A novel framework for predicting patients at risk of readmission

Uncertainty in decision-making for patients’ risk of re-admission arises due to non-uniform data and lack of knowledge in health system variables. The knowledge of the impact of risk factors will provide clinicians better decision-making and in reducing the number of patients admitted to the hospital. Traditional approaches are not capable to account for the uncertain nature of risk of hospital re-admissions. More problems arise due to large amount of uncertain information. Patients can be at high, medium or low risk of re-admission, and these strata have ill-defined boundaries. We believe that our model that adapts fuzzy regression method will start a novel approach to handle uncertain data, uncertain relationships between health system variables and the risk of re-admission. Because of nature of ill-defined boundaries of risk bands, this approach does allow the clinicians to target individuals at boundaries. Targeting individuals at boundaries and providing them proper care may provide some ability to move patients from high risk to low risk band. In developing this algorithm, we aimed to help potential users to assess the patients for various risk score thresholds and avoid readmission of high risk patients with proper interventions. A model for predicting patients at high risk of re-admission will enable interventions to be targeted before costs have been incurred and health status have deteriorated. A risk score cut off level would flag patients and result in net savings where intervention costs are much higher per patient. Preventing hospital re-admissions is important for patients, and our algorithm may also impact hospital income.

EULAR Recommendations for Women's Health and the Management of Family Planning, Assisted Reproduction, Pregnancy and Menopause in Patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome

OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. CONCLUSIONS: Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.

Infrared image enhancement based on hybrid-domain consideration and data fusion methods

Au cours des dernières décennies, l’effort sur les applications de capteurs infrarouges a largement progressé dans le monde. Mais, une certaine difficulté demeure, en ce qui concerne le fait que les objets ne sont pas assez clairs ou ne peuvent pas toujours être distingués facilement dans l’image obtenue pour la scène observée. L’amélioration de l’image infrarouge a joué un rôle important dans le développement de technologies de la vision infrarouge de l’ordinateur, le traitement de l’image et les essais non destructifs, etc. Cette thèse traite de la question des techniques d’amélioration de l’image infrarouge en deux aspects, y compris le traitement d’une seule image infrarouge dans le domaine hybride espacefréquence, et la fusion d’images infrarouges et visibles employant la technique du nonsubsampled Contourlet transformer (NSCT). La fusion d’images peut être considérée comme étant la poursuite de l’exploration du modèle d’amélioration de l’image unique infrarouge, alors qu’il combine les images infrarouges et visibles en une seule image pour représenter et améliorer toutes les informations utiles et les caractéristiques des images sources, car une seule image ne pouvait contenir tous les renseignements pertinents ou disponibles en raison de restrictions découlant de tout capteur unique de l’imagerie. Nous examinons et faisons une enquête concernant le développement de techniques d’amélioration d’images infrarouges, et ensuite nous nous consacrons à l’amélioration de l’image unique infrarouge, et nous proposons un schéma d’amélioration de domaine hybride avec une méthode d’évaluation floue de seuil amélioré, qui permet d’obtenir une qualité d’image supérieure et améliore la perception visuelle humaine. Les techniques de fusion d’images infrarouges et visibles sont établies à l’aide de la mise en oeuvre d’une mise en registre précise des images sources acquises par différents capteurs. L’algorithme SURF-RANSAC est appliqué pour la mise en registre tout au long des travaux de recherche, ce qui conduit à des images mises en registre de façon très précise et des bénéfices accrus pour le traitement de fusion. Pour les questions de fusion d’images infrarouges et visibles, une série d’approches avancées et efficaces sont proposés. Une méthode standard de fusion à base de NSCT multi-canal est présente comme référence pour les approches de fusion proposées suivantes. Une approche conjointe de fusion, impliquant l’Adaptive-Gaussian NSCT et la transformée en ondelettes (Wavelet Transform, WT) est propose, ce qui conduit à des résultats de fusion qui sont meilleurs que ceux obtenus avec les méthodes non-adaptatives générales. Une approche de fusion basée sur le NSCT employant la détection comprime (CS, compressed sensing) et de la variation totale (TV) à des coefficients d’échantillons clairsemés et effectuant la reconstruction de coefficients fusionnés de façon précise est proposée, qui obtient de bien meilleurs résultats de fusion par le biais d’une pré-amélioration de l’image infrarouge et en diminuant les informations redondantes des coefficients de fusion. Une procédure de fusion basée sur le NSCT utilisant une technique de détection rapide de rétrécissement itératif comprimé (fast iterative-shrinking compressed sensing, FISCS) est proposée pour compresser les coefficients décomposés et reconstruire les coefficients fusionnés dans le processus de fusion, qui conduit à de meilleurs résultats plus rapidement et d’une manière efficace.

Encontra-te

Um dos grandes desafios para a valorização de Portugal como destino cultural, assenta na agregação de toda a oferta que o nosso país apresenta. A música, por tudo aquilo que representa para o nosso país, apresenta as características certas para se tornar num elo de ligação entre a cultura e as pessoas. Nos últimos anos assistimos a uma alteração do consumo de música através de aplicações que emergiram e que alcançaram o seu espaço na sociedade moderna. Paralelamente, temos presenciado no nosso país a um aumento de concertos e espetáculos ao vivo, número de espectadores e de receitas de bilheteira, gerando receitas em torno dos 70 000 000 de euros. Beneficiando da experiência e conhecimento na área musical, este projeto visa desenvolver uma aplicação mobile que funcione como agregador de toda a informação relativa a espetáculos musicais ao vivo na área de Lisboa. Na base da construção do Plano de Negócios foi utilizado o programa FINICIA do Instituto de Apoio às Pequenas e Médias Empresas e à Inovação (IAPMEI) que revelou todas as conjeturas necessárias à sua realização e implementação. Os indicadores de validade do projeto, recolhidos através do questionário online com base no método Delphi, comprovaram a relevância da criação de uma aplicação mobile focada na área da música em Lisboa. De acordo com os indicadores de viabilidade utilizados neste projeto, nomeadamente a Taxa Interna de Rendibilidade (TIR), o Valor Atual Líquido (VAL) e o Período de Payback, foi possível determinar que o mesmo é economicamente viável.

Andamos - Agência de Marketing Digital para Micro Empresas e PMEs

Nos últimos anos, tem sido evidente o crescimento exponencial das novas tecnologias e da utilização frequente de plataformas digitais. A tendência de mercado é a continuação deste aumento, contribuindo para que cada vez mais, surjam prestações de serviços e vendas de produtos no âmbito digital. As agências ocupam um lugar de destaque neste tipo de oferta, no entanto, as mais pequenas tem por vezes dificuldade em subsistir, devido à maioria do seu target serem pequenas e médias empresas. Tendo em conta esta realidade, foi criado o projeto Andamos, que consiste na criação de uma agência de marketing digital, adequada à realidade portuguesa, sendo o seu target micro, pequenas e médias empresas, mas que consiga criar uma estrutura de custos muito reduzidos, potenciando um negócio viável e lucrativo. Nesse sentido, foi desenvolvido uma descrição de projeto, que pretende detalhar o mercado através de benchmark, desenvolver o planeamento estratégico, o plano de marketing e comunicação e o modelo de negócio. Com o intuito de sustentar a validade do projeto, foi efetuado numa primeira fase um estudo, utilizando um questionário segundo o método Delphi, que demonstrou com base nas respostas apuradas, que existe necessidade no mercado, justificando a existência da Andamos. Numa segunda fase foi estudada a viabilidade do projeto, através de um planeamento financeiro, utilizando o modelo FINICIA, do IAPMEI. Por conseguinte, foi possível analisar os indicadores mais importantes, como a TIR, VAL, cash flow e payback period, entre outros, que suportaram a exequibilidade do negócio e a sua capacidade de gerar lucro.

Algarve – relação enogastronómica

Dissertação de Mestrado, Direção e Gestão Hoteleira, Escola Superior de Gestão, Hotelaria e Turismo, Universidade do Algarve, 2015

Os sistemas de Informação, Gestão e Apoio Operacional no apoio à tomada de decisão : O Sistema de Gestão das Salas de Situação

Assistimos hodiernamente à automatização de procedimentos nas organizações, dado à inserção das novas tecnologias, e mais em concreto das ferramentas computacionais, no ambiente organizacional. Esta automatização permite a simplificação do processo de tomada de decisão, a manipulação de dados e lidar com o excesso de informação. No seu dia-a-dia, a Guarda Nacional Republicana enfrenta uma elevada diversidade e complexidade de ocorrências, que motiva a utilização de um sistema de informação que se constitua como primeira linha da Gestão das Ocorrências, permitindo ao comandante gerir criteriosamente os seus meios no processo de tomada de decisão. Este trabalho de investigação tem como objetivo descrever de que forma pode o Sistema de Gestão das Salas de Situação influenciar a tomada de decisão. Para tal foi realizado um estudo de caso, reunindo um grupo de sete Chefes de Sala de Situação, reunindo-os num painel de especialistas para aplicar o método de Delphi, visando inferir as potencialidades do sistema e as vulnerabilidades sentidas pelos operadores. Foram também aplicados inquéritos por questionário aos operadores do sistema no sentido de compreender a sua perceção de utilidade desta ferramenta na gestão de meios. A análise de resultados permitiu verificar que o Sistema de Gestão das Salas de Situação é uma importante ferramenta na gestão de ocorrências, ao fornecer informação necessária à tomada de decisão do comandante, embora possua imperfeições que necessitam de ser mitigadas, no sentido de serem exploradas as potencialidades na sua plenitude. Conclui-se com esta investigação que o Sistema de Gestão das Salas de Situação facilita a tomada de decisão ao fornecer informações acerca das ocorrências ativas na zona de ação da sua Unidade, bem como das patrulhas disponíveis. Este sistema, deve ser complementado com a utilização do Sistema de Informação de Gestão dos meios SIRESP, para que o comandante consiga percecionar a localização das patrulhas disponíveis. Desta forma, o comandante consegue tomar decisões de maneira mais sustentada, permitindo a rápida mobilização dos recursos policiais, visando a excelência operacional e o aumento de eficácia da ação policial.

Business Ethics: towards a map of emergent issues in Europe

[EN] The emergence of the sensitisation in business ethics creates a need to answer some questions. We have placed special attention in three areas: level of development, importance in each European country and the teaching of emergent issues in business ethics. In order to do this, we have selected the Delphi method, with the purpose of the consensus of the most important and relevant business ethics experts.

Study of the impact federated erubrics on assessing competences in the practicum

Presentation Research of the Practicum and externships has a long history and involves important aspects for analysis. For example, the recent changes taking place in university grades allot more credits to the Practicum course in all grades, and the Company-University collaboration has exposed the need to study in new learning environments. The rise of ICT practices like ePortfolios, which require technological solutions and methods supported by experimentation, study and research, require particular examination due to the dynamic momentum of technological innovation. Tutoring the Practicum and externships requires remote monitoring and communication using ePortfolios, and competence-based assessment and students’ requirement to provide evidence of learning require the best tutoring methods available with ePortfolios. Among the elements of ePortfolios, eRubrics emerge as a tool for design, communication and competence-assessment. This project aims to consolidate a research line on eRubrics, already undertaken by another project -I+D+i [EDU2010-15432]- in order to expand the network of researchers and Centres of Excellence in Spain and other countries: Harvard University in USA, University of Cologne in Germany, University of Colima in Mexico, Federal University of Parana, University of Santa Catarina in Brasil, and Stockholm University in Sweden(1). This new project [EDU2013-41974-P](2) examines the impact of eRubrics on tutoring and on assessing the Practicum course and externships. Through technology, distance tutoring grants an extra dimension to human communication. New forms of teaching with technological mediation are on the rise and are highly valuable, not only for formal education but especially in both public and private sectors of non-formal education, such as occupational training, unemployed education and public servant training. Objectives Obj. 1. To analyse models of technology used in assessing learning in the Practicum of all grades at Spanish Faculties of Education. Obj. 2. To study models of learning assessment measured by eRubrics in the Practicum. Obj. 3. To analyse communication through eRubrics between students and their tutors at university and practice centres, focusing on students’ understanding of competences and evidences to be assessed in the Practicum. Obj. 4. To design assessment services and products, in order to federate companies and practice centres with training institutions. Among many other features, it has the following functions CoRubric(3) 1. The possibility to assess people, products or services by using rubrics. 2. Ipsative assessment. 3. Designing fully flexible rubrics. 4. Drafting reports and exporting results from eRubrics in a project. 5. Students and teachers talk about the evaluation and application of the criteria Methodology, Methods, Research Instruments or Sources Used The project will use techniques to collect and analyse data from two methodological approaches: 1. In order to meet the first objective, we suggest an initial exploratory descriptive study (Buendía Eisman, Colás Bravo & Hernández Pina, 1998), which involves conducting interviews with Practicum coordinators from all educational grades across Spain, as well as analysing the contents of the teaching guides used in all educational grades across Spain. 55 academic managers were interviewed from about 10 faculties of education in public universities in Spain (20%), and course guides 376 universities from 36 public institutions in Spain (72%) are analyzed. 2. In order to satisfy the second objective, 7 universities have been selected to implement the project two instruments aimed at tutors practice centers and tutors of the faculty. All instruments for collecting data were validated by experts using the Delphi method. The selection of experts had three aspects: years of professional experience, number and quality of publications in the field (Practicum, Educational Technology and Teacher Training), and self-rating of their knowledge. The resulting data was calculated using the Coefficient of Competence (Kcomp) (Martínez, Zúñiga, Sala & Meléndez, 2012). Results in all cases showed an average experience of more than 0.09 points. The two instruments of the first objective were validated during the first half of 2014-15 year, data collected during the second half. And the second objective during the first half of 2015-16 year and data collection for the second half. The set of four instruments (two for each objective 1 and 2) have the same dimensions as each of the sources (Coordinators, course guides, tutors of practice centers and faculty) as they were: a. Institution-Organization, b. Nature of internships, c. Relationship between agents, d. Management Practicum, e. Assessment. F. Technological support, g. Training and h. Assessment Ethics. Conclusions, Expected Outcomes or Findings The first results respond to Objective 1, where we find different conclusions depending on each of the six dimensions. In the case of internal regulations governing the organization and structure of the practicum, we note that most traditional degrees (Elementary and Primary grades) share common internal rules, in particular development methodology and criteria against other grades (Pedagogy and Social Education ). It is also true that the centers of practices in last cases are very different from each other and can be a public institution, a school, a company, a museum, etc. The memory with a 56.34% and 43.67% daily activities are more demands on students in all degrees, Lesson plans 28.18% 19.72% Portfolio 26.7% Didactic units and Others 32,4%. The technical support has been mainly used the platform of the University 47.89% and 57.75% Email, followed by other services and tools 9.86% and rubric platforms 1.41%. The assessment criteria are divided between formal aspects of 12.38%, Written expresión 12.38%, treatment of the subject 14.45%, methodological rigor of work 10.32%, and Level of argument Clarity and relevance of conclusions 10.32%. In general terms, we could say that there is a trend and debate between formative assessment against a accreditation. It has not yet had sufficient time to further study and confront other dimensions and sources of information. We hope to provide more analysis and conclusions in the conference date.

Building environmental assessment scheme for residential building in Brunei

Building's construction activities, operation and demolition are increasingly recognised as a major source of environmental impact. One strategy for reducing such impacts is most widely known by the term Building Environmental Assessment (BEA). The research is an attempt to develop a new BEA scheme for residential buildings in Brunei which focussing on identifying BEA indicators that best suit for Brunei environment, social and economy. Studies show that Brunei residential sector needs urgent attention to transform its current consumption rate in more sustainable way. Recent launch of Brunei Green Building Council, mandatory energy efficiency guidelines and declaration of ambitious energy intensity reduction target, a new BEA scheme will help contribute sustainability target in residential sector. However the issues of developing a new BEA schemes using existing methods may face constraints in their effectiveness. In this regard, a consensus-forming technique-Delphi method-helps improve greater communication and gain consensus from experts in the construction industry through series of questionnaires. As a result, the final framework is produced comprises of 7 key categories and 37 applicable criteria that achieved high degree of consensus and importance.

Spanish Rheumatology Society and Hospital Pharmacy Society Consensus on recommendations for biologics optimization in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis

The aim of this study was to establish guidelines for the optimization of biologic therapies for health professionals involved in the management of patients with RA, AS and PsA. Recommendations were established via consensus by a panel of experts in rheumatology and hospital pharmacy, based on analysis of available scientific evidence obtained from four systematic reviews and on the clinical experience of panellists. The Delphi method was used to evaluate these recommendations, both between panellists and among a wider group of rheumatologists. Previous concepts concerning better management of RA, AS and PsA were reviewed and, more specifically, guidelines for the optimization of biologic therapies used to treat these diseases were formulated. Recommendations were made with the aim of establishing a plan for when and how to taper biologic treatment in patients with these diseases. The recommendations established herein aim not only to provide advice on how to improve the risk:benefit ratio and efficiency of such treatments, but also to reduce variability in daily clinical practice in the use of biologic therapies for rheumatic diseases

Fuzzy tolerance/equivalence relations from intersection, union and complement operators and their application to a clustering method

This master thesis work introduces the fuzzy tolerance/equivalence relation and its application in cluster analysis. The work presents about the construction of fuzzy equivalence relations using increasing generators. Here, we investigate and research on the role of increasing generators for the creation of intersection, union and complement operators. The objective is to develop different varieties of fuzzy tolerance/equivalence relations using different varieties of increasing generators. At last, we perform a comparative study with these developed varieties of fuzzy tolerance/equivalence relations in their application to a clustering method.

Application of an iterative method and an evolutionary algorithm in fuzzy optimization

This work develops two approaches based on the fuzzy set theory to solve a class of fuzzy mathematical optimization problems with uncertainties in the objective function and in the set of constraints. The first approach is an adaptation of an iterative method that obtains cut levels and later maximizes the membership function of fuzzy decision making using the bound search method. The second one is a metaheuristic approach that adapts a standard genetic algorithm to use fuzzy numbers. Both approaches use a decision criterion called satisfaction level that reaches the best solution in the uncertain environment. Selected examples from the literature are presented to compare and to validate the efficiency of the methods addressed, emphasizing the fuzzy optimization problem in some import-export companies in the south of Spain. © 2012 Brazilian Operations Research Society.

On the Newton method for solving fuzzy optimization problems

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)