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Efeitos da posição social da infância e da vida adulta na perda dentária, nas doenças crônicas e na qualidade de vida relacionada a saúde bucalVendrame, Édina January 2016 (has links)
Introdução: Dado que a trajetória socioeconômica pode influenciar na saúde individual durante a vida, nosso objetivo foi testar um modelo de efeitos socioeconômicos do curso de vida na perda dentária, doenças crônicas e qualidade de vida relacionada a saúde bucal. Método: Este estudo de base populacional (n=433) foi realizado em Porto Alegre entre 2010 e 2012 com os usuários do Sistema Único de Saúde (SUS) com 18 anos de idade ou mais. As variáveis observadas utilizadas foram: sexo, idade, fumo e número de dentes presentes. As variáveis latentes utilizadas foram Oral Health Impact Profile (OHIP), Posição Social na Infância (SESC), Posição Social na Vida Adulta (SESA) e Doença Crônica (CD). A análise estatística foi realizada utilizando-se o modelo de equações estruturais (SEM) com o software Mplus. No modelo final foram mantidas as associações significativas (p<0,30). Resultados: O modelo final apresentou um ajuste adequado: RMSA 0,039, CFI 0,972, TLI 0,969 e WRMR 1.199. O efeito da SESC na SESA foi forte β= 0,59 (p<0,01). O efeito direto da SESC na perda dentária foi β= -0,08 (p= 0,19), e nas doenças crônicas foi β= -0,14 (p= 0,10). O efeito direto da SESA na perda dentária foi β= -0,20 (p<0,01), e no OHIP foi β= -0,14 (p= 0,05). O efeito indireto de SESC na perda dentária foi β= -0,12 (p= 0,02), e no OHIP foi β= -0,14 (p= 0,01). O efeito indireto da SESA no OHIP foi β= -0,02 (p= 0.3). SESC tem um efeito indireto sobre OHIP e perda dentária via SESA, apoiando a teoria da cadeia de efeitos. SESC e SESA tem efeitos independentes na perda dentária, apoiando a teoria do acúmulo de risco. SESC tem um efeito direto nas doenças crônicas apoiando a teoria do período crítico. Conclusão: Investigações com base no curso de vida relacionada à saúde bucal usando SEM são necessárias para melhor compreender os mecanismos que ligam fatores sociais à saúde das pessoas causando inequidades. / Introduction: Since the socioeconomic trajectory can influence on individual health during the life course, we aimed to test a model of life course socioeconomic effects on tooth loss, chronic disease and Oral Health Related to Quality of Life. Method: This population-based study (n = 433) was held in Porto Alegre between 2010 and 2012 with the Public Health (PH) users aged 18 or over. The observable variables were: gender, age, smoking and number of teeth. Latent variables were Oral Health Impact Profile (OHIP), Socioeconomic Status in Childhood (SESC) Socioeconomic Status in Adulthood (SESA) and Chronic Disease (CD). Statistical analysis was performed using the Structural Equation Modeling (SEM) with Mplus software. For the final model only significant associations were kept (p<0.30). Results: The final model presented an adequate fit: RMSA 0.039, CFI 0.972, TLI 0.969 and WRMR 1.199. The effect of SESC on SESA was strong β = 0.59 (p<0.01). The direct effect of SESC on tooth loss was β = -0.08 (p = 0.19), and on chronic diseases was β = -0.14 (p = 0.10). The direct effect of SESA on tooth loss was β = -0.20 (p <0.01), and on OHIP was β = -0.14 (p = 0.05). The indirect effect of SESC on tooth loss was β = -0.12 (p = 0.02), and on OHIP was β = -0.14 (p = 0.01). The indirect effect of SESA on OHIP was β = -0.02 (p = 0.3). SESC has an indirect effect on OHIP and tooth loss via SESA, supporting the chain of effects theory. SESC and SESA have independent effects on tooth loss, supporting the accumulation theory. SESC has a direct effect on chronic diseases supporting the critical period theory. Conclusion: Investigations based on the life course approach relating to the oral health using SEM are necessary to understand the mechanisms and social determinants of health, causing inequalities.
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Influence des Services d’Accompagnement à l'Export sur les ressources et la performance internationale des Exportatrices Précoces / Influence of Export Support Services on resources and international performance of Early ExportersCatanzaro, Alexis 08 December 2014 (has links)
Cette thèse s'intéresse aux Services d'Accompagnement à l'Export proposés par les acteurs de l'accompagnement. Les pouvoirs publics s'interrogent sur l'efficacité de ces aides. La littérature fait état de résultats contradictoires sur cette question, notamment à cause de l'absence d'une mesure valide de l'accompagnement à l'export qui rend difficile la comparaison des résultats. Cette difficulté est exacerbée par la diversité des entreprises accompagnées. En effet, les aides ont été pensées pour les entreprises à internationalisation par étapes. Pourtant, il apparaît que les Exportatrices Précoces, type d'entreprise à internationalisation précoce le plus répandu mais aussi le plus fragile, utilisent les mêmes aides. Dès lors, deux questions se posent ; d'une part, la manière de mesurer l'accompagnement à l'export reçu par l'entreprise et, d'autre part, la question de l'efficacité des Services d'Accompagnement à l'Export pour les Exportatrices Précoces. Pour répondre à la première question, une démarche de construction d'une échelle de mesure de l'accompagnement à l'export est mise en œuvre en s'appuyant sur le paradigme de Churchill (1979). Une étude exploratoire est menée auprès de treize acteurs de l'accompagnement à l'export et cinq entreprises accompagnées afin de faire émerger des items de mesure. Ensuite, 288 questionnaires d'entreprises accompagnées à l'export sont récoltés et utilisés pour tester les qualités psychométriques de l'échelle. Cette démarche aboutit à une échelle de mesure multidimensionnelle composée de neuf items et distinguant accompagnement informationnel, opérationnel et financier. Cet outil permet de mesurer plus précisément les Services d'Accompagnement à l'Export utilisés par l'entreprise. Pour répondre à la seconde question, la théorie des ressources est mobilisée afin d'identifier les ressources stratégiques des Exportatrices Précoces et l'influence que les différents types d'accompagnement à l'export peuvent avoir sur elles. Ces relations aboutissent à un modèle conceptuel testé par la méthode des équations structurelles à partir de 196 questionnaires d'entreprises accompagnées à l'export. Il en ressort que les Services d'Accompagnement à l'Export sont moins efficaces pour les Exportatrices Précoces, notamment en ce qui concerne l'accompagnement financier qui n'a aucune influence sur leur performance internationale. Les résultats soulignent ainsi la nécessité d'élaborer de nouveaux services pour accompagner efficacement les Exportatrices Précoces. Plusieurs propositions sont faites en ce sens. / This thesis focuses on Export Support Services offered by the public and semi-public actors. Public authorities are questioning the effectiveness of these services. The literature reports conflicting results on this issue, especially because of the lack of a valid measure of export support which makes it difficult to compare results. This difficulty is exacerbated by the diversity of firms supported. Indeed, the services was thought to firm with internationalization by stages. Yet it appears that Early Exporters, the most common but also the most fragile type of International New Ventures, use the same services. Therefore, two questions arise; first, how to measure the export support received by the firm and, secondly, the question of the effectiveness of the Export Support Services for Early Exporters. To answer the first question, a process of construction of a scale measurement of Export Support based on the Churchill paradigm (1979) is implemented. An exploratory study was conducted with thirteen support export actors and five companies to make measurement items. Then 288 questionnaires of supported firms are harvested and used to test the psychometric properties of the scale. This approach results in a multidimensional measurement scale with nine items and distinguishing informational, operational and financial Export Support. This tool can measure more accurately Export Support Services used by the firm. To answer the second question, the theory of resources is mobilized to identify the strategic resources of Early Exporters and influence that different types of Export Support can have on them. These relationships lead to a conceptual model tested by the method of structural equation from 196 questionnaires of supported companies. It shows that the Export Support Services are less effective for Early Exporters, especially with regard to the financial support that has no influence on their international performance. The results thus highlight the need to develop new services to effectively support Early Exporters. Several proposals are made in this direction.
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A relação entre cultura organizacional e o uso de técnicas da qualidade e seu impacto no desempenho operacional / The interplay between organizational culture and the use of quality techniques and its impact on operational performanceLillian do Nascimento Gambi 28 February 2014 (has links)
Muitas empresas têm adotado alguma iniciativa de gestão da qualidade para melhoria de seu desempenho. Entretanto, muitas dessas iniciativas nem sempre produzem os resultados pretendidos. Dentro desse contexto, a cultura organizacional tem se destacado como uma variável contextual que poderia explicar o sucesso, ou mesmo o fracasso, das iniciativas de gestão da qualidade. Dessa forma, esse estudo investiga a influência da cultura organizacional no uso das técnicas da qualidade e seu impacto no desempenho. Para isso, duas hipóteses foram consideradas 1) a cultura de uma organização influencia o conjunto de técnicas da qualidade que ela adota e, 2) a combinação entre o conjunto de técnicas da qualidade adotada por uma organização e sua cultura organizacional afeta o desempenho. Enquanto a maioria dos estudos anteriores considera a relação entre cultura, gestão da qualidade e desempenho no nível de práticas da qualidade, esse estudo estende essa discussão para o nível das técnicas. A partir de dados obtidos de 250 empresas no Brasil e Dinamarca, utilizou-se da Modelagem de Equações Estruturais para testar as hipóteses formuladas. Quatro grupos de técnicas da qualidade, quatro perfis de cultura organizacional definidos no Competing Values Framework, e diversos indicadores de desempenho foram considerados nesse estudo. Resultados mostram que certos perfis culturais estão mais relacionados ao uso de determinadas técnicas da qualidade que outras. Por exemplo, empresas com cultura de grupo orientada para colaboração e desenvolvimento de recursos humanos, tendem a usar técnicas de estabelecimento de metas e melhoria contínua, mas não técnicas associadas à medição. Em contrapartida, empresas que possuem características das culturas racional e hierárquica, que são orientadas para o controle e competição, tendem a usar mais as técnicas de medição do que aquelas culturas orientadas para colaboração e inovação. Além disso, os resultados também mostraram que as técnicas da qualidade contribuem para melhoria do desempenho desde que sustentadas por características culturais apropriadas. Esta pesquisa fornece contribuições práticas importantes para os gestores no sentido de que eles precisam estar cientes da necessidade de adotar técnicas da qualidade que sejam adequadas às características culturais de suas organizações para, com isso, obter melhores resultados a partir do uso dessas técnicas. / Most firms have adopted quality management initiatives to improve quality and other indicators of performance. However, quality management initiatives do not always produce the intended results. Organizational culture has been highlighted as one of the contextual variables that may explain the success or, for that matter, failure of quality management initiatives. Accordingly, this study investigates the influence of organizational culture on the use of quality techniques and its impact on performance. Therefore it hypothesizes that 1) a firm\'s culture affects the quality techniques it adopts, and 2) the quality techniques have a direct effect, and culture a direct and an indirect (i.e. through the quality techniques) effect, on firm operational performance. While most previous studies address the relationships between culture, quality management and performance at the level of quality practices, this study extends this discussion to the level of quality techniques to what should be its core, namely the influence of culture on the performance impact of quality techniques. Based on data collected from 250 firms in Brazil and Denmark, Structural Equation Modeling is used to test these hypotheses. Four quality technique groups, four cultural profiles adopted from the Competing Values Framework, and a wide range of performance indicators are used to operationalize the study. Findings show that culture does not appear to be an unequivocal predictor of the adoption of quality techniques. Furthermore, while the developmental and group cultures strengthen the performance effects of all four quality technique groups considered, the hierarchical culture does so for only one of these groups. In a rational culture the performance effects of all four groups are insignificant. As practical implication findings suggest that managers need to be actively aware of the cultural characteristics of their organization before adopting quality techniques, in order to benefit most from the use of these techniques.
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O processo de escolha de candidatos a programas de Pós-Graduação: uma análise a partir da perspectiva do orientador / The process of candidates choose graduate programs: an analysis from the advisor perspectiveRidnal João do Nascimento 01 April 2016 (has links)
O presente estudo tem por objetivo geral identificar os critérios utilizados na tomada de decisão do orientador em aceitar ou não um candidato a orientando e analisar as possíveis relações dessa decisão com a sua produção acadêmica e a evasão de seus orientados. Para o cumprimento desses objetivos buscou-se identificar e analisar os critérios de seleção de candidatos para os programas de mestrado e de doutorado em um Programa de Pós-Graduação, no caso do Instituto de Pesquisas Energéticas e Nucleares - IPEN, e mais especificamente, procurou-se estudar semelhanças e diferenças desses critérios entre os orientadores; verificar se existe correlação entre os critérios de seleção e as características (perfil) do orientador; identificar o processo de seleção utilizado pelos orientadores e apontar quais as possíveis motivações que levam à evasão segundo a visão desses orientadores. Para responder a tais desafios, como ponto de partida da pesquisa, foi elaborado um modelo conceitual da pesquisa, que serviu de base para a elaboração do roteiro de entrevistas com questões abertas para a identificação dos critérios de seleção utilizados por um grupo pequeno e com um perfil pré-definido de orientadores. Na sequência, a partir das respostas obtidas nas entrevistas, a pesquisa foi ampliada para todos os orientadores do programa de pós-graduação do IPEN mediante a aplicação de uma pesquisa online por meio do aplicativo Google Docs para coleta de dados. Em seguida, esses dados foram analisados e reorganizados segundo um modelo operacional de pesquisa que orientaria a análise através da Modelagem de Equações Estruturais (MEE) com o uso do software SmartPLS, cujo objetivo é identificar a existência ou não de correlação entre os critérios adotados pelos orientadores e sua produção acadêmica e a Evasão dos orientados, para isso nos apoiamos em nossos estudos em: Bazerman e Moore (2010); Hair Jr. et al (2009); Hansmann e Ringle (2004); Martins (1997); Ringle, C.; Silva e Bido (2014); Sousa (2007); Sousa e Yu (2014); Torres (2014); Yu (2011). A metodologia da pesquisa acima descrita pode ser definida como um estudo exploratório que combina aspectos qualitativos e quantitativos. Como conclusão da pesquisa, constatou-se que existem critérios tanto subjetivos como objetivos de escolha dos orientadores, que estão associados à produção acadêmica, esses se apresentam com média intensidade, e que os orientadores que valorizam mais os critérios subjetivos na seleção dos orientandos estão associados a uma maior produção acadêmica do que aqueles que valorizam mais os critérios objetivos. Dentre os critérios subjetivos, destacou-se o critério da disponibilidade enquanto dentre os critérios objetivos destacou-se a experiência. Com relação à evasão não foi possível neste estudo associar os critérios de seleção a esta variável dependente. Os resultados aqui apresentados sugerem que os critérios de escolha por um orientador de Pós-Graduação podem estar associados à produção acadêmica desse orientador. Por outro lado, vale destacar que esses resultados se encontram limitados ao de um Programa de Pós-Graduação. / This study aims to identify the criteria used by advisors in the decision-making on whether to accept a candidate for mentoring in a postgraduate stricto sensu program and examines possible relationships between this decision and their scientific production and mentees evasion. In order to meet these goals one seeks to identify and analyze the selection criteria of candidates for the master\'s and doctorate programs at an institution; in this case, the Energy and Nuclear Research Institute - IPEN. More specifically, one seeks to study similarities and differences between those criteria among the advisors; find out whether there is a correlation between the selection criteria and the advisors characteristics (Profile); identify the selection process used by advisors and point out which are the motivations that lead to evasion according to their point of view. To meet these challenges, as the starting point of the research, a conceptual model was designed in order to form the basis for the preparation of the script for the interviews with open-ended questions as to identify the selection criteria used by a small group of advisors with a predefined profile. From that point, based on the responses obtained in interviews, the survey was expanded to all advisors working in the IPEN Postgraduate program by implementing an online survey using Google Docs app for data collection. These data were then analyzed and reorganized according to an operational model of research that would guide the analysis by structural equation modeling (SEM) by means of the SmartPLS software, in order to identify the presence or absence of correlation between the criteria adopted by the advisors and their academic production and the evasion of their mentees, for that one relied on studies in: Bazerman and Moore (2010); Cohen (1988); Hair Jr. et al (2009); Hansmann and Ringle (2004); Martins (1997); Ringle, C.; Silva and Bido (2014); Sousa (2007); Sousa and Yu (2014); Torres (2014); Yu (2011). The methodology of the research described above can be defined as an exploratory study that combines qualitative and quantitative aspects. As a conclusion of the research, it was found that there are both subjective and objective selection criteria that are linked to academic production and they come up with medium intensity and that advisors who value the subjective criteria in the selection of mentees are associated with a greater academic production than those who value objective criteria. Among the subjective criteria, one highlights the criterion of availability, while among the objective criteria experience stood out. Regarding the evasion, it was not possible, in this study, to connect the selection criteria to this dependent variable. The results presented here suggest that the selection criteria used by a postgraduate advisor may be associated with his academic production. On the other hand, it is worth noting that these results are limited to a single postgraduate program.
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Effect of Gender, Guilt, and Shame on BYU Business School Students' Innovation: Structural Equation Modeling ApproachQudisat, Rasha Mohsen 01 December 2015 (has links)
Innovative people seize the opportunity to make lives better and more comfortable, which contribute to economy growth and financial gain. Stakeholders study innovativeness of business students, in depth, to understand gender differences, and the factors affecting students' innovativeness. Literature explains how males and females differ in their proneness to guilt and shame. However, a model that explains the dynamic of guilt, shame, and gender on innovativeness will help make policies to improve students' innovativeness. This study describes factor analysis approach to examine the TOSCA-3 subscales guilt, shame, and the DNA instrument of innovativeness. It also describes the measurement invariance across gender for each construct, and for the full measurement model to identify the differences between genders. Moreover, this study examines the total effect of gender on innovativeness, which includes the direct effect, and indirect effect via guilt and shame. The results indicated that guilt is positively associated with innovativeness, and shame and gender are negatively associated with innovativeness. This dissertation can be freely accessed and downloaded from (http://etd.byu.edu/).
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An examination of relations among Taiwanese elementary-aged children's effortful control, social relationships, and adjustment at schoolHuang, Chin-Fang 01 January 2010 (has links)
The purpose of the present study was to examine the relations among Taiwanese elementary school children's effortful control, social relationships and their adjustment at school. Data were gathered on 407 third- to sixth-grade children (81 third graders, 79 fourth graders, 116 fifth graders, and 131 sixth graders) attending three low- to middle-class public elementary schools in Taipei County, Taiwan. Participating children as well as their parents, teachers, and peers provided questionnaire and peer sociometric data. Two main research questions were addressed: a) whether there were direct relations among children's effortful control, social relationships, and adjustment at school; b) whether social relationships mediate the relations between children's effortful control and their adjustment at school. Additionally, two alternative models were tested to evaluate the likelihood of other conceptual considerations.
Structural equation modeling was used to analyze the data and examine the direct and meditational relations among the study constructs. As expectation, findings of this study provided illuminating evidence for the direct effects of effortful control on children's adjustment at school. Moreover, the role of teacher-child relationships as a mediator in the pathways from effortful control to children's adjustment at school (i.e., social behavior, school attitudes, and academic adjustment) was strongly supported. Consistent with the hypotheses, the meditational effects of peer relationships were also clearly supported in the pathways from effortful control to social behavior as well as school attitudes. However, inconsistent with the hypothesis, there is no evidence of mediating effect of peer relationships by which effortful control contribute to academic adjustment. Finally, to compare with the alternative models, the hypothesized model was ranked as the best fit model to the given data.
In general, the current study suggested that children's self-regulatory capabilities (i.e., effortful control) influence their adjustment at school both directly and indirectly through their relationships with teachers and peers. It contributes to the literature of children's school adjustment by examining the effects of both dispositional self-regulation and social relationships. It is also one of the first studies to examine how teacher-child relationships and peer relationships are linked to multiple aspects of children's adjustment at school. For practical implications, it is critical to provide parents, caregivers, and teachers with specific strategies and techniques to support the development of effortful control. The findings of the study also call for a need to develop preventive interventions or training programs focusing on the development of positive classroom relationships.
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Pathways of Embodiment: Drug Use Among Adolescents in Popay[aacute]n ColombiaFishleder, Sarah Louise 21 March 2014 (has links)
This research examines the interrelated biological and cultural factors that determine pathways by which recreational drug use is manifest to addiction in the lives of youth aged 12-18 in Popay[aacute]n, Colombia. It utilizes existing data from mixed methods research conducted between 2004-2005 examining epidemiological risk factors, drug use, perceptions about drugs, and a biological phenomenon of the brain known as incentive salience. Perceptions and experiences related to drugs were gathered using structured methods. MDS and hierarchical plots of drug perceptions are presented in order to demonstrate the power of culture and expectation on perception and choice. Structural equation modeling was used to analyze quantitative health survey data and evolution-based pathways to addiction are mapped. Results confirm the importance of biocultural models in addressing addiction medicine.
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Nearshore habitat and land-use effects on trophic interactions and growth of largemouth bass and bluegill in Indiana's glacial lakesPatricia A Nease (7469945) 17 October 2019 (has links)
Glacial lakes, such as those in the Midwest region
of the United States, are ecologically and economically important, and they
provide a wide range of ecosystem services, such as habitat for wildlife and
fishes, flood control and recreational boating. Glacial lakes often support
locally important sport fisheries, such as largemouth bass <i>Micropterus salmoides</i> and bluegill <i>Lepomis macrochirus</i>,<i> </i>which
are partially dependent on suitable habitat within lakes. Nearshore vegetation
is often removed by lakeshore landowners for perceived aesthetics and boat
access, or by area managers as a form of indirect fisheries management and
invasive species control. The connection between nearshore vegetation and fish
population health, though widely studied is somewhat unclear. In the two
research chapters of this thesis we attempted to further understanding of the
environmental factors that influence vegetation abundance and distribution, how
vegetation abundance and distribution influences fish population abundance and
size structure, and how young-of-year (YOY) largemouth bass utilize habitats
within the nearshore environment. In the first research chapter, we used
structural equation modeling (SEM) and data collected by the Indiana Department
of Natural Resources to quantify the complexity of relationships among catchment
characteristics (e.g., catchment size), lake morphology, water quality,
vegetation abundance and distribution, and fish population abundance and size
structure. Across multiple lakes, lake productivity was more influential in
explaining cross-lake variation of largemouth bass and bluegill proportional
stock density (PSD) and largemouth bass catch per unit effort (CPUE) than
vegetation. This may be a result of the feedback between phytoplankton
production and rooted vegetation production. The models we constructed provide
insights into the complexity of environmental variables that influence
nearshore vegetation and fish populations. In the second research chapter we
used stable isotopes (δ<sup>13</sup> Carbon, δ<sup>15</sup> Nitrogen, δ<sup>18</sup>
Oxygen and δ<sup>2</sup> Hydrogen) to examine the consistency of habitat use
and foraging of YOY largemouth bass within Indiana glacial lakes. We observed
spatial variation in stable isotope ratios of YOY largemouth bass between
habitat types and sites. Additionally, there were significant, positive
relationships between δ<sup>13</sup>C of locally collected potential prey items
and δ<sup>13</sup>C of YOY largemouth bass suggesting localized foraging patterns.
Later in the summer, as young bass grew in size and likely switched to
piscivory, we did not observe similar spatial variation in young bass stable
isotopes or spatial relationships between prey and the young bass suggesting
more homogeneous foraging patterns. Understanding the habitat use patterns of
young bass may allow for more efficient and effective management of the
nearshore environment. Overall, a greater consideration for the complexity of
relationships between nearshore habitat and fish populations may facilitate
more effective management.
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The impacts of port infrastructure and logistics performance on economic growth: the mediating role of seaborne tradeMunim, Ziaul Haque, Schramm, Hans-Joachim January 2018 (has links) (PDF)
Considering 91 countries with seaports, this study conducted an empirical inquiry into the broader economic contribution of seaborne trade, from a port infrastructure quality and logistics performance perspective. Investment in quality improvement of port infrastructure and its contribution to economy are often questioned by politicians, investors and general public. A structural equation model (SEM) is used to provide empirical evidence of significant economic impacts of port infrastructure quality and logistics performance. Furthermore, analysis of a multi-group SEM is performed by dividing countries into developed and developing economy groups. The results reveal that it is vital for developing countries to continuously improve the quality of port infrastructure as it contributes to better logistics performance, leading to higher seaborne trade, yielding higher economic growth. However, this association weakens as the developing countries become richer.
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Clinical Significance of Response Shift in a Spine Interventional Clinical TrialCarlson, Robin 01 January 2015 (has links)
The effectiveness of treatments for degenerative spine conditions, where the primary symptom is back pain, is typically determined using patient-reported quality of life (QoL) measures. However, patients may adjust their internal standards when scoring QoL based on factors other than their health. This response shift phenomenon could confound the interpretation of study data and impact effectiveness conclusions. In the current study, response shift was examined using structural equation modeling (SEM) and previously collected clinical trial data comparing 2 minimally invasive medical devices in lumbar spinal stenosis patients through 1 year postintervention. In subject QoL results, reprioritization shift between 3 months and 12 months that could confound standard analysis was identified. Treatment group did not influence response shift identified at 12 months. SEM provided an effective and practical tool for clinical investigators to assess response shift in available clinical study data. As response shift could lead to invalid conclusions when QoL measures are analyzed, clinical investigators should include response shift assessment in the design of clinical trials. This research into how response shift phenomenon can impact clinical trial results improves the ability of clinical investigators to interpret clinical trial data, potentially preventing erroneous conclusions. This research may also assist researchers and government regulators in the identification and reimbursement of beneficial, cost-effective medical treatments for patients worldwide. For clinical research designers, this study demonstrates a practical application of response shift assessment.
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