This paper describes a plan to implement the Delphi method to obtain consensus of expert opinions on policy statements derived from research evidence. The evidence is based on a three-year large-scale European Union (EU) research project ("SEARCH"). The SEARCH project focuses on trade, migration, innovation and institutional issues on relationships between the European Union (EU) and its neighbouring countries (NCs). The main objective of the use of Delphi in this context is to obtain as many high-quality responses and opinions as possible on policy implications of SEARCH project results. The SEARCH Project Delphi aims to inform policy formulation at the EU level, specifically European Neighbourhood Policy (ENP). (author's abstract) / Series: SRE - Discussion Papers

Purpose: While there are diagnostic criteria for functional gastrointestinal disorders (FGIDs), their evaluation is challenging. This is because criteria are based on symptoms, and the underlying pathophysiology is not clear; as such, there are no gold standard tests. Diagnosis is further challenged by considerable clinical overlap between different FGIDs as well as other organic diseases, while many people with FGIDs have more anxiety and depression than healthy individuals. I hypothesised that assessment of separate components of FGIDs that also indicate their effect on the patient could improve diagnosis. My aim was to investigate the evolution of opinions from experts involved in the development of FGID diagnostic criteria on the proposal for the development of multiaxial assessment criteria (MAC) for FGIDs. Methods: I conducted a web-based Delphi study using a group of purposively sampled experts identified from committees of the Rome Foundation and the International Foundation for Gastrointestinal Disorders. From a systematic search of relevant articles, I generated132 items that were sent to experts as a first round survey. The items assessed risk and contributing factors, the therapeutic relationship, areas of evaluation and the advantages and disadvantages of multiaxial assessment. Consensus on an item was reached when 75% of experts indicated that they agreed or strongly agreed with the statement. Key results: 36 of 68 eligible participants (52%) responded to the first round. Consensus was reached on 96 items. Using participant feedback, thematic analysis was used to generate 33 additional items for round two. Thirty-one of 36 participants (86%) replied to rounds two and three. In round two, 19 items gained consensus, and in round three, nine items gained consensus. Participants agreed that multiaxial assessment was needed, using a systematic approach to establish the physiological and psychosocial components of FGIDs. Participants were unable to agree on the importance of physical risk factors such as previous surgery and genetic association. Overall, 124 of the 167 items achieved consensus. Conclusion and inferences: The key finding from my study shows that experts agree that multiaxial assessment of FGIDs is needed. I also identified expert agreement on the consideration of psychological risk factors and the importance of the impact of FGID symptoms on daily life. Findings also show that experts disagreed on the impact of physical risk factors, socioeconomic status and spirituality on people with FGIDs. While experts could not agree on genetic and gender-based risk factors, they considered that these areas are important and require further research.

The use of Standards to reduce the complexity of Health Facilities Design has become an indispensable and integral part of the planning process. Unfortunately the structure of present Standards is inflexible, and while this structure may have been acceptable in the past, the standards it produces have become ineffective. Such Standards have been unable to adapt to the changing attitudes and needs of the planning participants who respond to the societal changes around them. It is our objective to develop a method which can build better Standards. In the first chapter we examine the structural problems of Standards and find that there is a fundamental difference between the positive purpose of Standards as used by hospitals and planners and the restrictive purposes of Standards used by government. We have used the terms Guidelines and Standards to denote these different contexts. Having established that a good Standard is one which is similar to a Guideline, we then explore an alternative structure developed at Berkeley, California, called a "Pattern" which we observe will satisfy the requirements for "good" Standards. Since Pattern formats are admirably suited to developing societally-responsive Guidelines and Standards we evolve a method to assemble these new Standards. This method is based upon the Delphi Technique. It uses the technique's inherent advantages to establish communication between two groups of experts (Planners and Medical) who then interact to explore problems and solutions in planning Newborn Nurseries and Neonatal Intensive Care Units. The methodology which is described in Chapter 2 uses the classical components of a Policy Delphi with three rounds of questionnaires sent to Medical Experts (Physicians and Nurses) in various parts of British Columbia and Alberta. It adds such variations as the including of input from the Planner Experts as one method for the feed back of information. This special Delphi design anticipates effects from independent variables and builds in compensatory steps. One of the steps included is a Mini-Survey of a larger group of potential participants, to evaluate the Patterns resulting from the Delphi Study. This larger group was sixteen hospitals in British Columbia and ten hospitals in Alberta. Chapter 3 describes the details in carrying out the three questioning rounds of this modified Delphi method, and its success in assisting the production of a series of Nursery Patterns which are usable as Guidelines. In the methodology is the inherent capability for retaining flexibility, and there are a series of process adjustments that occur. Evaluation of the method in Chapter 4 shows that despite weaknesses, both anticipated and unanticipated, the results provide an important starting point that helps create better, more usable Standards. Possible future developments are briefly mentioned in the hope that evaluation and change will occur as the planning environment changes about us. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Orientadores : Paulo S. Graziano Magalhães, Sidney Rosa Vieira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Agricola / Made available in DSpace on 2018-07-31T21:20:18Z (GMT). No. of bitstreams: 1 Vendrusculo_LaurimarGoncalves_M.pdf: 3747447 bytes, checksum: 265d9892402e68135bb069374a2b81a4 (MD5) Previous issue date: 2001 / Resumo: A adoção de técnicas e métodos de gerenciamento, mais eficazes, em propriedades rurais visando o aumento da produção agropecuária, em bases sustentáveis, deve merecer mais atenção por parte dos agentes do sistema produtivo. Destaca-se neste trabalho a amostragem de solos com incorporação de métodos sistemáticos e preditivos. É sabido que as propriedades do solo diferenciam-se por seus padrões de variabilidade espacial e temporal. Ao contrário da estatística clássica, a geo-estatística considera a distância para melhor explicar a variância entre as amostras e predizer valores em locais não amostrados. A geo-estatística e outras técnicas integram a abordagem denominada de Agricultura de Precisão, a qual preconiza o tratamento diferenciado para cada área de acordo com as necessidades e potencial produtivo. Dentre seus objetivos a Agricultura de Precisão procura: reduzir desperdícios, aumentar produtividade e garantir a qualidade do meio ambiente. O objetivo deste estudo compreende a concepção e desenvolvimento de um sistema para análise de variabilidade espacial com uso da técnica de geo-estatística. A ferramenta é constituída de módulos que permitem: a modelagem de semivariogramas médios, direcionais e cruzados, o ajuste de modelos matemáticos, o tratamento da estacionariedade dos dados e teste de autovalidação. Permite ainda a interpolação de pontos não amostrados, disponibilizando informações para a geração de mapas de atributos de solo. O sistema utilizou duas ferramentas básicas, a saber: biblioteca de rotinas geo-estatísticas escritas anteriormente em Fortran 77, e ambiente de programação Delphi 5. O sistema desenvolvido foi validado por meio de um conjunto de dados relatado em literatura. Foram estudados os comportamentos espaciais das variáveis Carbono, Nitrogênio e da relação C/N, num esquema de amostragem denso. Os resultados obtidos se mostraram semelhantes aqueles encontrados em literatura específica e a integração das rotinas geo-estatísticas agilizou o processo de análiseem relação ao uso modular das mesmas em ambiente DOS / Abstract: The growing demand for agricultural land is obliging the productive agents to adopt modero methods and teehniques. The soil sampling makes up as an important teehnique since it ean incorporate systematie and predictive tools. lt is known that the soil properties have differenee when analyzing pattems of spatial and temporal variability.Nevertheless, different of the elassical statisties, geostatisties takes into account the distanee between samples pairs to better explain the varianee and to estimate values in areas not sampled. Precision Farming eomprises geostatisties and other techniques, whieh deal with a speeifie management system to eaeh field. The purpose of the precision farming is to inerease the production while guaranteeing the environmental quality and redueing the waste. The goal of this study is to design and develop a eomputer system able to analyze soil spatial variability through geostatistical methods. lt has modules for: modeling of average, directional and cross semivariogram; fitting mathematieal models, data stationarity treating and autovalidation testing. Moreover, attributes soil maps eould be generate by kriging module. Two basies tools have been used to develop the system: Geoestatistieal FORTRAN routines and application development environrnent for Windows Borland Delphi 5. Dataset available in the literature were used to validate the system performanee. Spatial strueture of Carbon, Nitrogen and C/N were studied in dense soil sampling. The results were close with those obtained in specifie literature and the modules integration provided by the system allowed to accelerate the data analysis / Mestrado / Planejamento e Desenvolvimento Rural Sustentável / Mestre em Engenharia Agrícola

Background The University of Cape Town Faculty of Health Sciences (UCT FHS) adopted the Primary Health Care (PHC) approach as its lead theme for teaching, research, and clinical service in1994 Aim To develop indicators to monitor and evaluate the implementation of the PHC approach in Health Sciences Education . Method A Delphi study, conducted over two rounds, presented indicators of Social Accountability from the Training for Health Equity Network (THEnet), as well as indicators derived from the principles of the PHC approach in the UCT FHS, to a national multidisciplinary panel. An electronic questionnaire was used to score each indicator according to relevance, feasibility/measurability, and its application to undergraduate and postgraduate curricula. Qualitative feedback on the proposed indicators was also elicited. Results Round 1: Of the 59 Social Accountability indicators presented to the panel, the 20 highest ranked indicators were selected for Round 2. Qualitative feedback challenged the link between social accountability and PHC, resulting in an additional 19 PHC-specific indicators being presented in Round 2. Round 2: The indicators which scored >85% and made the final list were: PHC: Continuity of care (94%); Holistic understanding of health care (88%); Respecting human rights (88%); Providing accessible care to all (88%); and Promoting health through health education (88%). THEnet: Safety of learners (88%); Education reflects communities' needs (86%); Teaching embodies social accountability (86%); Teaching is appropriate to learners' needs (86%) Conclusion These PHC and THEnet indicators can be used to assess the implementation of PHC in Health Sciences Education. The specific indicators identified reflect priorities relevant to the local context. One limitation is that some key priority indicators did not make the final list.

Introduction: Compassion fatigue is an extreme state of tension and preoccupation with the suffering of those being helped and affects those who work in caring professions. Helping people in distress can traumatise the helper because of their empathetic ability. Nurses who work in ARV clinics witness the suffering of their patients when they listen to their patients' descriptions of the trauma that they have to cope with. The patients get the chance to let go of the trauma and to share their concerns. Unfortunately the nurses often absorb some of the emotional pain of their patients and not all nurses are equipped to handle the situations in such a way that they do not become secondarily affected by the trauma of their patients and therefore, become vulnerable to develop compassion fatigue. If compassion fatigue is not identified in time and addressed adequately, the affected nurses may develop feelings of hopelessness in their ability to take care of their patients with detrimental effect on the quality of nursing care to these patients. Aims: Firstly, to explore and describe the extent of the manifestation of compassion fatigue amongst nurses working in antiretroviral clinics; and secondly, to develop a wellness programme to aid in the identification and management of episodes of compassion fatigue as well as the prevention of future occurrences of such episodes of compassion fatigue amongst nurses working in antiretroviral clinics. Methodology: The researcher conducted the study in two phases. In Phase one, a single embedded case study design, with three sub-units situated within the case, namely nurses who work in the adult, ante-natal and paediatric ARV clinics in a tertiary public hospital, was used. Purposive sampling was used to select seven nurses. Data was collected using semi-structured interviews. The researcher used content analysis as described by Elo and Kyngäs (2008) to analyse the transcribed interviews. The themes identified include the risk to develop compassion fatigue, manifestation of compassion fatigue and strategies to prevent and manage compassion fatigue. For document analysis the researcher used professional and enrolled nurses' job description and the employee health and wellness programme for public service. In Phase two, the researcher developed the wellness programme to aid in the identification, prevention and management of compassion fatigue amongst nurses who work in antiretroviral clinics and the Delphi Method was used to refine the wellness programme. Findings: Nurses working in the ARV clinics are at risk of developing compassion fatigue due to work environment issues such as challenges created by the health care system, lack of support from management, and their overwhelming work load. The cost of the nurse-patient relationship also contributed to nurses being at risk of compassion fatigue. Aspects that were identified that relate to the cost of a relationship with patients who are HIV positive include caring for traumatised patients, vicarious exposure to traumatic experiences of patients, and the influence caring for patients who are HIV positive has had on nurses' personal lives and their families. Nurses can traumatise their family members by continually not being available for them through emotional withdrawal. Nurses presented with physical, psychological, spiritual symptoms and changes in their behaviour that are indicative of compassion fatigue. Various strategies to prevent and manage compassion fatigue were identified: both what nurses can do, and what they expected from management. Nurses' job description is generic and does not spell out their role and function within antiretroviral clinics. The implementation of the health and wellness programme is lacking. The findings of Phase one and related literatures formed the bases from which the researcher developed the wellness programme to aid with the identification, prevention and management of compassion fatigue. Conclusion: Nurses are at risk of developing compassion fatigue due to the cost of the nurse-patient relationship with patients who are HIV positive. The key to prevention of compassion fatigue is awareness and a number of strategies that can aid in the identification, prevention and management of compassion fatigue have been identified and included in the wellness programme. Managerial support and practicing of self-care is important to maintain the health and well-being of nurses who work in antiretroviral clinic. / Thesis (PhD)--University of Pretoria, 2016. / Nursing Science / PhD / Unrestricted

Orientador: Fernando Augusto Silva Marins / Coorientador: Maurício César Delamaro / Banca: Messias Borges Silva / Banca: Otávio José de Oliveira / Banca: Henrique Martins Rocha / Banca: Marco Antonio Carvalho Pereira / Resumo: Esta Tese de doutoramento apresenta um Modelo de Plataforma Integrativa para Soluções Habilitantes (MPISH). Este modelo foi construído a partir de uma pesquisa sobre a Tríplice Hélice (TH) do vale da eletrônica, que se encontra inserido nos limites do município de Santa Rita do Sapucaí, região Sul do Estado de Minas Gerais - Brasil, sob a motivação de conhecer o modus agendi da TH local e por meio de seus integrantes identificar os desafios atuais de cada um dos setores, quais sejam: governo - universidade - indústria. O modelo tem por finalidade promover o envolvimento dos integrantes da TH, visando a criação de programas e ações de desenvolvimento mais adequadas à realidade de uma dada região. O MPISH baseia-se na formação de redes sociais, contemplando a integração de entidades industriais e empresariais, organizações políticas e sociais, poder público, instituições acadêmicas em todos os seus níveis, bem como a própria população, instigando sua associabilidade e valorizando o seu potencial criativo empreendedor. O MPISH sustenta-se no aproveitamento das potencialidades locais, visando desenvolver uma cultura de desenvolvimento participativo de uma região. Neste trabalho foi adotado o método indutivo de pesquisa básica com abordagens qualitativa e quantitativa, tendo objetivo exploratório e descritivo, utilizando levantamento bibliográfico, análise documental e pesquisa de campo. Buscou-se por meio da análise bibliométrica, da revisão sistemática da literatura e das anális... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

Orientador: Maria Rita Marques de Oliveira / Resumo: A Obesidade é um problema de saúde pública altamente prevalente e de caráter complexo, exigindo efetivas políticas públicas. Brasil e Portugal são países de língua portuguesa com sistemas universais de saúde. Cada um, à sua maneira, tem buscado adotar políticas de enfrentamento do problema. Assim, o pressuposto para este trabalho foi que as estratégias para prevenção e cuidado do sobrepeso e obesidade estão presentes nas políticas públicas destes países em sintonia com as diretrizes extranacionais. O objetivo geral foi desenvolver estudo sobre as políticas públicas de Cuidados Primários ao excesso de peso nos adultos, adotadas pelo Brasil e Portugal ao longo das duas últimas décadas. O trabalho envolveu pesquisa documental e a elaboração de matriz de critérios de avaliação dessas políticas. Foi elaborada uma matriz de critérios para avaliação dos Cuidados Primários de Saúde no Brasil e outra em Portugal, com a participação de especialistas de cada país. Foram elaborados três artigos, o primeiro teve por objetivo examinar o percurso da institucionalização das iniciativas de abordagem da obesidade nas políticas públicas de saúde do Brasil e Portugal nas duas últimas décadas, identificando as diretrizes e estratégias de ação. O Segundo artigo teve por objetivo avaliar a validade de constructo e conteúdo de uma matriz avaliativa dos Cuidados Primários de Saúde ao sobrepeso e obesidade no Sistema Único de Saúde do Brasil. O terceiro artigo teve por objetivo identificar e discutir ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Obesity is a highly prevalent and complex public health problem, requiring effective public policies. Brazil and Portugal are Portuguese-speaking countries with universal health systems. Each, in their own way, has sought to adopt policies to face the problem. Thus, the assumption for this work was that strategies for the prevention and care of overweight and obesity are present in the public policies of these countries in line with extranational guidelines. The general objective was to develop a study on the public policies of Primary Care for overweight in adults, adopted by Brazil and Portugal over the last two decades. The work involved documentary research and the elaboration of a matrix of evaluation criteria for these policies. A matrix of criteria was developed for the evaluation of Primary Health Care in Brazil and another in Portugal, with the participation of specialists from each country. Three articles were prepared, the first aimed at examining the path of institutionalization of initiatives to address obesity in public health policies in Brazil and Portugal in the last two decades, identifying guidelines and action strategies. The second article aimed to assess the construct and content validity of an evaluation matrix of Primary Health Care for overweight and obesity in the Brazilian Unified Health System. The third article aimed to identify and discuss the convergences and divergences of a process of construct validity and criteria for evaluating policies of ... (Complete abstract click electronic access below) / Doutor

Cruising, a ten million plus passenger, multi-billion dollar, world-wide industry, is one of tourism's fastest growing sectors. With many new ships entering the market each year, ships must capture the public imagination in order to compete. Over the years the ships that have done this have become legends. This study investigates the qualities necessary for a passenger ship to be identified as a legendary ship and asks how companies make their ships stand out as legends. This study proposes that legendary ships, "grand hotels of the sea," are extensions of other hospitality and tourism legends. Using the Grounded Theory Approach, in which the theory emerges from data, notable ships and their properties were identified from the literature. Integration of categories, factors, and their constituent properties under a Constant Comparative Method created a model of the legendary ship. A Delphi Panel tested and confirmed these properties as well as the study's initial model. It also produced a pool of legendary ships and additional properties. The results were further validated by the passenger shipping public using a world-wide electronic survey. Respondents rated intangible properties such as "External Appearance," "Internal Layout," "Quality of Service and Cuisine," "Funnel Design and Shape," "Repeat Passenger Patronage," "Legacy," "History," "Media Attention," "Speed," "Marine Technology," and "Route;" and the tangible properties of "Facilities, Fittings, and Furnishings," "Size," "Speed," "Marine Technology," and "Non Marine Technology," on their importance and named up to ten ships they considered legendary. Factor analysis was used to divide the properties into four composite factors - "Attractiveness," "Significance," "Power," and "Competitive Advantage." Cluster analysis of the ships produced four legend classifications - "Grand Legends," "Legends," "Demi Legends," and "Personal/Local Legends." Results confirmed the thesis that legendary status is based on superiority across a combination of factors. Those with more intangible properties were found to be stronger, with "Attractiveness," and "Significance" being the strongest. Significantly, no modern cruise ships placed in the top three legend classifications; except Queen Mary 2, built, marketed, and viewed as an ocean liner; indicating that the public views ocean liners and cruise ships as distinct entities. / Ph. D.

Researchers use the policy Delphi method to explore a complex topic with little historical context that requires expert opinion to fully understand underlying issues. The benefit of this research technique is the use of experts who have more timely information than can be gleamed from extant literature. Additionally, those experts place researchers in a specific moment, thus increasing the possibility of capturing change over time. One limitation of the policy Delphi is the difficulty in developing an accurate initial questionnaire to start the process. The purpose of this article is to identify benefits and limitations of this research method.