983 resultados para Practical nurses


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The biggest challenge in conservation biology is breaking down the gap between research and practical management. A major obstacle is the fact that many researchers are unwilling to tackle projects likely to produce sparse or messy data because the results would be difficult to publish in refereed journals. The obvious solution to sparse data is to build up results from multiple studies. Consequently, we suggest that there needs to be greater emphasis in conservation biology on publishing papers that can be built on by subsequent research rather than on papers that produce clear results individually. This building approach requires: (1) a stronger theoretical framework, in which researchers attempt to anticipate models that will be relevant in future studies and incorporate expected differences among studies into those models; (2) use of modern methods for model selection and multi-model inference, and publication of parameter estimates under a range of plausible models; (3) explicit incorporation of prior information into each case study; and (4) planning management treatments in an adaptive framework that considers treatments applied in other studies. We encourage journals to publish papers that promote this building approach rather than expecting papers to conform to traditional standards of rigor as stand-alone papers, and believe that this shift in publishing philosophy would better encourage researchers to tackle the most urgent conservation problems.

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This article reflects on key methodological issues emerging from children and young people's involvement in data analysis processes. We outline a pragmatic framework illustrating different approaches to engaging children, using two case studies of children's experiences of participating in data analysis. The article highlights methods of engagement and important issues such as the balance of power between adults and children, training, support, ethical considerations, time and resources. We argue that involving children in data analysis processes can have several benefits, including enabling a greater understanding of children's perspectives and helping to prioritise children's agendas in policy and practice. (C) 2007 The Author(s). Journal compilation (C) 2007 National Children's Bureau.

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Goal modelling is a well known rigorous method for analysing problem rationale and developing requirements. Under the pressures typical of time-constrained projects its benefits are not accessible. This is because of the effort and time needed to create the graph and because reading the results can be difficult owing to the effects of crosscutting concerns. Here we introduce an adaptation of KAOS to meet the needs of rapid turn around and clarity. The main aim is to help the stakeholders gain an insight into the larger issues that might be overlooked if they make a premature start into implementation. The method emphasises the use of obstacles, accepts under-refined goals and has new methods for managing crosscutting concerns and strategic decision making. It is expected to be of value to agile as well as traditional processes.

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Sequential methods provide a formal framework by which clinical trial data can be monitored as they accumulate. The results from interim analyses can be used either to modify the design of the remainder of the trial or to stop the trial as soon as sufficient evidence of either the presence or absence of a treatment effect is available. The circumstances under which the trial will be stopped with a claim of superiority for the experimental treatment, must, however, be determined in advance so as to control the overall type I error rate. One approach to calculating the stopping rule is the group-sequential method. A relatively recent alternative to group-sequential approaches is the adaptive design method. This latter approach provides considerable flexibility in changes to the design of a clinical trial at an interim point. However, a criticism is that the method by which evidence from different parts of the trial is combined means that a final comparison of treatments is not based on a sufficient statistic for the treatment difference, suggesting that the method may lack power. The aim of this paper is to compare two adaptive design approaches with the group-sequential approach. We first compare the form of the stopping boundaries obtained using the different methods. We then focus on a comparison of the power of the different trials when they are designed so as to be as similar as possible. We conclude that all methods acceptably control type I error rate and power when the sample size is modified based on a variance estimate, provided no interim analysis is so small that the asymptotic properties of the test statistic no longer hold. In the latter case, the group-sequential approach is to be preferred. Provided that asymptotic assumptions hold, the adaptive design approaches control the type I error rate even if the sample size is adjusted on the basis of an estimate of the treatment effect, showing that the adaptive designs allow more modifications than the group-sequential method.

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Objectives: To assess the potential source of variation that surgeon may add to patient outcome in a clinical trial of surgical procedures. Methods: Two large (n = 1380) parallel multicentre randomized surgical trials were undertaken to compare laparoscopically assisted hysterectomy with conventional methods of abdominal and vaginal hysterectomy; involving 43 surgeons. The primary end point of the trial was the occurrence of at least one major complication. Patients were nested within surgeons giving the data set a hierarchical structure. A total of 10% of patients had at least one major complication, that is, a sparse binary outcome variable. A linear mixed logistic regression model (with logit link function) was used to model the probability of a major complication, with surgeon fitted as a random effect. Models were fitted using the method of maximum likelihood in SAS((R)). Results: There were many convergence problems. These were resolved using a variety of approaches including; treating all effects as fixed for the initial model building; modelling the variance of a parameter on a logarithmic scale and centring of continuous covariates. The initial model building process indicated no significant 'type of operation' across surgeon interaction effect in either trial, the 'type of operation' term was highly significant in the abdominal trial, and the 'surgeon' term was not significant in either trial. Conclusions: The analysis did not find a surgeon effect but it is difficult to conclude that there was not a difference between surgeons. The statistical test may have lacked sufficient power, the variance estimates were small with large standard errors, indicating that the precision of the variance estimates may be questionable.

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Graphical tracking is a technique for crop scheduling where the actual plant state is plotted against an ideal target curve which encapsulates all crop and environmental characteristics. Management decisions are made on the basis of the position of the actual crop against the ideal position. Due to the simplicity of the approach it is possible for graphical tracks to be developed on site without the requirement for controlled experimentation. Growth models and graphical tracks are discussed, and an implementation of the Richards curve for graphical tracking described. In many cases, the more intuitively desirable growth models perform sub-optimally due to problems with the specification of starting conditions, environmental factors outside the scope of the original model and the introduction of new cultivars. Accurate specification for a biological model requires detailed and usually costly study, and as such is not adaptable to a changing cultivar range and changing cultivation techniques. Fitting of a new graphical track for a new cultivar can be conducted on site and improved over subsequent seasons. Graphical tracking emphasises the current position relative to the objective, and as such does not require the time consuming or system specific input of an environmental history, although it does require detailed crop measurement. The approach is flexible and could be applied to a variety of specification metrics, with digital imaging providing a route for added value. For decision making regarding crop manipulation from the observed current state, there is a role for simple predictive modelling over the short term to indicate the short term consequences of crop manipulation.