A concept-based framework for retrieving evidence to support emergency physician decision making at the point of care

The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.

Using secondary knowledge to support decision tree classification of retrospective clinical data

Retrospective clinical data presents many challenges for data mining and machine learning. The transcription of patient records from paper charts and subsequent manipulation of data often results in high volumes of noise as well as a loss of other important information. In addition, such datasets often fail to represent expert medical knowledge and reasoning in any explicit manner. In this research we describe applying data mining methods to retrospective clinical data to build a prediction model for asthma exacerbation severity for pediatric patients in the emergency department. Difficulties in building such a model forced us to investigate alternative strategies for analyzing and processing retrospective data. This paper describes this process together with an approach to mining retrospective clinical data by incorporating formalized external expert knowledge (secondary knowledge sources) into the classification task. This knowledge is used to partition the data into a number of coherent sets, where each set is explicitly described in terms of the secondary knowledge source. Instances from each set are then classified in a manner appropriate for the characteristics of the particular set. We present our methodology and outline a set of experiential results that demonstrate some advantages and some limitations of our approach. © 2008 Springer-Verlag Berlin Heidelberg.

A tree-based decision model to support prediction of the severity of asthma exacerbations in children

This paper describes the development of a tree-based decision model to predict the severity of pediatric asthma exacerbations in the emergency department (ED) at 2 h following triage. The model was constructed from retrospective patient data abstracted from the ED charts. The original data was preprocessed to eliminate questionable patient records and to normalize values of age-dependent clinical attributes. The model uses attributes routinely collected in the ED and provides predictions even for incomplete observations. Its performance was verified on independent validating data (split-sample validation) where it demonstrated AUC (area under ROC curve) of 0.83, sensitivity of 84%, specificity of 71% and the Brier score of 0.18. The model is intended to supplement an asthma clinical practice guideline, however, it can be also used as a stand-alone decision tool.

Marketing responsibility in an era of economic and climatic challenge

Purpose – The purpose of this paper is to illustrate Michael Thomas's concept of civic professionalism and social trusteeship as a future alternative to the current marketing profession's code of conduct and to put this in the context of climate change and ecological sustainability as a model for firms everywhere. Design/methodology/approach – Review of the marketing profession's responsibility towards society, communities and the ecology of the planet in the twenty-first century in the light of climate change. Findings – The hypothesis for the paper emerges as: whether it is possible for Chinese firms to embrace the needs of twenty-first century global ecological sustainability in meeting their own economic requirements for development and financial prosperity. Research limitations/implications – Limited secondary research and primary research that is also limited in terms of scope. Practical implications – As we move into an era of Chinese economic supremacy, we marketers must face up to the responsibility we have towards balancing the progression of global economic development (and selling goods and services in global market systems) with our responsibility towards our cultural systems and the global ecological system (the global ecosystem), the home of all our economic wealth. Social implications – To extrapolate lessons and opportunities for firms from developing economies as they move towards global domination of world economic markets and, suggest strategies for sustainability that they can, and should, adopt. Originality/value – The paper presents a theoretical framework for a global strategy for sustainability, and provides a vision of marketing responsibility that embraces civic professionalism, social trusteeship and a strategy for sustainability.

The Specialist: Coming Soon To Your Local Hotel

In an article entitled - The Specialist: Coming Soon To Your Local Hotel - by Stan Bromley, Regional Vice President and General Manager, Four Seasons Clift Hotel, San Francisco, the author’s introduction states: “An experienced hotelier discusses the importance of the delivery of a high “quality-to-value” ratio consistently to guests, particularly as the hotel market becomes specialized and a distinction is drawn between a “property” and a “hotel.” The author’s primary intention is to make you, the reader, aware of changes in the hospitality/hotel marketplace. From the embryo to the contemporary, the hotel market has consistently evolved; this includes but is not limited to mission statement, marketing, management, facilities, and all the tangibles and intangibles of the total hotel experience. “Although we are knocking ourselves out trying to be everything to everyone, I don't think hotel consumers are as interested in “mixing and matching” as they were in the past,” Bromley says. “Today's hotel guest is looking for “specialized care,” and is increasingly skeptical of our industry-wide hotel ads and promises of greatness.” As an example Bromley makes an analogy using retail outlets such as Macy’s, Saks, and Sears, which cater to their own unique market segment. Hotels now follow the same outline, he allows. “In my view, two key factors will make a hotel a success,” advises Bromley. “First, know your specialty and market to that segment. Second, make sure you consistently offer a high quality-to-value ratio. That means every day.” To emphasize that second point, Bromley offers this bolstering thought, “The second factor that will make or break your business is your ability to deliver a high "quality/value" ratio-and to do so consistently.” The author evidently considers quality-to-value ratio to be an important element. Bromley emphasizes the importance of convention and trade show business to the hotel industry. That business element cannot be over-estimated in his opinion. This doesn’t mean an operator who can accommodate that type of business should exclude other client opportunities outside the target market. It does mean, however, these secondary opportunities should only be addressed after pursuing the primary target strategy. After all, the largest profit margin lies in the center of the target. To amplify the above statement, and in reference to his own experience, Bromley says, “Being in the luxury end of the business I, on the other hand, need to uncover and book individuals and small corporate meetings more than convention or association business.

Criminalising the payment for sex in northern ireland; sketching the contours of a moral panic

This paper examines recent legislative developments in Northern Ireland around Lord Morrow’s Human Trafficking & Exploitation (Further Provisions and Support for Victims) Bill that was passed unanimously in the Northern Ireland Assembly and which uniquely in the United Kingdom now makes it a criminal offence to pay for sexual services. I suggest that issues around sex trafficking, sexual slavery and prostitution in Northern Ireland bear all the hallmarks of Stan Cohen’s famous articulation of a moral panic (Cohen 1972) but also argue that his original for- mulation needs to be recast slightly to take account of the horizontal structuring of moral panics in contemporary society.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013

Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015

Modelo de operação de unidades de fragmentação no tratamento de veículos em fim de vida

A recuperação de metais a partir de resíduos é uma actividade ligada à valorização de resíduos que se afigura essencial à preservação de recursos naturais. O tratamento de resíduos metálicos é essencial para o sucesso da reciclagem. O tratamento permite diminuir contaminações com outros materiais, melhorar a valorização e diminuir os custos de transporte. Ao tratamento encontram-se associadas diferentes operações, cuja finalidade é preparar os metais de acordo com os requisitos de processo dos recicladores. A fragmentação é uma das operações de pré-tratamento mais relevantes pela sua capacidade de processamento e pela possibilidade de permitir separar resíduos contaminados com outros materiais. O presente trabalho efectua uma análise inicial ao sector e às tecnologias existentes permitindo introduzir posteriormente o caso de estudo, a instalação em Vila Nova de Gaia da empresa Constantino Fernandes Oliveira & Filhos, SA. O enfoque ao caso de estudo aborda o tema da eficiência energética, um dos principais custos de produção. Nesta perspectiva identifica pontos críticos e estabelece medidas de eficiência energética que permitam reduzir o consumo energético. As medidas propostas foram a colocação de um variador electrónico de velocidade no ventilador principal da fragmentadora e no compressor e a substituição da iluminação existente por iluminação LED. As medidas propostas permitem a redução do consumo específico de energia de 9,39 kgep/t para 8,81 kgep/t. Sendo a fragmentação uma das operações mais relevantes na actividade da instalação estudada, no presente trabalho, efectuou-se a análise do modelo operatório com recurso à aplicação STAN de análise de fluxos de materiais. O procedimento de análise envolveu a criação de vários cenários de exploração no tratamento de resíduos. O objectivo das simulações é a contabilização dos custos referentes ao tratamento dos resíduos permitindo melhorias na vertente operacional, ambiental e económica. Um dos cenários simulados foi a remoção dos veículos em fim de vida dos resíduos a fragmentar, onde se constatou que apesar de uma redução dos resíduos processados, os proveitos por quantidade processada não alteram relativamente ao modelo operatório de base. Este facto deve-se sobretudo aos custos elevados de tratamento de resíduos gerados no processo de fragmentação dos veículos em fim de vida.

Opłata planistyczna. Studium finansowoprawne

Wydział Prawa i Administracji: Katedra Prawa Finansowego