916 resultados para foot ulcer


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Building assessment methods have become a popular research field since the early 1990s. An international tool which allows the assessment of buildings in all regions, taking into account differences in climates, topographies and cultures does not yet exist. This paper aims to demonstrate the importance of criteria and sub-criteria in developing a new potential building assessment method for Saudi Arabia. Recently, the awareness of sustainability has been increasing in developing countries due to high energy consumption, pollution and high carbon foot print. There is no debate that assessment criteria have an important role to identify the tool’s orientation. However, various aspects influence the criteria and sub-criteria of assessment tools such as environment, economic, social and cultural to mention but a few. The author provides an investigation on the most popular and globally used schemes: BREEAM, LEED, Green Star, CASBEE and Estidama in order to identify the effectiveness of the different aspects of the assessment criteria and the impacts of these criteria on the assessment results; that will provide a solid foundation to develop an effective sustainable assessment method for buildings in Saudi Arabia. Initial results of the investigation suggest that each country needs to develop its own assessment method in order to achieve desired results, while focusing upon the indigenous environmental, economic, social and cultural conditions. Keywords: Assessment methods, BREEAM, LEED, Green Star, CASBEE, Estidama, sustainability, sustainable buildings, Environment, Saudi Arabia.

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Children are expensive to raise. Ensuring that they are raised such that they are able to lead a minimally decent life costs time and money, and lots of both. Who is responsible for bearing the costs of the things that children are undoubtedly owed? This is a question that has received comparatively little scrutiny from political philosophers, despite children being such a drain on public and private finances alike. To the extent that there is a debate, two main views can be identified. The Parents Pay view says that parents, responsible for the existence of the costs, must foot the bill. The Society Pays view says that a next generation is a benefit to all, and so to allow parents to foot the bill alone is the worst kind of free-riding. In this paper, I introduce a third potentially liable party currently missing from the debate: children themselves. On my backward-looking view, we are entitled to ask people to contribute to the raising of children on the basis that they have benefited from being raised themselves.

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Dipolar streamers are coronal structures formed by open solar flux converging from coronal holes of opposite polarity. Thus the dipolar streamer belt traces the coronal foot print of the heliospheric current sheet (HCS), and it is strongly associated with the origin of slow solar wind. Pseudostreamers, on the other hand, separate converging regions of open solar flux from coronal holes of the same polarity and do not contain current sheets. They have recently received a great deal of interest as a possible additional source of slow solar wind. Here we add to that growing body of work by using the potential-field source-surface model to determine the occurrence and location of dipolar and pseudostreamers over the last three solar cycles. In addition to providing new information about pseudostreamer morphology, the results help explain why the observations taken during the first Ulysses perihelion pass in 1995 showed noncoincidence between dipolar streamer belt and the locus of slowest flow. We find that Carrington rotation averages of the heliographic latitudes of dipolar and pseudostreamer belts are systematically shifted away from the equator, alternately in opposite directions, with a weak solar cycle periodicity, thus keeping slow wind from the web of combined streamer belts approximately symmetric about the equator. The largest separation of dipolar and pseudostreamer belts occurred close to the Ulysses pass, allowing a unique opportunity to see that slow wind from pseudostreamer belts north of the southward-displaced dipolar belt was responsible for the noncoincident pattern.

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The link between natural ion-line enhancements in radar spectra and auroral activity has been the subject of recent studies but conclusions have been limited by the spatial and temporal resolution previously available. The next challenge is to use shorter sub-second integration times in combination with interferometric programmes to resolve spatial structure within the main radar beam, and so relate enhanced filaments to individual auroral rays. This paper presents initial studies of a technique, using optical and spectral satellite signatures, to calibrate the received phase of a signal with the position of the scattering source along the interferometric baseline of the EISCAT Svalbard Radar. It is shown that a consistent relationship can be found only if the satellite passage through the phase fringes is adjusted from the passage predicted by optical tracking. This required adjustment is interpreted as being due to the vector between the theoretical focusing points of the two antennae, i.e. the true radar baseline, differing from the baseline obtained by survey between the antenna foot points. A method to obtain a measurement of the true interferometric baseline using multiple satellite passes is outlined.

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A coordinated ground-based observational campaign using the IMAGE magnetometer network, EISCAT radars and optical instruments on Svalbard has made possible detailed studies of a travelling convection vortices (TCV) event on 6 January 1992. Combining the data from these facilities allows us to draw a very detailed picture of the features and dynamics of this TCV event. On the way from the noon to the drawn meridian, the vortices went through a remarkable development. The propagation velocity in the ionosphere increased from 2.5 to 7.4 km s−1, and the orientation of the major axes of the vortices rotated from being almost parallel to the magnetic meridian near noon to essentially perpendicular at dawn. By combining electric fields obtained by EISCAT and ionospheric currents deduced from magnetic field recordings, conductivities associated with the vortices could be estimated. Contrary to expectations we found higher conductivities below the downward field aligned current (FAC) filament than below the upward directed. Unexpected results also emerged from the optical observations. For most of the time there were no discrete aurora at 557.7 nm associated with the TCVs. Only once did a discrete form appear at the foot of the upward FAC. This aurora subsequently expanded eastward and westward leaving its centre at the same longitude while the TCV continued to travel westward. Also we try to identify the source regions of TCVs in the magnetosphere and discuss possible generation mechanisms.

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On December 1, 1986 the ISEE 1 and 2 spacecraft pair passed through the dayside magnetopause at a location which mapped approximately to ionospheric field-line foot-points near the fields of view of the EISCAT radar and photometers and an all-sky camera on Svalbard. The magnetosheath magnetic field was southward and duskward at the time, and flux transfer events (FTEs) were observed at the ISEE location. At the same time, the EISCAT radar observed ionospheric flow bursts of up to 1 km s−1. The peak of each burst followed an FTE observation at ISEE by a few minutes. The bursts, each lasting ten or fifteen minutes, were comprised of first a westward then a poleward flow. An all-sky camera at Ny Ålesund observed dayside auroral breakup forms during or shortly after the flow bursts, moving westward then poleward. While these flow bursts and associated dayside auroral forms have been previously reported in association with southward IMF orientations, this is the first observation of a direct link to FTEs at the magnetopause. On this occasion, the lower limit on the inferred potential associated with the FTEs is roughly 10 kV. Their inferred east-west extent in the ionosphere ranges between 700 and 1000 km, corresponding to a 3 – 5 RE local time extent at the average magnetopause.

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Recent literature has highlighted that the flexibility of walking barefoot reduces overload in individuals with knee osteoarthritis (OA). As such, the aim of this study was to evaluate the effects of inexpensive, flexible, non-heeled footwear (Moleca (R)) as compared with a modern heeled shoes and walking barefoot on the knee adduction moment (KAM) during gait in elderly women with and without knee OA. The gait of 45 elderly women between 60 and 70 years of age was evaluated. Twenty-one had knee OR graded 2 or 3 according to Kellgren and Lawrence`s criteria, and 24 who had no OA comprised the control group (CG). The gait conditions were: barefoot, Moleca (R), and modern heeled shoes. Three-dimensional kinematics and ground reaction forces were measured to calculate KAM by inverse dynamics. For both groups, the Moleca (R) provided peak KAM and KAM impulse similar to barefoot walking. For the OA group, the Moleca (R) reduced KAM even more as compared to the barefoot condition during midstance. On the other hand, the modern heeled shoes increased this variable in both groups. Inexpensive, flexible, and non-heeled footwear provided loading on the knee joint similar to a barefoot gait and significant overload decreases in elderly women with and without knee OA, compared to modern heeled shoes. During midstance, the Moleca (R) also allowed greater reduction in the knee joint loads as compared to barefoot gait in elderly women with knee OA, with the further advantage of providing external foot protection during gait. (C) 2011 Elsevier B.V. All rights reserved.

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We describe a Brazilian boy with semilobar holoprosencephaly, ectrodactyly, bilateral cleft of lip and palate, and severe mental retardation. The karyotype was normal and the screening for mutations in the genes SHH, TGIF, SIX3, GLI2 TP73L, and DHCR7 did not show any change. This rare condition was described previously in seven male patients. Clinical and genetic aspects are discussed. (C) 2009 Wiley-Liss, Inc.

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In tetrapod squamates, the diversity of micro-ornamentations of the epidermis of the contact areas of hands and feet is generally associated with constraints and modalities related to locomotion. Polychrus acutirostris is a medium-sized lizard that occurs in open heterogeneous habitats in South America, such as the cerrados, caatingas, and fallow lands. It progresses slowly on branches of various diameters in its arboreal environment. It can also move more rapidly on the ground. The hands and feet are prehensile and may be considered an adaptation for grasping and climbing. Epidermal surfaces from the palmar and plantar areas of the hands and feet of P. acutirostris were prepared for SEM examination, and studied at various magnifications. They show three major levels of complexity: (1) scale types, organized in gradients of size and imbrication, (2) scalar ornamentations, organized by increasing complexity and polarity, and (3) presence of Oberhautchen showing typically iguanian honeycomb micro-ornamentations. The shape and surface structure of the scales with their pattern of micro-ornamental peaks, which improve grip, and the grasping hands and feet indicate that P. acutirostris is morpho-functionally specialized for arboreality. (C) 2009 Elsevier GmbH. All rights reserved.

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In the present study, we propose a theoretical graph procedure to investigate multiple pathways in brain functional networks. By taking into account all the possible paths consisting of h links between the nodes pairs of the network, we measured the global network redundancy R (h) as the number of parallel paths and the global network permeability P (h) as the probability to get connected. We used this procedure to investigate the structural and dynamical changes in the cortical networks estimated from a dataset of high-resolution EEG signals in a group of spinal cord injured (SCI) patients during the attempt of foot movement. In the light of a statistical contrast with a healthy population, the permeability index P (h) of the SCI networks increased significantly (P < 0.01) in the Theta frequency band (3-6 Hz) for distances h ranging from 2 to 4. On the contrary, no significant differences were found between the two populations for the redundancy index R (h) . The most significant changes in the brain functional network of SCI patients occurred mainly in the lower spectral contents. These changes were related to an improved propagation of communication between the closest cortical areas rather than to a different level of redundancy. This evidence strengthens the hypothesis of the need for a higher functional interaction among the closest ROIs as a mechanism to compensate the lack of feedback from the peripheral nerves to the sensomotor areas.

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Syftet med denna litteraturstudie var att beskriva riskfaktorer som påverkade uppkomsten av trycksår samt de vanligaste förekommande preventiva åtgärderna. Vidare var syftet att beskriva sjuksköterskans roll vid förebyggandet samt behandlingen av trycksår. De vetenskapliga artiklar (n=21) som ingick i studien söktes manuellt samt datoriserat via databaserna Blackwell Synergy, CHINAL, Elin@Dalarna och Elsiever. Inklusionskriterierna var att de skulle vara vetenskapliga samt av kvalitativ och kvantitativ design. Även litteraturstudier inkluderades. Artiklarna skulle vara publicerade 1990 eller senare och vara svensk eller engelskspråkiga. Resultatet visade att patienter med lågt nutritionsstatus och låga serum albuminvärden riskerade att utveckla trycksår. En annan stor riskgrupp var patienter i peri- och postoperativa skeden där operationstiden kraftigt inverkade på uppkomsten av sår. Även anestesiformen spelade roll. Trycksåren uppkom vanligen på hälarna och korsbenet. I preventativt syfte var evidensbaserade mätskalor viktiga. Även trycksårsreducerande madrasser visade sig vara betydelsefulla. Vidare framkom att hälso- och sjukvårdspersonalen visade ett svalt intresse för trycksår och att kvalitetssäkringen var bristfällig. Sjuksköterskan hade främst en informerande roll inom trycksårspreventionen. Såren rengjordes lämpligast med fysiologisk koksaltlösning och omlades med våt omläggning. Resultatet visade även att smärtanalyser i högre grad borde involveras i trycksårsbehandlingen.

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Background and aims: The population of older people in our society is increasing. Agerelated changes in the skin results in a diminished perception of pain and pressure and a decreased microcirculation in the skin affects its ability to adapt to injury. Occurrence of pressure sore on geriatrikal clinics are 5-10%, witch means that between five and ten thousand patients gets daily treat for pressure sores. When the patient gets a pressure sore the need for help increases. A common apprehension is that if the patient’s affects with pressure sores it’s because of deficiency in care. According to the law, all nursing interventions should be performed according to scientific and evidence and the nurse’s assistants are responsible for how they perform. The aim of this study was to examine how much knowledge the nurses assistants in community care services has about preventing, predicting and locate riskfactors for pressure sores and if they get the right education. Methods: A questionnaire based on 20 questions was maid and used for this purpose. Out of 99 persons the questionnaires was answered bye 65 nurses assistants working in community care service in a small town in Sweden. Results: The results shown that the nurses assistants don’t use risk assessment scales in attempt to identify patients vulnerable to pressure sores and they are not well associated with the riskfactors. The study even shows that they have little knowledge in how to prevent pressure sores from appearing. The nursing model are some times out of date and the nurses assistants personal view attends to decide witch care they will perform instead of scientific and evidenced based nursing.

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Syftet med denna systematiska litteraturstudie var att ta reda på vilka mätinstrument som används för att identifiera patienter med risk att utveckla trycksår samt beskriva vilka omvårdnadsåtgärder som har betydelse för trycksårsprevention och sårläkning. De vetenskapliga artiklarna (n=16) som ingick i denna studie söktes i databasen Elin@dalarna. Sökorden som användes var pressure ulcer i olika kombinationer med nutrition, activity, skin, Norton, treatment och hydrocolloid. Inklusionskriterierna var att artiklarna skulle vara publicerade mellan åren 1999-2006 och vara i fulltext samt svensk och/eller engelskspråkig. Resultatet visade att patienter borde riskbedömas för trycksår så snart som möjligt efter att de anlänt till vårdinrättningen. Bedömningen kunde göras med ett flertal olika evidensbaserade mätinstrument såsom Norton, modifierad Norton, Braden, modifierad Braden, och RAPS skalorna samt bedömning av BMI, serum albuminvärde och hudtemperatur. Sjuksköterskans omvårdnadsåtgärder gällande prevention och sårläkning var att snabbt mobilisera patienter. Hos immobiliserade patienter var det viktigt att dessa vändes varannan timme samt att sjuksköterskan använde kuddar, fårskinn eller anti- decubitus madrasser för att tryckavlasta huden i denna patientgrupp. Resultatet visade även att kosttillägg hade stor betydelse för trycksårsprevention och sårläkning. Det var viktigt att sjuksköterskan rengjorde såret med tvål/vatten eller natriumklorid och använde hydrocolloida förband för att få en optimal sårläkning.

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I föreliggande systematiska litteraturstudie var syftet att samla information om och belysa sjuksköterskans evidensbaserade omvårdnadsåtgärder för att förebygga och bedöma trycksår. Artiklar söktes via Högskolan Dalarnas bibliotek och sökmotorn Electronic Library Information Navigator (ELIN). Sökorden pressure, ulcer och nurs* användes. De vetenskapliga artiklarna (n= 15) kvalitetsbedömdes enligt granskningsmallar som bestod av 28 kvalitetskriterier. Därefter evidensgraderades artiklarna. Resultatet i föreliggande studie visade att sjuksköterskan använde sig av tre evidensbaserade omvårdnadsåtgärder i omsorgen om patienter med risk för trycksår. Den första omvårdnadsåtgärden omfattade tryckavlastande omvårdnadsåtgärder, vilka insatser befanns vila på stark vetenskaplig grund. Den andra omvårdnadsåtgärden inbegrep användning av riskbedömningsinstrument och den tredje bestod av klinisk bedömning som båda befanns vila på måttlig vetenskapligt underlag. I resultatet framkom att riskbedömningsinstrument hjälpte sjuksköterskan att reducera uppkomsten av trycksår och därmed minskade ett onödigt lidande för patienten. Resultatet diskuterades utifrån Florence Nightingales omvårdnadsteori, där miljön var en av grundstenarna i omsorgen och att sjuksköterskan hade ansvaret för att anpassa miljön efter patientens behov. Medvetenheten om detta tillsammans med de evidensbaserade omvårdnadsåtgärderna som framkom i föreliggande studie kunde minska risken för trycksår hos patienter och i förlängningen reducera sjukvårds- kostnaderna.

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Syftet med denna studie var att belysa patienters erfarenheter av trycksår. Frågeställningarna var: Hur påverkas patientens välbefinnande av trycksår samt vilka erfarenheter av trycksår beskrivs av patienterna. Studien genomfördes som en litteraturöversikt och artiklar söktes i databaserna PubMed samt Cinahl med hjälp av sökorden ”pressure ulcer”, ”quality of life”, ”well being” och pain. Artiklarna skulle fokusera på patienternas perspektiv samt inte vara för medicinskt inriktade. Artiklarna kvalitetsgranskades utifrån två vedertagna mallar, sammanlagt tretton artiklar valdes ut för att användas i resultatet. Materialet lästes igenom flera gånger, analyserades och syntetiserades för att få fram viktiga teman. Resultatet visade att trycksår påverkade patienten både fysiskt, psykiskt och socialt, där den största fysiska faktorn var smärta. De flesta patienterna hade trycksår grad två eller tre och dessa var oftast belägna vid korsbenet, hälarna, höften eller sacrum. Smärtan beskrevs som värre av patienter med högre grad på trycksåren. Den ständiga smärtan påverkade det dagliga livet och innebar olika begränsningar för patienten. Många patienter upplevde också att de preventiva åtgärder som personalen satte in förvärrade smärtan och vissa ansåg att dessa orsakade nya trycksår. Livskvaliteten och välbefinnandet hos patienterna påverkades negativt i form av exempelvis depressioner och social isolering. Patienterna beskrev olika grader av bland annat känslomässig stress, humörsvängningar, frustration, ilska, nedstämdhet och depression. Oro för sårläkning förekom ofta hos patienterna. Den sociala påverkan hade flera orsaker, bland annat begränsades patienterna fysiskt av att vara på sjukhus, vara sängliggande eller ha besvärande förband. En del patienter upplevde även en minskad vilja att vara social på grund av bland annat sårlukt eller smärta. Med denna litteraturstudie hoppas vi att inblicken i hur patienter med trycksår ökar så att förståelsen samt omvårdnaden för dessa patienter kan förbättras.