917 resultados para Communication in medicine.


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Desde la noción universal sobre la empresa como un sistema de interacción con un entorno determinado para alcanzar un objetivo, de manera planificada y en función de satisfacer las demandas de un mercado mediante la actividad económica, su viabilidad, sostenibilidad y crecimiento dependerán, por supuesto, de una serie de estrategias adecuadas no solo para tales fines, sino también para enfrentar diversidad de agentes endógenos y exógenos que puedan afectar el normal desempeño de su gestión. Estamos hablando de la importancia de la resiliencia organizacional y del Capital Psicológico. En un escenario tan impredecible como el de la economía mundial, donde la constante son los cambios en su comportamiento —unos propios de su dinámica e interdependencia, naturales de fenómenos como la globalización, y otros derivados de eventos disruptivos— hoy más que nunca es necesario implementar el modelo de la empresa resiliente, que es aquella entidad capaz de adaptarse y recuperarse frente a una perturbación. Al mismo tiempo, más allá de su tamaño, naturaleza u objeto social, es indispensable reconocer básicamente que toda organización está constituida por personas, lo cual implica la trascendencia que para su funcionamiento tiene el factor humano-dependiente, y por lo tanto se crea la necesidad de promover el Capital Psicológico y la resiliencia a nivel de las organizaciones a través de una cultura empresarial.

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La coordinació i assignació de tasques en entorns distribuïts ha estat un punt important de la recerca en els últims anys i aquests temes són el cor dels sistemes multi-agent. Els agents en aquests sistemes necessiten cooperar i considerar els altres agents en les seves accions i decisions. A més a més, els agents han de coordinar-se ells mateixos per complir tasques complexes que necessiten més d'un agent per ser complerta. Aquestes tasques poden ser tan complexes que els agents poden no saber la ubicació de les tasques o el temps que resta abans de que les tasques quedin obsoletes. Els agents poden necessitar utilitzar la comunicació amb l'objectiu de conèixer la tasca en l'entorn, en cas contrari, poden perdre molt de temps per trobar la tasca dins de l'escenari. De forma similar, el procés de presa de decisions distribuït pot ser encara més complexa si l'entorn és dinàmic, amb incertesa i en temps real. En aquesta dissertació, considerem entorns amb sistemes multi-agent amb restriccions i cooperatius (dinàmics, amb incertesa i en temps real). En aquest sentit es proposen dues aproximacions que permeten la coordinació dels agents. La primera és un mecanisme semi-centralitzat basat en tècniques de subhastes combinatòries i la idea principal es minimitzar el cost de les tasques assignades des de l'agent central cap als equips d'agents. Aquest algoritme té en compte les preferències dels agents sobre les tasques. Aquestes preferències estan incloses en el bid enviat per l'agent. La segona és un aproximació d'scheduling totalment descentralitzat. Això permet als agents assignar les seves tasques tenint en compte les preferències temporals sobre les tasques dels agents. En aquest cas, el rendiment del sistema no només depèn de la maximització o del criteri d'optimització, sinó que també depèn de la capacitat dels agents per adaptar les seves assignacions eficientment. Addicionalment, en un entorn dinàmic, els errors d'execució poden succeir a qualsevol pla degut a la incertesa i error de accions individuals. A més, una part indispensable d'un sistema de planificació és la capacitat de re-planificar. Aquesta dissertació també proveeix una aproximació amb re-planificació amb l'objectiu de permetre als agent re-coordinar els seus plans quan els problemes en l'entorn no permeti la execució del pla. Totes aquestes aproximacions s'han portat a terme per permetre als agents assignar i coordinar de forma eficient totes les tasques complexes en un entorn multi-agent cooperatiu, dinàmic i amb incertesa. Totes aquestes aproximacions han demostrat la seva eficiència en experiments duts a terme en l'entorn de simulació RoboCup Rescue.

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This paper describes a novel methodology for observing and analysing collaborative design by using the concepts of cognitive dimensions related to concept-based misfit analysis. The study aims at gaining an insight into support for creative practice of graphical communication in collaborative design processes of designers while sketching within a shared white board and audio conferencing environment. Empirical data on design processes have been obtained from observation of groups of student designers solving an interior space-planning problem of a lounge-diner in a shared virtual environment. The results of the study provide recommendations for the design and development of interactive systems to support such collaborative design activities.

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Many different individuals, who have their own expertise and criteria for decision making, are involved in making decisions on construction projects. Decision-making processes are thus significantly affected by communication, in which a dynamic performance of human intentions leads to unpredictable outcomes. In order to theorise the decision making processes including communication, it is argued here that the decision making processes resemble evolutionary dynamics in terms of both selection and mutation, which can be expressed by the replicator-mutator equation. To support this argument, a mathematical model of decision making has been made from an analogy with evolutionary dynamics, in which there are three variables: initial support rate, business hierarchy, and power of persuasion. On the other hand, a survey of patterns in decision making in construction projects has also been performed through self-administered mail questionnaire to construction practitioners. Consequently, comparison between the numerical analysis of mathematical model and the statistical analysis of empirical data has shown a significant potential of the replicator-mutator equation as a tool to study dynamic properties of intentions in communication.

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In this paper, Bayesian decision procedures previously proposed for dose-escalation studies in healthy volunteers are reviewed and evaluated. Modifications are made to the expression of the prior distribution in order to make the procedure simpler to implement and a more relevant criterion for optimality is introduced. The results of an extensive simulation exercise to establish the proper-ties of the procedure and to aid choice between designs are summarized, and the way in which readers can use simulation to choose a design for their own trials is described. The influence of the value of the within-subject correlation on the procedure is investigated and the use of a simple prior to reflect uncertainty about the correlation is explored. Copyright (c) 2005 John Wiley & Sons, Ltd.

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Motivated by a matched case-control study to investigate potential risk factors for meningococcal disease amongst adolescents, we consider the analysis of matched case-control studies where disease incidence, and possibly other risk factors, vary with time of year. For the cases, the time of infection may be recorded. For controls, however, the recorded time is simply the time of data collection, which is shortly after the time of infection for the matched case, and so depends on the latter. We show that the effect of risk factors and interactions may be adjusted for the time of year effect in a standard conditional logistic regression analysis without introducing any bias. We also show that, if the time delay between data collection for cases and controls is constant, provided this delay is not very short, estimates of the time of year effect are approximately unbiased. In the case that the length of the delay varies over time, the estimate of the time of year effect is biased. We obtain an approximate expression for the degree of bias in this case. Copyright © 2004 John Wiley & Sons, Ltd.

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Pharmacovigilance, the monitoring of adverse events (AEs), is an integral part in the clinical evaluation of a new drug. Until recently, attempts to relate the incidence of AEs to putative causes have been restricted to the evaluation of simple demographic and environmental factors. The advent of large-scale genotyping, however, provides an opportunity to look for associations between AEs and genetic markers, such as single nucleotides polymorphisms (SNPs). It is envisaged that a very large number of SNPs, possibly over 500 000, will be used in pharmacovigilance in an attempt to identify any genetic difference between patients who have experienced an AE and those who have not. We propose a sequential genome-wide association test for analysing AEs as they arise, allowing evidence-based decision-making at the earliest opportunity. This gives us the capability of quickly establishing whether there is a group of patients at high-risk of an AE based upon their DNA. Our method provides a valid test which takes account of linkage disequilibrium and allows for the sequential nature of the procedure. The method is more powerful than using a correction, such as idák, that assumes that the tests are independent. Copyright © 2006 John Wiley & Sons, Ltd.

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Assaying a large number of genetic markers from patients in clinical trials is now possible in order to tailor drugs with respect to efficacy. The statistical methodology for analysing such massive data sets is challenging. The most popular type of statistical analysis is to use a univariate test for each genetic marker, once all the data from a clinical study have been collected. This paper presents a sequential method for conducting an omnibus test for detecting gene-drug interactions across the genome, thus allowing informed decisions at the earliest opportunity and overcoming the multiple testing problems from conducting many univariate tests. We first propose an omnibus test for a fixed sample size. This test is based on combining F-statistics that test for an interaction between treatment and the individual single nucleotide polymorphism (SNP). As SNPs tend to be correlated, we use permutations to calculate a global p-value. We extend our omnibus test to the sequential case. In order to control the type I error rate, we propose a sequential method that uses permutations to obtain the stopping boundaries. The results of a simulation study show that the sequential permutation method is more powerful than alternative sequential methods that control the type I error rate, such as the inverse-normal method. The proposed method is flexible as we do not need to assume a mode of inheritance and can also adjust for confounding factors. An application to real clinical data illustrates that the method is computationally feasible for a large number of SNPs. Copyright (c) 2007 John Wiley & Sons, Ltd.

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We focus on the comparison of three statistical models used to estimate the treatment effect in metaanalysis when individually pooled data are available. The models are two conventional models, namely a multi-level and a model based upon an approximate likelihood, and a newly developed model, the profile likelihood model which might be viewed as an extension of the Mantel-Haenszel approach. To exemplify these methods, we use results from a meta-analysis of 22 trials to prevent respiratory tract infections. We show that by using the multi-level approach, in the case of baseline heterogeneity, the number of clusters or components is considerably over-estimated. The approximate and profile likelihood method showed nearly the same pattern for the treatment effect distribution. To provide more evidence two simulation studies are accomplished. The profile likelihood can be considered as a clear alternative to the approximate likelihood model. In the case of strong baseline heterogeneity, the profile likelihood method shows superior behaviour when compared with the multi-level model. Copyright (C) 2006 John Wiley & Sons, Ltd.

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This paper explores the theoretical developments and subsequent uptake of sequential methodology in clinical studies in the 25 years since Statistics in Medicine was launched. The review examines the contributions which have been made to all four phases into which clinical trials are traditionally classified and highlights major statistical advancements, together with assessing application of the techniques. The vast majority of work has been in the setting of phase III clinical trials and so emphasis will be placed here. Finally, comments are given indicating how the subject area may develop in the future.

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Background: Difficulties with social interaction and understanding lie at the heart of the communication disorder that characterises the autism spectrum. This study sought to improve social communication for individuals with autism spectrum disorder (ASD) by means of a groupwork intervention focusing on social and emotional perspective-taking, conversation skills, and friendship skills. It also aimed to address some of the limitations of previous interventions, including a lack of generalisation to other settings, so as to maximise inclusion in the community. Method A group of 46 high functioning children and adolescents with ASD (38 boys, 8 girls, age range 6-16 years) were allocated to one of 6 intervention groups. Each group met over a period of 12-16 weeks for a minimum of one 1 1/2-hour weekly session aimed at promoting key areas of social interaction and understanding, supported by home-based practice. Results: Significant gains were achieved in comparison with a normative population, and individual parent ratings showed marked and sustained changes in the key areas targeted in the group sessions. Conclusion: Social communication in children and adolescents with ASD can be enhanced through the use of a groupwork intervention addressing social interaction and understanding.

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Objectives: To investigate people's views about the efficacy and specific risks of herbal, over-the-counter (OTC) conventional, and prescribed conventional medicines, and their likelihood of taking a second (herbal or OTC conventional) product in addition to a prescribed medicine. Methods: Experiment 1 (1 factor within-participant design); Experiment 2 (1 factor between-participant design). Convenience samples of general population were given a hypothetical scenario and required to make a number of judgements. Results: People believed herbal remedies to be less effective, but less risky than OTC and prescribed conventional medicines. Herbal medicines were not seen as being safer simply because of their easier availability. Participants indicated that they would be more likely to take a herbal medicine than a conventional OTC medicine in addition to a prescribed medicine, and less likely to consult their doctor in advance. Conclusion: People believe that herbal medicines are natural and relatively safe and can be used with less caution. People need to be given clear information about the risks and benefits of herbal medicines if they are to use such products safety and effectively. (c) 2006 Elsevier Ltd. All rights reserved.

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Three experiments examined the effects of adding information about medication benefits to a short written explanation about a medicine. Participants were presented with a fictitious scenario about visiting the doctor, being prescribed an antibiotic and being given information about the medicine. They were asked to make various judgements relating to the information, the medicine and their intention to take it. Experiment 1 found that information about benefits enhanced the judgements, but did not influence the intention to comply. Experiment 2 compared the relative effectiveness of two different forms of the benefit statement, and found that both were effective in improving judgements, but had no effect on intention to comply. Experiment 3 compared the effectiveness of the two forms of benefit information but participants were told that the medicine was associated with four named side effects. Both types of statement improved ratings of the intention to comply, as well as ratings on the other measures. The experiments provide fairly consistent support for the inclusion of benefit information in medicine information leaflets, particularly to balance concerns about side effects.