions under Section 4(3)(e) fall under Section 4(2). 2) Change the rhetoric from “combining elements of minor variances” to “replacing minor variances”. 3) Establish clear evaluation criteria. 4) Understand the evaluative criteria of the municipality in which you are working.
Resumo:
Participation in organized activities is associated with many markers of positive youth development (PYD) such as improved self-esteem, social competence, and academic achievement (Mahoney et al., 2009). Sport is an extra-curricular activity that is particularly popular among youth, as nearly three quarters of Canadian children and adolescents are engaged in organized sport or physical activity (CFLRI, 2012). Much of the research in this area has examined sport programs which are explicitly structured to promote life skills or PYD outcomes; however, the sustainability of such programs has recently been called into question (Turnnidge, Hancock, & Côté, 2014). The purpose of this program of research was to conduct an in-depth case study of a successful, sustainable community youth basketball league. Study 1 was a qualitative descriptive exploration of coaches’ perceptions of the basketball league. This study provided a general overview of the structure and perceived benefits of the league, from the perspective of current coaches. Coaches highlighted the unique emphasis that the league places on fun and positive immediate sport experiences. Study 2 expanded on selected themes from Study 1, namely, the salience of the league’s culture and tendency for former players to return to the league as volunteers. This study used an ethnographic approach wherein the first author volunteered as an assistant coach on a basketball team over the course of a six-month season. This approach enabled him to gain considerable first hand insight into the organizational culture of the basketball league. The third and final study adopted a quantitative approach using both systematic observation and questionnaires to investigate the relationship between PYD outcomes and observed athlete behaviour during basketball games. A cluster analysis revealed the presence of two distinct groups of athletes characterized by relatively high and low perceptions of PYD outcomes, which were also associated with varying behavioural characteristics during competition. The results of these three studies provide a detailed blueprint of a successful youth sport program that has been sustained over 60 years. While not without limitations, many characteristics of the league should prove useful in structuring youth sport programs in other contexts.
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Eight universities have collaborated in an Erasmus+ funded project to create a lean process to enhance self-evaluation and accreditation through peer alliance and cooperation. Central to this process is the partnering of two institutions as critical friends, based on prior selfevaluations of specific programmes to identify particular criteria for improvement. A pairing algorithm matches two institutions based on their respective self-evaluation scores. It ensures there are significant differences in key criteria that are mutually beneficial for future programme development and enhancement. The ensuing meetings between critical friends have been designated as ‘cross-sparring’. This paper focuses on a case-study of the crosssparring and resulting enhancement outcomes between Umeå University and Queen’s University Belfast, and their respective Masters programmes in Software Engineering and Mechanical Engineering. The collaborative experiences of the process are evaluated, reported, discussed and conclusions provided on the efficacy of this particular application of cross-sparring.
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This paper reviews literature on alternative convenience food choices and analyses the findings from consumer behaviour and manufacturing/retailing perspective. As consumers’ demand for easy prepared and healthier food products has gradually increased, so has the related research activity. This address provides a synopsis of 60 relevant peer-review publications based on an online research carried out using related to organic ready-to-eat meals search terms. An overview of topic’s most important outcomes is presented, compared and evaluated. Results reveal positive attitudes, increased interest and willingness to purchase such products. Research gaps are identified in the field of personal and social norms as well as in the regulation and seeking information process. Policy making implications and recommendations are also discussed in conjunction with future research opportunities
Resumo:
BACKGROUND: -There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease (RHD) or information on their predictors. We report the two year follow-up of individuals with RHD from 14 low and middle income countries in Africa and Asia.
METHODS: -Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for two years to assess mortality, congestive heart failure (CHF), stroke or transient ischemic attack (TIA), recurrent acute rheumatic fever (ARF), and infective endocarditis (IE).
RESULTS: -Vital status at 24 months was known for 2960 (88.5%) patients. Two thirds were female. Although patients were young (median age 28 years, interquartile range 18 to 40), the two year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio (HR) 2.36, 95% confidence interval (CI) 1.80-3.11), CHF (HR 2.16, 95% CI 1.70-2.72), New York Heart Association functional class III/IV (HR 1.67, 95% CI 1.32-2.10), atrial fibrillation (AF) (HR 1.40, 95% CI 1.10-1.78) and older age (HR 1.02, 95% CI 1.01-1.02 per year increase) at enrolment. Post-primary education (HR 0.67, 95% CI 0.54-0.85) and female sex (HR 0.65, 95%CI 0.52-0.80) were associated with lower risk of death. 204 (6.9%) had new CHF (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or TIA (8.45/1000 patient-years), 19 (0.6%) had ARF (3.49/1000 patient-years), and 20 (0.7%) had IE (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/TIA or systemic embolism. Patients from low and lower-middle income countries had significantly higher age- and sex-adjusted mortality compared to patients from upper-middle income countries. Valve surgery was significantly more common in upper-middle income than in lower-middle- or low-income countries.
CONCLUSIONS: -Patients with clinical RHD have high mortality and morbidity despite being young; those from low and lower-middle income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and treatment of clinical RHD are required to improve outcomes.
Resumo:
Traditional utility analysis only calculates the value of a given selection procedure over random selection. This assumption is not only an inaccurate representation of staffing policy but also leads to overestimates of a device’s value. This paper presents a more accurate method for computing the validity of a selection battery for when there are multiple selection devices and multiple criteria. Application of the method is illustrated using previous utility analysis work and an actual case of administrative assistants with eight predictors and nine criteria. A final example also is provided that includes these advancements as well as other researchers’ advances in a combined utility model. Results reveal that accounting for multiple criteria and outcomes dramatically reduces the utility estimates of implementing new selection devices.
Resumo:
Thesis (Ph.D.)--University of Washington, 2016-08
Resumo:
The adoption of bioregionalism by institutions that are instrumental in river basin management has significant potential to resolve complex water resource management problems. The Westcountry Rivers Trust (WRT) in England provides an example of how localized bioregional institutionalization of adaptive comanagement, consensus decision making, local participation, indigenous technical and social knowledge, and “win-win” outcomes can potentially lead to resilient partnership working. Our analysis of the WRT’s effectiveness in confronting nonpoint source water pollution, previously impervious to centralized agency responses, provides scope for lesson-drawing on institutional design, public engagement, and effective operation, although some evident issues remain.
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Stormwater management has long been a critical societal and environmental challenge for communities. An increasing number of municipalities are turning to novel approaches such as green infrastructure to develop more sustainable stormwater management systems. However, there is a need to better understand the technological decision-making processes that lead to specific outcomes within urban stormwater governance systems. We used the social-ecological system (SES) framework to build a classification system for identifying significant variables that influence urban stormwater governance decisions related to green infrastructure adoption. To adapt the framework, we relied on findings from observations at national stormwater meetings in combination with a systematic literature review on influential factors related to green infrastructure adoption. We discuss our revisions to the framework that helped us understand the decision by municipal governments to adopt green infrastructure. Remaining research needs and challenges are discussed regarding the development of an urban stormwater SES framework as a classification tool for knowledge accumulation and synthesis.
Resumo:
Aim. The most efficacious surgical treatment for renal hyperparathyroidism is still subject of research. Considering its low incidence rate of long-term relapse, “presumed” total parathyroidectomy without autotrasplantation (TP) may be indicated for secondary hyperparathyroidism (2HPT) in patients with chronic kidney disease (CKD), not eligible for kidney transplantation. The aim of this study was to analyse the TP long-term results in 2HPT haemodialysis (HD) patients. Method. Between January 2004 and October 2009, 25 2HPT HD patients, not eligible for kidney transplantation, underwent TP of at least four parathyroid glands. Clinical status and intact parathyroid hormone (iPTH) serum levels were assessed intraoperatively and during a 36-month follow-up. Results. TP improved the typical clinical symptoms and a significant reduction of iPTH serum levels was achieved in each patient. Aparathyroidism was never observed; in case of severe postoperative hypocalcemia, hypocalcemic seizures were never reported and the long-term recurrence rate was 8%. Only one patient received a kidney transplantation. Postoperative cardiovascular events (hypertension, peripheral artery disease, arrhythmia, coronary or cerebrovascular disease) were observed in 32% of cases and mortality rate was 16%. Conclusions. Considering its low long-term relapse rate and the absence of postoperative aparathyroidism, TP may still be considered the treatment of choice in patients with aggressive forms of 2HPT or of advanced dialytic vintage, with no access to renal transplantation. In case of postoperative hypoparathyroidism, hypocalcaemia can be effectively managed by medical treatment.
Resumo:
Modern software application testing, such as the testing of software driven by graphical user interfaces (GUIs) or leveraging event-driven architectures in general, requires paying careful attention to context. Model-based testing (MBT) approaches first acquire a model of an application, then use the model to construct test cases covering relevant contexts. A major shortcoming of state-of-the-art automated model-based testing is that many test cases proposed by the model are not actually executable. These \textit{infeasible} test cases threaten the integrity of the entire model-based suite, and any coverage of contexts the suite aims to provide. In this research, I develop and evaluate a novel approach for classifying the feasibility of test cases. I identify a set of pertinent features for the classifier, and develop novel methods for extracting these features from the outputs of MBT tools. I use a supervised logistic regression approach to obtain a model of test case feasibility from a randomly selected training suite of test cases. I evaluate this approach with a set of experiments. The outcomes of this investigation are as follows: I confirm that infeasibility is prevalent in MBT, even for test suites designed to cover a relatively small number of unique contexts. I confirm that the frequency of infeasibility varies widely across applications. I develop and train a binary classifier for feasibility with average overall error, false positive, and false negative rates under 5\%. I find that unique event IDs are key features of the feasibility classifier, while model-specific event types are not. I construct three types of features from the event IDs associated with test cases, and evaluate the relative effectiveness of each within the classifier. To support this study, I also develop a number of tools and infrastructure components for scalable execution of automated jobs, which use state-of-the-art container and continuous integration technologies to enable parallel test execution and the persistence of all experimental artifacts.
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A bio-economic modelling framework (GRASP-ENTERPRISE) was used to assess the implications of retaining woody regrowth for carbon sequestration on a case study beef grazing property in northern Australia. Five carbon farming scenarios, ranging from 0% to 100% of the property regrowth retained for carbon sequestration, were simulated over a 20-year period (1993–2012). Dedicating regrowth on the property for carbon sequestration reduced pasture (up to 40%) and herd productivity (up to 20%), and resulted in financial losses (up to 24% reduction in total gross margin). A net carbon income (income after grazing management expenses are removed) of $2–4 per t CO2-e was required to offset economic losses of retaining regrowth on a moderately productive (~8 ha adult equivalent–1) property where income was from the sale of weaners. A higher opportunity cost ($ t–1 CO2-e) of retaining woody regrowth is likely for feeder steer or finishing operations, with improved cattle prices, and where the substantial transaction and reporting costs are included. Although uncertainty remains around the price received for carbon farming activities, this study demonstrated that a conservatively stocked breeding operation can achieve positive production, environmental and economic outcomes, including net carbon stock. This study was based on a beef enterprise in central Queensland’s grazing lands, however, the approach and learnings are expected to be applicable across northern Australia where regrowth is present.
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Background. Several pregnancies have been reported after embolization of uterine artery. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids but its safety in women desiring future childbearing is not well established. Case Report. We present a 40-year-old woman with leiomyomata who became pregnant after previously undergone uterine artery embolization for three times. The placenta was previa and the fetus was in transverse position. She had a cesarean delivery of an appropriately grown fetus at 37 weeks, which was followed by uterine atony requiring hysterectomy. Conclusion. Although pregnancy-related outcomes remain understudied, the available reports evidence that pregnancies after uterine artery embolization may be at significantly increased risk for postpartum hemorrhage, cesarean delivery, abnormal placentation, and malpresentation. In patients who are undergoing this type of treatment and contemplating pregnancy, the possibility of adverse complications should be taken in consideration and women should be appropriately advised.