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Showing 61 to 66 of 66 (0.021 seconds)Spelling suggestions: "subject:"natal""
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Somatske komplikacije u akutnoj fazi moždanog udara: učestalost, prediktori i uticaj na ishod bolesti / Somatic complications in the acute phase of stroke: frequency, predictors and impact on the outcome of the diseaseMilićević Marija 18 October 2019 (has links)
<p>Moždani udar predstavlja drugi uzrok smrti u celom svetu i neurološku bolest sa najvećim stepenom invaliditeta. Za povoljan ishod moždanog udara veoma je važno sprečavanje i lečenje somatskih kompikacija (SK), pri čemu je njihova učestalost i značaj za oporavak pacijenata potcenjena, a uticaj na ishod moždanog udara zanemaren. Ciljevi istraživanja su bili da se utvrdi učestalost pacijenata sa somatskim komplikacijama u akutnoj fazi moždanog udara; zatim da se utvrdi učestalost svake pojedinačne somatske komplikacije: pneumonije, urinarnih infekcija, duboke venske tromboze, tromboembolije pluća, dijarealnog sindroma i akutnog koronarnog sindroma; zatim da se utvrde faktori rizika za nastanak svake pojedinačne SK, kao i da se utvrdi uticaj SK na ishod bolesti - iskazan kroz njihovu povezanost sa funkcionalnim statusom, dužinom hospitalizacije i mortalitetom pacijenata. Istraživanje je sprovedeno kao prospektivno i obuhvatilo je 403 pacijenta hospitalizovanih zbog akutnog moždanog udara na Klinici za neurologiju Kliničkog centra Vojvodine u periodu od godinu dana. Pacijenti su podeljeni u dve grupe, gde su prvu grupu sačinjavali pacijenti sa registrovanom jednom ili više somatskih komplikacija (n = 162), a drugu su činili pacijenti koji nisu imali somatske komplikacije (n = 241). Evaluacija pacijenata obuhvatila je registrovanje sociodemografskih karakteristika, ličnu i porodičnu anamnezu, karakteristike moždanog udara, neurološki status na prijemu i otpustu, funkcionalni status na prijemu i otpustu, laboratorijske analize krvi i urina na prijemu, vrstu i vreme nastanka pojedinačne somatske komplikacije, sve relevantne dijagnostičke metode za postavljenje dijagnoze i definisanje potencijalnih faktora rizika. Somatske komplikacije se češće javljaju kod starijih osoba, prosečne starosti 72,9 godina, kod osoba ženskog pola i kod pacijenata sa hemoragijskim moždanim udarom. Somatske komplikacije registrovane su kod 40,2% pacijenata, pri tome urinarnu infekciju imalo je 20,3% pacijenata, pneumoniju 16,3%, infarkt miokarda 4,7%, plućnu tromboemboliju 3,4%, duboku vensku trombozu 2,4% i dijarealni sindrom 2,9% pacijenata. Nezavisni prediktori pneumonije su disfagija, narušeno stanje svesti, hronična opstruktivna bolest pluća, mRS veći od 3. Prediktori urinarnih infekcija su: podatak o rekurentnim urinarnim infekcijama, ženski pol, starost preko 70 godina, mRS veći od 3 i NIHSS skor veći od 16. Kao nezavisni prediktori plućnog tromboembolizma dobijeni su duboka venska tromboza, narušeno stanje svesti i gojaznost, dok se jedinim nezavisnim prediktorom dijarealnog sindroma pokazala starost pacijenta preko 70 godina. Prediktori akutnog koronarnog sindroma su: starost veća od 70 godina i hemoragijski moždani udar. Pacijenti sa SK, na kraju hospitalnog lečenja imaju značajno lošiji funkcionalni status u odnosu na pacijente bez somatskih komplikacija. Somatske komplikacije statistički značajno produžavaju hospitalizaciju. Kod četvrtine pacijenata (25,9%) sa somatskim komplikacijama u akutnoj fazi moždanog udara registrovan je letalni ishod. Najveći procenat smrtnih ishoda kod pacijenata sa somatskim komplikacijama registrovan je kod pacijenata sa infarktom miokarda (63,2%), a najmanji kod pacijenata sa urinarnom infekcijom (18,3%).</p> / <p>Stroke is the second cause of death worldwide and neurological disease with the highest level of disability. For a favorable outcome of stroke, the prevention and treatment of somatic complications are of great importance, while their frequency and the importance of the recovery of patients are underestimated, and the influence on the outcome of stroke is neglected. The aims of the study were: to determine the frequency of patients with somatic complications in the acute phase of stroke; to determine the frequency of each somatic complication: pneumonia, urinary infections, deep venous thrombosis, lung thromboembolism, diarrheal syndrome, and acute coronary syndrome; to identify risk factors for the emergence of each somatic complication, as well as to determine the effect of those complications on the outcome of the disease - expressed through their association with the functional status, length of hospitalization and mortality of patients. The study was conducted as a prospective and included 403 patients hospitalized due to acute stroke at the Clinic for Neurology of the Clinical Center of Vojvodina for a period of one year. Patients were divided into two groups; the first group included patients with one or more somatic complications registered (n = 162), and the second group consisted of patients without any somatic complication (n = 241). Patient evaluation included registration of socio-demographic characteristics, personal and family history, stroke characteristics, neurological and functional status at the time of admission and discharge, laboratory analysis of blood and urine at admission, type and time of emergence of each somatic complication, all relevant diagnostic methods for setting diagnosis and defining potential risk factors. Somatic complications are more common in older people (the average age of 72.9 years) in females and in patients with hemorrhagic stroke. Somatic complications were reported in 40.2% of patients, 20.3% of patients had urinary infection, 16.3% pneumonia, 4.7% myocardial infarction, 3.4% pulmonary thromboembolism, deep venous thrombosis 2.4% and diarrheal syndrome 2.9% of patients. Independent predictors of pneumonia were dysphagia, impaired state of consciousness, chronic obstructive pulmonary disease, mRS higher than 3. Predictors of urinary infections were: data on recurrent urinary tract infections, female sex, age over 70 years, mRS higher than 3 and NIHSS score higher than 16. As independent predictors of pulmonary thromboembolism, deep venous thrombosis, impaired state of consciousness and obesity were obtained, while the only independent predictor of diarrheal syndrome proved to be the age of the patient over 70 years. Predictors of acute coronary syndrome were: age over 70 years and haemorrhagic stroke. Patients with somatic complications at the end of hospital treatment had significantly worse functional status compared to patients without somatic complications. Somatic complications statistically significantly prolong hospitalization. A quarter of patients (25.9%) with somatic complications in the acute phase of the stroke had a lethal outcome. The highest percentage of deaths in patients with somatic complications was registered in patients with myocardial infarction (63.2%) and the lowest was registered in patients with urinary tract infections (18.3%).</p>
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Analýza návrhových prvků okružních křižovatek v závislosti na nehodovost / Analysis of roundabout design parameters and their impact on accidents.Novák, Jan January 2018 (has links)
The dissertation deals with the analysis of roundabout design elements and their impact on accidents. The analysis objective was to identify the important elements of roundabouts that have impact on accidents. In order to achieve this goal, the multifactorial statistical safety assessment method was used on the basis of a representative sample of data, by developing several safety performance functions, verifying them and interpreting the result. Several design elements, which from the point of view of the traffic accident mechanism belong to the infrastructure factor, have been identified: AADT, average diameter, entrance width, entry angle, direct passage angle, location and many others. The original sample contained about 1200 roundabouts, which were reduced to 200 based on data availability. Accident frequencies were monitored between 2009 and 2016, i.e. for eight years, resulting in total 2674 roundabouts accidents. The result is an accident prediction model, developer based on roundabout approach design elements, and map of critical roundabouts, identified based on empirical Bayes estimate of accident frequency. Following approach parameters were identified: AADT, entry angle, distance between collision points, deviation of angles between approaches, presence of apron, presence of bypass, entry type, presence of pedestrian crossing and surrounding area type.
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Time trends in childhood cancer : Britain 1966-2005Kroll, Mary Eileen January 2009 (has links)
Increasing time trends in the recorded incidence of childhood cancer have been reported in many different settings. The extent to which these trends reflect real changes in incidence, rather than improvements in methods for diagnosis and registration, is controversial. Using data from the National Registry of Childhood Tumours (NRCT), this thesis investigates time trends in cancer diagnosed under age 15 in residents of Britain during 1966-2005 (54650 cases), and considers potential sources of artefact in detail. Several different methods are used to estimate completeness of NRCT registration. The history of methods for diagnosis and registration of childhood cancers in Britain is described, and predictions are made for effects on recorded incidence. For each of the 12 main diagnostic groups, Poisson regression is used to fit continuous time trends and ‘step’ models to the annual age-sex-standardised rates by year of birth and year of diagnosis. Age-specific rates by period, and quinquennial standardised rates for diagnostic subgroups, are shown graphically. For three broad groups (leukaemia, CNS tumours and other cancer), geographical variation is compared by period of diagnosis. The results of these analyses are discussed in relation to the predicted artefacts. The evidence for a positive association between affluence and recorded incidence of childhood leukaemia is briefly reviewed. A special form of diagnostic artefact, the ‘fatal infection’ hypothesis, is proposed as an explanation of both this association and the leukaemia time trend. This hypothesis is examined in a novel test based on clinical data. The recorded incidence of childhood cancer in Britain increased in each of 12 diagnostic groups during 1966-2005 (from 0.5% per year for bone cancer to 2.5% for hepatic cancer, with 0.7% for leukaemia). Evidence presented here suggests that these increases are probably artefacts of diagnosis and registration. The potential implications for epidemiological studies of childhood cancer should be considered.
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Vergiftungsbedingte Todesfälle - Retrospektive Analyse von 316 letalen Intoxikationen des Giftinformationszentrums-Nord / Intoxication related fatalitities - Retrospective study of 316 lethal poisonings of GIZ-Nord Poisons Centre GöttingenKalentzi, Chrissi 25 June 2013 (has links)
Schätzungen über die Gesamtzahl der Vergiftungen in Deutschland belaufen sich auf 150 - 200.000 pro Jahr. In Deutschland machen Vergiftungsfälle 10% der in Notaufnahmen und auf Intensivstationen behandelten Patienten aus. Bis dato gibt es in Deutschland nur wenige strukturiert erfasste epidemiologische Daten von vergiftungsbedingten Todesfällen.
In der vorliegenden Arbeit wurden die vergiftungsbedingten Todesfälle aus dem Giftinformationszentrum-Nord (GIZ-Nord) für den Zeitraum vom 01.01.1996 bis einschließlich 31.12.2009 retrospektiv analysiert. Insbesondere vor dem Hintergrund der Toxikovigilanz konnten folgende Fragen zu Risikokonstellationen für letale Vergiftungen durch diese Arbeit beantwortet werden:
1. Gibt es bei den vergiftungsbedingten Todesfällen jahreszeitliche Schwankungen?
Ja, die vergiftungsbedingten bzw. suizidalen letalen Intoxikationen zeigen jahreszeitliche Schwankungen mit einem maximalen Anteil im Frühling von knapp 30% und dem geringsten Anteil im Herbst mit etwa 20%.
2. Bergen die iatrogen bedingten Vergiftungen ein besonderes Mortalitätsrisiko?
Ja, die iatrogenen Vergiftungen weisen die höchste Mortalitätsrate mit knapp 5 ‰ aller iatrogenen Expositionen auf, vor allem bei parenteraler Arzneimittelapplikation.
3. Stellen Adoleszente (Heranwachsende und Jugendliche) und Senioren über 70 Jahre besonders gefährdete Altersgruppen für letale Intoxikationen dar?
Ja, beide Populationen stellen besondere Risikogruppen für vergiftungsbedingte Todesfälle dar.
Vor allem männliche Heranwachsende repräsentieren eine Risikogruppe für letale Intoxikationen durch Abusus. 30% aller vergiftungbedingten Todesfälle durch Abusus sind bei männlichen Jugendlichen aufgetreten.
Senioren (Männer und Frauen) über 70 Jahre sind eine im hohen Maß gefährdete Altersgruppe für letale Vergiftungen. Einerseits ist die relative Mortalitätsrate bezogen auf alle Expositionen dieser Altersgruppe mit knapp 6 ‰ am höchsten. Andererseits zeigen die suizidalen Intoxikationen bei den Senioren eine zunehmende Tendenz. Außerdem bilden Senioren mit einem Anteil von 24% die Gruppe mit dem größten Anteil an den letalen nicht suizidalen Intoxikationen. Mehr als 70% der akzidentellen letalen Intoxikationen und 50% der letalen Vergiftungen durch Verwechslungen betreffen Senioren, dabei sind Frauen mehr als 3fach häufiger betroffen als Männer.
Darüber hinaus sind Senioren durch Aspiration schäumender, prinzipiell niedrig toxischer Kosmetika und tensidhaltiger Chemikalien besonders gefährdet.
4. Gibt es bei den gewerblichen Expositionen besondere Risikokonstellationen?
Ja, die gewerblichen Expositionen, die mit einer hohen Männerlastigkeit auftreten, bergen eine hohe letale Intoxikationsgefahr. Vor allem bei den gewerblichen inhalativen Expositionen von toxischen Reizgasen besteht eine Gefährdung für die betroffenen Beschäftigten, aber auch für die nicht selbstgeschützten Ersthelfer: 6% der inhalativen gewerblichen Intoxikationen durch Schwefelwasserstoff endeten letal.
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Plotting HorrorHeuer, Thomas 06 May 2019 (has links)
Die Entwicklungsschübe der modernen Medien im 20. Jahrhundert haben die Wechselbeziehungen zwischen den Künsten, den Medien, den Sinnesmodalitäten, den verbalen und nonverbalen Ausdrucks- und Zeichenprozessen verstärkt und erweitert. Im Zuge dieser Entwicklungen sind Genre- und Formatfragen über das disziplinäre Interesse einzelner Kunst- und Medienwissenschaften hinaus ins Aufmerksamkeitsfeld einer vergleichenden Medienästhetik und -dramaturgie ge-rückt.
Aufbauend auf den Erkenntnissen von Kalisch 2014, 2016 und den Überlegungen Gaudreaults 2009 zu einer Unterscheidung zwischen Narration und Monstration, ist es gelungen ein Modell zur Analyse von Werken unter dem Ausgangspunkt von Dramaturgie und Präsentationsstruktur herauszubilden, das für jedwedes dramaturgisch motiviertes und fiktionales Werk verwendet werden kann, unab-hängig vom Medium. Als Mittel zur Verdeutlichung der Thesen wird Horror als ästhetische Kategorie definiert, die einen direkten Einfluss auf die narrativen Strukturen eines Werkes besitzt, was den narrativ-monstrativen Doppelcharakter von Werken belegt und ferner verdeutlicht, dass Erzählung und Formung eines Werkes untrennbar verbunden sind. Die Dualität von Dramaturgie und Präsenta-tionsstruktur wird in der Formung eines Werkes offenbar. Um dies zu verdeutli-chen, werden im Verlauf der Arbeit kursorisch Beispiele von Werken mit Schre-ckensinhalten diskutiert und analysiert.
Basierend auf diesem Modell wird eine Diskussion des Themenkomplexes von Intermedialität und Transmedialität im Spannungsverhältnis zur Komparistik der Künste durchgeführt. In der Folge wird eine Ästhetik des Schreckens diskutiert und anhand von ästhetischen Wertungskategorien aufgezeigt. Abschließend werden drei narrativ-motivierte Konzeptionen für dramaturgisch angetriebene Schre-ckensinszenierungen aufgeführt, die zur Kategorisierung von Werken angewendet werden können: düstere Präfiguration, düstere Konfiguration und düstere Manifestation. / The development in modern media during the 20th century (from movies over television to the hybrid forms of audiovisual and textual media in the internet) reveals interdependencies between art, media, the modalities of senses, the verbal and nonverbal dictions and semiotic processes that have evolved and expanded themselfes. According to this progress the interest in art and media studies should achive a collective interest in the changes of genre and formats, instead of a sepa-rated observation of only single disciplines.
Following the Prolegomena on a comperative drama of media by Eleonore Ka-lisch (Kalisch 2014) and the thougts of André Gaudreault on Narration and Mon-stration (Gaudreault 2009) this thesis bulids a system to analyse works of fiction (e. g. movies, pictures, literature, video games). This system allows to analyse and compare works of fiction based on drama and presentation structure. The horror genre is used to show the mechanics of this system. Horror has a direct influence on the narrative structure of a work and manifests a duality of narration and mon-stration (Kalisch 2016), that binds drama and presentation to each other and shows the necessity of a separated consideration on both aspects. The duality of drama and presentation reveals itself during the modeling of a work of fiction.
Build on the system the discourse is open to discuss intermetiality and transmedi-ality and their influence on the field of interest. Furthermore, an aesthetic of hor-ror is defined by evaluation categories of aesthetic indicators. In the end three types of narrativ driven concepts of horror are revealed and discussed: gloomy pre-figuaration, gloomy configuration and gloomy manifestation.
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Cuidados paliativos e a construção da identidade médica paliativista no Brasil / Palliative care and the construction of medical identity paliativista in BrazilMachado, Mariana de Abreu January 2009 (has links)
Made available in DSpace on 2011-05-04T12:36:18Z (GMT). No. of bitstreams: 0
Previous issue date: 2009 / O objetivo desta dissertação consiste em investigar o processo de construção da identidade profissional de médicos que se dedicam à assistência a pacientes que apresentam doenças progressivas e ameaçadoras da continuidade existencial e que têm contribuído para o desenvolvimento dos Cuidados Paliativos no Brasil. Buscamos conhecer a trajetória profissional destes médicos desde a escolha da medicina como profissão até o encontro com a filosofia e a prática dos Cuidados Paliativos. Com este intuito, realizamos entrevistas semiestruturadas,colhidas segundo a metodologia de História Oral de Vida. Foram entrevistados seis médicos de diferentes especialidades que ocupam cargos diretivos em uma das associações profissionais voltadas para a disseminação e legitimação política e social dos Cuidados Paliativos no Brasil. Os depoentes se destacam no cenário nacional no que diz respeito às discussões sobre esta temática e mantêm contato com importantes instituições internacionais. Por esta razão, chamamos o conjunto de entrevistados de elite médica paliativista. Percebemos uma pobre interlocução entre os médicos paliativistas, o que se reflete na ausência de uma identidade integrada desse grupo profissional. Os entrevistados acentuaram as competências humanitárias necessárias ao bom exercício da Medicina Paliativa, mas, no entanto, não foram explicitadas as competências específicas a este campo profissional, que justificariam seu reconhecimento pelas entidades médicas competentes comouma nova área de atuação ou especialidade.
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