38 research outputs found
It is time to talk about people: a human-centered healthcare system
Examining vulnerabilities within our current healthcare system we propose borrowing two tools from the fields of engineering and design: a) Reason's system approach [1] and b) User-centered design [2,3]. Both approaches are human-centered in that they consider common patterns of human behavior when analyzing systems to identify problems and generate solutions. This paper examines these two human-centered approaches in the context of healthcare. We argue that maintaining a human-centered orientation in clinical care, research, training, and governance is critical to the evolution of an effective and sustainable healthcare system
International Consensus Statement on Rhinology and Allergy: Rhinosinusitis
Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICARâRS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICARâRSâ2021 as well as updates to the original 140 topics. This executive summary consolidates the evidenceâbased findings of the document. Methods: ICARâRS presents over 180 topics in the forms of evidenceâbased reviews with recommendations (EBRRs), evidenceâbased reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICARâRSâ2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidenceâbased management algorithm is provided. Conclusion: This ICARâRSâ2021 executive summary provides a compilation of the evidenceâbased recommendations for medical and surgical treatment of the most common forms of RS
Comment la maĂźtrise dâouvrage urbaine conçoit-elle les choix dâamĂ©nagement ? : Ă©laboration et assemblage des choix Ă©nergĂ©tiques Ă Bordeaux Euratlantique
âHow is energetical design done in urban development projects?â This question goes beyond curiosity, in line with current preoccupations. Facing the growing pressure of environment and energy challenges within urban fabric, urban development is trying to renew its practices. Such changes, however, need to address the general lack of understanding about the actual logics of collective action during urban development projects.Our research aims to better understand the generation processes of design choices in French urban development projects. We focus on the space of âmaĂźtrise dâouvrage urbaineâ (local development authority), which stretches at the interface between strategic orientations of planning authorities and technical choices of formal designers. Moving away from the traditional division of labour, we assume that local development authorities are actually responsible for a design activity, which covers the generation and update of strategic orientations for urban development, the regulation of buildings, infrastructures and public spaces productions, and the organisation and management of collective design activity.Within this framework, this research first provides empirical insights of the urban development authorityâs energy design activity at Bordeaux Euratlantique, France. Through an extensive account of energy choices in this project, we document the various, intertwined design arenas, the processes for designing and updating design choices, and the instrumentation of urban development authorityâs design activity. To understand these phenomena from political, cognitive and managerial perspectives, we combine various theoretical frameworks derived from pragmatic approaches of organizational studies, science & technology studies and management sciences.The cross-analysis of our empirical account allows us to highlight the key role of collective action initiation and lock-in, which are embodied by the concept of decision. Decision then become a macro-objective for urban developers alongside quality, costs and delays. But the management of design activity from a decision-making perspective sometimes comes into conflict with the complexity of urban sociotechnical assemblages, which call for an integrated processing of interfaces and interdependencies. The thesis then concludes on the tension between the logic of âdefinitionâ, which is steered by techno-economic performance objectives, and the logic of âimplementationâ, which is steered by operational effectivity challenges« Comment sont opĂ©rĂ©s les choix Ă©nergĂ©tiques dans les projets dâamĂ©nagement ? » Cette question, de curiositĂ©, sâinscrit par ailleurs dans des prĂ©occupations dâactualitĂ©. Face Ă la montĂ©e en puissance des enjeux environnementaux et plus particuliĂšrement Ă©nergĂ©tiques dans la fabrique urbaine, le monde de lâamĂ©nagement cherche en effet Ă renouveler ses maniĂšres de faire. Cependant, la mise en oeuvre de tels changements se heurte Ă une mĂ©connaissance de la mĂ©canique opĂ©rationnelle des projets dâamĂ©nagement. DĂšs lors, notre thĂšse sâest construite autour de la comprĂ©hension des mĂ©canismes de production des choix dâamĂ©nagement dans les projets urbains français. Nous nous sommes plus prĂ©cisĂ©ment intĂ©ressĂ©s Ă lâespace dâaction de la maĂźtrise dâouvrage urbaine, qui sâĂ©tend Ă lâinterface entre les orientations « stratĂ©giques » de la planification (planning) et les choix « techniques » de la conception formelle (design). Nous Ă©cartant de la division artificielle des tĂąches entre maĂźtrise dâouvrage et maĂźtrise dâoeuvre, nous postulons que la maĂźtrise dâouvrage urbaine est responsable dâune vĂ©ritable activitĂ© de conception qui se dĂ©cline sous plusieurs formes :- la participation Ă lâĂ©laboration et Ă lâactualisation des orientations stratĂ©giques et des choix de programmation et de composition du projet dâamĂ©nagement ;- lâencadrement des couples maĂźtrise dâouvrage/maĂźtrise dâoeuvre dans la fabrique des diffĂ©rentes composantes matĂ©rielles (bĂątiments, infrastructures, espaces publics) de lâespace urbain ;- lâĂ©laboration et le pilotage des dispositifs et des processus dâorganisation de lâaction collective.Dans ce cadre, la thĂšse propose dâabord de documenter empiriquement la « boĂźte noire » que constitue encore lâactivitĂ© de conception de la maĂźtrise dâouvrage urbaine. Nous appuyant sur une analyse approfondie des choix Ă©nergĂ©tiques opĂ©rĂ©s Ă lâoccasion de lâopĂ©ration dâintĂ©rĂȘt national Bordeaux Euratlantique, il sâagit de traiter les questions suivantes : quelles sont les scĂšnes de conception internes et externes Ă la maĂźtrise dâouvrage urbaine et comment sâarticulent-elles ? quels sont les processus qui aboutissent aux formulations et aux reformulations des choix dâamĂ©nagement au cours du projet ? et quelle instrumentation maĂźtrise dâouvrage urbaine mobilise-t-elle dans son activitĂ© de conception ?Pour ce faire nous reconstruisons, sous forme de rĂ©cit, les principales sĂ©quences dâaction ayant abouti Ă la dĂ©finition dâune stratĂ©gie Ă©nergĂ©tique et environnementale, Ă lâorganisation de la prise en compte des aspects Ă©nergĂ©tiques dans la fabrique du bĂąti, et Ă la mise en place de systĂšmes dâapprovisionnement en chaleur et en froid. Adoptant une approche pragmatique, nous combinons des grilles de lecture issues de diffĂ©rentes disciplines (sociologies des organisations et des techniques, sciences de gestion) pour interprĂ©ter chacune de ces sĂ©quences dâaction en mettant en lumiĂšre leurs dimensions politique, cognitive et productive.La lecture transversale du rĂ©cit nous permet ensuite de mettre en Ă©vidence le rĂŽle primordial allouĂ© Ă la dĂ©cision, comprise comme un dispositif dâengagement et dâirrĂ©versibilisation de lâaction collective. Comme la qualitĂ©, les coĂ»ts et les dĂ©lais, la dĂ©cision peut alors ĂȘtre considĂ©rĂ©e comme un macro-objectif qui guide la maĂźtrise dâouvrage dans son activitĂ© de conception.Toutefois, le pilotage de la conception par la facilitation de la dĂ©cision entre parfois en conflit avec la complexitĂ© des assemblages sociotechniques de la fabrique urbaine, caractĂ©risĂ©s par des interdĂ©pendances qui poussent Ă un traitement intĂ©grĂ© de certaines interfaces. La thĂšse se conclut donc par une relecture des objectifs de qualitĂ©-coĂ»ts-dĂ©lais-dĂ©cision au prisme dâune tension entre la logique du « dĂ©finir », guidĂ©e par la performance technico-Ă©conomique, et la logique du « faire advenir », guidĂ©e par lâeffectivitĂ© opĂ©rationnell
Sinusite fĂșngica alĂ©rgica: atualização Allergic fungal sinusitis: an update
Sinusite fĂșngica alĂ©rgica Ă© uma modalidade de sinusite fĂșngica reconhecida hĂĄ aproximadamente 20 anos. Os critĂ©rios diagnĂłsticos ainda nĂŁo estĂŁo bem definidos e muitas dĂșvidas existem com relação Ă sua fisiopatogenia e tratamento. Com o intuito de rever os mais modernos conceitos desta nova entidade clĂnica, foi realizada uma pesquisa utlilizando como fontes de referĂȘncias bibliogrĂĄficas o Medline e o Lilacs, abrangendo os Ășltimos 20 anos. A sinusite fĂșngica alĂ©rgica vem sendo reconhecida como uma importante causa de rinossinusite crĂŽnica e a integração entre otorrinolaringologistas, imunologistas e patologistas faz-se necessĂĄria para seu manuseio adequado.<br>Allergic fungal sinusitis is a well recognized form of fungal sinusitis first described 20 years ago. This entity hasn't a well defined diagnostic criteria and many questions rise about its true fisiopathology and treatment. The authors have performed a MEDLINE and LILACS search, comprising the last 20 years, in order to review the most moderns concepts about this new clinical entity. Allergic fungal sinusitis has been considered an important cause of chronic rhinosinusitis and a good relation envolving otolaryngologists, immunologists and pathologists is essential for its correct management