143 resultados para compétence de communication orale


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In this paper, the impact of hardware impairments on secrecy performance of cognitive MIMO schemes is investigated. In addition, the relay which helps the source forward the source signal to the destination can operate either half-duplex mode or full-duplex mode. For performance evaluation, we give the expressions of average secrecy rate over Rayleigh fading channel. Monte-Carlo simulations are presented to compare and optimize the performance of the proposed schemes.

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The allocation of a large amount of bandwidth by regulating bodies in the 70/80 GHz band, i.e., the E-band, has opened up new potentials and challenges for providing affordable and reliable Gigabit per second wireless point-to-point links. This article first reviews the available bandwidth and licensing regulations in the E-band. Subsequently, different propagation models, e.g., the ITU-R and Cane models, are compared against measurement results and it is concluded that to meet specific availability requirements, E-band wireless systems may need to be designed with larger fade margins compared to microwave systems. A similar comparison is carried out between measurements and models for oscillator phase noise. It is confirmed that phase noise characteristics, that are neglected by the models used for narrowband systems, need to be taken into account for the wideband systems deployed in the E-band. Next, a new multi-input multi-output (MIMO) transceiver design, termed continuous aperture phased (CAP)-MIMO, is presented. Simulations show that CAP-MIMO enables E-band systems to achieve fiber-optic like throughputs. Finally, it is argued that full-duplex relaying can be used to greatly enhance the coverage of E-band systems without sacrificing throughput, thus, facilitating their application in establishing the backhaul of heterogeneous networks.

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OBJECTIVE: To understand patients' preferences for physician behaviours during end-of-life communication.

METHODS: We used interpretive description methods to analyse data from semistructured, one-on-one interviews with patients admitted to general medical wards at three Canadian tertiary care hospitals. Study recruitment took place from October 2012 to August 2013. We used a purposive, maximum variation sampling approach to recruit hospitalised patients aged ≥55 years with a high risk of mortality within 6-12 months, and with different combinations of the following demographic variables: race (Caucasian vs non-Caucasian), gender and diagnosis (cancer vs non-cancer).

RESULTS: A total of 16 participants were recruited, most of whom (69%) were women and 70% had a non-cancer diagnosis. Two major concepts regarding helpful physician behaviour during end-of-life conversations emerged: (1) 'knowing me', which reflects the importance of acknowledging the influence of family roles and life history on values and priorities expressed during end-of-life communication, and (2) 'conditional candour', which describes a process of information exchange that includes an assessment of patients' readiness, being invited to the conversation, and sensitive delivery of information.

CONCLUSIONS: Our findings suggest that patients prefer a nuanced approach to truth telling when having end-of-life discussions with their physician. This may have important implications for clinical practice and end-of-life communication training initiatives.

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Much is already known about medically unexplained symptoms (MUS) in terms of incidence, presentation and current treatment. What needs to be urgently addressed is a strategy for dealing with patients and their conditions, particularly when they do not fall neatly into medical frameworks or pathologies where the syndrome can be easily explained. This article will consider the provision of health and social care support for patients with MUS within an interprofessional education context. The author will contend that a sensitive and valued service for this large client group is dependent upon services without professional boundaries and practitioners with a clinical interest that can work together and agree an appropriate way forward in terms of care, support and strategic service provision. The article will support the idea that clear guidelines through the National Institute for Health and Care Excellence can offer clear clinical direction for practitioners working in primary and secondary care settings to work together interprofessionally to ensure a seamless and sensitive service for people with this condition.

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Objective

Global migration of healthcare workers places responsibility on employers to comply with legal employment rights whilst ensuring patient safety remains the central goal. We describe the pilot of a communication assessment designed for doctors who trained and communicated with patients and colleagues in a different language from that of the host country. It is unique in assessing clinical communication without assessing knowledge.

Methods

A 14-station OSCE was developed using a domain-based marking scheme, covering professional communication and English language skills (speaking, listening, reading and writing) in routine, acute and emotionally challenging contexts, with patients, carers and healthcare teams. Candidates (n = 43), non-UK trained volunteers applying to the UK Foundation Programme, were provided with relevant station information prior to the exam.

Results

The criteria for passing the test included achieving the pass score and passing 10 or more of the 14 stations. Of the 43 candidates, nine failed on the station criteria. Two failed the pass score and also the station criteria. The Cronbach's alpha coefficient was 0.866.

Conclusion

This pilot tested ‘proof of concept’ of a new domain-based communication assessment for non-UK trained doctors.

Practice implications

The test would enable employers and regulators to verify communication competence and safety in clinical contexts, independent of clinical knowledge, for doctors who trained in a language different from that of the host country.

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Aim
To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance.

Background
Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy.

Design
A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods.

Methods
Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012).

Discussion
Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.

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This paper presents a simple polarization encoding strategy that operates using only single element dual port transmit and receive antennas in such a way that selective spatial scrambling of QPSK data can be effected. The key transmitter and receiver relationships needed for this operation to occur are derived. The system is validated using a cross dipole antenna arrangement. Unlike all previously reported physical layer wireless solutions the approach developed in this paper transfers the security property to the receive side resulting in very simple transmit and receive side architectures thus avoiding the need for near field modulated array technology. In addition the scheme permits, for the first time, multiple spatially separated secured receive sites to operate in parallel.

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In this paper, we investigate secure device-to-device (D2D) communication in energy harvesting large-scale cognitive cellular networks. The energy constrained D2D transmitter harvests energy from multi-antenna equipped power beacons (PBs), and communicates with the corresponding receiver using the spectrum of the cellular base stations (BSs). We introduce a power transfer model and an information signal model to enable wireless energy harvesting and secure information transmission. In the power transfer model, we propose a new power transfer policy, namely, best power beacon (BPB) power transfer. To characterize the power transfer reliability of the proposed policy, we derive new closed-form expressions for the exact power outage probability and the asymptotic power outage probability with large antenna arrays at PBs. In the information signal model, we present a new comparative framework with two receiver selection schemes: 1) best receiver selection (BRS), and 2) nearest receiver selection (NRS). To assess the secrecy performance, we derive new expressions for the secrecy throughput considering the two receiver selection schemes using the BPB power transfer policies. We show that secrecy performance improves with increasing densities of PBs and D2D receivers because of a larger multiuser diversity gain. A pivotal conclusion is reached that BRS achieves better secrecy performance than NRS but demands more instantaneous feedback and overhead.

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Energy in today's short-range wireless communication is mostly spent on the analog- and digital hardware rather than on radiated power. Hence,purely information-theoretic considerations fail to achieve the lowest energy per information bit and the optimization process must carefully consider the overall transceiver. In this paper, we propose to perform cross-layer optimization, based on an energy-aware rate adaptation scheme combined with a physical layer that is able to properly adjust its processing effort to the data rate and the channel conditions to minimize the energy consumption per information bit. This energy proportional behavior is enabled by extending the classical system modes with additional configuration parameters at the various layers. Fine grained models of the power consumption of the hardware are developed to provide awareness of the physical layer capabilities to the medium access control layer. The joint application of the proposed energy-aware rate adaptation and modifications to the physical layer of an IEEE802.11n system, improves energy-efficiency (averaged over many noise and channel realizations) in all considered scenarios by up to 44%.