MS

thesisNursing service administrators strive to provide quality patient care through retention of competent, motivated nurses. Nurse job satisfaction is essential to retention and critical in Intensive Care Units (ICUs). Although there are many variables contributing to nurse job satisfaction, this study examined ICU staff nurse job satisfaction in relationship to performance appraisal systems, frequency of feedback and certain demographic characteristics. ICU staff nurses from three private hospitals responded to the study by completing a Personal Satisfaction Inventory instrument, a question on frequency of feedback and demographic questionnaire. An expert panel, instructed in motivational theory, examined the three hospitals' job descriptions/performance evaluation instruments for congruence and motivational design. Consensus of the panel was numerically translated on a Likert scale to allow statistical analysis with job satisfaction scores. Frequency of feed back and marital status achieved significant correlations with job satisfaction. No significant relationship was found with congruence/design of performance appraisal systems

Using graphical models and multi-attribute utility theory for probabilistic uncertainty handling in large systems, with application to nuclear emergency management

Although many decision-making problems involve uncertainty, uncertainty handling within large decision support systems (DSSs) is challenging. One domain where uncertainty handling is critical is emergency response management, in particular nuclear emergency response, where decision making takes place in an uncertain, dynamically changing environment. Assimilation and analysis of data can help to reduce these uncertainties, but it is critical to do this in an efficient and defensible way. After briefly introducing the structure of a typical DSS for nuclear emergencies, the paper sets up a theoretical structure that enables a formal Bayesian decision analysis to be performed for environments like this within a DSS architecture. In such probabilistic DSSs many input conditional probability distributions are provided by different sets of experts overseeing different aspects of the emergency. These probabilities are then used by the decision maker (DM) to find her optimal decision. We demonstrate in this paper that unless due care is taken in such a composite framework, coherence and rationality may be compromised in a sense made explicit below. The technology we describe here builds a framework around which Bayesian data updating can be performed in a modular way, ensuring both coherence and efficiency, and provides sufficient unambiguous information to enable the DM to discover her expected utility maximizing policy

Bayesian decision support for complex systems with many distributed experts

Complex decision support systems often consist of component modules which, encoding the judgements of panels of domain experts, describe a particular sub-domain of the overall system. Ideally these modules need to be pasted together to provide a comprehensive picture of the whole process. The challenge of building such an integrated system is that, whilst the overall qualitative features are common knowledge to all, the explicit forecasts and their associated uncertainties are only expressed individually by each panel, resulting from its own analysis. The structure of the integrated system therefore needs to facilitate the coherent piecing together of these separate evaluations. If such a system is not available there is a serious danger that this might drive decision makers to incoherent and so indefensible policy choices. In this paper we develop a graphically based framework which embeds a set of conditions, consisting of the agreement usually made in practice of certain probability and utility models, that, if satisfied in a given context, are sufficient to ensure the composite system is truly coherent. Furthermore, we develop new message passing algorithms entailing the transmission of expected utility scores between the panels, that enable the uncertainties within each module to be fully accounted for in the evaluation of the available alternatives in these composite systems

Forecasting environmental migration to the United Kingdom, 2010 - 2060: an exploration using Bayesian models

Over the next fifty years the potential impact on human livelihoods of environmental change could be considerable. One possible response may be increased levels of human mobility. This paper offers a first quantification of the levels of environmental migration to the United Kingdom that might be expected. The authors apply Bijak and Wi?niowski’s (2010) methodology for forecasting migration using Bayesian models. They seek to advance the conceptual understanding of forecasting in three ways. First, the paper is believed to be the first time that the Bayesian modelling approach has been attempted in relation to environmental mobility. Second, the paper examines the plausibility of Bayesian modelling of UK immigration by cross-checking expert responses to a Delphi survey with the expectations about environmental mobility evident in the recent research literature. Third, the values and assumptions of the expert evidence provided in the Delphi survey are interrogated to illustrate the limited set of conditions under which the forecasts of environmental mobility, as set out in this paper, are likely to hold

Automated identification of Fos expression

The concentration of Fos, a protein encoded by the immediate-early gene c-fos, provides a measure of synaptic activity that may not parallel the electrical activity of neurons. Such a measure is important for the difficult problem of identifying dynamic properties of neuronal circuitries activated by a variety of stimuli and behaviours. We employ two-stage statistical pattern recognition to identify cellular nuclei that express Fos in two-dimensional sections of rat forebrain after administration of antipsychotic drugs. In stage one, we distinguish dark-stained candidate nuclei from image background by a thresholding algorithm and record size and shape measurements of these objects. In stage two, we compare performance of linear and quadratic discriminants, nearest-neighbour and artificial neural network classifiers that employ functions of these measurements to label candidate objects as either Fos nuclei, two touching Fos nuclei or irrelevant background material. New images of neighbouring brain tissue serve as test sets to assess generalizability of the best derived classification rule, as determined by lowest cross-validation misclassification rate. Three experts, two internal and one external, compare manual and automated results for accuracy assessment. Analyses of a subset of images on two separate occasions provide quantitative measures of inter- and intra-expert consistency. We conclude that our automated procedure yields results that compare favourably with those of the experts and thus has potential to remove much of the tedium, subjectivity and irreproducibility of current Fos identification methods in digital microscopy

Synthesis and final recommendations on the development of a European Information System for Organic Markets. = Deliverable D6 of the European Project EISfOM QLK5-2002-02400

Executive summary European markets for organic products are growing rapidly, but the market information available in most European countries is woefully inadequate. Often only very basic data such as certified organic holdings and land area are reported, and sometimes not even individual crop areas or livestock numbers. Important market data, such as the amount of production, consumption, international trade or producer and consumer prices, do not exist in most European countries. In some European countries there are only rough estimates of the levels of production and consumption. There is no standardisation and data are seldom comparable. Furthermore, detailed information on specific commodities is missing. Hence, investment decisions are taken under conditions of great uncertainty. Policy evaluation, including periodic monitoring of the European Action Plan for Organic Food and Farming and RDP 2007-2013, will require many other data in addition to those regarding production structures and financial data that are already available, but obtaining this information would require a new EU-wide data collection and processing system (DCPS) to be put in place. The European Information System for Organic Markets (EISfOM) project is an EUfunded Concerted Action which has analysed and documented the current situation and proposed ways in which organic data collection and processing systems (DCPS) can be improved by means of: • improvement in the current situation of data collecting and processing systems for the organic sector • innovation in data collection and processing systems for the organic sector • integration of conventional and organic data collection and processing systems This report summarises the most relevant findings of the EISfOM project, which are analysed in the main project reports: Wolfert, S., Kramer, K. J., Richter, T., Hempfling, G., Lux. S. and Recke, G. (eds.) (2004). Review of data collection and processing systems for organic and conventional markets. EISfOM (QLK5-2002-02400) project deliverable submitted to European Commission. www.eisfom.org/publications. Recke, G., Hamm, U., Lampkin, N., Zanoli, R., Vitulano, S. and Olmos, S. (eds.) (2004a) Report on proposals for the development, harmonisation and quality assurance of organic data collection and processing systems (DCPS). EISfOM (QLK5-2002-02400) project deliverable submitted to European Commission. www.eisfom.org/publications. Recke, G., Willer, H., Lampkin, N. and Vaughan, A. (eds.) (2004b). Development of a European Information System for Organic Markets – Improving the Scope and Quality of Statistical Data. Proceedings of the 1st EISfOM European Seminar, Berlin, Germany, 26-27 April, 2004. Research Institute of Organic Agriculture (FiBL), Frick, Switzerland. www.eisfom.org/publications. Gleirscher, N., Schermer, M., Wroblewska, M. and Zakowska-Biemans, S. (2005) Report on the evaluation of the pilot case studies. EISfOM (QLK5-2002-02400) project deliverable submitted to European Commission. www.eisfom.org/publications. QLK5-2002-02400 European Information System for Organic Markets (EISfOM) D6 final report Rippin, M. and Lampkin, N. (eds.) (2005) Framework for a European Information System for Organic Markets. Unpublished report of the project European Information System for Organic Markets (EISfOM) (QLK5-2002-02400). Rippin, M., Willer, H., Lampkin, N., and Vaughan A. (2006). Towards a European Framework for Organic Market information, Proceedings of the 2nd EISfOM European Seminar, Brussels, November 10 and 11, 2005. Research Institute of Organic Agriculture (FiBL), Frick, Switzerland. www.eisfom.org/publications

A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics