Principios de metodología de superficie de respuesta para modelos logísticos

En esta tesis doctoral abordamos algunos principios para estudiar la Metodología de Superficie de Respuesta (que abreviaremos en adelante como MSR) para datos que siguen distribuciones binarias (Bernoulli y binomial), y que se ajustan mediante Modelos Lineales Generalizados (que abreviaremos como MLG). El punto de partida elegido ha sido el enfoque clásico de la MSR, es decir, en el contexto de modelos lineales y normales y, en particular, a partir del trabajo seminal de Box y Wilson (1951).Nuestra pregunta de investigación alrededor de la cual hemos elaborado este trabajo gira alrededor del siguiente planteamiento: "¿cómo podría proceder el experimentador cuando la naturaleza de su proceso no sigue los supuestos clásicos de normalidad y linealidad?". Enlazando esta cuestión con el estado actual del arte en materia de la MSR, una segunda pregunta fue: "¿Cómo podría ser un proceso secuencial de aprendizaje del funcionamiento de un sistema en los que intervengan respuestas de naturaleza binaria en el que se persiga un objetivo determinado?". Para poder investigar con mayor profundidad esta pregunta, y mediante un sustento metodológico lo suficientemente sólido, nos apoyamos en los MLG. Estos modelos -a partir de su primera presentación y formulación en el trabajo de Nelder y Wedderburn (1972)- son la herramienta que elegimos para encontrar una metodología de aplicación sistemática, que nos permita buscar modelos adecuados que puedan ajustar respuestas de naturaleza binaria. Consideramos como estrategia particular aquella en la que se encontraría el experimentador cuando dispone de un número fijo de observaciones a realizar de las variables de un sistema, que traducimos con el nombre de "estrategia de presupuesto fijo". Así, el objetivo será poder cuantificar de alguna forma la ganancia de información que alcanzamos a conocer del proceso luego de haber utilizado todo el presupuesto disponible. En todos los casos nuestro plan es el de utilizar familias de estrategias de diseños factoriales a dos niveles, secuencialmente encadenados. Nuestro estudio comienza definiendo una familia de estrategias de exploración de un proceso representado por una superficie de respuesta teórica binaria, en la que hemos identificado tres variables: un valor llamado w, acotado entre 0 y 1, el cual es utilizado para definir el primer centro de experimentación. Luego, se considera una segunda variable, que será el valor que tenga el rango de variación de los factores, L, y finalmente, cuando se ensayen nuevas alternativas de puntos de diseño, habrá un valor S, que llamaremos "salto", que representará la longitud que separa un centro de diseño del siguiente. De esta manera, diremos que una estrategia de diseño queda caracterizada por los valores L, S y w. Partiendo así de una superficie de respuesta que sea la que mejor se considera que se aproxima a un proceso real, el objetivo será el de encontrar a través de simulaciones los niveles de w, L y S que alcancen los mejores valores posibles bajo dos criterios de selección de diseños: (a) una basada en el determinante de la Matriz de Información de Fisher (que hemos llamado "criterio de la cantidad de información"), y (b) el otro, basado en el valor de la superficie teórica evaluado en las mejores condiciones que se obtengan del modelo ajustado (que hemos llamado "criterio de proximidad al máximo"). A tal efecto, hemos utilizado programas escritos en el lenguaje R (www.r-project.orq), un entorno de programación potente y flexible,La completa revisión bibliográfica de ambos temas (MSR y MLG), junto con el diseño de herramientas informáticas "ad-hoc", ofrecen un enfoque novedoso y origina! que puede servir como punto de partida para continuar buscando el enlace entre estas dos metodologías y su aplicación en problemas prácticos sobre la base de criterios objetivos que puedan soportar la toma de decisiones.In this PhD thesis we approached some principles that relate to the study the Response Surface Methodology (abbreviated as RSM) for binary responses (Bernoulli and binomial distributions), modellable through the scope of Generalized Linear Models (abbreviated as GLM}. Our starting point is the classic approach of the RSM, in the context of linear normal models and, particularly, from the seminal work on the subject, by the article of Box and Wilson (1951). Our first research question from which we started ellaborating this work was around of the following statement: "How could experimenters deal with this problem when the nature of the process does not follow the classical assumptions of normality and linearity?". Connecting this question with the present state-of-the-art in RSM, the second question that we address is: "How could one design a sequential strategy to learn about the operation of a system with binary response, when certain objectives are persecuted?". In order to explore these questions deeper by means of a methodological support, we leaned towards the GLM approach. These models -presented and formulated primarily in the work of Nelder and Wedderburn (1972)- are the tool that we have chosen in order to find a systematic applied methodology, that aims for suitable models that can be fitted to binary response.We consider as a particular strategy, the one in which the experimenter has a fixed number of observations to be made, in what we labeled as "strategy of fixed budget". Thus, the objective will be to quantify the information gain once we have used all the budget available. In both cases, our plan is to carry out 2-level factorial and sequential designs. Our approach starts with a definition of a family of design strategies for exploration of a process that is being represented by a certain response surface. These strategies are characterized though three variables: w, bounded between 0 and 1, used to define the first experimentation center point. Once that is determined, a second variable is considered: L, or the range of variation of the factors. Finally, when several experimental conditions were considered, the variable S, identifies the jump length that connects one center point of experimentation with the following one, Having defined the scope this way, we can say that a design strategy may be characterized by means of a three-variable picture: L, S and w. Once the experimenter defined what kind of response surface is the best one to approach the real process, the goal will be to find the levels of L, S and w that maximizes the value of two alternative criteria: the first one is based on the determinant of the Fisher's Information Matrix, and it captures (he amount of information gathered by the design, and the second one is the value taken by the theoretical surface on the maximum of the fitted surface. In order to this scope, we have written some programs in R language (www.r-proiect.org), a powerful and flexible environment of programming and doing statistics.A complete bibliographical review of both topics (RSM and GLM), as well as the design of "ad-hoc" specific software, try to offer a new and an original point of view to study this problem, which maybe useful as a starting point for continuing the research in these areas and the link between these two methodologies. It is of special interest the exploration of new practical applications to real problems based on some objective criteria that can support the process of decision making.Postprint (published version

Diseños experimentales secuenciales para modelos logísticos de regresión

Cuando los supuestos habituales de normalidad y varianza constante no se cumplen (e.g. en procesos de Bernoulli o binomiales), el problema de la elección de diseños adecuados ocasiona cierta dificultad a los experimentadores, especialmente cuando lo que se persigue es una exploración secuencial del proceso. Este artículo está basado en De Zan (2006), en donde se proponen dos criterios para evaluar estrategias de diseño. Una de ellas toma en cuenta la cantidad de información contenida en el modelo ajustado, mientras que la otra explora la información contenida en las mejores condiciones de experimentación encontradas en el modelo ajustado. Se desarrolla un ejemplo simulado con el paquete R acerca de cómo funcionan estas estrategias.When the usual hypotheses of normality and constant variance do not hold (e.g. in binomial or Bernoulli processes), the problem of choosing appropriate designs creates problems to researches when pursuing a sequential exploration of process. This paper is based on De Zan (2006), where the author proposes two criteria to evaluate design strategies, that take the amount of information as the main evaluation tool. One into account the information of the fitted model, and the other explores the information that is contained on the approximation of a set of the best conditions of factors found on a fitted model. An example of how these strategies work is also given through a simulation using R software

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Elementos de diseño de un currículo basado en el enfoque de procesos

13 páginasThis paper corresponds to a description of the curriculum process management approach developed at the Universidad de La Sabana, Colombia. Particularly, we present the design basis of a form of efficient management of curricula based on Shewhart’s PDCA Cycle of continuous improvement of processes, providing a coherent set of alternatives that allows not only a design of a solid performance curriculum management but also an organized and systematic way of measuring and improving all its components.Este trabajo presenta una propuesta de gestión curricular basada en el enfoque de procesos desarrollada en la Universidad de La Sabana en Colombia, en la definición del programa de Ingeniería Industrial. En particular, se presentan las bases del diseño de una forma de gestión eficiente de los currículos basada en el ciclo de mejora continua PDCA o Ciclo de Shewhart, que ofrece un conjunto coherente de alternativas que permiten no sólo una ejecución sólida sino también una forma organizada y sistemática de medirla y mejorarla continuamente

Las competencias: base para la internacionalización de la educación superior

11 páginasThis article provides in a descriptive manner the main topics that links globalization with the internationalization of higher education and also shows how the concept of skills introduced in higher education since the 1990s, becomes a key factor in the internationalization of curriculum. This concept facilitates the pedagogical communication and its integration to institutional networks. Cultural, social and epistemological true differences are respected by this scope in the Higher Education context in several levels, e.g. regional and local ones, as well.El presente artículo presenta los principales temas que relacionan la globalización con la internacionalización de la educación superior y muestra cómo el concepto de competencias, introducido en la educación superior desde la década de los noventa, se convierte en un factor clave para la internacionalización del currículo, pues facilita la comunicación pedagógica, la integración en redes institucionales y, a la vez, respeta y promueve las legítimas diferencias culturales, sociales y epistemológicas a las que responde la educación superior en cada contexto regional o loca

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat