960 resultados para Clinical reasoning
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Z. Huang and Q. Shen. Scale and move transformation-based fuzzy interpolative reasoning: A revisit. Proceedings of the 13th International Conference on Fuzzy Systems, pages 623-628, 2004.
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The impacts of antiretroviral therapy on quality of life, mental health, labor productivity, and economic wellbeing for people living with HIV/AIDS in developing countries are only beginning to be measured. We conducted a systematic literature review to analyze the effect of antiretroviral therapy (ART) on these non-clinical indicators in developing countries and assess the state of research on these topics. Both qualitative and quantitative studies were included, as were peer-reviewed articles, gray literature, and conference abstracts and presentations. Findings are reported from 12 full-length articles, 7 abstracts, and 1 presentation (representing 16 studies). Compared to HIV-positive patients not yet on treatment, patients on ART reported significant improvements in physical, emotional and mental health and daily function. Work performance improved and absenteeism decreased, with the most dramatic changes occurring in the first three months of treatment and then leveling off. Little research has been done on the impact of ART on household wellbeing, with modest changes in child and family wellbeing within households where adults are receiving ART reported so far. Studies from developing countries have not yet assessed non-clinical outcomes of therapy beyond the first year; therefore, longitudinal outcomes are still unknown. As ART roll out extends throughout high HIV prevalence, low-resource countries and is sustained over years and decades, both positive and adverse non-clinical outcomes need to be empirically measured and qualitatively explored in order to support patient adherence and maximize treatment benefits.
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In college courses dealing with material that requires mathematical rigor, the adoption of a machine-readable representation for formal arguments can be advantageous. Students can focus on a specific collection of constructs that are represented consistently. Examples and counterexamples can be evaluated. Assignments can be assembled and checked with the help of an automated formal reasoning system. However, usability and accessibility do not have a high priority and are not addressed sufficiently well in the design of many existing machine-readable representations and corresponding formal reasoning systems. In earlier work [Lap09], we attempt to address this broad problem by proposing several specific design criteria organized around the notion of a natural context: the sphere of awareness a working human user maintains of the relevant constructs, arguments, experiences, and background materials necessary to accomplish the task at hand. We report on our attempt to evaluate our proposed design criteria by deploying within the classroom a lightweight formal verification system designed according to these criteria. The lightweight formal verification system was used within the instruction of a common application of formal reasoning: proving by induction formal propositions about functional code. We present all of the formal reasoning examples and assignments considered during this deployment, most of which are drawn directly from an introductory text on functional programming. We demonstrate how the design of the system improves the effectiveness and understandability of the examples, and how it aids in the instruction of basic formal reasoning techniques. We make brief remarks about the practical and administrative implications of the system’s design from the perspectives of the student, the instructor, and the grader.
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In work that involves mathematical rigor, there are numerous benefits to adopting a representation of models and arguments that can be supplied to a formal reasoning or verification system: reusability, automatic evaluation of examples, and verification of consistency and correctness. However, accessibility has not been a priority in the design of formal verification tools that can provide these benefits. In earlier work [Lap09a], we attempt to address this broad problem by proposing several specific design criteria organized around the notion of a natural context: the sphere of awareness a working human user maintains of the relevant constructs, arguments, experiences, and background materials necessary to accomplish the task at hand. This work expands one aspect of the earlier work by considering more extensively an essential capability for any formal reasoning system whose design is oriented around simulating the natural context: native support for a collection of mathematical relations that deal with common constructs in arithmetic and set theory. We provide a formal definition for a context of relations that can be used to both validate and assist formal reasoning activities. We provide a proof that any algorithm that implements this formal structure faithfully will necessary converge. Finally, we consider the efficiency of an implementation of this formal structure that leverages modular implementations of well-known data structures: balanced search trees and transitive closures of hypergraphs.
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Gesture spotting is the challenging task of locating the start and end frames of the video stream that correspond to a gesture of interest, while at the same time rejecting non-gesture motion patterns. This paper proposes a new gesture spotting and recognition algorithm that is based on the continuous dynamic programming (CDP) algorithm, and runs in real-time. To make gesture spotting efficient a pruning method is proposed that allows the system to evaluate a relatively small number of hypotheses compared to CDP. Pruning is implemented by a set of model-dependent classifiers, that are learned from training examples. To make gesture spotting more accurate a subgesture reasoning process is proposed that models the fact that some gesture models can falsely match parts of other longer gestures. In our experiments, the proposed method with pruning and subgesture modeling is an order of magnitude faster and 18% more accurate compared to the original CDP algorithm.
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Most associative memory models perform one level mapping between predefined sets of input and output patterns1 and are unable to represent hierarchical knowledge. Complex AI systems allow hierarchical representation of concepts, but generally do not have learning capabilities. In this paper, a memory model is proposed which forms concept hierarchy by learning sample relations between concepts. All concepts are represented in a concept layer. Relations between a concept and its defining lower level concepts, are chunked as cognitive codes represented in a coding layer. By updating memory contents in the concept layer through code firing in the coding layer, the system is able to perform an important class of commonsense reasoning, namely recognition and inheritance.
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This paper provides a system description and preliminary results for an ongoing clinical study currently being carried out at the Mid-Western Regional Hospital, Nenagh, Ireland. The goal of the trial is to determine if wireless inertial measurement technology can be employed to identify elderly patients at risk of death or imminent clinical deterioration. The system measures cumulative movement and provides a score that will help provide a robust early warning to clinical staff of clinical deterioration. In addition the study examines some of the logistical barriers to the adoption of wearable wireless technology in front-line medical care.
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Background: Hospital clinicians are increasingly expected to practice evidence-based medicine (EBM) in order to minimize medical errors and ensure quality patient care, but experience obstacles to information-seeking. The introduction of a Clinical Informationist (CI) is explored as a possible solution. Aims: This paper investigates the self-perceived information needs, behaviour and skill levels of clinicians in two Irish public hospitals. It also explores clinicians perceptions and attitudes to the introduction of a CI into their clinical teams. Methods: A questionnaire survey approach was utilised for this study, with 22 clinicians in two hospitals. Data analysis was conducted using descriptive statistics. Results: Analysis showed that clinicians experience diverse information needs for patient care, and that barriers such as time constraints and insufficient access to resources hinder their information-seeking. Findings also showed that clinicians struggle to fit information-seeking into their working day, regularly seeking to answer patient-related queries outside of working hours. Attitudes towards the concept of a CI were predominantly positive. Conclusion: This paper highlights the factors that characterise and limit hospital clinicians information-seeking, and suggests the CI as a potentially useful addition to the clinical team, to help them to resolve their information needs for patient care.
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This Portfolio of Exploration (PoE) tracks a transformative learning developmental journey that is directed at changing meaning making structures and mental models within an innovation practice. The explicit purpose of the Portfolio is to develop new and different perspectives that enable the handling of new and more complex phenomena through self transformation and increased emotional intelligence development. The Portfolio provides a response to the question: ‘What are the key determinants that enable a Virtual Team (VT) to flourish where flourishing means developing and delivering on the firm’s innovative imperatives?’ Furthermore, the PoE is structured as an investigation into how higher order meaning making promotes ‘entrepreneurial services’ within an intra-firm virtual team, with a secondary aim to identify how reasoning about trust influence KGPs to exchange knowledge. I have developed a framework which specifically focuses on the effectiveness of any firms’ Virtual Team (VT) through transforming the meaning making of the VT participants. I hypothesized it is the way KGPs make meaning (reasoning about trust) which differentiates the firm as a growing firm in the sense of Penrosean resources: ‘inducement to expand and a limit of expansion’ (1959). Reasoning about trust is used as a higher order meaning-making concept in line with Kegan’s (1994) conception of complex meaning making, which is the combining of ideas and data in ways that transform meaning and implicates participants to find new ways of knowledge generation. Simply, it is the VT participants who develop higher order meaning making that hold the capabilities to transform the firm from within, providing a unique competitive advantage that enables the firm to grow.
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A notable feature of the surveillance case law of the European Court of Human Rights has been the tendency of the Court to focus on the “in accordance with the law” aspect of the Article 8 ECHR inquiry. This focus has been the subject of some criticism, but the impact of this approach on the manner in which domestic surveillance legislation has been formulated in the Party States has received little scholarly attention. This thesis addresses that gap in the literature through its consideration of the Interception of Postal Packets and Telecommunications Messages (Regulation) Act, 1993 and the Criminal Justice (Surveillance) Act, 2009. While both Acts provide several of the safeguards endorsed by the European Court of Human Rights, this thesis finds that they suffer from a number of crucial weaknesses that undermine the protection of privacy. This thesis demonstrates how the focus of the European Court of Human Rights on the “in accordance with the law” test has resulted in some positive legislative change. Notwithstanding this fact, it is maintained that the legality approach has gained prominence at the expense of a full consideration of the “necessary in a democratic society” inquiry. This has resulted in superficial legislative responses at the domestic level, including from the Irish government. Notably, through the examination of a number of more recent cases, this project discerns a significant alteration in the interpretive approach adopted by the European Court of Human Rights regarding the application of the necessity test. The implications of this development are considered and the outlook for Irish surveillance legislation is assessed.
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Objectives: to assess elderly patients’ dental status and dental habits and compare the survival rates, impact on patients’ quality of life and cost-effectiveness of Atraumatic Restorative Treatment (ART) and a conventional treatment (CT) to restore carious lesions in an elderly population. Methods: In this randomised clinical trial, 99 independently living adults (65-90 yrs) with carious lesions were randomly allocated to receive either ART or CT. Details of restored, missing and carious teeth were recorded and patients answered some questions about their oral hygiene and dental attendance habits. Direct and indirect costs were measured based on treatment time, materials and labour. Effectiveness was measured using restoration survival percentage after one year. The survival of restorations was assessed 6 months and one year after restoration placement by an independent examiner. Oralhealth related quality of life (OHRQoL) was assessed using the OHIP-14 at baseline and 2 months after treatment together with a global transition statement. Results: The patient sample comprised 46 (46.46%) male and 53 (53.54) female participants at baseline, with a mean age of 73.18 (SD=6.76). The mean DMFT of the entire sample was 27.10. Ninety patients and 268 restorations could be assessed after one year, 127 ART (46 patients) and 141 conventional restorations (44 patients). 93.7% and 97.2% of the restorations placed were considered successful in the ART and CT groups, respectively. The OHIP scores did not change dramatically 2 months after treatment, in either group. The global transition scale showed an improvement in overall oral health after treatment for the majority of patients. The ART were more cost-effective compared to the CT restorations. Conclusions: ART presented survival rates similar to CT after 1 year and was a more cost-effective alternative to treat the elderly.
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Bacteriophages, viruses infecting bacteria, are uniformly present in any location where there are high numbers of bacteria, both in the external environment and the human body. Knowledge of their diversity is limited by the difficulty to culture the host species and by the lack of the universal marker gene present in all viruses. Metagenomics is a powerful tool that can be used to analyse viral communities in their natural environments. The aim of this study was to investigate diverse populations of uncultured viruses from clinical (a sputum of patient with cystic fibrosis, CF) and environmental samples (a sludge from a dairy food wastewater treatment plant) containing rich bacterial populations using genetic and metagenomic analyses. Metagenomic sequencing of viruses obtained from these samples revealed that the majority of the metagenomic reads (97-99%) were novel when compared to the NCBI protein database using BLAST. A large proportion of assembled contigs were assignable as novel phages or uncharacterised prophages, the next largest assignable group being single-stranded eukaryotic virus genomes. Sputum from a cystic fibrosis patient contained DNA typical of phages of bacteria that are traditionally involved in CF lung infections and other bacteria that are part of the normal oral flora. The only eukaryotic virus detected in the CF sputum was Torque Teno virus (TTV). A substantial number of assigned sequences from dairy wastewater could be affiliated with phages of bacteria that are typically found in the soil and aquatic environments, including wastewater. Eukaryotic viral sequences were dominated by plant pathogens from the Geminiviridae and Nanoviridae families, and animal pathogens from the Circoviridae family. Antibiotic resistance genes were detected in both metagenomes suggesting phages could be a source for transmissible antimicrobial resistance. Overall, diversity of viruses in the CF sputum was low, with 89 distinct viral genotypes predicted, and higher (409 genotypes) in the wastewater. Function-based screening of a metagenomic library constructed from DNA extracted from dairy food wastewater viruses revealed candidate promoter sequences that have ability to drive expression of GFP in a promoter-trap vector in Escherichia coli. The majority of the cloned DNA sequences selected by the assay were related to ssDNA circular eukaryotic viruses and phages which formed a minority of the metagenome assembly, and many lacked any significant homology to known database sequences. Natural diversity of bacteriophages in wastewater samples was also examined by PCR amplification of the major capsid protein sequences, conserved within T4-type bacteriophages from Myoviridae family. Phylogenetic analysis of capsid sequences revealed that dairy wastewater contained mainly diverse and uncharacterized phages, while some showed a high level of similarity with phages from geographically distant environments.
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Aim: To investigate clinical autonomy and Nurse/Physician collaboration among emergency nurses and the relationship between these concepts, personal characteristics and organisational influences. Background: Nurses have been identified as having a significant role in addressing the challenges of providing modern healthcare. Emergency nurses have reported competence in a wide range of emergency care skills. However, there is evidence that Emergency Department (ED) nurses may have lower levels of clinical autonomy than other areas of practice. Levels of clinical autonomy appear to be influenced by levels of collaboration with physicians and the organisations in which nurses work Methods: A descriptive correlational study using a survey design with a purposive convenience sample of 141 ED staff nurses (response 70.9%) from 3 EDs in Ireland. Data were collected using the Dempster Practice Behaviours Scale (DPBS) the Nurse/Physician Collaboration Scale (NPCS) and the newly developed Organisational Influences on Nursing Scale. Demographic information was also sought from participants. Results: Participants were largely female (87%), relatively young (mean age 35.57, SD=7.83) and educated to degree level (48%) or higher (31%) with 40% posessing specialist emergency nursing qualifications. Participants reported moderate levels of clinical autonomy and Nurse/Physician collaboration. No relationships were found between sample characteristics and clinical autonomy and Nurse/Physician collaboration among emergency nurses. Relationships were found between levels of clinical autonomy and Nurse/Physician collaboration (r=-0.395, n=100, p<0.001), and organisational influence on nursing (r=0.455, p<0.001) and also between Nurse/Physician collaboration and organisational influence on nursing (r=-0.413, p<0.001). Discussion: Clinical autonomy of nurses has been linked with quality outcomes in healthcare. The quest for quality in modern healthcare in a challenging environment should acknowledge that strategies need to focus beyond education and skills provision and include essential elements such as Nurse/Physician collaboration and the organisational influence on nursing to ensure the greater involvement of nurses in patient care.
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In decision making problems where we need to choose a particular decision or alternative from a set of possible choices, we often have some preferences which determine if we prefer one decision over another. When these preferences give us an ordering on the decisions that is complete, then it is easy to choose the best or one of the best decisions. However it often occurs that the preferences relation is partially ordered, and we have no best decision. In this thesis, we look at what happens when we have such a partial order over a set of decisions, in particular when we have multiple orderings on a set of decisions, and we present a framework for qualitative decision making. We look at the different natural notions of optimal decision that occur in this framework, which gives us different optimality classes, and we examine the relationships between these classes. We then look in particular at a qualitative preference relation called Sorted-Pareto Dominance, which is an extension of Pareto Dominance, and we give a semantics for this relation as one that is compatible with any order-preserving mapping of an ordinal preference scale to a numerical one. We apply Sorted-Pareto dominance to a Soft Constraints setting, where we solve problems in which the soft constraints associate qualitative preferences to decisions in a decision problem. We also examine the Sorted-Pareto dominance relation in the context of our qualitative decision making framework, looking at the relevant optimality classes for the Sorted-Pareto case, which gives us classes of decisions that are necessarily optimal, and optimal for some choice of mapping of an ordinal scale to a quantitative one. We provide some empirical analysis of Sorted-Pareto constraints problems and examine the optimality classes that result.