992 resultados para COMA VEGETATIVO


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Investigació socioeducativa que estudia les necessitats socials de les persones de més de 80 anys que viuen soles a la ciutat d’Olot. Els objectius de la recerca són descriure, explicar i comprendre les característiques i les necessitats socials d’aquesta població i contribuir a millorar les pràctiques de les polítiques locals referents als plans d’atenció a gent gran i Serveis Socials. La principal tècnica per recollir les dades ha estat un qüestionari d’elaboració expressa per aquesta investigació, contestat per 400 persones

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Els objectius d'aquest projecte són el disseny d'una instal·lació fotovoltaica connectada a xarxa que sigui capaç de produir la mateixa quantitat d’energia que consumeix la casa de colònies a on es troba ubicada. La particularitat d’aquesta instal·lació serà que els generadors fotovoltaics aniran sobra una plataforma giratòria que seguirà el sol buscant sempre la millor i major producció energètica. El control d'aquesta estructura anirà a càrrec d'un autòmat programable. Aprofitant l'existència de panells fotovoltaics, s'ha dissenyat un sistema d’acumulació d’energia de 2 kW de potència que dotarà de corrent una línia que, en cas de falla en el sistema d’alimentació general, es mantindrà ininterrompuda. Aquesta línia serà de 230 V i està dissenyada per tenir una autonomia de 2 hores

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L’objecte del projecte és el de crear una xarxa de comunicacions Modbus. La xarxa unirà els autòmats del laboratori de regulació Telemecanique TSX Micro (els 9 autòmats TSX 3705 i l’autòmat de nova adquisició TSX 3722). Com a complement de la xarxa, es prepararan dues experiències i un qüestionari. La primera experiència servirà als alumnes com a exemple de comunicació Modbus, i la segona, l’hauran de realitzar els alumnes. Aquesta segona experiència només és introductòria, no serà de gran dificultat i l’alumne no adquirirà grans coneixements, simplement agafarà nocions del funcionament d’una comunicació entre autòmats en el cas concret d’una xarxa Modbus. El qüestionari permetrà avaluar els coneixements adquirits sobre la comunicació Modbus abans de que l’alumne realitzi les experiències

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Biological nutrient removal has been studied and applied for decades in order to remove nitrogen and phosphorus from wastewater. However, more anthropogenic uses and the continued demand for water have forced the facilities to operate at their maximum capacity. Therefore, the goal of this thesis is to obtain more compact systems for nutrient removal from domestic wastewater. In this sense, optimization and long-term stabilization of high volume exchange ratios reactors, treating higher volumes of wastewater, have been investigated. With the same target, aerobic granular sludge was proposed as a reliable alternative to reduce space and increase loading rates in treatment plants. However, the low organic loading rate from low-strength influents (less than 1 Kg COD•m-3d-1) results in slower granular formation and a longer time to reach a steady state. Because of that, different methodologies and operational conditions were investigated in order to enhance granulation and nutrient removal from domestic wastewater.

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Este ensaio analisa o modo como as vias através das quais a razão humana, definida como um instrumento para eliminar os obstáculos da existência, na deriva da civilização resultaram frequentemente em “eliminações racionais” dos potenciais inimigos e de pessoas comuns.O autor realça esses processos desumanos com base em vários exemplos da história moderna. Começa com a Revolução Francesa até chegar ao século XX coma experiência devastadora dos totalitarismos, acabando por lembrar os massacres do Ruanda.

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Apesar dos hidratos de carbono representarem apenas 1% do peso corporal, são essencialmente importantes nas reações químicas que fornecem energia às células, principalmente ao cérebro. A glicose é o monossacarídeo com maior relevância para obtenção de energia. As outras oses provenientes dos hidratos de carbono vão-se integrar no metabolismo da glicose. Para manter a glicémia dentro do intervalo de valores de referência, há um sistema de regulação endócrino, do qual a insulina e o glucagon desempenham um papel predominante. A hipoglicémia define-se como um estado metabólico caracterizado por níveis de glicémia inferiores a 55 mg/dL, acompanhada de manifestações clínicas de intensidade e expressão variáveis, que refletem sintomas como a ansiedade, palpitações, tremores, défice cognitivo e coma. A glicose presente no organismo pode ser proveniente da dieta, ou da produção endógena. Deste modo, a hipoglicémia pode resultar de um consumo excessivo de glicose (exercício físico ou aumento de perdas externas) ou de um inadequado aporte de glicose (produção endógena insuficiente ou inanição). A hipoglicémia é uma complicação aguda, muito frequente, que surge como consequência do tratamento da diabetes com insulina e/ou sulfonilureias e, com muito menos frequência, no individuo não diabético. Neste, a hipoglicémia pode ser consequência primária de uma patologia, ou seja, por intervenção direta no metabolismo da glicose, ou consequência secundária de uma patologia, ou seja, por um mecanismo não direto. O estado de jejum ou pós-prandial do individuo quando surge a hipoglicémia também auxilia no diagnóstico diferencial. Para estabelecer o diagnóstico é necessário se verificar a tríade de Whipple: (1) sinais e sintomas compatíveis com hipoglicémia; (2) baixa concentração de glicémia; (3) melhoria dos sintomas após aumento da glicémia. O tratamento da hipoglicémia passa pela administração de hidratos de carbono, nomeadamente sacarose. O presente trabalho tem como objetivo, numa primeira parte, fazer a revisão, do ponto de vista bioquímico, dos mecanismos associados ao metabolismo dos glícidos e da regulação da glicémia que contribuem para a rápida correção da hipoglicémia. Numa segunda parte, pretende-se descreve-se as manifestações clinicas, as várias classificações de hipoglicémia e os mecanismos em cada caso/patologia. Numa terceira parte apresenta-se a abordagem diagnóstica na suspeita de hipoglicémia e qual a terapêutica mais adequada. Por último pretende-se evidenciar a relação da hipoglicémia versus hiperglicemia. Enquanto estados crónicos de hiperglicemia têm sido associados a disfunções de vários órgãos a longo prazo, episódios hipoglicémicos, apesar de pontuais, estão associados, a lesões neurológicas a curto prazo e até morte. Associações cientificas como The American Diabetes Association e The Endocrine Society têm vindo a disponibilizar informação para uma maior compreensão do episódio hipoglicémico, as suas implicações e estratégias para prevenção. Neste sentido, concluiu-se que é essencial identificar o mecanismo que conduziu à hipoglicémia de modo a prevenir a sua recorrência.

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Background: The care of the acutely ill patient in hospital is often sub-optimal. Poor recognition of critical illness combined with a lack of knowledge, failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice and poor communication have been identified as contributory factors. At present the training of medical students in these important skills is fragmented. The aim of this study was to use consensus techniques to identify the core competencies in the care of acutely ill or arrested adult patients that medical students should possess at the point of graduation. Design: Healthcare professionals were invited to contribute suggestions for competencies to a website as part of a modified Delphi survey. The competency proposals were grouped into themes and rated by a nominal group comprised of physicians, nurses and students from the UK. The nominal group rated the importance of each competency using a 5-point Likert scale. Results: A total of 359 healthcare professionals contributed 2,629 competency suggestions during the Delphi survey. These were reduced to 88 representative themes covering: airway and oxygenation; breathing and ventilation; circulation; confusion and coma; drugs, therapeutics and protocols; clinical examination; monitoring and investigations; team-working, organisation and communication; patient and societal needs; trauma; equipment; pre-hospital care; infection and inflammation. The nominal group identified 71 essential and 16 optional competencies which students should possess at the point of graduation. Conclusions: We propose these competencies form a core set for undergraduate training in resuscitation and acute care.

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The discourse surrounding the virtual has moved away from the utopian thinking accompanying the rise of the Internet in the 1990s. The Cyber-gurus of the last decades promised a technotopia removed from materiality and the confines of the flesh and the built environment, a liberation from old institutions and power structures. But since then, the virtual has grown into a distinct yet related sphere of cultural and political production that both parallels and occasionally flows over into the old world of material objects. The strict dichotomy of matter and digital purity has been replaced more recently with a more complex model where both the world of stuff and the world of knowledge support, resist and at the same time contain each other. Online social networks amplify and extend existing ones; other cultural interfaces like youtube have not replaced the communal experience of watching moving images in a semi-public space (the cinema) or the semi-private space (the family living room). Rather the experience of viewing is very much about sharing and communicating, offering interpretations and comments. Many of the web’s strongest entities (Amazon, eBay, Gumtree etc.) sit exactly at this juncture of applying tools taken from the knowledge management industry to organize the chaos of the material world along (post-)Fordist rationality. Since the early 1990s there have been many artistic and curatorial attempts to use the Internet as a platform of producing and exhibiting art, but a lot of these were reluctant to let go of the fantasy of digital freedom. Storage Room collapses the binary opposition of real and virtual space by using online data storage as a conduit for IRL art production. The artworks here will not be available for viewing online in a 'screen' environment but only as part of a downloadable package with the intention that the exhibition could be displayed (in a physical space) by any interested party and realised as ambitiously or minimally as the downloader wishes, based on their means. The artists will therefore also supply a set of instructions for the physical installation of the work alongside the digital files. In response to this curatorial initiative, File Transfer Protocol invites seven UK based artists to produce digital art for a physical environment, addressing the intersection between the virtual and the material. The files range from sound, video, digital prints and net art, blueprints for an action to take place, something to be made, a conceptual text piece, etc. About the works and artists: Polly Fibre is the pseudonym of London-based artist Christine Ellison. Ellison creates live music using domestic devices such as sewing machines, irons and slide projectors. Her costumes and stage sets propose a physical manifestation of the virtual space that is created inside software like Photoshop. For this exhibition, Polly Fibre invites the audience to create a musical composition using a pair of amplified scissors and a turntable. http://www.pollyfibre.com John Russell, a founding member of 1990s art group Bank, is an artist, curator and writer who explores in his work the contemporary political conditions of the work of art. In his digital print, Russell collages together visual representations of abstract philosophical ideas and transforms them into a post apocalyptic landscape that is complex and banal at the same time. www.john-russell.org The work of Bristol based artist Jem Nobel opens up a dialogue between the contemporary and the legacy of 20th century conceptual art around questions of collectivism and participation, authorship and individualism. His print SPACE concretizes the representation of the most common piece of Unicode: the vacant space between words. In this way, the gap itself turns from invisible cipher to sign. www.jemnoble.com Annabel Frearson is rewriting Mary Shelley's Frankenstein using all and only the words from the original text. Frankenstein 2, or the Monster of Main Stream, is read in parts by different performers, embodying the psychotic character of the protagonist, a mongrel hybrid of used language. www.annabelfrearson.com Darren Banks uses fragments of effect laden Holywood films to create an impossible space. The fictitious parts don't add up to a convincing material reality, leaving the viewer with a failed amalgamation of simulations of sophisticated technologies. www.darrenbanks.co.uk FIELDCLUB is collaboration between artist Paul Chaney and researcher Kenna Hernly. Chaney and Hernly developed together a project that critically examines various proposals for the management of sustainable ecological systems. Their FIELDMACHINE invites the public to design an ideal agricultural field. By playing with different types of crops that are found in the south west of England, it is possible for the user, for example, to create a balanced, but protein poor, diet or to simply decide to 'get rid' of half the population. The meeting point of the Platonic field and it physical consequences, generates a geometric abstraction that investigates the relationship between modernist utopianism and contemporary actuality. www.fieldclub.co.uk Pil and Galia Kollectiv, who have also curated the exhibition are London-based artists and run the xero, kline & coma gallery. Here they present a dialogue between two computers. The conversation opens with a simple text book problem in business studies. But gradually the language, mimicking the application of game theory in the business sector, becomes more abstract. The two interlocutors become adversaries trapped forever in a competition without winners. www.kollectiv.co.uk

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This continuing study of intragroup light in compact groups of galaxies aims to establish new constraints to models of formation and evolution of galaxy groups, specially of compact groups, which are a key part in the evolution of larger structures, such as clusters. In this paper we present three additional groups (HCG 15, 35 and 51) using deep wide-field B- and R-band images observed with the LAICA camera at the 3.5-m telescope at the Calar Alto observatory (CAHA). This instrument provides us with very stable flat-fielding, a mandatory condition for reliably measuring intragroup diffuse light. The images were analysed with the OV_WAV package, a wavelet technique that allows us to uncover the intragroup component in an unprecedented way. We have detected that 19, 15 and 26 per cent of the total light of HCG 15, 35 and 51, respectively, are in the diffuse component, with colours that are compatible with old stellar populations and with mean surface brightness that can be its low as 28.4 B mag arcsec(-2). Dynamical masses, crossing times and mass-to-light ratios were recalculated using the new group parameters. Also tidal features were analysed using the wavelet technique.

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In the present study, films based on linter cellulose and chitosan were prepared using an aqueous solution of sodium hydroxide (NaOH)/thiourea as the solvent system. The dissolution process of cellulose and chitosan in NaOH/thiourea aqueous solution was followed by the partial chain depolymerization of both biopolymers, which facilitates their solubilization. Biobased films with different chitosan/cellulose ratios were then elaborated by a casting method and subsequent solvent evaporation. They were characterized by X-ray analysis, scanning electron microscopy (SEM), atomic force microscopy (AFM), thermal analysis, and tests related to tensile strength and biodegradation properties. The SEM images of the biofilms with 50/50 and 60/40 ratio of chitosan/cellulose showed surfaces more wrinkled than the others. The AFM images indicated that higher the content of chitosan in the biobased composite film, higher is the average roughness value. It was inferred through thermal analysis that the thermal stability was affected by the presence of chitosan in the films; the initial temperature of decomposition was shifted to lower levels in the presence of chitosan. Results from the tests for tensile strength indicated that the blending of cellulose and chitosan improved the mechanical properties of the films and that an increase in chitosan content led to production of films with higher tensile strength and percentage of elongation. The degradation study in a simulated soil showed that the higher the crystallinity, the lower is the biodegradation rate.

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Environmentally friendly biocomposites were successfully prepared by dissolving chitosan and cellulose in a NaOH/thiourea solvent with subsequent heating and film casting. Under the considered conditions, NaOH/thiourea led to chain depolymerization of both biopolymers without a dramatic loss of film forming capacities. Compatibility of both biopolymers in the biocomposite was firstly assessed through scanning electron microscopy, revealing an intermediate organization between cellulose fiber network and smoothness of pure chitosan. DSC analyses led to exothermic peaks close to 285 and 315 degrees C for the biocomposite, compared to the exothermic peaks of chitosan (275 degrees C) and cellulose (265 and 305 degrees C), suggesting interactions between chitosan and cellulose. Contact angle analyses pointed out the deformation that can occur at the surface due to the high affinity of the;e materials with water. T(2) NMR relaxometry behavior of biocomposites appeared to be dominated by chitosan. Other properties of films, as crystallinity, water sorption isotherms, among others, are also discussed. (C) 2010 Published by Elsevier Ltd.

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Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

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A Sindrome Miofascial constitui, dentre os quadros de dor crônica, o que leva um número expressivo de pacientes a buscar atendimento médico nos Serviços de Tratamento de Dor. Caracteriza-se pela presença de pontos dolorosos localizados na musculatura, chamados de “pontos de gatilho”, e de espasmo muscular, podendo ocorrer limitação funcional e disfunção do sistema vegetativo (Sola & Bonica, 2001). A dor e a limitação funcional decorrentes da Sindrome Miofascial constituem atualmente uma das grandes causas de falta ou afastamento do trabalho, o que acarreta graves problemas econômicos e sociais (Roth et al, 1998; Sola & Bonica, 2001). Seu tratamento pode ser demorado e requer participação ativa por parte do paciente. O índice de melhora dos pacientes portadores de Síndrome Miofascial parece sofrer influência de diversos fatores tais como sintomas depressivos, ansiedade, ganho com os sintomas, etc. Os objetivos deste trabalho foram estabelecer a incidência de sucesso e insucesso da terapêutica proposta e verificar qual a relação daqueles fatores com o desfecho clínico estabelecido. Efetuou-se um estudo observacional. O delineamento experimental realizado foi um estudo de incidência. Estudaram-se 62 pacientes adultos (mais de 18 anos), de ambos os sexos, com diagnóstico de Síndrome Miofascial, que procuraram atendimento no Serviço de Tratamento de Dor e Medicina Paliativa do HCPA. Os instrumentos de aferição utilizados foram a Escala Análoga Visual de Dor (VAS), Escala de Ansiedade Traço- Estado (IDATE), Escala para Depressão de Montegomery-Äsberg, Self-Reporting Questionnaire (OMS), Questionário sobre Expectativa de Futuro e questionário estruturado. Os testes psicológicos e de avaliação da dor foram aplicados em dois momentos, na primeira consulta e ao final do tratamento proposto. Foi considerado como desfecho clínico o insucesso terapêutico, avaliado ao final do estudo. Observaram-se incidência de 71% e 29%, respectivamente, para sucesso e insucesso terapêutico. Os pacientes que estavam afastados do trabalho apresentaram aproximadamente 9 vezes mais chances de insucesso terapêutico. Aqueles que obtiveram ganho com os sintomas apresentaram em torno de 7 vezes mais chances de manutenção da dor ao final do tratamento. Maior ansiedade-estado (razão de chances ou RC = 3,4), expectativa negativa de futuro (RC = 22), sintomas depressivos moderados a intensos (RC =4,5) e presença de distúrbios psiquiátricos menores (RC = 3,6) associaram-se com maiores chances de insucesso terapêutico. Características demográficas, familiares, de ocupação e clínicas não se associaram ao desfecho clínico avaliado. Dos pacientes analisados, 29% permaneceram sem alívio da dor, com dificuldades para dormir e afastados de suas atividades, caracterizando o insucesso terapêutico. Observou-se a associação entre insucesso e presença de distúrbios psiquiátricos menores, sintomas depressivos moderados a intensos, maior estado de ansiedade, ganho com os sintomas e afastamento do trabalho. A abordagem multidisciplinar destes pacientes se faz necessária para elevar os índices de sucesso terapêutico no tratamento da SMF.