824 resultados para Practice Management, Medical.
Resumo:
The response of montane and subalpine hay meadow plant and arthropod communities to the application of liquid manure and aerial irrigation – two novel, rapidly spreading management practices – remains poorly understood, which hampers the formulation of best practice management recommendations for both hay production and biodiversity preservation. In these nutrient-poor mountain grasslands, a moderate management regime could enhance overall conditions for biodiversity. This study experimentally assessed, at the site scale, among low-input montane and subalpine meadows, the short-term effects (1 year) of a moderate intensification (slurry fertilization: 26.7–53.3 kg N·ha−1·year−1; irrigation with sprinklers: 20 mm·week−1; singly or combined together) on plant species richness, vegetation structure, hay production, and arthropod abundance and biomass in the inner European Alps (Valais, SW Switzerland). Results show that (1) montane and subalpine hay meadow ecological communities respond very rapidly to an intensification of management practices; (2) on a short-term basis, a moderate intensification of very low-input hay meadows has positive effects on plant species richness, vegetation structure, hay production, and arthropod abundance and biomass; (3) vegetation structure is likely to be the key factor limiting arthropod abundance and biomass. Our ongoing experiments will in the longer term identify which level of management intensity achieves an optimal balance between biodiversity and hay production.
Resumo:
El pensamiento médico y el ejercicio de la medicina plantean un cúmulo de problemas filosóficos que no pueden reducirse a la parcela de lo ético. La medicina está atravesada por cuestiones filosóficas que la definen y la constituyen como ciencia. Se trata de cuestiones sobre las cuales gira y se desarrolla el entero ejercicio médico y la medicina teórica. La filosofía y la medicina no deben ser entendidas como dos cuerpos de conocimiento autónomo e independiente, sino que en orden a alcanzar una ciencia más madura y humana, ambas deben embarcarse en un proyecto común. Paul Karl Feyerabend nos ofrece una primera aproximación a esta tesis.
Resumo:
At present, in the University curricula in most countries, the decision theory and the mathematical models to aid decision making is not included, as in the graduate program like in Doctored and Master´s programs. In the Technical School of High Level Agronomic Engineers of the Technical University of Madrid (ETSIA-UPM), the need to offer to the future engineers training in a subject that could help them to take decisions in their profession was felt. Along the life, they will have to take a lot of decisions. Ones, will be important and others no. In the personal level, they will have to take several very important decisions, like the election of a career, professional work, or a couple, but in the professional field, the decision making is the main role of the Managers, Politicians and Leaders. They should be decision makers and will be paid for it. Therefore, nobody can understand that such a professional that is called to practice management responsibilities in the companies, does not take training in such an important matter. For it, in the year 2000, it was requested to the University Board to introduce in the curricula an optional qualified subject of the second cycle with 4,5 credits titled " Mathematical Methods for Making Decisions ". A program was elaborated, the didactic material prepared and programs as Maple, Lingo, Math Cad, etc. installed in several IT classrooms, where the course will be taught. In the course 2000-2001 this subject was offered with a great acceptance that exceeded the forecasts of capacity and had to be prepared more classrooms. This course in graduate program took place in the Department of Applied Mathematics to the Agronomic Engineering, as an extension of the credits dedicated to Mathematics in the career of Engineering.
Resumo:
El propósito de esta tesis doctoral es el desarrollo de un modelo integral de evaluación de la gestión para instituciones de educación superior (IES), fundamentado en valorar la gestión de diferentes subsistemas que la integran, así como estudiar el impacto en la planificación y gestión institucional. Este Modelo de Evaluación Institucional fue denominado Modelo Integral de Evaluación de Gestión de las IES (MIEGIES), que incorpora la gestión de la complejidad, los aspectos gerenciales, el compromiso o responsabilidad social, los recursos, además de los procesos propios universitarios con una visión integral de la gestión. Las bases conceptuales se establecen por una revisión del contexto mundial de la educación superior, pasando por un análisis sobre evaluación y calidad en entornos universitarios. La siguiente reflexión conceptual versó sobre la gestión de la complejidad, de la gestión gerencial, de la gestión de responsabilidad social universitaria, de la gestión de los recursos y de la gestión de los procesos, seguida por un aporte sobre modelaje y modelos. Para finalizar, se presenta un resumen teórico sobre el alcance de la aplicación de ecuaciones estructurales para la validación de modelos. El desarrollo del modelo conceptual, dimensiones e indicadores, fue efectuado aplicando los principios de la metodología de sistemas suaves –SSM. Para ello, se identifica la definición raíz (DR), la razón sistémica de ser del modelo, para posteriormente desarrollar sus componentes y principios conceptuales. El modelo quedó integrado por cinco subsistemas, denominados: de la Complejidad, de la Responsabilidad Social Universitaria, Gerencial, de Procesos y de Recursos. Los subsistemas se consideran como dimensiones e indicadores para el análisis y son los agentes críticos para el funcionamiento de una IES. Los aspectos referidos a lo Epistemetodológico, comenzó por identificar el enfoque epistemológico que sustenta el abordaje metodológico escogido. A continuación se identifican los elementos clásicos que se siguieron para llevar a cabo la investigación: Alcance o profundidad, población y muestra, instrumentos de recolección de información y su validación, para finalizar con la explicación procedimental para validar el modelo MIEGIES. La población considerada para el estudio empírico de validación fueron 585 personas distribuidas entre alumnos, docentes, personal administrativo y directivos de una Universidad Pública Venezolana. La muestra calculada fue de 238 individuos, número considerado representativo de la población. La aplicación de los instrumentos diseñados y validados permitió la obtención de un conjunto de datos, a partir de los cuales se validó el modelo MIEGIES. La validación del Modelo MIGEIES parte de sugerencias conceptuales para el análisis de los datos. Para ello se identificaron las variables relevantes, que pueden ser constructos o conceptos, las variables latentes que no pueden ser medidas directamente, sino que requiere seleccionar los indicadores que mejor las representan. Se aplicó la estrategia de modelación confirmatoria de los Modelos de Ecuaciones Estructurales (SEM). Para ello se parte de un análisis descriptivo de los datos, estimando la fiabilidad. A continuación se aplica un análisis factorial exploratorio y un análisis factorial confirmatorio. Para el análisis de la significancia del modelo global y el impacto en la planificación y gestión, se consideran el análisis de coeficientes de regresión y la tabla de ANOVA asociada, la cual de manera global especifica que el modelo planteado permite explicar la relación entre las variables definidas para la evaluación de la gestión de las IES. Así mismo, se encontró que este resultado de manera global explica que en la evaluación institucional tiene mucha importancia la gestión de la calidad y las finanzas. Es de especial importancia destacar el papel que desarrolla la planificación estratégica como herramienta de gestión que permite apoyar la toma de decisiones de las organizaciones en torno al quehacer actual y al camino que deben recorrer en el futuro para adecuarse a los cambios y a las demandas que les impone el entorno. El contraste estadístico de los dos modelos ajustados, el teórico y el empírico, permitió a través de técnicas estadísticas multivariables, demostrar de manera satisfactoria, la validez y aplicación del modelo propuesto en las IES. Los resultados obtenidos permiten afirmar que se pueden estimar de manera significativa los constructos que definen la evaluación de las instituciones de educación superior mediante el modelo elaborado. En el capítulo correspondiente a Conclusiones, se presenta en una de las primeras instancias, la relación conceptual propuesta entre los procesos de evaluación de la gestión institucional y de los cinco subsistemas que la integran. Posteriormente se encuentra que los modelos de ecuaciones estructurales con base en la estrategia de modelación confirmatoria es una herramienta estadística adecuada en la validación del modelo teórico, que fue el procedimiento propuesto en el marco de la investigación. En cuanto al análisis del impacto del Modelo en la Planificación y la Gestión, se concluye que ésta es una herramienta útil para cerrar el círculo de evaluación institucional. La planificación y la evaluación institucional son procesos inherentes a la filosofía de gestión. Es por ello que se recomienda su práctica como de necesario cumplimiento en todas las instancias funcionales y operativas de las Instituciones de Educación Superior. ABSTRACT The purpose of this dissertation is the development of a comprehensive model of management evaluation for higher education institutions (HEIs), based on evaluating the management of different subsystems and study the impact on planning and institutional management. This model was named Institutional Assessment Comprehensive Evaluation Model for the Management of HEI (in Spanish, MIEGIES). The model incorporates the management of complexity, management issues, commitment and social responsibility and resources in addition to the university's own processes with a comprehensive view of management. The conceptual bases are established by a review of the global context of higher education, through analysis and quality assessment in university environments. The following conceptual discussions covered the management of complexity, management practice, management of university social responsibility, resources and processes, followed by a contribution of modeling and models. Finally, a theoretical overview of the scope of application of structural equation model (SEM) validation is presented. The development of the conceptual model, dimensions and indicators was carried out applying the principles of soft systems methodology (SSM). For this, the root definition (RD), the systemic rationale of the model, to further develop their components and conceptual principles are identified. The model was composed of five subsystems, called: Complexity, University Social Responsibility, Management, Process and Resources. The subsystems are considered as dimensions and measures for analysis and are critical agents for the functioning of HEIs. In matters relating to epistemology and methodology we began to identify the approach that underpins the research: Scope, population and sample and data collection instruments. The classic elements that were followed to conduct research are identified. It ends with the procedural explanation to validate the MIEGIES model. The population considered for the empirical validation study was composed of 585 people distributed among students, faculty, staff and authorities of a public Venezuelan university. The calculated sample was 238 individuals, number considered representative of the population. The application of designed and validated instruments allowed obtaining a data set, from which the MIEGIES model was validated. The MIGEIES Model validation is initiated by the theoretical analysis of concepts. For this purpose the relevant variables that can be concepts or constructs were identified. The latent variables cannot be measured directly, but require selecting indicators that best represent them. Confirmatory modeling strategy of Structural Equation Modeling (SEM) was applied. To do this, we start from a descriptive analysis of the data, estimating reliability. An exploratory factor analysis and a confirmatory factor analysis were applied. To analyze the significance of the overall models the analysis of regression coefficients and the associated ANOVA table are considered. This comprehensively specifies that the proposed model can explain the relationship between the variables defined for evaluating the management of HEIs. It was also found that this result comprehensively explains that for institutional evaluation quality management and finance are very important. It is especially relevant to emphasize the role developed by strategic planning as a management tool that supports the decision making of organizations around their usual activities and the way they should evolve in the future in order to adapt to changes and demands imposed by the environment. The statistical test of the two fitted models, the theoretical and the empirical, enabled through multivariate statistical techniques to demonstrate satisfactorily the validity and application of the proposed model for HEIs. The results confirm that the constructs that define the evaluation of HEIs in the developed model can be estimated. In the Conclusions section the conceptual relationship between the processes of management evaluation and the five subsystems that comprise it are shown. Subsequently, it is indicated that structural equation models based on confirmatory modeling strategy is a suitable statistical tool in validating the theoretical model, which was proposed in the framework of the research procedure. The impact of the model in Planning and Management indicates that this is a useful tool to complete the institutional assessment. Planning and institutional assessment processes are inherent in management philosophy. That is why its practice is recommended as necessary compliance in all functional and operational units of HEIs.
Resumo:
Account book maintained by Dr. Daniel Brigham (1760-1830) for services provided to approximately 180 patients, treated primarily in Northborough, Westborough, and Marlborough, Massachusetts, and surrounding towns between 1781 and 1798. The ledger details the charges for his visits to patients and medicines he prescribed. Common charges included one shilling, four pence for Brigham to visit and administer an emetic or cathartic to a patient. A visit and bloodletting by Brigham cost one patient two shillings, eight pence. He charged six shillings to amputate a toe, and eight pence to extract a tooth. Includes an index to patient names. The ledger also records household and miscellaneous expenses of Brigham.
Resumo:
Ledger maintained by Dr. Daniel Brigham (1760-1837) containing financial accounts for medical patients treated primarily in Northborough, Westborough, and Marlborough, Massachusetts from 1789 to 1837. The ledger details the charges for medical services and the corresponding payments, often made by payment-in-kind. Common charges included a shilling for a visit and administration of cathartics, emetics, or anodynes. Extraction of a tooth cost eight pence, and Brigham charged one woman nine shillings for delivering her son. A number of entries are obscured by pasted-in newspaper articles.
Resumo:
Pseudopregnancy in the bitch is a normal phenomenon. It refers to the dioestrus phase of the bitch's reproductive cycle. It can range in severity from covert pseudopregnancy, in which the signs are barely noticeable, to severe clinical or overt pseudopregnancy. It occurs six to eight weeks following oestrous. The bitch may present with pregnancy-like behaviour including nesting and aggression, excessive mammary enlargement and contractions. These signs are an exaggerated version of the normal signs shown in a normal entire cycling bitch. The exact aetiology behind pseudopregnancy is not known. It is believed to be associated with a rapid decline in serum progesterone concentrations and the resulting surge in prolactin. Treatment may involve conservative management, medical therapy or ovariectomy/ovariohysterectomy. In the past medical therapy has included sex steroids including oestrogens, androgens and progestins. However, due to the frequent incidence and severity of side effects their use is contraindicated. Recommended forms of management incorporate the use of prolactin inhibitors such as cabergoline, metergoline and bromocriptine. These drugs reduce serum levels of prolactin and therefore reduce the development of mammary glands and decrease the behavioural signs associated with overt pseudopregnancy.
Resumo:
Although risk management can be justified by financial distress, the theoretical models usually contain hedging instruments free of funding risk. In practice, management of the counterparty risk in derivative transactions is of enhanced importance, consequently not only is trading on exchanges subject to the presence of a margin account, but also in bilateral (OTC) agreements parties will require margins or collateral from their partners in order to hedge the mark-tomarket loss of the transaction. The aim of this paper is to present and compare two models where the financing need of the hedging instrument also appears, influencing the hedging strategy and the optimal hedging ratio. Both models contain the same source of risk and optimisation criterion, but the liquidity risk is modelled in different ways. In the first model, there is no additional financing resource that can be used to finance the margin account in case of a margin call, which entails the risk of liquidation of the hedging position. In the second model, the financing is available but a given credit spread is to be paid for this, so hedging can become costly.
Resumo:
Aims: To determine the self-assessed continuing professional development (CPD) needs of dental practitioners and identify how each discipline can best be served by a dental CPD programme. To set findings in the context of the available literature and contribute to the development of CPD programmes. Method: Topics were arranged into eight disciplines: practice management; paediatric dentistry; preventive dentistry; orthodontics; behaviour management; dentistry for people with a disability; oral medicine and surgery; and, restorative dentistry. A web-based questionnaire was constructed and administered using a MarkClass 2.21 online survey tool. Results: Fifty-six self-reported assessment responses were received, with three-quarters of participants having graduated within the past 10 years. Topics in oral medicine and surgery attracted consistently high levels of interest. A tendency to favour topics with a perceived direct clinical application was observed. Topics recommended by the Dental Council as core areas for CPD were given a high level of priority by respondents. Conclusions: Traditional lectures remain a valued mode of CPD participation. Practical courses were valued across all dental topics offered. A varied approach to determining the requirements of dentists is essential to appropriately support the practitioner.
Resumo:
In the US, one in every eight deaths is due to an obesity-related chronic health condition (ORCHC). More than half of African American women (AAW) 20 years old or older are obese or morbidly obese, as are 63% of menopausal AAW. Many have ORCHC that increase their morbidity and mortality and increase health care costs. In 2013, 42.6 percent of AAs living in South Carolina (SC) were obese. The purpose of this cross-sectional study was to identify the cognitive, behavioral, biological, and demographic factors that influence health outcomes (BMI, and ORCHC) of AAW living in rural SC. A sample of 200 AAW (50 in each of the 4 groups of rurality by menopausal status), 18-64 years, completed the: Menopausal Rating Scale (symptoms); Body Image Assessment for Obesity (self-perception of body); Mental Health Inventory; Block Food Frequency Questionnaire; Eating Behaviors and Chronic Conditions, Traditional Food Habits, and Food Preparation Technique questionnaires – and measures for Body Mass Index. Most rural, and premenopausal AAW were single and not living with a partner. Premenopausal women had significantly higher educational levels. Sixty percent of AAW had between 1 and 5 ORCHC. Most AAW used salt based seasonings, ate deep fried foods 1 to 3 times a week, and ate outside the home 1 to 3 times a month. Few AAW knew the correct daily serving for grains and dairy, and most consumed less than the recommended daily serving of fruits, vegetables and dairy. Morbidly obese AAW used more traditional food preparation techniques than obese and normal-weight AAW. Rural, and menopausal AAW had significantly higher morbid obesity levels, consumed larger portions of meats and vegetables, and reported more body image dissatisfaction than very rural AAW, and premenopausal AAW, respectively. Controlling for socioeconomic factors the relationships between perceptions of body images, psychological distress, and psychological wellbeing remained significant for numbers of ORCHC
Resumo:
Hedgerows represent important components of agri-environment landscapes that are increasingly coming under threat from climate change, emergent diseases, invasive species and land use change. Given that population genetic data can be used to inform best-practice management strategies for woodland and hedgerow tree species, we carried out a study on hawthorn (Crataegus monogyna Jacq.), a key component of hedgerows, on a regional basis using a combination of nuclear and chloroplast microsatellite markers. We found that levels of genetic diversity were high and comparable to, or slightly higher than, other tree species from the same region. Levels of population differentiation for both sets of markers, however, were extremely low, suggesting extensive gene flow via both seed and pollen. These findings suggest that a holistic approach to woodland management, one which does not necessarily rely on the concept of “seed zones” previously suggested, but which also takes into account populations with high and/or rare chloroplast (i.e. seed-specific) genetic variation, might be the best approach to restocking and replanting.
Resumo:
Cholesterol-lowering treatment by statins is an important and costly issue; however, its role in stroke has not been well documented. The aim of the present study was to review literature and current practice regarding cholesterol-lowering treatment for stroke patients. A literature review was conducted on lipids in stroke and their management with both statins and diet, including the cost-effectiveness of medical nutrition therapy. Qualifying criteria and prescription procedures of the Pharmaceutical Benefits Scheme (PBS) were also reviewed. Data on lipid levels and statin prescriptions were analysed for 468 patients admitted to a stroke unit. The literature shows that management with both medication and diet can be effective, especially when combined; however, 60% of patients with an ischaemic event had fasting total cholesterol measures ≥4 mmol/L (n = 231), with only 52% prescribed statins on discharge (n = 120). Hypercholesterolaemia is an underdiagnosed and undertreated risk factor within the stroke population. It appears that the PBS has not kept pace with advances in the evidence in terms of statin use in the stroke population, and review is needed. The present review should address the qualifying criteria for the stroke population and recommendations on referral to dietitians for dietary advice. Cholesterol-lowering treatment for both stroke patients and the wider population is an area that needs awareness raising and review by the PBS, medical practitioners and dietitians. The role of dietary and pharmacological treatments needs to be clearly defined, including adjunct therapy, and the cost-effectiveness of medical nutrition therapy realised.
Resumo:
"Using the nursing process as a framework for practice, the fourth edition has been extensively revised to reflect the rapid changing nature of nursing practice and the increasing focus on key nursing care priorities. Building on the strengths of the third Australian and New Zealand edition and incorporating relevant global nursing research and practice from the prominent US title Medical-Surgical Nursing, 9Th Edition, Lewis’s Medical-Surgical Nursing, 4th Edition is an essential resource for students seeking to understand the role of the professional nurse in the contemporary health environment."--Publisher website
Resumo:
Chronic disease accounts for about 80 per cent of the total disease burden in Australia, and its management accounts for 70 per cent of all current health expenditure.1 Effective prevention and management of chronic disease requires a coordinated approach between primary health care, acute care services, and the patients.2 However, what is not clear is whether improvements in primary healthcare management can have a clear benefit in the cost of care of patients with chronic disease. We recently completed a pilot study in rural Western Australia to ascertain the feasibility of a coordinated general practice-based approach to managing chronic respiratory and cardiovascular conditions, and to determine the direct cost savings to the public insurer through reduction in avoidable hospital admission. The aim of this correspondence is to share our preliminary findings and encourage debate on how such a project may be scaled up or adapted to other primary healthcare settings.