933 resultados para person-centred


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In this paper we highlight how current approaches to design for disability have failed to consider the emotional needs not only of those with disabilities but their families and other carers as well. In conjunction with this, we demonstrate through a review of literature the significance of the house, the home and home in the support and growth of the person as a whole in association with their loved ones, and the potential inequity that arises when the emotional and holistic dimensions of 'being' are neglected. With a growing trend nationally and internationally away from group and shared housing, a greater focus on the family and their home is required. However, as research has shown, home for families where a family member has a disability is not necessarily a positive experience; it can be a source of stress, work, conflict and burden, arousing emotions ranging from loss of control through guilt. As proposed in the paper, consideration of the negative as well as positive emotions demands exploration of the 'middle ground' between institutions and home-based care models. This paper outlines the beginning of one such exploration.

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Can my immediate physical environment affect how I feel? The instinctive answer to this question must be a resounding “yes”. What might seem a throwaway remark is increasingly borne out by research in environmental and behavioural psychology, and in the more recent discipline of Evidence-Based Design. Research outcomes are beginning to converge with findings in neuroscience and neurophysiology, as we discover more about how the human brain and body functions, and reacts to environmental stimuli. What we see, hear, touch, and sense affects each of us psychologically and, by extension, physically, on a continual basis. The physical characteristics of our daily environment thus have the capacity to profoundly affect all aspects of our functioning, from biological systems to cognitive ability. This has long been understood on an intuitive basis, and utilised on a more conscious basis by architects and other designers. Recent research in evidence-based design, coupled with advances in neurophysiology, confirm what have been previously held as commonalities, but also illuminate an almost frightening potential to do enormous good, or alternatively, terrible harm, by virtue of how we make our everyday surroundings. The thesis adopts a design methodology in its approach to exploring the potential use of wireless sensor networks in environments for elderly people. Vitruvian principles of “commodity, firmness and delight” inform the research process and become embedded in the final design proposals and research conclusions. The issue of person-environment fit becomes a key principle in describing a model of continuously-evolving responsive architecture which makes the individual user its focus, with the intention of promoting wellbeing. The key research questions are: What are the key system characteristics of an adaptive therapeutic single-room environment? How can embedded technologies be utilised to maximise the adaptive and therapeutic aspects of the personal life-space of an elderly person with dementia?.

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Derek Parfit’s discussion of our bias towards the future has sparked considerable discussion of our pervasively asymmetrical attitudes towards past and future goods. Much of this discussion has centred on whether we can rationally justify such attitudes or whether they are intrinsically irrational. This paper seeks neither to justify nor to reject temporally asymmetrical attitudes, but to explicate the way perspective, and particularly temporal perspective, operates in such biases, in order to show how our temporal biases point to something important about the structure of selfhood. By employing an emerging distinction in the personal identity literature between the ‘self’ as an intrinsically first personal and temporally indexical locus of consciousness, and the ‘person’ as a diachronic bearer of various forms of physical and psychological predicates, we can see that the clash between temporally asymmetrical attitudes and symmetrical welfare judgments is in fact a result of the ways in which selves and persons interact.

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This research work analyses techniques for implementing a cell-centred finite-volume time-domain (ccFV-TD) computational methodology for the purpose of studying microwave heating. Various state-of-the-art spatial and temporal discretisation methods employed to solve Maxwell's equations on multidimensional structured grid networks are investigated, and the dispersive and dissipative errors inherent in those techniques examined. Both staggered and unstaggered grid approaches are considered. Upwind schemes using a Riemann solver and intensity vector splitting are studied and evaluated. Staggered and unstaggered Leapfrog and Runge-Kutta time integration methods are analysed in terms of phase and amplitude error to identify which method is the most accurate and efficient for simulating microwave heating processes. The implementation and migration of typical electromagnetic boundary conditions. from staggered in space to cell-centred approaches also is deliberated. In particular, an existing perfectly matched layer absorbing boundary methodology is adapted to formulate a new cell-centred boundary implementation for the ccFV-TD solvers. Finally for microwave heating purposes, a comparison of analytical and numerical results for standard case studies in rectangular waveguides allows the accuracy of the developed methods to be assessed.

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Person tracking systems to date have either relied on motion detection or optical flow as a basis for person detection and tracking. As yet, systems have not been developed that utilise both these techniques. We propose a person tracking system that uses both, made possible by a novel hybrid optical flow-motion detection technique that we have developed. This provides the system with two methods of person detection, helping to avoid missed detections and the need to predict position, which can lead to errors in tracking and mistakes when handling occlusion situations. Our results show that our system is able to track people accurately, with an average error less than four pixels, and that our system outperforms the current CAVIAR benchmark system.

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Person tracking systems are dependent on being able to locate a person accurately across a series of frames. Optical flow can be used to segment a moving object from a scene, provided the expected velocity of the moving object is known; but successful detection also relies on being able segment the background. A problem with existing optical flow techniques is that they don’t discriminate the foreground from the background, and so often detect motion (and thus the object) in the background. To overcome this problem, we propose a new optical flow technique, that is based upon an adaptive background segmentation technique, which only determines optical flow in regions of motion. This technique has been developed with a view to being used in surveillance systems, and our testing shows that for this application it is more effective than other standard optical flow techniques.

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Purpose – The paper aims to describe a workforce-planning model developed in-house in an Australian university library that is based on rigorous environmental scanning of an institution, the profession and the sector. Design/methodology/approach – The paper uses a case study that describes the stages of the planning process undertaken to develop the Library’s Workforce Plan and the documentation produced. Findings – While it has been found that the process has had successful and productive outcomes, workforce planning is an ongoing process. To remain effective, the workforce plan needs to be reviewed annually in the context of the library’s overall planning program. This is imperative if the plan is to remain current and to be regarded as a living document that will continue to guide library practice. Research limitations/implications – Although a single case study, the work has been contextualized within the wider research into workforce planning. Practical implications – The paper provides a model that can easily be deployed within a library without external or specialist consultant skills, and due to its scalability can be applied at department or wider level. Originality/value – The paper identifies the trends impacting on, and the emerging opportunities for, university libraries and provides a model for workforce planning that recognizes the context and culture of the organization as key drivers in determining workforce planning. Keywords - Australia, University libraries, Academic libraries, Change management, Manpower planning Paper type - Case study

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While it is uncontested that the medical profession makes a valuable contribution to society, doctors should not always be beyond the reach of the criminal law and they should not automatically be treated as God. Doctors should act reasonably and be conscious of their position of trust. In this sense, the notion of “doctors” is construed broadly to include a range of health care professionals such as podiatrists, radiographers, surgeons and general practitioners. This paper will explore contemporary Australian examples where doctors have acted inappropriately and been convicted of non-fatal offences against the person. The physical invasiveness involved in these scenarios varies significantly. In one example, a doctor penetrates a patient’s private body part with a probe for their own sexual gratification, and in another, a doctor covertly visually records a naked patient. The examples will be connected to the theories underpinning criminalisation, particularly social welfare and individual autonomy, with a view to framing guidelines on when doctors should not be immune from non-fatal offences against a person, and thus where the criminal law should respond.

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An airport is one of the largest and most complex systems in modern society. Observational field studies have been conducted to investigate passenger experiences in, and interactions within, an international airport. Based on these studies, this paper discusses how activities mediate people’s experiences in the airport. For example, moving through the security screening process is discussed from both passenger and staff perspectives. The applied coding scheme ensured research rigor. The findings illustrate that passenger activities are complex and shared, and only partially supported by current terminal design. Thus, this research has the potential to impact on airport design to facilitate passenger flow through airport precincts.

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Protein-energy wasting (PEW) is commonly seen in patients with chronic kidney disease (CKD). The condition is characterised by chronic, systemic low-grade inflammation which affects nutritional status by a variety of mechanisms including reducing appetite and food intake and increasing muscle catabolism. PEW is linked with co-morbidities such as cardiovascular disease, and is associated with lower quality of life, increased hospitalisations and a 6-fold increase in risk of death1. Significant gender differences have been found in the severity and effects of several markers of PEW. There have been limited studies testing the ability of anti-inflammatory agents or nutritional interventions to reduce the effects of PEW in dialysis patients. This thesis makes a significant contribution to the understanding of PEW in dialysis patients. It advances understanding of measurement techniques for two of the key components, appetite and inflammation, and explores the effect of fish oil, an anti-inflammatory agent, on markers of PEW in dialysis patients. The first part of the thesis consists of two methodological studies conducted using baseline data. The first study aims to validate retrospective ratings of hunger, desire to eat and fullness on visual analog scales (VAS) (paper and pen and electronic) as a new method of measuring appetite in dialysis patients. The second methodological study aims to assess the ability of a variety of methods available in routine practice to detect the presence of inflammation. The second part of the thesis aims to explore the effect of 12 weeks supplementation with 2g per day of Eicosapentaenoic Acid (EPA), a longchain fatty acid found in fish oil, on markers of PEW. A combination of biomarkers and psychomarkers of appetite and inflammation are the main outcomes being explored, with nutritional status, dietary intake and quality of life included as secondary outcomes. A lead in phase of 3 months prior to baseline was used so that each person acts as their own historical control. The study also examines whether there are gender differences in response to the treatment. Being an exploratory study, an important part of the work is to test the feasibility of the intervention, thus the level of adherence and factors associated with adherence are also presented. The studies were conducted at the hemodialysis unit of the Wesley Hospital. Participants met the following criteria: adult, stage 5 CKD on hemodialysis for at least 3 months, not expected to receive a transplant or switch to another dialysis modality during the study, absence of intellectual impairment or mental illness impairing ability to follow instructions or complete the intervention. A range of intermediate, clinical and patient-centred outcome measures were collected at baseline and 12 weeks. Inflammation was measured using five biomarkers: c-reactive protein (CRP), interleukin-6 (IL6), intercellular adhesion molecule (sICAM-1), vascular cell adhesion molecule (sVCAM-1) and white cell count (WCC). Subjective appetite was measured using the first question from the Appetite and Dietary Assessment (ADAT) tool and VAS for measurements of hunger, desire to eat and fullness. A novel feature of the study was the assessment of the appetite peptides leptin, ghrelin and peptide YY as biomarkers of appetite. Nutritional status/inflammation was assessed using the Malnutrition-Inflammation Score (MIS) and the Patient-Generated Subjective Global Assessment (PG-SGA). Dietary intake was measured using 3-day records. Quality of life was measured using the Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SF™ v1.3 © RAND University), which combines the Short-Form 36 (SF36) with a kidney-disease specific module2. A smaller range of these variables was available for analysis during the control phase (CRP, ADAT, dietary intake and nutritional status). Statistical analysis was carried out using SPSS version 14 (SPSS Inc, Chicago IL, USA). Analysis of the first part of the thesis involved descriptive and bivariate statistics, as well as Bland-Altman plots to assess agreement between methods, and sensitivity analysis/ROC curves to test the ability of methods to predict the presence of inflammation. The unadjusted (paired ttests) and adjusted (linear mixed model) change over time is presented for the main outcome variables of inflammation and appetite. Results are shown for the whole group followed by analyses according to gender and adherence to treatment. Due to the exploratory nature of the study, trends and clinical significance were considered as important as statistical significance. Twenty-eight patients (mean age 61±17y, 50% male, dialysis vintage 19.5 (4- 101) months) underwent baseline assessment. Seven out of 28 patients (25%) reported sub-optimal appetite (self-reported as fair, poor or very poor) despite all being well nourished (100% SGA A). Using the VAS, ratings of hunger, but not desire to eat or fullness, were significantly (p<0.05) associated with a range of relevant clinical variables including age (r=-0.376), comorbidities (r=-0.380) nutritional status (PG-SGA score, r=-0.451), inflammatory markers (CRP r=-0.383; sICAM-1 r=-0.387) and seven domains of quality of life. Patients expressed a preference for the paper and pen method of administering VAS. None of the tools (appetite, MIS, PG-SGA, albumin or iron) showed an acceptable ability to detect patients who are inflamed. It is recommended that CRP should be tested more frequently as a matter of course rather than seeking alternative methods of measuring inflammation. 27 patients completed the 12 week intervention. 20 patients were considered adherent based on changes in % plasma EPA, which rose from 1.3 (0.94)% to 5.2 (1.1)%, p<0.001, in this group. The major barriers to adherence were forgetting to take the tablets as well as their size. At 12 weeks, inflammatory markers remained steady apart from the white cell count which decreased (7.6(2.5) vs 7.0(2.2) x109/L, p=0.058) and sVCAM-1 which increased (1685(654) vs 2249(925) ng/mL, p=0.001). Subjective appetite using VAS increased (51mm to 57mm, +12%) and there was a trend towards reduction in peptide YY (660(31) vs 600(30) pg/mL, p=0.078). There were some gender differences apparent, with the following adjusted change between baseline and week 12: CRP (males -3% vs females +17%, p=0.19), IL6 (males +17% vs females +48%, p=0.77), sICAM-1 (males -5% vs females +11%, p=0.07), sVCAM-1 (males +54% vs females +19%, p=0.08) and hunger ratings (males 20% vs females -5%, p=0.18). On balance, males experienced a maintainence or reduction in three inflammatory markers and an improvement in hunger ratings, and therefore appeared to have responded better to the intervention. Compared to those who didn’t adhere, adherent patients maintained weight (mean(SE) change: +0.5(1.6) vs - 0.8(1.2) kg, p=0.052) and fat-free mass (-0.1 (1.6) vs -1.8 (1.8) kg, p=0.045). There was no difference in change between the intervention and control phase for CRP, appetite, nutritional status or dietary intake. The thesis makes a significant contribution to the evidence base for understanding of PEW in dialysis patients. It has advanced knowledge of methods of assessing inflammation and appetite. Retrospective ratings of hunger on a VAS appear to be a valid method of assessing appetite although samples which include patients with very poor appetite are required to confirm this. Supplementation with fish oil appeared to improve subjective appetite and dampen the inflammatory response. The effectiveness of the intervention is influenced by gender and adherence. Males appear to be more responsive to the primary outcome variables than females, and the quality of response is improved with better adherence. These results provide evidence to support future interventions aimed at reducing the effects of PEW in dialysis patients.

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This paper demonstrates the application of the reliability-centred maintenance (RCM) process to analyse and develop preventive maintenance tasks for electric multiple units (EMU) in the East Rail of the Kowloon-Canton Railway Corporation (KCRC). Two systems, the 25 kV electrical power supply and the air-conditioning system of the EMU, have been chosen for the study. RCM approach on the two systems is delineated step by step in the paper. This study confirms the feasibility and effectiveness of RCM applications on the maintenance of electric trains.