811 resultados para Unidade de Cuidados Continuados - Unity of Continuous Care
Resumo:
The attempt to refer meaningful reality as a whole to a unifying ultimate principle - the quest for the unity of Being - was one of the basic tendencies of Western philosophy from its beginnings in ancient Greece up to Hegel's absolute idealism. However, the different trends of contemporary philosophy tend to regard such a speculative metaphysical quest for unity as obsolete. This study addresses this contemporary situation on the basis of the work of Martin Heidegger (1889-1976). Its methodological framework is Heidegger's phenomenological and hermeneutical approach to the history of philosophy. It seeks to understand, in terms of the metaphysical quest for unity, Heidegger's contrast between the first (Greek) beginning or "onset" (Anfang) of philosophy and another onset of thinking. This other onset is a possibility inherent in the contemporary situation in which, according to Heidegger, the metaphysical tradition has developed to its utmost limits and thereby come to an end. Part I is a detailed interpretation of the surviving fragments of the Poem of Parmenides of Elea (fl. c. 500 BC), an outstanding representative of the first philosophical beginning in Heidegger's sense. It is argued that the Poem is not a simple denial of apparent plurality and difference ("mortal acceptances," doxai) in favor of an extreme monism. Parmenides' point is rather to show in what sense the different instances of Being can be reduced to an absolute level of truth or evidence (aletheia), which is the unity of Being as such (to eon). What in prephilosophical human experience is accepted as being is referred to the source of its acceptability: intelligibility as such, the simple and undifferentiated presence to thinking that ultimately excludes unpresence and otherness. Part II interprets selected key texts from different stages in Heidegger's thinking in terms of the unity of Being. It argues that one aspect of Heidegger's sustained and gradually deepening philosophical quest was to think the unity of Being as singularity, as the instantaneous, context-specific, and differential unity of a temporally meaningful situation. In Being and Time (1927) Heidegger articulates the temporal situatedness of the human awareness of meaningful presence. His later work moves on to study the situational correlation between presence and the human awareness. Heidegger's "postmetaphysical" articulation seeks to show how presence becomes meaningful precisely as situated, in an event of differentiation from a multidimensional context of unpresence. In resigning itself to this irreducibly complicated and singular character of meaningful presence, philosophy also faces its own historically situated finitude. This resignation is an essential feature of Heidegger's "other onset" of thinking.
Resumo:
- BACKGROUND Access to information on the features and outcomes associated with the various models of maternity care available in Australia is vital for women's informed decision-making. This study sought to identify women's preferences for information access and decision-making involvement, as well as their priority information needs, for model of care decision-making. - METHODS A convenience sample of adult women of childbearing age in Queensland, Australia were recruited to complete an online survey assessing their model of care decision support needs. Knowledge on models of care and socio-demographic characteristics were also assessed. - RESULTS Altogether, 641 women provided usable survey data. Of these women, 26.7 percent had heard of all available models of care before starting the survey. Most women wanted access to information on models of care (90.4%) and an active role in decision-making (99.0%). Nine priority information needs were identified: cost, access to choice of mode of birth and care provider, after hours provider contact, continuity of carer in labor/birth, mobility during labor, discussion of the pros/cons of medical procedures, rates of skin-to-skin contact after birth, and availability at a preferred birth location. This information encompassed the priority needs of women across age, birth history, and insurance status subgroups. - CONCLUSIONS This study demonstrates Australian women's unmet needs for information that supports them to effectively compare available options for model of maternity care. Findings provide clear direction on what information should be prioritized and ideal channels for information access to support quality decision-making in practice.
Resumo:
Objective To identify factors associated with critical care nurses’ engagement in end-of-life care practices. Methods Multivariable regression modelling was undertaken on 392 responses to an online self-report survey of end-of-life care practices and factors influencing practice by Australian critical care nurses’. Univariate general linear models were built for six end-of-life care practice areas. Results Six statistically significant (p < 0.001) models were developed: Information sharing F(3, 377) = 40.53, adjusted R2 23.8%; Environmental modification F(5, 380) = 19.55, adjusted R2 19.4%; Emotional support F(10, 366) = 12.10, adjusted R2 22.8%; Patient and family centred decision making F(8, 362) = 17.61 adjusted R2 26.4%; Symptom management F(8, 376) = 7.10, adjusted R2 11.3%; and Spiritual support F(9, 367) = 14.66, adjusted R2 24.6%. Stronger agreement with values consistent with a palliative approach, and greater support for patient and family preferences were associated with higher levels of engagement in end-of-life care practices. Higher levels of preparedness and access to opportunities for knowledge acquisition were associated with engagement in the interpersonal practices of patient and family centred decision making and emotional support. Conclusion This study provides evidence for interventions to address factors associated with nurse engagement to increase participation in all end-of-life care practice areas.
Resumo:
This is an updated version of a Cochrane review published in Issue 11, 2013 in the Cochrane Library. In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans that detail essential steps in caring for patients with specific clinical problems. In particular, care pathways for the dying have been developed as a model to improve care of patients who are in the last days of life. The care pathways were designed with an aim of ensuring that the most appropriate management occurs at the most appropriate time, and that it is provided by the most appropriate health professional. Since the last update, there have been sustained concerns about the safety of implementing end-of-life care pathways, particularly in the United Kingdom (UK). Therefore, there is a significant need for clinicians and policy makers to be informed about the effects of end-of-life care pathways via a systematic review.
Resumo:
Learning automata are adaptive decision making devices that are found useful in a variety of machine learning and pattern recognition applications. Although most learning automata methods deal with the case of finitely many actions for the automaton, there are also models of continuous-action-set learning automata (CALA). A team of such CALA can be useful in stochastic optimization problems where one has access only to noise-corrupted values of the objective function. In this paper, we present a novel formulation for noise-tolerant learning of linear classifiers using a CALA team. We consider the general case of nonuniform noise, where the probability that the class label of an example is wrong may be a function of the feature vector of the example. The objective is to learn the underlying separating hyperplane given only such noisy examples. We present an algorithm employing a team of CALA and prove, under some conditions on the class conditional densities, that the algorithm achieves noise-tolerant learning as long as the probability of wrong label for any example is less than 0.5. We also present some empirical results to illustrate the effectiveness of the algorithm.
Resumo:
Carers are at the frontline working with children in the care of the child protection system. This paper reports carer's views about key factors influencing the placement trajectories of children and young people living in out-of-home care in Queensland, Australia. The study sample included 21 foster and kinship carers with a minimum two-year experience in the carer role. Study data were from semi-structured telephone interviews in which carers shared their experiences of the factors impacting upon placement stability and placement movement. Carers' responses were analysed thematically. Data analysis yielded an overarching theme regarding placement trajectory: Carer engagement, and its three sub-themes; with the child; with the child protection system; and, with the caring role. Findings suggested that carer engagement and ‘fit’ are complex constructs that play critical influential roles in placement outcomes (stability or movement) for individual children in out-of-home care. It is argued that practice needs to be better grounded in these relational dynamics, and better aligned concerning the power differentials that exist.
Resumo:
Despite the potential harm to patients (and others) and the financial cost of providing futile treatment at the end of life, this practice occurs. This article reports on empirical research undertaken in Queensland that explores doctors’ perceptions about the law that governs futile treatment at the end of life, and the role it plays in medical practice. The findings reveal that doctors have poor knowledge of their legal obligations and powers when making decisions about withholding or withdrawing futile treatment at the end of life; their attitudes towards the law were largely negative; and the law affected their clinical practice and had or would cause them to provide futile treatment.
Resumo:
Väitöskirjassa selvitettiin ikäihmisten laitoshoitoon siirtymisen todennäköisyyttä ja sen taustoja kansainvälisesti ainutlaatuisen rekisteriaineiston avulla. Selvitettäviä asioita olivat eri sairauksien, sosioekonomisten tekijöiden, puolison olemassaolon ja leskeksi jäämisen yhteys laitoshoitoon siirtymiseen yli 65-vuotiailla suomalaisilla. Tutkimuksessa havaittiin, että dementia, Parkinsonin tauti, aivohalvaus, masennusoireet ja muut mielenterveysongelmat, lonkkamurtuma sekä diabetes lisäsivät ikäihmisten todennäköisyyttä siirtyä laitoshoitoon yli 50 prosentilla, kun muut sairaudet ja sosiodemografiset tekijät oli otettu huomioon. Korkeat tulot vähensivät laitoshoidon todennäköisyyttä, kun taas puutteellinen asuminen (ilman peseytymistiloja tai keskus- tai sähkölämmitystä) sekä erittäin puutteellinen asuminen (ilman lämmintä vettä, vesijohtoa, viemäriä tai vesivessaa) lisäsivät todennäkösyyttä, kun muut sosiodemografiset tekijät, sairaudet ja asuinalue oli huomioitu. Kerrostalon hissittömyys ei ollut yhteydessä laitoshoidon todennäköisyyteen. Todennäköisyys siirtyä laitoshoitoon oli jostain syystä korkeampaa niillä ikäihmisillä, jotka asuivat vuokralla ja matalampaa omakotitalossa asuvilla ja niillä, joilla oli auto. Puolison olemassaolo vähensi ja leskeksi jääminen lisäsi laitoshoidon todennäköisyyttä huomattavasti. Todennäköisyys oli erityisen suuri, yli kolminkertainen, kun puolison kuolemasta oli kulunut enintään kuukausi verrattuna niihin, joiden puoliso oli elossa. Todennäköisyys laski, kun puolison kuolemasta kului aikaa. Miesten ja naisten tulokset olivat samansuuntaisia. Korkeat tulot tai koulutus eivät suojanneet riskiltä joutua laitoshoitoon puolison kuoltua. Puolison kuolema näyttää lisäävän hoidon tarvetta, kun kotona ei ole enää puolisoa tukemassa ja huolehtimassa kodin askareista. Laitoshoidon tarve vähenee, jos ja kun lesket ajan kuluessa oppivat elämään yksin. Toisaalta tutkimustulokset saattavat viitata myös siihen, että kaikkein huonokuntoisimmat lesket, jotka eivät pärjää yksin asuessaan, siirtyvät laitoshoitoon hyvin nopeasti puolison kuoltua. Tutkimuksessa oli mukana yhteensä yli 280 000 yli 65-vuotiasta henkilöä, joiden pitkäaikaiseen laitoshoitoon siirtymistä seurattiin tammikuusta 1998 syyskuuhun 2003. Laitoshoidoksi määriteltiin terveyskeskuksissa, sairaaloissa ja vanhainkodeissa tai vastaavissa yksiköissä tapahtuva pitkäaikainen hoito, joka kesti yli 90 vuorokautta tai oli vahvistettu pitkäaikaishoidon päätöksellä. Tutkimuksessa käytetty aineisto koottiin väestörekistereistä, sosiaali- ja terveydenhuollon rekistereistä ja lääkerekistereistä.
Resumo:
A three dimensional elasticity solution for the analysis of beams continuous over an infinite number of equally spaced supports has been given. The beam has been subjected to normal tractions on its two opposite faces and these loads are identical over each span. The other two faces are traction free. Numerical results have been given for different cases when the beam is loaded on its bottom face. The results obtained have been compared with the results of two dimensional elasticity solution.
Resumo:
A compression moulded Kevlar-phenolic resin composite consisting of 30 wt% continuous fibres was slid against a steel disc such that the fibre axis was normal to the sliding plane. The sliding experiments were conducted in a normal pressure range of 0.47–4.27 MPa and at a sliding speed of 0.5 ms–1. The initial sliding interaction is abrasive. With further sliding, as patches of polymer transfer film develop on the polymer pin and counterface, the interaction becomes adhesive and steady-state friction is established. The wear resistance of the polymer was found to be related to the stability of this film.
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An adaptive optimization algorithm using backpropogation neural network model for dynamic identification is developed. The algorithm is applied to maximize the cellular productivity of a continuous culture of baker's yeast. The robustness of the algorithm is demonstrated in determining and maintaining the optimal dilution rate of the continuous bioreactor in presence of disturbances in environmental conditions and microbial culture characteristics. The simulation results show that a significant reduction in time required to reach optimal operating levels can be achieved using neural network model compared with the traditional dynamic linear input-output model. The extension of the algorithm for multivariable adaptive optimization of continuous bioreactor is briefly discussed.
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Strategies for efficient start-up of a continuous process for biooxidation of refractory gold ore and concentrate obtained from Hutti, Gold Mines Limited (HGML), India are discussed in this work. The biooxidation of the concentrate at high pulp density (10%) with wild strain of Thiobacillus ferrooxidans isolated from HGML mines is characterized by significant lag phase (20 days) and incomplete oxidation (35%) even after prolonged operation (60 days). Two strategies, biooxidation with concentrate adapted cells and a step leaching strategy, in which the pulp density is progressively increased from 2% to 10% were considered and the latter resulted in efficient biooxidation of concentrate. Conversion of such a process from batch to continuous operation is shown to result in complete biooxidation of the concentrate and gold extraction efficiency in excess of 90%. (C) 2002 Elsevier Science Ltd. All rights reserved.
Resumo:
Differential evolution (DE) is arguably one of the most powerful stochastic real-parameter optimization algorithms of current interest. Since its inception in the mid 1990s, DE has been finding many successful applications in real-world optimization problems from diverse domains of science and engineering. This paper takes a first significant step toward the convergence analysis of a canonical DE (DE/rand/1/bin) algorithm. It first deduces a time-recursive relationship for the probability density function (PDF) of the trial solutions, taking into consideration the DE-type mutation, crossover, and selection mechanisms. Then, by applying the concepts of Lyapunov stability theorems, it shows that as time approaches infinity, the PDF of the trial solutions concentrates narrowly around the global optimum of the objective function, assuming the shape of a Dirac delta distribution. Asymptotic convergence behavior of the population PDF is established by constructing a Lyapunov functional based on the PDF and showing that it monotonically decreases with time. The analysis is applicable to a class of continuous and real-valued objective functions that possesses a unique global optimum (but may have multiple local optima). Theoretical results have been substantiated with relevant computer simulations.