738 resultados para Amputation, nursing assessment, pain management, patient teaching, phantom limb pain


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This report concerns the provisions and practices on betting-related match fixing in sports<br/>within the 28 Member States. Carried out in late 2013/early 2014, respondents in each Member<br/>State reported on that states gambling-related provisions in respect of football and tennis and<br/>(in each country) a third sport determined on the basis of either its popularity (in terms of<br/>participation or television viewing) or the existence of betting-related scandals in that sport<br/>within that particular jurisdiction. Those reports helped the authors to compare the Member<br/>States regulatory and self-regulatory frameworks relating to risk assessment and conflict of<br/>interest management, with a view to indicating areas of best practice, identifying particularly<br/>good legislative frameworks and highlighting areas where change was either desirable or<br/>necessary. While some individual Member States have legislation which might provide<br/>templates that others could adapt for their own use, the authors were not convinced that more<br/>law, whether at the national or European level, was desirable. Rather, more effective<br/>cooperation among the stakeholders was identified as being more likely to provide tangible<br/>benefits than would new legal frameworks.

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The purpose of this study on beach quality assessment and management was to evaluate the quality of five beaches in the Algarve Sotavento region of Portugal and to identify beach users preferences and priorities regarding their visit to a beach. The Algarve is one of the countrys most internationally known regions and it is generally perceived as a major tourist destination. Because of the increasing level of tourists, there is a specific need to address beach quality, as overcrowding can result in excessive litter, reduce water quality and consequently reduce the socio-economic value of the area. The main methodology for the evaluation of the beach quality in this pilot project was the Bathing Area Registration and Evaluation framework (BARE), which recognizes five beach types (rural, remote, resort, urban and village) through five main priority issues of concern to beach users (water quality, scenery, litter, safety, facilities) and evaluates the beach quality, ranging from one (low) to five (high) stars. After overall bathing area classification, Quarteira-Vilamoura, Ilha do Farol, Ilha Deserta and Ilha da Armona received three-star rating and Quinta do Lago site obtained a one-star rating. The quantitative research data on beach users preferences and priorities was obtained through administration of 50 questionnaires per beach and showed that beach users at all sites expressed the need for improved cleanliness, safety and facilities on the beach. The BARE framework, together with the questionnaire surveys, allowed the identification of management priorities required to improve the quality of individual beaches and therefore increase income from tourism.

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This training video is intended to familiarise researchers and technicians working in animal containment facilities with appropriate risk assessment and risk management systems. It is in Windows Media Video format which will require a free media player such as Windows Media Player or VLC Media Player (http://www.videolan.org/vlc/) to watch.

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This paper is studied look at the Teachers Assessment of Grammatical Structures (TAGS), Teacher Assessment of Spoken Language (TASL), and Cottage Acquisition Scales for Listening, Language and Speech (CASLLS) criterion-referenced language assessments as well as an inquiry into how teachers of the deaf use the TAGS currently as a teaching tool.

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Anxiety disorders in childhood and adolescence are extremely common and are often associated with lifelong psychiatric disturbance. Consistent with DSM-5 and the extant literature, this review concerns the assessment and treatment of specific phobias, separation anxiety disorder, generalised anxiety disorder, social anxiety disorder, panic disorder and agoraphobia. Evidence-based psychological treatments (cognitive behaviour therapy; CBT) for these disorders have been developed and investigated, and in recent years promising low-intensity versions of CBT interventions have been proposed that offer a means to increase access to evidence-based treatments. There is some evidence of effectiveness of pharmacological treatments for anxiety disorders in children and young people, however, routine prescription is not recommended due to concerns about potential harm.

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It has been suggested that Assessment for Learning (AfL) plays a significant role in enhancing teaching and learning in mainstream educational contexts. However, little empirical evidence can support these claims. As AfL has been shown to be enacted predominantly through interactions in primary classes, there is a need to understand if it is appropriate, whether it can be efficiently used in teaching English to Young Learners (TEYL) and how it can facilitate learning in such a context. This emerging research focus gains currency especially in the light of SLA research, which suggests the important role of interactions in foreign language learning. This mixed-method, descriptive and exploratory study aims to investigate how teachers of learners aged 7-11 understand AfL; how they implement it; and the impact that such implementation could have on interactions which occur during lessons. The data were collected through lesson observations, scrutiny of school documents, semi-structured interviews and a focus group interview with teachers. The findings indicate that fitness for purpose guides the implementation of AfL in TEYL classrooms. Significantly, the study has revealed differences in the implementation of AfL between classes of 7-9 and 10-11 year olds within each of the three purposes (setting objectives and expectations; monitoring performance; and checking achievement) identified through the data. Another important finding of this study is the empirical evidence suggesting that the use of AfL could facilitate creating conditions conducive to learning in TEYL classes during collaborative and expert/novice interactions. The findings suggest that teachers understanding of AfL is largely aligned with the theoretical frameworks (Black & Wiliam, 2009; Swaffield, 2011) already available. However, they also demonstrate that there are TEYL specific characteristics. This research has important pedagogical implications and indicates a number of areas for further research.

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Our main purpose in this study was to quantify biological tissue in computed tomography (CT) examinations with the aim of developing a skull and a chest patient equivalent phantom (PEP), both specific to infants, aged between 1 and 5 years old. This type of phantom is widely used in the development of optimization procedures for radiographic techniques, especially in computed radiography (CR) systems. In order to classify and quantify the biological tissue, we used a computational algorithm developed in Matlab (R). The algorithm performed a histogram of each CT slice followed by a Gaussian fitting of each tissue type. The algorithm determined the mean thickness for the biological tissues (bone, soft, fat, and lung) and also converted them into the corresponding thicknesses of the simulator material (aluminum, PMMA, and air). We retrospectively analyzed 148 CT examinations of infant patients, 56 for skull exams and 92 were for chest. The results provided sufficient data to construct a phantom to simulate the infant chest and skull in the posterior anterior or anterior posterior (PA/AP) view. Both patient equivalent phantoms developed in this study can be used to assess physical variables such as noise power spectrum (NPS) and signal to noise ratio (SNR) or perform dosimetric control specific to pediatric protocols.

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This descriptive study addresses the job satisfaction of nurse managers and clinical nurses working at the Hematology and Hemotherapy Services of a public hospital in Sao Paulo. The study objectives were to identify the factors that caused job satisfaction among nurse managers and clinical nurses, and support the results in the development of indicators to evaluate the quality of nursing human resource management. The components of the study were: autonomy, interaction, professional status, job requirements, organizational norms and remuneration. Participants were 44 nurses. Data were collected using a Job Satisfaction Index (JSI) questionnaire. In conclusion, this study permitted the identification of the clinical nurse group, which was the most satisfied, with a JSI of 10.5; the managerial group scored 10.0. Regarding the satisfaction levels in regards to the current activity, 88.9% of the nurse managers reported feeling satisfied, as did 90.9% of clinical nurses. For both groups, autonomy was the component with the highest level of professional satisfaction.

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Proper hazard identification has become progressively more difficult to achieve, as witnessed by several major accidents that took place in Europe, such as the Ammonium Nitrate explosion at Toulouse (2001) and the vapour cloud explosion at Buncefield (2005), whose accident scenarios were not considered by their site safety case. Furthermore, the rapid renewal in the industrial technology has brought about the need to upgrade hazard identification methodologies. Accident scenarios of emerging technologies, which are not still properly identified, may remain unidentified until they take place for the first time. The consideration of atypical scenarios deviating from normal expectations of unwanted events or worst case reference scenarios is thus extremely challenging. A specific method named Dynamic Procedure for Atypical Scenarios Identification (DyPASI) was developed as a complementary tool to bow-tie identification techniques. The main aim of the methodology is to provide an easier but comprehensive hazard identification of the industrial process analysed, by systematizing information from early signals of risk related to past events, near misses and inherent studies. DyPASI was validated on the two examples of new and emerging technologies: Liquefied Natural Gas regasification and Carbon Capture and Storage. The study broadened the knowledge on the related emerging risks and, at the same time, demonstrated that DyPASI is a valuable tool to obtain a complete and updated overview of potential hazards. Moreover, in order to tackle underlying accident causes of atypical events, three methods for the development of early warning indicators were assessed: the Resilience-based Early Warning Indicator (REWI) method, the Dual Assurance method and the Emerging Risk Key Performance Indicator method. REWI was found to be the most complementary and effective of the three, demonstrating that its synergy with DyPASI would be an adequate strategy to improve hazard identification methodologies towards the capture of atypical accident scenarios.

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BACKGROUND: Calcitonin was effective in a study of acute phantom limb pain, but it was not studied in the chronic phase. The overall literature on N-methyl-D-aspartate antagonists is equivocal. We tested the hypothesis that calcitonin, ketamine, and their combination are effective in treating chronic phantom limb pain. Our secondary aim was to improve our understanding of the mechanisms of action of the investigated drugs using quantitative sensory testing. METHODS: Twenty patients received, in a randomized, double-blind, crossover manner, 4 i.v. infusions of: 200 IE calcitonin; ketamine 0.4 mg/kg (only 10 patients); 200 IE of calcitonin combined with ketamine 0.4 mg/kg; placebo, 0.9% saline. Intensity of phantom pain (visual analog scale) was recorded before, during, at the end, and the 48 h after each infusion. Pain thresholds after electrical, thermal, and pressure stimulation were recorded before and during each infusion. RESULTS: Ketamine, but not calcitonin, reduced phantom limb pain. The combination was not superior to ketamine alone. There was no difference in basal pain thresholds between the amputated and contralateral side except for pressure pain. Pain thresholds were unaffected by calcitonin. The analgesic effect of the combination of calcitonin and ketamine was associated with a significant increase in electrical thresholds, but with no change in pressure and heat thresholds. CONCLUSIONS: Our results question the usefulness of calcitonin in chronic phantom limb pain and stress the potential interest of N-methyl-D-aspartate antagonists. Sensory assessments indicated that peripheral mechanisms are unlikely important determinants of phantom limb pain. Ketamine, but not calcitonin, affects central sensitization processes that are probably involved in the pathophysiology of phantom limb pain.

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The Nursing Home Survey on Patient Safety Culture (NHSPSC) was specically developed for nursing homes to assess a facilitys safety climate and it consists of 12 dimensions. After its pilot testing, however, no fur- ther psychometric analyses were performed on the instrument. For this study of safety climate in Swiss nursing home units, the NHSPSC was linguistically adapted to the Swiss context and to address the unit as well as facility level, with the aim of testing aspects of the validity and reliability of the Swiss version before its use in Swiss nursing home units. Psychometric analyses were performed on data from 367 nurs- ing personnel from nine nursing homes in the German-speaking part of Switzerland (response rate = 66%), and content validity (CVI) examined. The statistical inuence of unit membership on respondents answers, and on their agreement concerning their units safety climate, was tested using intraclass corre- lation coefcients (ICCs) and the rWG(J) interrater agreement index. A multilevel exploratory factor analysis (MEFA) with oblimin rotation was applied to examine the questionnaires dimensionality. Cronbachs alpha and Raykovs rho were calculated to assess factor reliability. The relationship of safety climate dimensions with clinical outcomes was explored. Expert feedback conrmed the relevance of the instru- ments items (CVI = 0.93). Personnel showed strong agreement in their perceptions in three dimensions of the questionnaire. ICCs supported a multilevel analysis. MEFA produced nine factors at the within-level (in comparison to 12 in the original version) and two factors at the between-level with satisfactory t statis- tics. Raykovs Rho for the single level factors ranged between 0.67 and 0.86. Some safety climate dimen- sions show moderate, but non-signicant correlations with the use of bedrails, physical restraint use, and fall-related injuries. The Swiss version of the NHSPSC needs further renement and testing before its use can be recommended in Swiss nursing homes: its dimensionality needs further clarication, particularly to distinguish items addressing the unit-level safety climate from those at the facility level.