966 resultados para comprehensive geriatric assessment
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This paper reviews the literature of construction risk modelling and assessment. It also reviews the real practice of risk assessment. The review resulted in significant results, summarised as follows. There has been a major shift in risk perception from an estimation variance into a project attribute. Although the Probability–Impact risk model is prevailing, substantial efforts are being put to improving it reflecting the increasing complexity of construction projects. The literature lacks a comprehensive assessment approach capable of capturing risk impact on different project objectives. Obtaining a realistic project risk level demands an effective mechanism for aggregating individual risk assessments. The various assessment tools suffer from low take-up; professionals typically rely on their experience. It is concluded that a simple analytical tool that uses risk cost as a common scale and utilises professional experience could be a viable option to facilitate closing the gap between theory and practice of risk assessment.
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According to the U.S. National Environmental Policy Act of 1969 (NEPA), federal action to manipulate habitat for species conservation requires an environmental impact statement, which should integrate natural, physical, economic, and social sciences in planning and decision making. Nonetheless, most impact assessments focus disproportionately on physical or ecological impacts rather than integrating ecological and socioeconomic components. We developed a participatory social-ecological impact assessment (SEIA) that addresses the requirements of NEPA and integrates social and ecological concepts for impact assessments. We cooperated with the Bureau of Land Management in Idaho, USA on a project designed to restore habitat for the Greater Sage-Grouse (Centrocercus urophasianus). We employed questionnaires, workshop dialogue, and participatory mapping exercises with stakeholders to identify potential environmental changes and subsequent impacts expected to result from the removal of western juniper (Juniperus occidentalis). Via questionnaires and workshop dialogue, stakeholders identified 46 environmental changes and associated positive or negative impacts to people and communities in Owyhee County, Idaho. Results of the participatory mapping exercises showed that the spatial distribution of social, economic, and ecological values throughout Owyhee County are highly associated with the two main watersheds, wilderness areas, and the historic town of Silver City. Altogether, the SEIA process revealed that perceptions of project scale varied among participants, highlighting the need for specificity about spatial and temporal scales. Overall, the SEIA generated substantial information concerning potential impacts associated with habitat treatments for Greater Sage-Grouse. The SEIA is transferable to other land management and conservation contexts because it supports holistic understanding and framing of connections between humans and ecosystems. By applying this SEIA framework, land managers and affected people have an opportunity to fulfill NEPA requirements and develop more comprehensive management plans that better reflect the linkages of social-ecological systems.
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Protective factors are neglected in risk assessment in adult psychiatric and criminal justice populations. This review investigated the predictive efficacy of selected tools that assess protective factors. Five databases were searched using comprehensive terms for records up to June 2014, resulting in 17 studies (n = 2,198). Results were combined in a multilevel meta-analysis using the R (R Core Team, R: A Language and Environment for Statistical Computing, Vienna, Austria: R Foundation for Statistical Computing, 2015) metafor package (Viechtbauer, Journal of Statistical Software, 2010, 36, 1). Prediction of outcomes was poor relative to a reference category of violent offending, with the exception of prediction of discharge from secure units. There were no significant differences between the predictive efficacy of risk scales, protective scales, and summary judgments. Protective factor assessment may be clinically useful, but more development is required. Claims that use of these tools is therapeutically beneficial require testing.
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Background: Falls are the leading cause of geriatric injury. Objectives: We aimed to study the anatomical distribution, severity, and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. Methods: All injured patients with an age ≥ 60 years who were admitted to Al-Ain Hospital or died in the Emergency Department due to falls were prospectively studied over a four year period. Results: We studied 92 patients. Fifty six of them (60.9%) were females. The mean (standard deviation) of age was 72.2 (9.6) years. Seventy three (89%) of all incidents occurred at home. Eighty three patients (90.2%) fell on the same level. The median (range) ISS was 4 (1-16) and the median GCS (range) was 15 (12-15). The lower limb was the most common injured body region (63%). There were no statistical significant differences between males and females regarding age, ISS, and hospital stay (p = 0.85, p = 0.57, and p = 0.35 respectively). Conclusion: The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk factors for falls including home hazards is essential for prevention of geriatric fall-related injuries.
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Dissertação de Mestrado Integrado em Medicina Veterinária
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Dissertação de Mestrado, Neurociências Cognitivas e Neuropsicologia, Faculdade de Ciências Humanas e Sociais, Universidade do Algarve, 2016
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A comprehensive method for the analysis of 11 target pharmaceuticals representing multiple therapeutic classes was developed for biological tissues (fish) and water. Water samples were extracted using solid phase extraction (SPE), while fish tissue homogenates were extracted using accelerated solvent extraction (ASE) followed by mixed-mode cation exchange SPE cleanup and analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS). Among the 11 target pharmaceuticals analyzed, trimethoprim, caffeine, sulfamethoxazole, diphenhydramine, diltiazem, carbamazepine, erythromycin and fluoxetine were consistently detected in reclaimed water. On the other hand, caffeine, diphenhydramine and carbamazepine were consistently detected in fish and surface water samples. In order to understand the uptake and depuration of pharmaceuticals as well as bioconcentration factors (BCFs) under the worst-case conditions, mosquito fish were exposed to reclaimed water under static-renewal for 7 days, followed by a 14-day depuration phase in clean water. Characterization of the exposure media revealed the presence of 26 pharmaceuticals while 5 pharmaceuticals including caffeine, diphenhydramine, diltiazem, carbamazepine, and ibuprofen were present in the organisms as early as 5 h from the start of the exposure. Liquid chromatography ultra-high resolution Orbitrap mass spectrometry was explored as a tool to identify and quantify phase II pharmaceutical metabolites in reclaimed water. The resulting data confirmed the presence of acetyl-sulfamethoxazole and sulfamethoxazole glucuronide in reclaimed water. To my knowledge, this is the first known report of sulfamethoxazole glucuronide surviving intact through wastewater treatment plants and occurring in environmental water samples. Finally, five bioaccumulative pharmaceuticals including caffeine, carbamazepine, diltiazem, diphenhydramine and ibuprofen detected in reclaimed water were investigated regarding the acute and chronic risks to aquatic organisms. The results indicated a low potential risk of carbamazepine even under the worst case exposure scenario. Given the dilution factors that affect environmental releases, the risk of exposure to carbamazepine will be even more reduced.
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This is a redacted version of the the final thesis. Copyright material has been removed to comply with UK Copyright Law.
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Este artículo pretende tener en cuenta las peculiaridades y características específicas de los pacientes ancianos con cardiopatía isquémica crónica desde una perspectiva multidisciplinar, con la participación de la Sociedad Española de Cardiología (secciones de Cardiología Geriátrica y Cardiopatía Isquémica/Cuidados Agudos Cardiovasculares), la Sociedad Española de Medicina Interna, la Sociedad Española de Médicos de Atención Primaria y la Sociedad Española de Geriatría y Gerontología. En este documento de consenso se detalla cómo el abordaje de estos enfermos de edad avanzada exige una valoración integral de la comorbilidad, la fragilidad, el estado funcional, la polifarmacia y las interacciones medicamentosas. Concluimos que en la mayoría de los pacientes el tratamiento médico es la mejor opción y que, a la hora de programarlo, se deben tener en cuenta los factores anteriores y las alteraciones biológicas asociadas al envejecimiento.
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La enfermedad renal crónica ha aumentado a nivel mundial y nacional, mientras que el número de donantes viene en descenso, y los pacientes en lista de espera aumentan. Los donantes cadavéricos son una opción para estos pacientes, y han sido utilizados en últimos años para aumentar los órganos disponibles. La evaluación de la calidad de estos es importante para optimizar su uso. Estudio analítico tipo cohorte retrospectiva, cálculo de KDPI en donantes cadavéricos, seguimiento función renal creatinina sérica 1 mes, 3 meses, 6 meses y un año. Correlación supervivencia del injerto, función renal, KDPI y EPTS. Análisis de supervivencia y regresión logística con variables del donante, receptor y acto quirúrgico.
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El objetivo de la presente investigación fue identificar la relación entre ideación suicida y desesperanza en 160 pacientes con cáncer. La ideación suicida se midió a través de dos ítems de una entrevista semiestructurada, la escala de ideación suicida (ISS), el ítem 9 del inventario de depresión de Beck (BDI-IA). La desesperanza se midió con la escala de desesperanza de Beck (BHS). Los resultados obtenidos indicaron una relación significativa (p=.000) entre ideación suicida y desesperanza; una prevalencia de ideación suicida en los pacientes con cáncer entre 4.4% y 13.8% y de riesgo de suicidio entre 5.6% y 30.6%; y algún grado de desesperanza en 31.9 % de los participantes. De acuerdo con lo anterior, se confirma que existe relación entre la desesperanza y la ideación suicida en pacientes oncológicos adultos. Adicionalmente, que estas variables están presentes en los pacientes y que ameritan atención en la intervención interdisciplinaria.
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El propósito de este estudio es medir los efectos que tiene el videojuego League of Legends en los procesos cognitivos de memoria de trabajo visual (MVT) y solución de problemas (SP). Para medir dichos efectos se implementó un diseño pre test-post con un grupo experimental y uno control, compuestos cada uno por siete participantes, en donde se evaluaron los procesos previamente mencionados utilizando los cubos de Corsi para MVT y las matrices del WAIS III para SP. Después de realizar los respectivos entrenamientos se encontraron resultados significativos en los diferentes momentos de aplicación. En el grupo experimental se encontraron diferencias en la variable dependiente SP, mientras que en el grupo control en MVT, pero no en la interacción entre grupos ni diferencias entre grupos, lo que sugiere un efecto de familiarización a la prueba.
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Monitoring agricultural crops constitutes a vital task for the general understanding of land use spatio-temporal dynamics. This paper presents an approach for the enhancement of current crop monitoring capabilities on a regional scale, in order to allow for the analysis of environmental and socio-economic drivers and impacts of agricultural land use. This work discusses the advantages and current limitations of using 250m VI data from the Moderate Resolution Imaging Spectroradiometer (MODIS) for this purpose, with emphasis in the difficulty of correctly analyzing pixels whose temporal responses are disturbed due to certain sources of interference such as mixed or heterogeneous land cover. It is shown that the influence of noisy or disturbed pixels can be minimized, and a much more consistent and useful result can be attained, if individual agricultural fields are identified and each field's pixels are analyzed in a collective manner. As such, a method is proposed that makes use of image segmentation techniques based on MODIS temporal information in order to identify portions of the study area that agree with actual agricultural field borders. The pixels of each portion or segment are then analyzed individually in order to estimate the reliability of the temporal signal observed and the consequent relevance of any estimation of land use from that data. The proposed method was applied in the state of Mato Grosso, in mid-western Brazil, where extensive ground truth data was available. Experiments were carried out using several supervised classification algorithms as well as different subsets of land cover classes, in order to test the methodology in a comprehensive way. Results show that the proposed method is capable of consistently improving classification results not only in terms of overall accuracy but also qualitatively by allowing a better understanding of the land use patterns detected. It thus provides a practical and straightforward procedure for enhancing crop-mapping capabilities using temporal series of moderate resolution remote sensing data.
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A possible future scenario for the water injection (WI) application has been explored as an advanced strategy for modern GDI engines. The aim is to verify whether the PWI (Port Water Injection) and DWI (Direct Water Injection) architectures can replace current fuel enrichment strategies to limit turbine inlet temperatures (TiT) and knock engine attitude. In this way, it might be possible to extend the stoichiometric mixture condition over the entire engine map, meeting possible future restrictions in the use of AES (Auxiliary Emission Strategies) and future emission limitations. The research was first addressed through a comprehensive assessment of the state-of-the-art of the technology and the main effects of the chemical-physical water properties. Then, detailed chemical kinetics simulations were performed in order to compute the effects of WI on combustion development and auto-ignition. The latter represents an important methodology step for accurate numerical combustion simulations. The water injection was then analysed in detail for a PWI system, through an experimental campaign for macroscopic and microscopic injector characterization inside a test chamber. The collected data were used to perform a numerical validation of the spray models, obtaining an excellent matching in terms of particle size and droplet velocity distributions. Finally, a wide range of three-dimensional CFD simulations of a virtual high-bmep engine were realized and compared, exploring also different engine designs and water/fuel injection strategies under non-reacting and reacting flow conditions. According to the latter, it was found that thanks to the introduction of water, for both PWI and DWI systems, it could be possible to obtain an increase of the target performance and an optimization of the bsfc (Break Specific Fuel Consumption), lowering the engine knock risk at the same time, while the TiT target has been achieved hardly only for one DWI configuration.
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Snow plays a crucial role in the Earth's hydrological cycle and energy budget, making its monitoring necessary. In this context, ground-based radars and in situ instruments are essential thanks to their spatial coverage, resolution, and temporal sampling. Deep understanding and reliable measurements of snow properties are crucial over Antarctica to assess potential future changes of the surface mass balance (SMB) and define the contribution of the Antarctic ice sheet on sea-level rise. However, despite its key role, Antarctic precipitation is poorly investigated due to the continent's inaccessibility and extreme environment. In this framework, this Thesis aims to contribute to filling this gap by in-depth characterization of Antarctic precipitation at the Mario Zucchelli station from different points of view: microphysical features, quantitative precipitation estimation (QPE), vertical structure of precipitation, and scavenging properties. For this purpose, a K-band vertically pointing radar collocated with a laser disdrometer and an optical particle counter (OPC) were used. The radar probed the lowest atmospheric layers with high vertical resolution, allowing the first trusted measurement at only 105 m height. Disdrometer and OPC provided information on the particle size distribution and aerosol concentrations. An innovative snow classification methodology was designed by comparing the radar reflectivity (Ze) and disdrometer-derived reflectivity by means of DDA simulations. Results of classification were exploited in QPE through appropriate Ze-snow rate relationships. The accuracy of the resulting QPE was benchmarked against a collocated weighing gauge. Vertical radar profiles were also investigated to highlight hydrometeors' sublimation and growth processes. Finally, OPC and disdrometer data allowed providing the first-ever estimates of scavenging properties of Antarctic snowfall. Results presented in this Thesis give rise to advances in knowledge of the characteristics of snowfall in Antarctica, contributing to a better assessment of the SMB of the Antarctic ice sheet, the major player in the global sea-level rise.