921 resultados para value communication methods


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Sequential panel selection methods (spsms — procedures that sequentially use conventional panel unit root tests to identify I(0)I(0) time series in panels) are increasingly used in the empirical literature. We check the reliability of spsms by using Monte Carlo simulations based on generating directly the individual asymptotic pp values to be combined into the panel unit root tests, in this way isolating the classification abilities of the procedures from the small sample properties of the underlying univariate unit root tests. The simulations consider both independent and cross-dependent individual test statistics. Results suggest that spsms may offer advantages over time series tests only under special conditions.

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Part 1: Introduction

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Mestrado Vinifera Euromaster - Instituto Superior de Agronomia - UL

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Dissertação de Mestrado Integrado em Medicina Veterinária

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Background: The levels of Th1/Th2 cytokine can alter in pathogenic infection in children with pneumonia. Objectives: To evaluate Th1/Th2 cytokine profile and its diagnostic value in M. pneumoniae pneumonia in children. Patients and Methods: Children with M. pneumoniae mono-infection and 30 healthy children were tested with cytokines assay. We used real time PCR to detect M. pneumoniae in children with pneumonia. Results: M. pneumoniae test was positive in 2188 (16.62%) out of 13161 pneumonia children. Children aged 5 - 9 years had the highest rate and summer was a season with high rate of M. pneumoniae incidence in Zhejiang province. During the course of study, in 526 pneumonia children with M. pneumoniae mono-infection and 30 healthy children cytokines assay was performed. IL-2 level of M. pneumoniae pneumonia children was lower than that of healthy children (median levels, pg/mL: IL-2: 3.2 vs. 5.7, P = 0.00), while IL-4, IL-10 and IFN-γ were higher than in healthy children (median levels, pg/mL: IL-4: 3.2 vs. 1.5, P = 0.00; IL-10: 5.6 vs. 2.5, P = 0.001; IFN-γ: 20.4 vs. 4.8, P = 0.001). Conclusions: IL-2 decreases and IL-4, IL-10 and IFN-γ increase in children with M. pneumoniae pneumonia, which has a promising prospect in diagnosis of this disease in clinical practice.

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Objective Transparent evidence-based decision making has been promoted worldwide to engender trust in science and policy making. Yet, little attention has been given to transparency implementation. The degree of transparency (focused on how uncertain evidence was handled) during the development of folate and vitamin D Dietary Reference Values was explored in three a priori defined areas: (i) value request; (ii) evidence evaluation; and (iii) final values. Design Qualitative case studies (semi-structured interviews and desk research). A common protocol was used for data collection, interview thematic analysis and reporting. Results were coordinated via cross-case synthesis. Setting Australia and New Zealand, Netherlands, Nordic countries, Poland, Spain and UK. Subjects Twenty-one interviews were conducted in six case studies. Results Transparency of process was not universally observed across countries or areas of the recommendation setting process. Transparency practices were most commonly seen surrounding the request to develop reference values (e.g. access to risk manager/assessor problem formulation discussions) and evidence evaluation (e.g. disclosure of risk assessor data sourcing/evaluation protocols). Fewer transparency practices were observed to assist with handling uncertainty in the evidence base during the development of quantitative reference values. Conclusions Implementation of transparency policies may be limited by a lack of dedicated resources and best practice procedures, particularly to assist with the latter stages of reference value development. Challenges remain regarding the best practice for transparently communicating the influence of uncertain evidence on the final reference values. Resolving this issue may assist the evolution of nutrition risk assessment and better inform the recommendation setting process.

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BACKGROUND: The majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure.

OBJECTIVES: The objectives of this study were to explore how NICU/PICU nurses care for families before and after death; to explore the nurses' perspectives on their preparedness/ability to provide family care; and to determine the emotional content of language used by nurse participants.

METHODS: Focus group and individual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content.

RESULTS: Four core themes were identified: preparing for death; communication challenges; the nurse-family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses.

CONCLUSION: This study provided rich insights into the experiences of nurses who are caring for dying children including the nurses' need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses' provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.

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We are often confronted with the dilemmas of interacting with people from different cultural backgrounds. How do we ensure that we meet their needs, if they have some barriers to communicating those needs? This project explores the communication mechanisms used by mental health clinicians, to explore how they modify their communication to reconcile cultural differences and promote self-disclosure. It also identifies the practical experiences that have enlightened clinicians' practice when interacting with culturally and linguistically diverse (CALD) groups. Through focus groups, mental health clinicians were probed about their experiences with CALD groups and the methods used to facilitate communication. Clinicians were working in either acute adult inpatient or community settings in a large metropolitan health service. Fifty-three clinicians formed 7 focus groups. In the focus groups, clinicians were asked about their perceptions of communication with CALD clients. Guided questions were used. All focus groups were audio-taped and transcribed. Two distinct themes emerged. They were ‘respect’ and ‘cultural understanding’. The clinicians recognized that showing and maintaining respect for the CALD client, and their families significantly impacted on the development of a therapeutic relationship. Showing cultural understanding and acceptance for difference also enhanced communication.

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The conception of the child that a researcher holds has implications for research methods. This article adds to work that mobilises Deleuze and Guattari’s becoming-child in Childhood Studies, exploring what their conceptual tools do to research methods and analysis. I map how puppet production emerged as a research method during an ethnography at a high school and how the students and I co-theorised the methodological value of puppet production. Exploring one particular puppet production, it is argued that puppet productions, analysed with young people, may open up conceptual possibilities, but must be examined alongside the dynamic conditions of their creation and analysis.

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BACKGROUND: People with communication disability often struggle to convey their health information to multiple service providers and are at increased risk of adverse health outcomes related to the poor exchange of health information. OBJECTIVE: The purpose of this article was to (a) review the literature informing future research on the Australian personally controlled electronic health record, 'My Health Record' (MyHR), specifically to include people with communication disability and their family members or service providers, and (b) to propose a range of suitable methodologies that might be applied in research to inform training, policy and practice in relation to supporting people with communication disability and their representatives to engage in using MyHR. METHOD: The authors reviewed the literature and, with a cross-disciplinary perspective, considered ways to apply sociotechnical, health informatics, and inclusive methodologies to research on MyHR use by adults with communication disability. RESEARCH OUTCOMES: This article outlines a range of research methods suitable for investigating the use of MyHR by people who have communication disability associated with a range of acquired or lifelong health conditions, and their family members, and direct support workers. CONCLUSION: In planning the allocation of funds towards the health and well-being of adults with disabilities, both disability and health service providers must consider the supports needed for people with communication disability to use MyHR. There is an urgent need to focus research efforts on MyHR in populations with communication disability, who struggle to communicate their health information across multiple health and disability service providers. The design of studies and priorities for future research should be set in consultation with people with communication disability and their representatives.

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PURPOSE: Adults with cerebral palsy (CP) experience multiple, functional changes as they age, including changes to communication modes and methods that enable development and maintenance of relationships, communicative participation and quality-of-life. Little is known about the nature of communication changes experienced by this group. The aim of this study was to better understand how adults with CP experience changes in their communication abilities as they age and the subsequent psychosocial impact.

METHOD: Twenty adults with cerebral palsy aged 40-72 years with complex communication needs (CCN) participated in a series of in-depth interviews, framing their experiences of loss and grief throughout their lives. The impact of changing communication abilities emerged as an important area of focus. Data were analysed using constructivist grounded theory methodology.

RESULT: Themes arising from the participants' perceptions of their communication included experiencing communication change as a loss with subsequent impact on self-concept; and how communication is integral to the process of managing losses associated with older age.

CONCLUSION: Implications for speech-language pathologists working with older people with cerebral palsy and CCN include the need to understand the psychosocial impact of communication changes on social interaction, relationships and communicative participation. It is important to promote positive and meaningful communication options that maintain a coherent sense of self in addition to promoting functional communication skills and communicative participation.

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AIMS AND OBJECTIVES: This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. BACKGROUND: Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. DESIGN: A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. METHODS: A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. FINDINGS: Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. CONCLUSIONS: The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. RELEVANCE TO CLINICAL PRACTICE: Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed.

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Optical waveguides have shown promising results for use within printed circuit boards. These optical waveguides have higher bandwidth than traditional copper transmission systems and are immune to electromagnetic interference. Design parameters for these optical waveguides are needed to ensure an optimal link budget. Modeling and simulation methods are used to determine the optimal design parameters needed in designing the waveguides. As a result, optical structures necessary for incorporating optical waveguides into printed circuit boards are designed and optimized. Embedded siloxane polymer waveguides are investigated for their use in optical printed circuit boards. This material was chosen because it has low absorption, high temperature stability, and can be deposited using common processing techniques. Two sizes of waveguides are investigated, 50 $unit{mu m}$ multimode and 4 - 9 $unit{mu m}$ single mode waveguides. A beam propagation method is developed for simulating the multimode and single mode waveguide parameters. The attenuation of simulated multimode waveguides are able to match the attenuation of fabricated waveguides with a root mean square error of 0.192 dB. Using the same process as the multimode waveguides, parameters needed to ensure a low link loss are found for single mode waveguides including maximum size, minimum cladding thickness, minimum waveguide separation, and minimum bend radius. To couple light out-of-plane to a transmitter or receiver, a structure such as a vertical interconnect assembly (VIA) is required. For multimode waveguides the optimal placement of a total internal reflection mirror can be found without prior knowledge of the waveguide length. The optimal placement is found to be either 60 µm or 150 µm away from the end of the waveguide depending on which metric a designer wants to optimize the average output power, the output power variance, or the maximum possible power loss. For single mode waveguides a volume grating coupler is designed to couple light from a silicon waveguide to a polymer single mode waveguide. A focusing grating coupler is compared to a perpendicular grating coupler that is focused by a micro-molded lens. The focusing grating coupler had an optical loss of over -14 dB, while the grating coupler with a lens had an optical loss of -6.26 dB.

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My dissertation emphasizes a cognitive account of multimodality that explicitly integrates experiential knowledge work into the rhetorical pedagogy that informs so many composition and technical communication programs. In these disciplines, multimodality is widely conceived in terms of what Gunther Kress calls “socialsemiotic” modes of communication shaped primarily by culture. In the cognitive and neurolinguistic theories of Vittorio Gallese and George Lakoff, however, multimodality is described as a key characteristic of our bodies’ sensory-motor systems which link perception to action and action to meaning, grounding all communicative acts in knowledge shaped through body-engaged experience. I argue that this “situated” account of cognition – which closely approximates Maurice Merleau-Ponty’s phenomenology of perception, a major framework for my study – has pedagogical precedence in the mimetic pedagogy that informed ancient Sophistic rhetorical training, and I reveal that training’s multimodal dimensions through a phenomenological exegesis of the concept mimesis. Plato’s denigration of the mimetic tradition and his elevation of conceptual contemplation through reason, out of which developed the classic Cartesian separation of mind from body, resulted in a general degradation of experiential knowledge in Western education. But with the recent introduction into college classrooms of digital technologies and multimedia communication tools, renewed emphasis is being placed on the “hands-on” nature of inventive and productive praxis, necessitating a revision of methods of instruction and assessment that have traditionally privileged the acquisition of conceptual over experiential knowledge. The model of multimodality I construct from Merleau-Ponty’s phenomenology, ancient Sophistic rhetorical pedagogy, and current neuroscientific accounts of situated cognition insists on recognizing the significant role knowledges we acquire experientially play in our reading and writing, speaking and listening, discerning and designing practices.

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A purpose of this research study was to demonstrate the practical linguistic study and evaluation of dissertations by using two examples of the latest technology, the microcomputer and optical scanner. That involved developing efficient methods for data entry plus creating computer algorithms appropriate for personal, linguistic studies. The goal was to develop a prototype investigation which demonstrated practical solutions for maximizing the linguistic potential of the dissertation data base. The mode of text entry was from a Dest PC Scan 1000 Optical Scanner. The function of the optical scanner was to copy the complete stack of educational dissertations from the Florida Atlantic University Library into an I.B.M. XT microcomputer. The optical scanner demonstrated its practical value by copying 15,900 pages of dissertation text directly into the microcomputer. A total of 199 dissertations or 72% of the entire stack of education dissertations (277) were successfully copied into the microcomputer's word processor where each dissertation was analyzed for a variety of syntax frequencies. The results of the study demonstrated the practical use of the optical scanner for data entry, the microcomputer for data and statistical analysis, and the availability of the college library as a natural setting for text studies. A supplemental benefit was the establishment of a computerized dissertation corpus which could be used for future research and study. The final step was to build a linguistic model of the differences in dissertation writing styles by creating 7 factors from 55 dependent variables through principal components factor analysis. The 7 factors (textual components) were then named and described on a hypothetical construct defined as a continuum from a conversational, interactional style to a formal, academic writing style. The 7 factors were then grouped through discriminant analysis to create discriminant functions for each of the 7 independent variables. The results indicated that a conversational, interactional writing style was associated with more recent dissertations (1972-1987), an increase in author's age, females, and the department of Curriculum and Instruction. A formal, academic writing style was associated with older dissertations (1972-1987), younger authors, males, and the department of Administration and Supervision. It was concluded that there were no significant differences in writing style due to subject matter (community college studies) compared to other subject matter. It was also concluded that there were no significant differences in writing style due to the location of dissertation origin (Florida Atlantic University, University of Central Florida, Florida International University).