896 resultados para Decision-support tools
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"May 1991."
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"January 1991."
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Thesis (Ph.D.)--University of Washington, 2016-06
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In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF. Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P=0.06) and from 13.4% to 10.1% (P= 0.06) for patients with ACS and from 22.8% to 15.2% (P < 0.001) and from 32.8% to 22.4% (P= 0.005) for patients with CHF. Quality improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes.
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In both Australia and Brazil there are rapid changes occurring in the macroenvironment of the dairy industry. These changes are sometimes not noticed in the microenvironment of the farm, due to the labour-intensive nature of family farms, and the traditionally weak links between production and marketing. Trends in the external environment need to be discussed in a cooperative framework, to plan integrated actions for the dairy community as a whole and to demand actions from research, development and extension (R, D & E). This paper reviews the evolution of R, D & E in terms of paradigms and approaches, the present strategies used to identify dairy industry needs in Australia and Brazil, and presents a participatory strategy to design R, D & E actions for both countries. The strategy incorporates an integration of the opinions of key industry actors ( defined as members of the dairy and associated communities), especially farm suppliers ( input market), farmers, R, D & E people, milk processors and credit providers. The strategy also uses case studies with farm stays, purposive sampling, snowball interviewing techniques, semi-structured interviews, content analysis, focus group meetings, and feedback analysis, to refine the priorities for R, D & E actions in the region.
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This paper investigates how demographic (socioeconomic) and land-use (physical and environmental) data can be integrated within a decision support framework to formulate and evaluate land-use planning scenarios. A case-study approach is undertaken with land-use planning scenarios for a rapidly growing coastal area in Australia, the Shire of Hervey Bay. The town and surrounding area require careful planning of the future urban growth between competing land uses. Three potential urban growth scenarios are put forth to address this issue. Scenario A ('continued growth') is based on existing socioeconomic trends. Scenario B ('maximising rates base') is derived using optimisation modelling of land-valuation data. Scenario C ('sustainable development') is derived using a number of social, economic, and environmental factors and assigning weightings of importance to each factor using a multiple criteria analysis approach. The land-use planning scenarios are presented through the use of maps and tables within a geographical information system, which delineate future possible land-use allocations up until 2021. The planning scenarios are evaluated by using a goal-achievement matrix approach. The matrix is constructed with a number of criteria derived from key policy objectives outlined in the regional growth management framework and town planning schemes. The authors of this paper examine the final efficiency scores calculated for each of the three planning scenarios and discuss the advantages and disadvantages of the three land-use modelling approaches used to formulate the final scenarios.
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Power systems are large scale nonlinear systems with high complexity. Various optimization techniques and expert systems have been used in power system planning. However, there are always some factors that cannot be quantified, modeled, or even expressed by expert systems. Moreover, such planning problems are often large scale optimization problems. Although computational algorithms that are capable of handling large dimensional problems can be used, the computational costs are still very high. To solve these problems, in this paper, investigation is made to explore the efficiency and effectiveness of combining mathematic algorithms with human intelligence. It had been discovered that humans can join the decision making progresses by cognitive feedback. Based on cognitive feedback and genetic algorithm, a new algorithm called cognitive genetic algorithm is presented. This algorithm can clarify and extract human's cognition. As an important application of this cognitive genetic algorithm, a practical decision method for power distribution system planning is proposed. By using this decision method, the optimal results that satisfy human expertise can be obtained and the limitations of human experts can be minimized in the mean time.
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This paper highlights challenges in implementing mental health policy at a service delivery level. It describes an attempt to foster greater application of recovery-orientated principles and practices within mental health services. Notwithstanding a highly supportive policy environment, strong support from service administrators, and an enthusiastic staff response to training, application of the training and support tools was weaker than anticipated. This paper evaluates the dissemination trial against key elements to promote sustained adoption of innovations. Organisational and procedural changes are required before mental health policies are systematically implemented in practice.
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The consequences of demographic dissimilarity for group trust in work teams was examined in a virtual (computer-mediated) and a face-to-face (FTF) environment. Demographic dissimilarity (based on age, gender, country of birth, enrolled degree) was predicted to be negatively associated with group trust in the FTF environment but not in the computer-mediated environment. Participants worked in small groups on a creative task for 3 consecutive days. In the computer-mediated environment, participants worked on the task for an hour per day. In the FTF environment, participants worked on the task for 20 minutes per day. Partial support was found for the effectiveness of computer-mediated groups in reducing the negative consequences of dissimilarity. Age dissimilarity was negatively related to trust in FTF groups but not in computer-mediated groups. Birthplace dissimilarity was positively related to trust in computer-mediated groups. Implications for the successful management of virtual teams are discussed.
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bstract: During the Regional Forest Agreement (RFA) process in south-east Queensland, the conservation status of, and threats to, priority vascular plant taxa in the region was assessed. Characteristics of biology, demography and distribution were used to assess the species' intrinsic risk of extinction. In contrast, the threats to the taxa (their extrinsic risk of extinction) were assessed using a decision-support protocol for setting conservation targets for taxa lacking population viability analyses and habitat modelling data. Disturbance processes known or suspected to be adversely affecting the taxa were evaluated for their intensity, extent and time-scale. Expert opinion was used to provide much of the data and to assess the recommended protection areas. Five categories of intrinsic risk of extinction were recognised for the 105 priority taxa: critically endangered (43 taxa); endangered (29); vulnerable (21); rare (10); and presumed extinct (2). Only 6 of the 103 extant taxa were found to be adequately reserved and the majority were considered inadequately protected to survive the current regimes of threatening processes affecting them. Data were insufficient to calculate a protection target for one extant taxon. Over half of the taxa require all populations to be conserved as well as active management to alleviate threatening processes. The most common threats to particular taxa were competition from weeds or native species, inappropriate fire regimes, agricultural clearing, forestry, grazing by native or feral species, drought, urban development, illegal collection of plants, and altered hydrology. Apart from drought and competition from native species, these disturbances are largely influenced or initiated by human actions. Therefore, as well as increased protection of most of the taxa, active management interventions are necessary to reduce the effects of threatening processes and to enable the persistence of the taxa.
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Researchers and extension officers collaborated with farmers in addressing peanut cropping and sowing decisions using on-farm experiments and cropping systems simulation in the Pollachi region of Tamil Nadu, India. The most influential variable affecting the peanut productivity in this irrigated region regard sowing date. During the 1998-1999 rabi (post rainy) season, three farmers fields in villages in Pollachi region were selected and monitored. The APSIM model was used to simulate the effect of sowing date. The APSIM-Peanut module simulation demonstrated close correspondence with the field observation in predicting yield. The model predicted that December sowing resulted in higher yield than January sowing due to longer pod filling period, and this was confirmed by farmer experience. The farmers and extension officers became comfortable with their role as owners of the collaborative experiments and custodians of the learning environment.
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Global Software Development (GSD) is an emerging distributive software engineering practice, in which a higher communication overhead due to temporal and geographical separation among developers is traded with gains in reduced development cost, improved flexibility and mobility for developers, increased access to skilled resource-pools and convenience of customer involvements. However, due to its distributive nature, GSD faces many fresh challenges in aspects relating to project coordination, awareness, collaborative coding and effective communication. New software engineering methodologies and processes are required to address these issues. Research has shown that, with adequate support tools, Distributed Extreme Programming (DXP) – a distributive variant of an agile methodology – Extreme Programming (XP) can be both efficient and beneficial to GDS projects. In this paper, we present the design and realization of a collaborative environment, called Moomba, which assists a distributed team in both instantiation and execution of a DXP process in GSD projects.