604 resultados para critical condition


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Due to its remarkable mechanical and biological properties, there is considerable interest in understanding, and replicating, spider silk's stress-processing mechanisms and structure-function relationships. Here, we investigate the role of water in the nanoscale mechanics of the different regions in the spider silk fibre, and their relative contributions to stress processing. We propose that the inner core region, rich in spidroin II, retains water due to its inherent disorder, thereby providing a mechanism to dissipate energy as it breaks a sacrificial amide-water bond and gains order under strain, forming a stronger amide-amide bond. The spidroin I-rich outer core is more ordered under ambient conditions and is inherently stiffer and stronger, yet does not on its own provide high toughness. The markedly different interactions of the two proteins with water, and their distribution across the fibre, produce a stiffness differential and provide a balance between stiffness, strength and toughness under ambient conditions. Under wet conditions, this balance is destroyed as the stiff outer core material reverts to the behaviour of the inner core.

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Consumer electronics increasingly find their way into cars and are often portrayed as unwanted distractions. As part of our endeavour to capitalise on these technologies as safety tools rather than safety threats, we suggest to use smartphones, head-up displays, vehicle interfaces, and other digital gadgets: a) as readily available and lightweight sensing devices, and b) as platforms for engaging interventions that provide safe stimuli in real- time while driving. In our effort to make safe driving behaviours more fun, we explore ways to apply gamification to driving. In this paper, we illustrate the need for a careful balance between fun and safety and reveal ethical issues that arise when introducing new technology interventions into this complex and safety- critical design space.

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"This important book translates seven landmark essays by one of Japan’s most respected and influential legal thinkers. While Takao Tanase concedes that law might not matter as much in Japan as it does in the United States, in a provocative challenge to socio-legal researchers and comparative lawyers, he asks: why should it? The issue, he contends, is not whether law matters to society; it is how society matters to law."--Publisher website

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Purpose In the mainstream relationship management literature, critical appraisal of the relationship paradigm in an international setting is virtually non-existent. The extant literature reveals a gap in terms of linking relationship management theories with international management. Furthermore, little research attention has been paid to synthesise the existing theories in a cohesive manner towards developing a theoretical paradigm in the interface of the importer-supplier relationship dyad. Thus, the purpose of this paper is to strengthen the theoretical grounds of relationship marketing in an international setting in an importer-exporter relationship context. Design/methodology/approach The paper follows a comprehensive review approach and applies the fundamental theory of trust and commitment to identify the relational factors. More precisely, the paper identifies and applies other relevant theories such as internationalisation process theory, resource-based theory of the firm, dependence theory and transaction cost theory in developing an innovative theoretical paradigm. Findings Based on the integration of extant theories, this paper proposes a new direction in the theoretical realm of the trust and commitment building process within an importer and supplier relationship management paradigm. The research concludes that trust and commitment are the focal factors within the international relational paradigm. Research limitations/implications The proposed research direction suggests an emerging framework integrating mainstream theoretical variables of trust and commitment in importer and foreign-supplier context. This novel framework has the potential for use in further research. Originality/value This paper advances a grounded theoretical exploration within an international management domain in the context of importers and foreign-suppliers.

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Patents provide monopoly rights to patent holders. There are safeguards in patent regime to ensure that exclusive right of the patent holder is not misused. Compulsory licensing is one of the safeguards provided under TRIPS using which patent granting state may allow a third party to exploit the invention without patent holder’s consent upon terms and conditions decided by the government. This concept existed since 1623 and was not introduced by TRIPS for the first time. But this mechanism has undergone significant changes especially in post-TRIPS era. History of evolution of compulsory licensing is one of the least explored areas of intellectual property law. This paper undertakes an analysis of different phases in the evolution of the compulsory licensing mechanism and sheds light on reasons behind developments especially after TRIPS.

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Robot Path Planning (RPP) in dynamic environments is a search problem based on the examination of collision-free paths in the presence of dynamic and static obstacles. Many techniques have been developed to solve this problem. Trapping in a local minima and maintaining a Real-Time performance are known as the two most important challenges that these techniques face to solve such problem. This study presents a comprehensive survey of the various techniques that have been proposed in this domain. As part of this survey, we include a classification of the approaches and identify their methods.

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Foot plantar fascia is an important foot tissue in stabilizing the longitudinal arch of human foot. Direct measurement to monitor the mechanical situation of plantar fascia at human locomotion is difficult. The purpose of this study was to construct a three-dimensional finite element model of the foot to calculate the internal stress/strain value of plantar fascia during different stage of gait. The simulated stress distribution of plantar fascia was the lowest at heel-strike, which concentrated on the medial side of calcaneal tubercle. The peak stress of plantar fascia was appeared at push-off, and the value is more than 5 times of the heel-strike position. Current FE model was able to explore the plantar fascia tension trend at the main sub-phases of foot. More detailed fascia model and intrinsic muscle forces could be developed in the further study.

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Background and Purpose Acute cerebral ischemic events are associated with rupture of vulnerable carotid atheroma and subsequent thrombosis. Factors such as luminal stenosis and fibrous cap thickness have been thought to be important risk factors for plaque rupture. We used a flow-structure interaction model to simulate the interaction between blood flow and atheromatous plaque to evaluate the effect of the degree of luminal stenosis and fibrous cap thickness on plaque vulnerability. Methods A coupled nonlinear time-dependent model with a flow-plaque interaction simulation was used to perform flow and stress/strain analysis in a stenotic carotid artery model. The stress distribution within the plaque and the flow conditions within the vessel were calculated for every case when varying the fibrous cap thickness from 0.1 to 2 mm and the degree of luminal stenosis from 10% to 95%. A rupture stress of 300 kPa was chosen to indicate a high risk of plaque rupture. A 1-sample t test was used to compare plaque stresses with the rupture stress. Results High stress concentrations were found in the plaques in arteries with >70% degree of stenosis. Plaque stresses in arteries with 30% to 70% stenosis increased exponentially as fibrous cap thickness decreased. A decrease of fibrous cap thickness from 0.4 to 0.2 mm resulted in an increase of plaque stress from 141 to 409 kPa in a 40% degree stenotic artery. Conclusions There is an increase in plaque stress in arteries with a thin fibrous cap. The presence of a moderate carotid stenosis (30% to 70%) with a thin fibrous cap indicates a high risk for plaque rupture. Patients in the future may be risk stratified by measuring both fibrous cap thickness and luminal stenosis.

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It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individuals practice progressing onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example practice development initiatives can be seen as advancing practice for the masses which ensures that practitioners are following the same level of practice. The question here is; are they developing individually.

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Carol and I just missed each other in the early 1990s: Carol left Manchester for Australia in 1990, while I an·iv·ed in Manchester from Australia in 1993. Sixteen years later and on the very opposite side of the world, we found ourselves sharing an adjacent room during the 2009 Agri-Food Research Network conference in Auckland. Carol was already an accomplished sociologist; I was a newbie PhD student, presenting on a thesis topic that was only just starting to take shape...

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This workshop introduces a range of process drama activities to develop students' critical literacy responses. Whilst children's picture books and process drama strategies have not traditionally been seen as sophisticated resources and strategies for developing students' critical literacy responses, this workshop shows teaching strategies that can be used in language instruction in primary classrooms with diverse student groups. The teaching activities include ‘attribute lists’, ‘sculptures’ and ‘freeze frames’.

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This lecture introduces a range of children's picture books from around the world and teaching strategies that develop students' critical literacy responses. Whilst children's picture books have not traditionally been seen as sophisticated resources for developing students' critical literacy responses, this lecture presents research that shows young children as code breakers, text participants, text users and text analysts (Luke & Freebody, 1999) of written, visual, oral and gestural texts. This lecture also outlines the teaching strategies as they have been used in language instruction in primary classrooms with diverse student groups.

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It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individuals practice progressing onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example practice development initiatives can be seen as advancing practice for the masses which ensures that practitioners are following the same level of practice. The question here is; are they developing individually. To discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. In an attempt to explore the development of leading edge critical care thinking and practice, a new model for advancing practice in critical care is proposed. This paper suggests that reflection may not be the best model for advancing practice unless the individual practitioner has a sound knowledge base both theoretically and experientially. Drawing on the contemporary literature and recent doctoral research, the knowledge integration model presented here uses multiple learning strategies that are focused in practise to develop practice, for example the use of work-based learning and clinical supervision. Ongoing knowledge acquisition and its relationship with previously held theory and experience will enable individual practitioners to advance their own practice as well as being a resource for others.

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Background It is often believed that by ensuring the ongoing completion of competency documents and life-long learning in nursing practice guarantees quality patient care. This is probably true in most cases where it provides reassurances that the nursing team is maintaining a safe “generalised” level of practice. However, competency does not always promise quality performance. There are a number of studies that have reported differences in what practitioners know and what they actually do despite being deemed competent. Aim The aim of this study was to assess whether our current competency documentation is fit for purpose and to ascertain whether performance assessment needs to be a key component in determining competence. Method 15 nurses within a General ICU who had been on the unit <4 years agreed to participate in this project. Using participant observation and assessing performance against key indicators of the Benner Novice to Expert5 model the participants were supported and assessed over the course of a ‘normal’ nursing shift. Results The results were surprising both positively and negatively. First, the nurses felt more empowered in their clinical decision making skills; second, it identified individual learning needs and milestones in educational development. There were some key challenges identified which included 5 nurses over estimating their level of competence, practice was still very much focused on task acquisition and skill and surprisingly some nurses still felt dominated by the other health professionals within the unit. Conclusion We found that the capacity and capabilities of our nursing workforce needs continual ongoing support especially if we want to move our staff from capable task-doer to competent performers. Using the key novice to expert indicators identified the way forward for us in how we assess performance and competence in practice particularly where promotion to higher grades is based on existing documentation.

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Explore and describe a conceptual model of knowledge integration pertinent to the development of individual practitioners in critical care. Discussion of how multiple learning strategies that are embedded in practice can be beneficial in developing knowledge.