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1.
J Environ Manage ; 261: 110150, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32148256

RESUMEN

Brownfields redevelopment creates opportunities for enhanced environmental conditions, improved physical and mental health, community cohesion, and economic prosperity. However, brownfields cleanup and recycling projects sometimes fail due to a lack of community engagement. Recent research suggests that such failures can stem from a lack of equitability in the planning process, especially when it comes to decision making. This paper examines issues of equitability in a recent brownfields redevelopment project in Tampa, Florida funded by the U.S. Environmental Protection Agency. The project focused on an underserved and under-resourced community with long-term environmental burdens and health disparities. Our ethnographic research shows that, while the project engaged in multiple and intersecting efforts to include a diversity of community voices in the decision-making process, ultimately structural and organizational power imbalances in sustainability transitions influenced participation in redevelopment initiatives. This study suggests that attending to issues of power articulated through expressions of local and authoritative knowledge about environmental cleanup and redevelopment can lead to deeper levels of community engagement.


Asunto(s)
Restauración y Remediación Ambiental , Toma de Decisiones , Florida , Estados Unidos , United States Environmental Protection Agency
2.
J Environ Manage ; 261: 110216, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32148286

RESUMEN

In Europe, 23% of the generated municipal solid waste (MSW) was landfilled in 2017. Despite the landfill targets which define waste and landfill requirements, there is still high variability in the waste management performance between EU Member States. Aim of the study was to give an overview of the variability of environmental impacts of MSW sanitary landfills in Europe in relation to the different levels of implementation of the requirements. Life cycle assessment (LCA) was adopted as tool to define the impacts of the different landfill conditions over a 100-year period. Based on previous studies, consistent methodological choices were made to allow comparability of the results. Four reference cases were defined based on average bulk MSW compositions to represent the European conditions, with L0 values of 18, 61, 90 and 138 [m3 CH4/t waste]. Furthermore, multiple scenario analysis was used to increase the relevance of the assessment and address the variability of site-specific factors, such as waste composition, climatic conditions and landfill management, which influence the impacts of landfills. Results of the study showed the range of potential impacts in Europe in relation to the variation of influencing factors, with values for climate change ranging from 124 to 841 kg CO2 eq., and with environmental savings obtained for categories such as ecotoxicity and human toxicity for scenarios with landfill gas - to - energy (LFGTE) solutions. The results emphasized the dependence of landfill impacts on waste composition, but also on the LFG treatment and climatic conditions. The outcome of the study also highlight how low amounts of biodegradable fractions reduce the impacts of landfills, as well as their variability in relation to leachate production rates or LFG treatment solutions. Therefore the overall results support the current targets and requirements reported in the Waste Directive 2008/98/EC, Circular Economy package and Landfill Directive 1999/31/EC.


Asunto(s)
Eliminación de Residuos , Residuos Sólidos , Toma de Decisiones , Ambiente , Europa (Continente) , Humanos , Instalaciones de Eliminación de Residuos
3.
Orthop Clin North Am ; 51(2): 241-258, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138862

RESUMEN

The glenohumeral joint is prone to instability. Patients with instability should have a physical examination. Imaging studies can provide additional information. Classification schemes that into account soft tissue pathology, neuromuscular control, bone loss, and activity level. An arthroscopic Bankart repair is the mainstay for unidirectional instability. Bone block procedures are indicated for patients with bone loss or a failed attempt at stabilization surgery. The arthroscopic Latarjet is a promising option for these patients. For patients with multidirectional instability, prolonged rehabilitation is indicated, followed by capsular plication or inferior capsular shift if instability is unresponsive to physical therapy.


Asunto(s)
Inestabilidad de la Articulación/cirugía , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía , Artroscopía , Toma de Decisiones , Humanos , Internacionalidad , Inestabilidad de la Articulación/clasificación , Inestabilidad de la Articulación/diagnóstico , Examen Físico , Luxación del Hombro/clasificación , Luxación del Hombro/diagnóstico , Articulación del Hombro/anatomía & histología
8.
J Med Syst ; 44(5): 93, 2020 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-32189081

RESUMEN

The novel coronavirus (COVID-19) outbreak, which was identified in late 2019, requires special attention because of its future epidemics and possible global threats. Beside clinical procedures and treatments, since Artificial Intelligence (AI) promises a new paradigm for healthcare, several different AI tools that are built upon Machine Learning (ML) algorithms are employed for analyzing data and decision-making processes. This means that AI-driven tools help identify COVID-19 outbreaks as well as forecast their nature of spread across the globe. However, unlike other healthcare issues, for COVID-19, to detect COVID-19, AI-driven tools are expected to have active learning-based cross-population train/test models that employs multitudinal and multimodal data, which is the primary purpose of the paper.


Asunto(s)
Algoritmos , Inteligencia Artificial , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Aprendizaje Automático , Neumonía Viral/epidemiología , Infecciones por Coronavirus/diagnóstico , Toma de Decisiones , Prestación de Atención de Salud , Predicción , Humanos , Neumonía Viral/diagnóstico
9.
West J Emerg Med ; 21(2): 404-410, 2020 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-32191198

RESUMEN

INTRODUCTION: Shortening emergency department (ED) visit time can reduce ED crowding, morbidity and mortality, and improve patient satisfaction. Point-of-care testing (POCT) has the potential to decrease laboratory turnaround time, possibly leading to shorter time to decision-making and ED length of stay (LOS). We aimed to determine whether the implementation of POCT could reduce time to decision-making and ED LOS. METHODS: We conducted a randomized control trial at the Urgency Room of Siriraj Hospital in Bangkok, Thailand. Patients triaged as level 3 or 4 were randomized to either the POCT or central laboratory testing (CLT) group. Primary outcomes were time to decision-making and ED LOS, which we compared using Mann-Whitney-Wilcoxon test. RESULTS: We enrolled a total of 248 patients: 124 in the POCT and 124 in the CLT group. The median time from arrival to decision was significantly shorter in the POCT group (106.5 minutes (interquartile [IQR] 78.3-140) vs 204.5 minutes (IQR 165-244), p <0.001). The median ED LOS of the POCT group was also shorter (240 minutes (IQR 161.3-410) vs 395.5 minutes (IQR 278.5-641.3), p <0.001). CONCLUSION: Using a point-of-care testing system could decrease time to decision-making and ED LOS, which could in turn reduce ED crowding.


Asunto(s)
Toma de Decisiones , Servicio de Urgencia en Hospital , Satisfacción del Paciente , Pruebas en el Punto de Atención , Tiempo de Tratamiento , Aglomeración , Femenino , Hospitales , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Tailandia , Factores de Tiempo , Triaje
10.
Behav Brain Sci ; 43: e10, 2020 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-32159469

RESUMEN

We review evidence that the resource-rationality principle generalizes to human movement control. Optimization of the use of limited neurocomputational resources is described by the inclusion of the "neurocomputational cost" of sensory information processing and decision making in the optimality criterion of movement control. A resulting tendency to decrease this cost can account for various phenomena observed during goal-directed movements.


Asunto(s)
Metas , Movimiento , Cognición , Toma de Decisiones , Humanos , Desempeño Psicomotor
11.
Behav Brain Sci ; 43: e6, 2020 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-32159472

RESUMEN

History can help refine the resource-rational model by uncovering how cultural and cognitive forces act together to shape decision-making. Specifically, history reveals how the meanings of key terms like "problem" and "solution" shift over time. Studying choices in their cultural contexts illuminates how changing perceptions of the decision-making process affect how choices are made on the ground.


Asunto(s)
Cognición , Toma de Decisiones , Humanos
12.
Behav Brain Sci ; 43: e17, 2020 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-32159505

RESUMEN

We propose an alternative and unifying framework for decision-making that, by using quantum mechanics, provides more generalised cognitive and decision models with the ability to represent more information compared to classical models. This framework can accommodate and predict several cognitive biases reported in Lieder & Griffiths without heavy reliance on heuristics or on assumptions of the computational resources of the mind.


Asunto(s)
Cognición , Toma de Decisiones , Sesgo , Heurística , Humanos
13.
Eur J Paediatr Dent ; 21(1): 74-79, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32183534

RESUMEN

AIM: Choosing a paediatric dentist is an important decision for parents. The mechanisms of this selection have hardly been studied. This study assesses the factors influencing parents' decision choosing a specialised paediatric dentist for their child. MATERIALS AND METHODS: A questionnaire consisting of 30 items that could potentially be relevant to decision-making was sent nationwide in Germany to paediatric dentists to be given to the parents of new patients (n=450). Eighty-nine out of 102 returned questionnaires (response rate=22.7%) were evaluated. RESULTS: Parent's and children's experience in previous dental visits played an "important" or "very important" role in choosing a paediatric dentist (78.8% and 62.2%, respectively). The most frequently mentioned recommendation for the paediatric dentist was by friends and acquaintances (86.5%). Recommendations from other dentists were often included in the decision making (60.7%), while specialist journals or Internet portals were less important for the respondents (15% and 19%, respectively). Most of the parents used Internet search engines and the practice website to obtain information. CONCLUSION: Previous negative experience with general dentists was the main reason for visiting a specialised paediatric dentist. Recommendations came mostly from the close social environment and the qualifications were the most important feature for choosing a paediatric dentist.


Asunto(s)
Actitud Frente a la Salud , Padres , Niño , Conducta Infantil , Toma de Decisiones , Odontólogos , Humanos , Encuestas y Cuestionarios
14.
N Engl J Med ; 382(12): 1161-1162, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32187474
15.
Bone Joint J ; 102-B(3): 365-370, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114820

RESUMEN

AIMS: Patient-specific instrumentation has been shown to increase a surgeon's precision and accuracy in placing the glenoid component in shoulder arthroplasty. There is, however, little available information about the use of patient-specific planning (PSP) tools for this operation. It is not known how these tools alter the decision-making patterns of shoulder surgeons. The aim of this study was to investigate whether PSP, when compared with the use of plain radiographs or select static CT images, influences the understanding of glenoid pathology and surgical planning. METHODS: A case-based survey presented surgeons with a patient's history, physical examination, and, sequentially, radiographs, select static CT images, and PSP with a 3D imaging program. For each imaging modality, the surgeons were asked to identify the Walch classification of the glenoid and to propose the surgical treatment. The participating surgeons were grouped according to the annual volume of shoulder arthroplasties that they undertook, and responses were compared with the recommendations of two experts. RESULTS: A total of 59 surgeons completed the survey. For all surgeons, the use of the PSP significantly increased agreement with the experts in glenoid classification (x2 = 8.54; p = 0.014) and surgical planning (x2 = 37.91; p < 0.001). The additional information provided by the PSP also showed a significantly higher impact on surgical decision-making for surgeons who undertake fewer than ten shoulder arthroplasties annually (p = 0.017). CONCLUSIONS: The information provided by PSP has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and PSP brings all surgeons in to closer agreement with the recommendations of experts for glenoid classification and surgical planning. Cite this article: Bone Joint J 2020;102-B(3):365-370.


Asunto(s)
Artroplastía de Reemplazo de Hombro/métodos , Toma de Decisiones , Imagen Tridimensional , Osteoartritis/cirugía , Articulación del Hombro/cirugía , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Articulación del Hombro/diagnóstico por imagen
16.
Artículo en Ruso | MEDLINE | ID: mdl-32119203

RESUMEN

The actual conditions of "physician-patient" interaction in hospital department presents high requirements to quality and rate of provided services. The development of conflicts because of misunderstanding of behavior motivation of physician and patient in hospital department determined purpose of actual study. The standardized psychological questionnaire "Big Five" and Myers-Briggs questionnaire were used to obtain needed data. The study results were statistically processed using Student's test. The statistical analysis established in physicians and patients' reliable difference in indices of "attachment - isolation" (p=0.035), prevalence in physicians of mental processes (p=0.001) and sensuous component in social interaction of patients (p=0.025). The physician of orthopedic department seeks to keep exact logical sequence of actions. The patients fully rely on their feelings in their decision making. The established hypersensitivity of patients and inner strive to move "not according plan" results in disagreements concerning therapeutic strategy and failure in strict applications of all physician recommendations that frequently becomes a cause of uncoordinated actions and conflict situations.


Asunto(s)
Toma de Decisiones , Médicos , Traumatología , Humanos , Motivación , Encuestas y Cuestionarios
18.
Quintessence Int ; 51(3): 248-257, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32020135

RESUMEN

Artificial intelligence (AI) encompasses a broad spectrum of emerging technologies that continue to influence daily life. The evolution of AI makes the analysis of big data possible, which provides reliable information and improves the decision-making process. This article introduces the principles of AI and reviews the development of AI and how it is currently being used. AI technology has influenced the health care field because of the need for accurate diagnosis and superior patient care. In order to understand the trend of AI in dentistry, electronic searching was carried out, combined with approaching individual companies to obtain the details of AI-based services. The current applications of AI in clinical dentistry were introduced and summarized. In the future, the AI-based comprehensive care system is expected to establish high-quality patient care and innovative research and development, facilitating advanced decision support tools. The authors believe that an innovative inter-professional coordination among clinicians, researchers, and engineers will be the key to AI development in the field of dentistry. Despite the potential misinterpretations and the concern of patient privacy, AI will continue to connect with dentistry from a comprehensive perspective due to the need for precise treatment procedures and instant information exchange. Moreover, such developments will enable professionals to share health-related big data and deliver insights that improve patient care through hospitals, providers, researchers, and patients.


Asunto(s)
Inteligencia Artificial , Odontología , Toma de Decisiones , Predicción , Humanos
20.
Rev Med Suisse ; 16(680): 275-277, 2020 Feb 05.
Artículo en Francés | MEDLINE | ID: mdl-32022494

RESUMEN

Prostate cancer screening remains controversial as the reduction in mortality is outweighed by overdiagnosis and overtreatment. Prostate specific antigen (PSA) testing remains a recurring issue for primary care physicians. Although the last guidelines recommend against the screening, everyone agreed on the importance of the shared decision-making process to inform the patient about the potential benefits and harms of screening. Existing decision support tools can help in this complex discussion. This clinical case report depicts the infectious risks of prostate biopsy that are often underestimated.


Asunto(s)
Tamizaje Masivo/efectos adversos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Toma de Decisiones , Detección Precóz del Cáncer/efectos adversos , Humanos , Masculino
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