Quality Of Provision Research Articles

Quality discrimination in healthcare markets

AbstractRecent advances in healthcare information technologies allow healthcare providers to more accurately track patient characteristics and predict the future treatment costs of previously treated patients, which increases the scope for providers to quality discriminate across different patient types. We theoretically analyze the potential implications of such quality discrimination in a duopoly setting with profit‐maximizing hospitals, fixed prices, and heterogeneous patients. Our analysis shows that the ability to quality discriminate tends to intensify competition and lead to higher quality provision, which benefits patients but makes the hospitals less profitable. Nevertheless, the effect on social welfare is a priori ambiguous, since quality discrimination also leads to an inefficient allocation of patients across hospitals.

ANALYSIS OF METHODS FOR DETERMINING THE QUALITY OF FUNCTIONING OF TELECOMMUNICATION SYSTEMS

The rapid development and spread of information and communication technologies is taking on the character of a global information revolution today. Users have a need for communication services that can be flexibly configured. Next Generation Networks (NGN) - the modern stage of development of telecommunication networks (TCN) - represent a single transport platform on the basis of which various types of services are combined. One of the main aspects that should be taken into account when designing NGN is the provision of appropriate quality of service. With the introduction of multi-service networks, the approach to the task of service level based on the requirements of the users themselves for the quality of services becomes predominant, which requires the improvement of methods of managing the quality of services in TCN. The analysis of the works of domestic and foreign scientists regarding service quality management in TCN indicates the need to improve service quality management methods. It should be noted that in the works on the quality management of telecommunication services (TCS), attention is mainly paid to the technical indicators of the quality of services, while the development of effective methods of taking into account the user's opinion in managing the quality of services is currently relevant. The existing subjective methods of assessing the quality of TCS take into account the quality of the transmitted media information based on expert assessments, but do not provide a full assessment of the quality of the service by the user. The ITU-T recommendations describe different points of view on the quality of service, but do not provide specific methods for evaluating and managing the quality of TCS taking into account the opinion of the user. It is the unsolved task of comprehensive assessment of the quality of services in next-generation TCN that determined the purpose of this work.

PUBLIC ADMINISTRATION OF THE QUALITY OF PROFESSIONAL PRE-HIGHER PEDAGOGICAL EDUCATION

The article analyzes the concepts of the quality of education and the quality of professional pre-higher pedagogical education in the context of different approaches to the definition, both from the side of the legislation and in the context of several fields of knowledge (in particular, public administration and pedagogy). The author emphasizes the role of the state in the management of pedagogical education and examines the influence of other subjects of management, reveals the importance of ensuring the continuous improvement of the quality of education, focuses on the development of the quality of pedagogical education as a basis for sustainable development of the country. In the course of the study, the development of the problem of the quality of professional pre-higher pedagogical education was updated and it was established that there is no strategy for the development of this component of education in Ukraine, which is a significant obstacle for public administration in accordance with the pressing issues. In order to determine the priority directions for the development of the quality of professional pre-higher education, the article analyzes the regulatory and legal field within the defined issues, namely: The National Strategy for the Development of Education of Ukraine, Laws of Ukraine «On Education», «On Vocational Pre-Higher Education», Concept of the Development of Pedagogical Education. During the analysis, the key advantages and disadvantages of the existing legal regulation were identified. Special attention in the article was paid to the Law of Ukraine «On Professional Pre-Higher Education» and the chapter on ensuring the quality of professional pre-higher education. A detailed analysis of this system confirmed its integrated nature, which combines not only internal aspects of quality control and assessment of professional pre-higher education, but also external mechanisms that contribute to objective assessment and maintenance of education quality standards. On the basis of the analyzed materials, the author developed the stages of the process of quality management of the professional pre-higher education, identified the advantages and disadvantages of quality provision of the professional pre-higher education, and proposed ways to improve it.

An Investigation of Practical Skills Competencies of Early Childhood Care and Education Programmes

Childhood Development training does not guarantee quality provisioning in ECD centres for several reasons: a lack of proficient instruction during training; a lack of support to help assist the students with work; a lack of knowledge; and a lack of follow-up support after the training is complete to ensure constant implementation. That is why it is necessary to educate practitioners and to continuously supervise their progress to ensure that they implement the appropriate activities relevant to their daily programmes for children to reach their full potential. This study considers the perceptions of five ECCE practitioners based in Gauteng who completed a Higher Certificate in Early Childhood Care and Education (ECCE) programme at a Private Higher Education Institution (PHEI) in South Africa. The study will focus on Health, Safety and Nutrition, which forms part of the ECCE programme. A qualitative research approach was utilized. Semi-structured interviews, observations, and document analysis through triangulation for this study were developed according to the criteria of the Experiential Learning Theory for the assessment of the themes from the study. A case study of narrative approach was used to explore reflections and authentic experiences the practitioners endure. This was executed to consider if the hands-on activities integrated into early learning programmes are sufficient for real-world applications. Furthermore, to ascertain the transition difficulty of newly graduated practitioners into ECD centres and to establish if the insights and skills training has equipped these practitioners for an ECD centre. The hands-on practical skills training competencies in early learning before entering an ECD centre as a practitioner will inform the development of future programmes as well as policy.

Key Principles Underlying a Research-Practice Alignment in a Federally Qualified Health Center.

Minoritized populations such as racial and ethnic minorities and individuals of less privileged socioeconomic status experience a disproportionate burden of poor hypertension (HTN) control in the United States. Multilevel systems interventions have been shown to improve patient-level outcomes in minoritized populations; however, there remains a large translational gap in implementing these approaches into federally qualified health centers (FQHC), which serve those at highest risk of HTN-related morbidity and mortality. The paucity of purposeful collaborations between academic researchers and practice staff throughout the research process remains a significant roadblock to the timely translation of evidence to practice. This commentary describes the key principles and best practices that underlie the development and sustainment of an equitable research-practice alignment, which is supporting the implementation of multilevel systems intervention for improved HTN care in a large FQHC in Brooklyn, New York. The key principles, which are derived from the central tenants of relationship development and maintenance in community-engaged participatory research, patient-centered outcomes research, and organizational alignment theory include (1) cocreation of a shared mental model, (2) bridging multilevel communication, (3) ensuring mutual accountability, and (4) creating a culture of continuous improvement. Together, the principles guide how the research and practice teams work together to achieve a shared goal of improving the health and well-being of minoritized patients through the provision of high quality, community-oriented HTN care. Best practices to sustain our alignment require an ongoing and deliberate investment in honest and transparent communication by all members.

Quality provision in Pakistani health care system: insights into a major obstacle and the way forward.

Madam, Safety, cost-effectiveness, efficiency and equity are all components of quality healthcare. Key factors determining quality are’ and their families’ satisfactions and better disease outcomes.1 Doctors, paramedics, pharmacists, laboratory technicians, administrative staff, pharmaceutical companies, government agencies and policymakers are the caregivers who have an essential direct or indirect role in providing, sustaining and improving health care.1 A population's health is crucial to a state's stability and growth. Quality in healthcare has been a subject of discussion across the globe for decades, with developed nations contributing the majority of its measures and recommendations6. In contrast it is still battling to fully establish and function in emerging nations like Pakistan. The health system in Pakistan comprises primary, secondary and tertiary health centres. The latter are found in a few urban cities and are run by both the public and private sectors. Private bodies include profit as well as welfare-based organizations.2,3 According to the WHO, on average, there are 6.3 hospital beds per 10,000 population in Pakistan, which is below its recommendation and much less compared to other developing nations.2 Majority of the population reside in rural areas and thus their option in various illnesses is primary or secondary health unit.3 The major drawback in such centres is lack of attendance by doctors and paramedical staff, lack of competent clinician or general practitioner along with absence of equipment, state-of-the-art laboratory and latest treatment options, all contributing to delays in diagnosis and management.4,5 There is also a lack of patient registry, long-term follow-ups, appropriate and timely referrals to higher health care centre and disease discussion between clinicians.3 Due to such weakened basic units, many patients directly visit an urbanized tertiary health center, which is a major cause of overcrowding of our hospitals. Some break-through policies which could address this dilemma is giving incentives to the assigned staff, providing commute in case of long travels, improving the infrastructure and facilities within the centers, installation of biometrics and having regular audit of attendance, number of patients treated and medications provided. Conducting education seminars regarding work ethics would also contribute towards a professional working environment leading to better patient outcomes.3,4 Creating awareness regarding the responsibility and crucial role of general practitioners in primary and secondary health units along with recognition of their importance, would also help in diverting medical community towards opting for such roles.6 ---Continue

Insomnia among Intensive Care Unit Nurses in the United Arab Emirates and its Association to Work Productivity and Quality of Life

Background: A healthy workforce is essential for sustainable healthcare systems, disease control, and the provision of quality and safe healthcare services. Insomnia is a common problem among critical care nurses attributed to the hard nature of their work, long and irregular shifts, high levels of stress and tension, and exposure to traumatic situations associated with critical care environments. These issues compromise their professional and personal lives, have financial consequences for health organizations, and may reduce the quality of care provided to patients. Aim: To assess the prevalence of insomnia among ICU nurses and determine its impact on their Quality of Life (QoL) and work productivity. Methods: This cross-sectional study involved 430 ICU nurses working in three major governmental hospitals in the United Arab Emirates. Nurses were selected via convenient sampling. Data collected included nurses’ demographic characteristics, insomnia levels using the Athens Insomnia Scale, work productivity using the workability index, and QoL using the World Health Organization Quality of Life Scale-Brief questionnaire Results: Approximately 237 (55%) of participants reported moderate to severe levels of insomnia, and 195 (45.3%) had moderate productivity levels. However, the majority of participants reported low QoL levels in physical, psychological, social, and environmental QoL domains (61.4%, 60.2%, 47.2%, and 70.5%), respectively. Bivariate correlations demonstrated a significant negative relationship; correlation coefficient of -0.517, between participants' insomnia levels and work productivity levels. Additionally, significant negative relationships were found between insomnia levels and the QoL domains, with correlation coefficients of -0.629, -0.568, -0.469, and -0.485, respectively. Conclusion: This study found that insomnia has a negative relationship with ICU nurses’ work productivity and QoL. This may impact care delivery patient care and safety.Regular counseling sessions, better working hours, less overtime, and a better work-life balance may contribute to increased productivity and improved QoL among ICU nurses in the UAE.

Differences between physician and patient preferences for cancer treatments: a systematic review

BackgroundShared decision-making is useful to facilitate cancer treatment decisions. However, it is difficult to make treatment decisions when physician and patient preferences are different. This review aimed to summarize and compare the preferences for cancer treatments between physicians and patients.MethodsA systematic literature search was conducted on PubMed, Embase, PsycINFO, CINAHL and Scopus. Studies elicited and compared preferences for cancer treatments between physicians and patients were included. Information about the study design and preference measuring attributes or questions were extracted. The available relative rank of every attribute in discrete choice experiment (DCE) studies and answers to preference measuring questions in non-DCE studies were summarized followed by a narrative synthesis to reflect the preference differences.ResultsOf 12,959 studies identified, 8290 were included in the title and abstract screening and 48 were included in the full text screening. Included 37 studies measured the preferences from six treatment-related aspects: health benefit, adverse effects, treatment process, cost, impact on quality of life, and provider qualification. The trade-off between health benefit and adverse effects was the main focus of the included studies. DCE studies showed patients gave a higher rank on health benefit and treatment process, while physicians gave a higher rank on adverse effects. Non-DCE studies suggested that patients were willing to take a higher risk of adverse effects or lower health benefit than physicians when accepting a treatment.ConclusionsPhysicians and patients had important preference differences for cancer treatment. More sufficient communication is needed in cancer treatment decision-making.

An Automated Electronic System in a Motorized Wheelchair for Telemonitoring: Mixed Methods Study Based on Internet of Things.

Wheelchair positioning systems can prevent postural deficits and pressure injuries. However, a more effective professional follow-up is needed to assess and monitor positioning according to the specificities and clinical conditions of each user. This study aims to present the concept of an electronic system embedded in a motorized wheelchair, based on the Internet of Things (IoT), for automated positioning as part of a study on wheelchairs and telemonitoring. We conducted a mixed methods study with a user-centered design approach, interviews with 16 wheelchair users and 66 professionals for the development of system functions, and a formative assessment of 5 participants with descriptive analysis to design system concepts. We presented a new wheelchair system with hardware and software components developed based on coparticipation with singular components in an IoT architecture. In an IoT solution, the incorporation of sensors from the inertial measurement unit was crucial. These sensors were vital for offering alternative methods to monitor and control the tilt and recline functions of a wheelchair. This monitoring and control could be achieved autonomously through a smartphone app. In addition, this capability addressed the requirements of real users. The technologies presented in this system can benefit telemonitoring and favor real feedback, allowing quality provision of health services to wheelchair users. User-centered development favored development with specific functions to meet the real demands of users. We emphasize the importance of future studies on the correlation between diagnoses and the use of the system in a real environment to help professionals in treatment.

Targeted, actionable and fair: Reviewer reports as feedback and its effect on ECR career choices.

Previous studies of the use of peer review for the allocation of competitive funding agencies have concentrated on questions of efficiency and how to make the 'best' decision, by ensuring that successful applicants are also the more productive or visible in the long term. This paper examines the components of feedback received from an unsuccessful grant application, is associated with motivating applicants career decisions to persist (reapply for funding at T1), or to switch (not to reapply, or else leave academia). This study combined data from interviews with unsuccessful ECR applicants (n = 19) to The Wellcome Trust 2009-19, and manual coding of reviewer comments received by applicants (n = 81). All applicants received feedback on their application at T0 with a large proportion of unsuccessful applicants reapplying for funding at T1. Here, peer-review-comments-as-feedback sends signals to applicants to encourage them to persist (continue) or switch (not continue) even when the initial application has failed. Feedback associated by unsuccessful applicants as motivating their decision to resubmit had three characteristics: actionable; targeted; and fair. The results lead to identification of standards of feedback for funding agencies and peer-reviewers to promote when providing reviewer feedback to applicants as part of their peer review process. The provision of quality reviewer-reports-as-feedback to applicants, ensures that peer review acts as a participatory research governance tool focused on supporting the development of individuals and their future research plans.

Deep Reinforcement Learning Framework with Q Learning For Optimal Scheduling in Cloud Computing

Cloud computing is an emerging technology that is increasingly being appreciated for its diverse uses, encompassing data processing, The Internet of Things (IoT) and the storing of data. The continuous growth in the number of cloud users and the widespread use of IoT devices have resulted in a significant increase in the volume of data being generated by these users and the integration of IoT devices with cloud platforms. The process of managing data stored in the cloud has become more challenging to complete. There are numerous significant challenges that must be overcome in the process of migrating all data to cloud-hosted data centers. High bandwidth consumption, longer wait times, greater costs, and greater energy consumption are only some of the difficulties that must be overcome. Cloud computing, as a result, is able to allot resources in line with the specific actions made by users, which is a result of the conclusion that was mentioned earlier. This phenomenon can be attributed to the provision of a superior Quality of Service (QoS) to clients or users, with an optimal response time. Additionally, adherence to the established Service Level Agreement further contributes to this outcome. Due to this circumstance, it is of utmost need to effectively use the computational resources at hand, hence requiring the formulation of an optimal approach for task scheduling. The goal of this proposed study is to find ways to allocate and schedule cloud-based virtual machines (VMs) and tasks in such a way as to reduce completion times and associated costs. This study presents a new method of scheduling that makes use of Q-Learning to optimize the utilization of resources.The algorithm's primary goals include optimizing its objective function, building the ideal network, and utilizing experience replay techniques.

Chilling Effects: Assessing Chlorine Levels in Hawker-Served Crystal Ice Cubes in Banjarbaru City

Cold drinks served will be served along with ice cubes, one of which is crystal ice cubes. In making ice cubes must have the same quality requirements as drinking water. The provision of water quality that is suitable for drinking needs to be examined. As for drinking water quality requirements according to the Regulation of the Minister of Health of the Republic of Indonesia Number 2 of 2023 concerning drinking water quality requirements, the presence of free chlorine compounds in the allowed network distribution is 0.2-0.5 mg/l. Chlorine serves to inhibit growth and eradicate bacteria from various types of microbes, but if chlorine exceeds quality standards and reacts with water it can form hypochlorous acid which can damage cells in the body and can cause digestive disorders because it can make the stomach wall erosion and cause ulcer disease and if used in the long term can cause kidney disease and cancer. This research aims to analyze chlorine levels and crystal ice cubes of hawker sellers in Banjarbaru City and the factors that influence it. The results of the study explained that from 28 samples of crystal ice cubes, only 2 (7%) samples of crystal ice cubes met the standards, while the other 26 samples (93%) had chlorine levels above the maximum limit of 0.5 mg / L. While the behavior of ice cube sellers in washing hands before taking ice cubes only 11 people (39%), 17 other beverage sellers (61%) did not wash their hands before taking ice cubes.

Wireless Networks using Visible Light Communication: A Review

Provisioning of quality of service (QoS) is a critical issue in visible light communication (VLC) systems and other wireless communication systems. LED lights are becoming widely used for homes and offices for their luminous efficacy improvement. VLC is a new way of wireless communication. Typical transmitters used for visible-light communication are visible-light LEDs, and receivers are photodiodes and image sensors. We present new applications that will be made possible by visible light communication technology. Especially location-based services are considered suitable for visible light communication applications.

The School Preparedness Toolkit: Building Systemic Resilience in Ukrainian Schools Through a Self-Assessment Digital Platform

During the COVID-19 outbreak, schools around the world faced major challenges and were required to adapt to new educational practices while supporting students’ learning and well-being. This study outlines the development of School Preparedness Toolkit (SPT), an online interactive checklist launched from January to March 2021 among 273 Ukrainian schools. SPT was a dual-use tool, aiming to inform and support efforts of school administrations in implementing effective strategies to address challenges arising from COVID-19 and to inform related public health and educational policies at regional and national levels. The toolkit focused on resilience against COVID-19 challenges across five main domains: Access to Education Provision of Quality and Inclusive Learning, Well-Being, Safety, Nutrition, and School Feeding. Completion of SPT was a collaborative process among school administrators. Chi-square tests were conducted to examine differences across schools’ geographical locations and between urban and rural areas. Results indicated that most schools were already adapting to the challenges, to the extent of implementing mandated safety and online education protocols, communicating these with families, and providing a psychosocial safety net for children in extreme distress. However, resilience could be further strengthened through a greater emphasis on school cohesion, connectedness, and solidarity, as well as on preventive psychosocial interventions. The SPT methodology was shown to be a promising approach in assisting schools to reflect and plan for greater resilience, not just in the context of the COVID-19 pandemic but also in other extreme adversities that school systems—in Ukraine and around the world—might be facing.

Competence of Health Care Providers on Clinical Management of Myocardial Infarction in Selected Hospitals with Intensive Care Unit Western Kenya

Background: The capacity of healthcare providers to execute an accurate initial assessment is crucial for recognizing the urgency and treatment needs of patients and for creating baseline data from which any changes in patient status may be monitored. In Western Kenya, there is little evidence of studies carried out on the competence of healthcare providers in the clinical management of myocardial infractions thus this study's main aim was to investigate the competence of healthcare providers in the clinical management of myocardial infractions.
 Material and Methods: A cross-sectional analytical study design was used. The study population comprised a total sample of 114 healthcare providers. A structured questionnaire and observation checklist were used. Participants will be picked using a systematic sampling method for those who meet the inclusion criteria. The sample size was determined using Fisher's Method. The data collected was compiled using SPSS software version 22. The data was analyzed through the application of descriptive statistical analysis.
 Findings: Variables that positively influenced the competency are specialization (AOR: 15.1; 95% CI: 2.6 – 87.3; p = 0.002), knowledge (AOR: 5.4; 95% CI: 1.1 – 26.5; p = 0.04) and having a protocol in patient's file (AOR: 10.2; 95% CI: 0.9 – 112.6.5; p = 0.06), although the latter was marginally statistically significant. Healthcare provider's qualification (KRCHN) (AOR: 0.04; 95% CI: 0.008 – 0.219; p = 0.002), filling of the protocol (AOR: 0.03; 95% CI: 0.001 – 0.585; p = 0.02) and use of high dose heparin as opposed to the use of other thrombolytic like Metalase (AOR: 0.1; 95% CI: 0.01 – 0.63; p = 0.02) were all negatively associated with healthcare providers competency.
 Recommendation/Conclusion: The study recommends the need of specialized training and knowledge advancement for health care providers on critical care nursing. This study found marginal statistical significance between the factors that influence competence among healthcare providers on clinical management of myocardial infraction.

The pricing and quality effects of network structure choice: Evidence from American airlines’ international route cancellations

American Airlines (AA) terminated two non-stop services from Chicago to Beijing and Shanghai, respectively, in October 2018. Using the DB1B database, I study the pricing and quality effects of AA’s network structure switch for the Chicago-China route. In particular, I examine how average fares and on-time performances (OTP) in AA’s three hubs, namely, Chicago (ORD), Dallas/Fort Worth (DFW), and Los Angeles (LAX), would be affected following the route cancellations. The estimation results indicate higher fares and worsening OTP for nonstop flights connecting DFW and ORD but not those connecting LAX. Coupled with AA’s reconstruction plans, these findings may be partly caused by the fact that most international passengers who would depart from ORD are now diverted through DFW instead, given its proximity, which disproportionally drives up the demand and traffic at DFW. My analysis adds to the literature by investigating the impact of network choice of an international market on price and quality provision in the domestic market.

Mergers and organizational disruption: Evidence from the US airline industry

AbstractMerger‐specific efficiencies alleviate anticompetitive concerns of horizontal mergers. However, organizational challenges inherent in mergers pose a threat to achieving these efficiencies and could negatively impact the merged firm's productivity and market outcomes. We separately measure the organizational and strategic effects of mergers on quality provision using administrative data from the US airline industry, leveraging an industry‐specific regulation. We find that organizational challenges (e.g., combining workforces) cause a significant reduction in the quality supplied by a merged firm. In contrast, strategic effects (e.g., market strategy) have a minor impact on quality. Also, we find that a merger can reduce the performance of both merging firms. Our results suggest a merger's organizational challenges create uncertain efficiency gains.

Exploring mental health consumer experiences of the strengths model of case management: A phenomenological study.

The strengths of model of case management is a recovery-oriented model of community mental health care that has been linked to positive consumer outcomes. The aim of this qualitative study was to explore the consumer perspective of the strengths model of case management using a descriptive phenomenological approach. Data were collected through in-depth, semi-structured interviews. In total, six consumers from a metropolitan community mental health service were interviewed. Interview transcripts were analysed using Colaizzi's phenomenological method. Three major themes were identified: the relationship between the consumer and the case manager is valuable, the strengths assessment supports identifying strengths and areas for action and the strengths model of case management promotes recovery and goal achievement. Implications for practice include an increased understanding of consumer preferences and promoting the consumer voice, thereby supporting the provision of higher quality evidence-based practice.

Development of an Extended Medical Diagnostic System for Typhoid and Malaria Fever

In developing countries like Nigeria, malaria and typhoid fever are major health challenges in society today. The symptoms vary and can lead to other illnesses in the body which include prolonged fever, fatigue, nausea, headaches, and the risk of contracting infection occurring concurrently if not properly diagnosed and treated. There is a strong need for cost-effective technologies to manage disease processes and reduce morbidity and mortality in developing countries. Some of the challenging issues confronting healthcare are lack of proper processing of data and delay in the dissemination of health information, which often causes delays in the provision of results and poor quality of service delivery. This paper addressed the weaknesses of the existing system through the development of an Artificial Intelligence (AI) driven extended diagnostic system (EDS). The dataset was obtained from patients’ historical records from the Lagos University Teaching Hospital (LUTH) and contained two-hundred and fifty (250) records with five (5) attributes such as risk level, gender, symptom 1, symptom 2, and ailment type. The malaria and typhoid dataset was pre-processed and cleansed to remove unwanted data and information. The EDS was developed using the Naive Bayes technique and implemented using software development tools. The performance of the system was evaluated using the following known metrics: accuracies of true positive (TP), true negative (TN), false positive (FP), and false negative (FN). The performance of the EDS was substantially significant for both malaria and typhoid fevers.

Ethical challenges in breastfeeding consultancy: regulation and scientific evidence as basis for promoting good professional practices

This narrative review article reflects the need for regulation of breastfeeding consultancy, so that an impartial, reputable conduct based on scientific evidence protects families from conflicts of interest and other dilemmas fostered by the interposition of the industry, the media and the market. The evaluation of a range of cases monitored by the consultants participating in this research, added to a vast review of the scientific and normative literature, observed the vulnerability of families who, during counseling, were induced to acquire superfluous devices and services, under the excuse that such investment would be essential for successful breastfeeding. It is noticed that the provision of quality, up-to-date information and support to lactating and infants does not take place in a humane way, neglecting the health and well-being of those involved and exposing families to adverse consequences of the financial interests of professionals. It can be conjectured that norms, laws and formal guidelines, supported by the scientific method, would cooperate for the technical and ethical improvement of professionals already active in the market, as well as for the training of new, more qualified professionals.