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2.
Medicine (Baltimore) ; 98(46): e17510, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725605

RESUMO

Due to the complexity of Crohn's disease (CD), it is difficult to predict disease course with a single stratification factor or biomarker. A logistic regression (LR) model has been proposed by Guizzetti et al to stratify patients with CD-related surgical risk, which could help decision-making on disease treatment. However, there are no reports on relevant studies on Chinese population. The aim of the study is to present and validate a novel surgical predictive model to facilitate therapeutic decision-making for Chinese CD patients. Data was extracted from retrospective full-mode electronic medical records, which contained 239 CD patients and 1524 instances. Two sub-datasets were generated according to different attribute selection strategies, both of which were split into training and testing sets randomly. The imbalanced data in the training sets was addressed by synthetic minority over-sampling technique (SMOTE) algorithm before model development. Seven predictive models were employed using 5 popular machine learning algorithms: random forest (RF), LR, support vector machine (SVM), decision tree (DT) and artificial neural networks (ANN). The performance of each model was evaluated by accuracy, precision, F1-score, true negative (TN) rate, and the area under the receiver operating characteristic curve (AuROC). The result revealed that RF outperformed all other baseline models on both sub-datasets. The 10 leading risk factors for CD-related surgery returned from RF for attribute ranking were changes of radiology, presence of a fistula, presence of an abscess, no infliximab use, enteroscopy findings, C-reactive protein, abdominal pain, white blood cells, erythrocyte sedimentation rate and platelet count. The proposed machine learning model can accurately predict the risk of surgical intervention in Chinese CD patients, which could be used to tailor and modify the treatment strategies for CD patients in clinical practice.


Assuntos
Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Técnicas de Apoio para a Decisão , Endoscopia do Sistema Digestório/estatística & dados numéricos , Modelos Anatômicos , Adulto , Algoritmos , Área Sob a Curva , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , China , Árvores de Decisões , Feminino , Humanos , Modelos Logísticos , Aprendizado de Máquina/estatística & dados numéricos , Masculino , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Máquina de Vetores de Suporte
3.
J Environ Manage ; 252: 109670, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31600687

RESUMO

The use of renewable energy sources instead of conventional energy sources is at the core of policy actions to reduce dependency on fossil fuels worldwide. As a result, especially during the last decade, the cost of renewable energy has significantly decreased, enriching renewable energy cost-competitiveness. Due to the spatial nature of renewable energy sector-related decisions, the synergy of geographical information systems (GIS) and Multiple Criteria Decision Analysis (MCDA) models can enrich the quality of the related decisions given their ability to effectively support land management considerations. Moreover, their implementation significantly enriches the performance of the traditional capital projects evaluation methods (CPEM) by providing physical data to the sizing process in a quick and accurate manner. Thus, decision-making frameworks that combine GIS-based suitability analysis with traditional financial evaluation techniques can significantly enrich the planning phase to achieve efficient installations in terms of required area reduction, power generation maximization and local characteristics examination. With respect to the realization of wind energy exploitation projects, the paper at hand proposes a framework capable of expanding the use of the traditional GIS-based derived suitability index to establishing portfolios. Moreover, the proposed framework is enriched by robust analysis using Monte Carlo Simulation (MCS), which provides significant insights regarding the stability of the derived portfolios and the projects that they comprise. The proposed framework is illustrated through a case study in the Thrace region in northeastern Greece.


Assuntos
Sistemas de Informação Geográfica , Energia Renovável , Tomada de Decisões , Técnicas de Apoio para a Decisão , Grécia
4.
Medicine (Baltimore) ; 98(40): e17368, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577737

RESUMO

This study evaluated the diagnostic performance of a new clinical approach based on decision tree (DT) analysis in adult patients with equivocal computed tomography (CT) findings of acute appendicitis (AA) compared with previous scoring systems.This retrospective study of 244 adult patients with equivocal CT findings included appendicitis (AG, n = 80) and non-appendicitis (NAG, n = 164) groups. The chi-squared automatic interaction detection algorithm was for AA prediction. A receiver operating characteristic curve analysis and area under the curve (AUC) were used to compare the DT analysis with Alvarado, Eskelinen score, and adult appendicitis scores (AAS).The following factors were selected for AA prediction: rebound tenderness severity, migration, urinalysis, symptom duration, leukocytosis, neutrophil count, and C-reactive protein levels. The DT comprised 11 final nodes with the following AA probabilities: node 1, 100% (16/16); node 2, 90% (9/10); node 3, 80% (8/10); node 4, 60.9% (14/23); node 5, 50% (3/6); node 6, 43.8% (7/16); node 7, 22.6% (12/53); node 8, 13% (10/77); node 9, 5.6% (1/18); node 10, 0% (0/12); and node 11, 0% (0/3). The AUC of the DT was higher (0.850 [95% confidence interval {CI}; 0.799-0.893]) than the Alvarado score (0.695 [95% CI; 0.633-0.752]), AAS (0.749 [95% CI; 0.690-0.802]), and the Eskelinen score (0.715 [95% CI; 0.654-0.770]). The results were statistically significant when compared with the AUCs of the Alvarado score, Eskelinen score, and AAS (P < .001, P < .001, P = .003, respectively).The DT-based approach facilitated AA diagnosis and determination of clinical status in patients with equivocal preoperative CT findings and ambiguous results.


Assuntos
Apendicite/diagnóstico , Árvores de Decisões , Dor Abdominal , Doença Aguda , Adulto , Algoritmos , Apendicite/sangue , Apendicite/diagnóstico por imagem , Proteína C-Reativa/análise , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Feminino , Testes Hematológicos , Humanos , Masculino , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Urinálise
5.
J Environ Manage ; 252: 109652, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31629174

RESUMO

Decision-making in environmental management requires eliciting preferences of stakeholders and predicting outcomes of decision alternatives. Usually, preferences and predictions are both uncertain. Uncertainty of predictions can be tackled by multi-attribute utility theory, but the uncertainty of preferences remains a challenge. We demonstrate an approach for including both uncertainties in a multi-criteria decision analysis (MCDA), using utility theory and the concept of expected expected utility. For a decision regarding a regional merger of wastewater infrastructure in Switzerland, we constructed preference models for four stakeholders. These models also allowed for non-additive interactions between objectives. We evaluated the performance of eleven decision alternatives for which we predicted potential outcomes. Even though uncertainties were high, we could draw conclusions based on the expected expected utility of alternatives. Building a pipeline to discharge treated wastewater to a larger river emerged as a potential consensus alternative to mitigate the problem of micropollutants in a small stream. We investigated the robustness of the findings with sensitivity analysis regarding the preference parameters and the included objectives. In their actual decision, the stakeholders partly preferred other alternatives than those proposed by the model. Their choices could be explained by reduced decision models in which only few objectives were included. This may indicate the use of simplified choice heuristics by the stakeholders. The presented approach is feasible for supporting other difficult environmental or engineering decisions in practice, for which we give a number of recommendations.


Assuntos
Tomada de Decisões , Águas Residuárias , Técnicas de Apoio para a Decisão , Suíça , Incerteza
7.
Hu Li Za Zhi ; 66(5): 80-85, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31549384

RESUMO

Shared decision making was used by a primipara with congenital adrenal hyperplasia to make decisions related to her delivery plans and process. The four components of the holistic nursing assessment process (physical, mental, social and spiritual) were conducted by the author from January 9th, 2018 to April 8th, 2018. The major concerns of the subject were anxiety and conflicts related to medical decision making for her health problems. The Case-Centered Care Model and Patient Decision Aids were applied in medical discussions conducted during the period of nursing care. The subject was encouraged to express her feelings during the process. The completed information for the delivery process, including the risks and benefits for the disease, was provided to the subject in order to lower her anxiety, assist her to select the most-appropriate plan for delivery, and ensure high quality, secure nursing care. Using Patient Decision Aids in clinical practice to help pregnant women make the best decisions for their delivery plans is recommended in cases where the patient has congenital adrenal hyperplasia.


Assuntos
Hiperplasia Suprarrenal Congênita , Tomada de Decisões , Parto Obstétrico/psicologia , Ansiedade , Técnicas de Apoio para a Decisão , Feminino , Humanos , Gravidez
8.
Arch Endocrinol Metab ; 63(5): 524-530, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482958

RESUMO

OBJECTIVE: The aim of the study is to describe a portable and convenient software to facilitate the diagnostics of gestational (GDM) and pre-gestational diabetes (PGDM). MATERIALS AND METHODS: An open source software, d-GDM, was developed in Java. The integrated development environment Android Studio was used as the Android operational system. The software for GDM diagnosis uses the criteria endorsed by the International Association of Diabetes and Pregnancy Study Group, modified by the World Health Organization. RESULTS: GDM diagnosis criteria is not simple to follow, therefore, errors or inconsistencies in diagnosis are expected and could delay the appropriate treatment. The d-GDM, was developed to assist GDM diagnosis with precision and consistency diagnostic reports. The open source software can be manipulated conveniently. The operator requires information regarding the gestational period and selects the appropriate glycaemic marker options from the menu. During operation, pressing the button "diagnosticar" on the screen will present the diagnosis and information for the follow up. d-GDM is available in Portuguese or English and can be downloaded from the Google PlayStore. A responsive web version of d-GDM is also available. The usefulness and accuracy of d-GDM was verify by field tests involving 22 subjects and 5 mobile phone brands. The approval regards user-friendliness and efficiency were 95% or higher. The GDM diagnosis were 100% correct, in this pilot test. d-GDM is a user-friendly, free software for diagnosis that was developed for mobile devices. It has the potential to contribute and facilitate the diagnosis of gestational diabetes for healthcare professionals.


Assuntos
Técnicas de Apoio para a Decisão , Diabetes Gestacional/diagnóstico , Aplicativos Móveis , Feminino , Humanos , Gravidez
9.
Transplant Proc ; 51(6): 1907-1912, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399174

RESUMO

BACKGROUND: Liver transplant and liver resection are surgical treatments for hepatocellular carcinoma (HCC) performed with curative intent. While liver transplant provides longer survival when compared to resection, the financial burden on patients and payors is significantly greater. With the increase in health care costs and the emergence of high deductible insurance policies that increase out of pocket deductibles for patients, assessment of value-based treatment is warranted. METHODS: We compiled total billable events from diagnosis of HCC through resection (N = 20) or transplant (N = 24) to death or last reported encounter from January 2011 to December 2012. RESULTS: Patients with HCC receiving resection had a model of end stage liver disease of 10.2 ± 1.2, survival 652 days (3-1, 167 days), and billable encounters of $316,873 ($2904/day). HCC patients receiving a liver transplant had a greater liver injury (model of end stage liver disease of 19.2 ± 3.7), longer survival (1579 days), and higher billable encounters, $740,714 ($2889/day). The surgical procedure represented the largest cost category (28% and 26% resection vs transplant, respectively). The cost effectiveness of treatment was directly proportional to length of survival. In resection, patients who survived >30 days (85%) cost per day dropped to $432. Transplant patients who survived >2 years (75%) saw the cost per day drop to $462. CONCLUSION: The relative financial burdens of liver resection vs liver transplant for treating HCC are comparable in patients who survive beyond a certain threshold. Transplant patients survived longer, and survival beyond 2 years makes this approach cost effective. In a health care climate aiming to contain costs and evaluate value-based treatment paradigms, expected survival and financial burden should be included in the treatment decision analysis.


Assuntos
Carcinoma Hepatocelular/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hepatectomia/economia , Neoplasias Hepáticas/economia , Transplante de Fígado/economia , Carcinoma Hepatocelular/cirurgia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Feminino , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade
10.
Z Evid Fortbild Qual Gesundhwes ; 144-145: 90-99, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31399391

RESUMO

BACKGROUND: Guideline developers can: (1) adopt existing recommendations from others; (2) adapt existing recommendations to their own context; or (3) create recommendations de novo. Monetary and nonmonetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes. OBJECTIVES: To describe a potentially efficient model for guideline production based on adoption, adaptation, and/or de novo development of recommendations utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks. STUDY DESIGN AND SETTING: We applied the model in a new national guideline program producing 22 practice guidelines. We searched for relevant evidence that informs the direction and strength of a recommendation. We then produced GRADE EtDs for guideline panels to develop recommendations. RESULTS: In two waves, a total of 80 EtD frameworks was produced approximately 4 months and 146 EtDs in about 6 months. Use of the EtD frameworks allowed panel members to understand judgments of other guideline groups about the criteria that bear on guideline recommendations and then make their own judgments about those criteria in a systematic approach. CONCLUSION: The "GRADE-ADOLOPMENT" approach to guideline production combines adoption, adaptation, and, as needed, de novo development of recommendations. If guideline developers apply EtD criteria more widely and make their work publically available, this approach should prove even more useful.


Assuntos
Tomada de Decisões , Medicina Baseada em Evidências , Guias de Prática Clínica como Assunto , Técnicas de Apoio para a Decisão , Assistência à Saúde , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Alemanha , Recursos em Saúde , Humanos , Guias de Prática Clínica como Assunto/normas
11.
Methodist Debakey Cardiovasc J ; 15(2): 111-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384374

RESUMO

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. The pathophysiology leading to sudden cardiac death, the specific risks associated with the different varieties of AAOCA, and the effects of different management strategies on the risk of sudden cardiac death are all unknown. This article describes the current knowledge of AAOCA, a proposed nomenclature for the different anatomic subtypes, the different modalities used to diagnose and characterize the disease, the available management strategies, and an algorithm used by the authors to diagnose and manage these patients.


Assuntos
Técnicas de Imagem Cardíaca , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Morte Súbita Cardíaca/prevenção & controle , Algoritmos , Tomada de Decisão Clínica , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Morte Súbita Cardíaca/etiologia , Técnicas de Apoio para a Decisão , Humanos , Seleção de Pacientes , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
12.
Environ Monit Assess ; 191(9): 535, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375991

RESUMO

Selecting the appropriate land use is one of the most important steps toward achieving sustainable development. The main objective of this research is to develop a new method to overcome the contradiction occurring when using the conventional methods to evaluate land suitability for newly reclaimed areas. A spatial model was developed to assess land suitability for wheat in El-Minia Governorate, Egypt, using integration of modeling and geographic information systems-based multi-criteria decision analysis (GIS-MCDA). Land suitability for wheat was performed using two approaches, namely the proposed model (GIS-MCDA) and the parametric method (square root). According to the square root, 75.0% of the study area was classified as not suitable, while the proposed model revealed that 20.5% of the study area was classified as highly suitable and 61.5% as moderately suitable. In order to examine the validity of the proposed model, a comparison was made between the obtained results of both the proposed model and the square root method with the actual yield of the wheat. The correlation coefficient (r) between actual yield and the estimated yield of the square root method was 0.46, while the proposed model gives higher value (r = 0.95), which proves the validity of the proposed model in estimating land suitability for wheat cultivation. The findings of this research revealed that the integration of modeling and GIS-MCDA adopted by the proposed model provides an effective and flexible technique contributing to improve land suitability assessment for wheat in newly reclaimed areas to be more accurate and reliable.


Assuntos
Técnicas de Apoio para a Decisão , Monitoramento Ambiental/métodos , Modelos Teóricos , Desenvolvimento Sustentável , Egito , Sistemas de Informação Geográfica
14.
Rev Lat Am Enfermagem ; 27: e3169, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432922

RESUMO

OBJECTIVE: To develop a web software prototype to support retirement planning. METHOD: This is a methodological research, applied and based on the principles of prototyping model, which followed the steps of communication, planning, prototype creation, functional tests and consolidation of web software version 1. RESULTS: The functions of the web software prototype were defined from a flowchart and scope. In the creation stage, the screens that integrated the prototype, composed by interview, were projected from the filling of the Retirement Resources Inventory, screen of access to support planning materials, including lectures, scientific texts, and technical materials, retirement news screen, experiences screen, which allow users to post retirement expectations and comment on other users' posts. After performing tests, the prototype was made available at www.aposentarsecomsaude.com.br . CONCLUSION: the web software prototype consists of an interactive environment in which the user feels active in the reflection process about the retirement along the different screens. With clear language and expressions that are easily understood by the public, they are applicable to users of different professional profiles.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Aposentadoria , Desenho de Programas de Computador , Brasil , Instrução por Computador , Humanos , Acontecimentos que Mudam a Vida , Motivação , Sistemas On-Line , Reprodutibilidade dos Testes
15.
Stud Health Technol Inform ; 265: 163-168, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431593

RESUMO

Individuals have different preferences in how they wish to relate to healthcare professionals such as doctors. Given choice, they also have preferences in relation to the type and location of support they want for their health and healthcare decisions. We argue that preference-based clusters within this heterogeneity constitute different contexts and that evaluations of decision aids should be context-sensitive in this respect. We draw attention to two distinct preference-based clusters: individuals with a preference for 'intermediative' decision support as a patient, implemented in a largely qualitative deliberative model, on the one hand, and for 'apomediative' decision support as a person, implemented in a largely quantitative multi-criteria decision analytic model, on the other. For convenience, we refer to the latter as Person Decision Support Tools (PDSTs), leaving Patient Decision Aids (PDAs) for its former, conventional use. Seeking to establish proof of method, we present an online PDST that can help individuals establish which of these two types of decision support they would find optimal. It is based on nine key attributes on which PDAs and PDSTs can be contrasted. Within population heterogeneity, preference clusters should be identified, and acknowledged and respected as contexts relevant to the evaluation of decision support tools.


Assuntos
Técnicas de Apoio para a Decisão , Médicos , Tomada de Decisões , Sistemas Especialistas , Humanos , Preferência do Paciente , Software
16.
Stud Health Technol Inform ; 263: 109-121, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31411157

RESUMO

The accumulation of medical knowledge, technology and expertise has provided people with more and more options to improve their health and increase longevity. However, healthcare options typically come with benefits as well as harms and often involve important and complex, high-stakes trade-offs. The ideal of Shared Decision Making (SDM), where a healthcare provider and a patient exchange information, bring in their respective professional and existential expertise and consider the options in light of what matters most from the patient's perspective, is a paradigm that is increasingly viewed as a gold standard for high quality care nowadays. eHealth provides ample opportunities to foster personal health choices and SDM through digital information exchange and personal values clarification support. The boosting framework attempts to describe how to foster people's competences to make choices. Its vision is to equip individuals with competences, for instance improved risk literacy, to empower them to make well-informed choices when facing a difficult choice, such as decisions about health issues. Application of the boosting framework to personal health choices and the SDM process unveils new and promising horizons for future research and could inform the design and evaluation of health informatics interventions such as decision support systems.


Assuntos
Técnicas de Apoio para a Decisão , Informática Médica , Participação do Paciente , Tomada de Decisões , Pessoal de Saúde , Humanos
17.
Stud Health Technol Inform ; 263: 146-158, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31411160

RESUMO

The rising use of the Internet and information technology has made computerized interventions an attractive channel for providing advice and support for behaviour change. Health behaviour and behaviour change theories are a family of theories which aim to explain the mechanisms by which human behaviours change and use that knowledge to promote change. Among the best-known of these theories are the Social Learning and Social Cognitive theories, the Health Belief Model, the Theory of Reasoned Action and its successors the Theory of Planned Behaviour and the Reasoned Action Approach, and the Transtheoretical model. We discuss three examples of how behaviour change theories have been applied in computer-based interventions: a system to aid users to quit smoking, a decision aid for choice of breast cancer therapy, and an internet-based exercise program for reducing cardiovascular risk. We also discuss misapplication of theory, and reflect on how these theories can best be used. Behaviour change theory can be applied in health informatics interventions in several ways; for example, to select participants for a particular intervention, to shape the content of the intervention to effectively influence behaviour, or to tailor content to individual needs. Application of these theories to provide personalized advice ("decision support") is a young but promising area of research, and could inform other decision support interventions, including those that provide support for clinicians.


Assuntos
Exercício , Comportamentos Relacionados com a Saúde , Informática Médica , Técnicas de Apoio para a Decisão , Humanos
18.
J Urol ; 202(5): 1007, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31403917
19.
Environ Monit Assess ; 191(9): 589, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31444584

RESUMO

Different water quality sampling practices such as location selection or frequency can inform future watershed management strategies. The objective of this work was to compare water quality sampling strategies based on different weighted criteria to determine the optimal sampling frequency and sampling location for an urbanized, eutrophic, freshwater system. Weekly water sampling was conducted over a 2-year period at five locations for six water quality parameters. This high frequency (HF) dataset was then deconstructed into a lower frequency (LF) dataset to simulate a monthly sampling strategy. Statistical analyses conducted showed that for all sampling locations the LF datasets were not significantly different from the HF datasets, suggesting monthly sampling is sufficient to capture the overall water quality conditions in this system. A multi-criteria decision analysis was constructed for statistical and operational criteria to determine the optimal sampling locations given different criteria weights. Results showed that the optimal sampling location changed depending on the criteria weighting, suggesting that statistical analyses alone would not be sufficient to determine optimal sampling locations in this system. This analysis was then used if optimal sampling location depended on specific water quality monitoring goals. Results showed that the optimal location depends on the particular water quality monitoring goals and that this effect should also be considered in the design of future sampling programs.


Assuntos
Técnicas de Apoio para a Decisão , Monitoramento Ambiental/métodos , Eutrofização , Qualidade da Água , Água Doce/química , Urbanização
20.
Stud Health Technol Inform ; 264: 576-580, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437989

RESUMO

A fast and frugal generic tool can provide decision support to those making decisions about individual cases, particularly clinicians and clinical commissioners operating within the budget and time constraints of their practices. The multi-national Generic Rapid Evaluation Support Tool (GREST) is a standard preference-sensitive Multi-Criteria Decision Analysis-based tool, but innovatory insofar as an equity criterion is introduced as one of six. Equity impact reflects the number of population QALYs lost or gained in moving from Old (current intervention) to New (contemplated intervention). In the exemplar UK implementation Claxton's NHS Willingness to Pay per QALY is the numeraire. Any weight from 0 to 100% may be assigned to the equity criterion but its presence affirms that it is persons-as-citizens who experience any opportunity harms or benefits arising from actions within the health service commons. A fully-operational but demonstration-only version is available on open access, as proof of concept and method.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Anos de Vida Ajustados por Qualidade de Vida
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