Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 6 uppsatser.

Thesis (doctoral)-Universität, Münster (Westfalen), 2002. / Includes bibliographical references (p.[538]-575) and indexes.

Current state: Using tools to identify and analyse risks is presently very important in nursing to minimise the risk of harm to patients that can be prevented. The FMEA (Failure Mode and Effect Analysis) is a very efficient tool to address the failure issue. It is an important preventive method determining possible failures and proposing preventive measures to minimise the risk of errors. The RCA (Root Cause Analysis) is another important tool to handle failures. Objectives of the work: The objective of the research was to determine processes with the highest risks in nursing and to find out the most common risks associated with the nurse profession. Another objective is to describe the undesirable events reporting methods and to find out the utilisation of all risk analysis methods by nurses. And the final objective was to describe the intervention fall prevention programmes.Methodology: A qualitative research method was used to prepare the empirical part of the thesis. Data were collected using in-depth interviews. Qualitative data were coded using the pencil and paper technique; data were then categorised and respective subcategories were determined and shown in the SmartArt application. Research participants: Interviews were conducted with the head nurse, quality manager, senior nursing officer and departmental sister from the department of internal medicine, department of neurology and aftercare department. The first research was conducted in Nemocnice Jindřichův Hradec, a.s., the second in Nemocnice Tábor, a.s. and the final one in Nemocnice Písek, a.s. Results: It was found out from the results of the qualitative research that the most risky processes included medication in form of pills when, for example, generics drugs are given incorrectly or drugs of wrong strength are administered. The second risk process is the preparation of drugs from concentrated solutions of kalium, heparin or insulin. Administering intravenous drugs and infusion solutions is the third risky process. Too many activities of a nurse at one time is often the cause. Non-cooperation, poor communication of the patient and his/her family also lead to risky situations.Another serious group of risky processes includes patient transfer, moving the patient from a stretcher to a bed or going to the toilet. Further, it was found out that the most common risks are nosocomial infections, falls and decubital ulcers. Too much workload of nurses and new staff undergoing training are also mentioned as a risk. They include in particular medical assistants. Prescribing drugs through a computer system where the doctor relies on the nurse that she will alert when wrong drugs are prescribed although it is not her obligation to do so is also considered a common risk. Closing the infectious department in a hospital is the next risk. Patients who have a suspicion for certain diseases are then examined in a department. Nurses working there are afraid of getting infected from the ill person. And quite often, a disease is really found in the patients. Respondents gave different answers to the procedure of reporting undesirable events. The answers were different from one hospital to another. Nevertheless, all the reporting go to the hospital management that evaluates it. Nurses in the inquired hospitals do not use any risk analysis method. Not even nurses in management positions do not work with the methods and do not know the FMEA method. A direct analysis is addressed by the quality manager who most often uses the RCA analysis. Its results are discussed at meetings of nurses in the department, meetings of senior nursing officers or meetings of chief physicians. As for preventive programmes reducing the risk of falls it was found out that in all hospitals the screening of the risk of falls is standardly performed in all patients upon admission, except hospitalisations shorter than 3 days.

Le nombre de Seniors de plus de 65 ans atteindra à l'horizon 2050, près de 22% de la population mondiale. Vieillir est une chance, mais cela entraîne chez de nombreuses personnes âgées une perte d'autonomie. Cette dépendance nécessite une aide, parfois permanente, de la famille, de personnels de santé voire dans certains cas une admission en institution. Malheureusement, celle-ci n'est et ne sera pas suffisante pour permettre à nos Seniors de finir leur vie dans le respect de la dignité humaine. Une aide technologique peut-être apportée par l'utilisation de systèmes de détections automatiques de situations critiques. Bien sûr, ils n'auront pas vocation de remplacer les aidants, mais au contraire de soulager leur intervention. Cette thèse a pour but de développer un dispositif intégré répondant à cette demande. Après une recherche approfondie des situations critiques des personnes âgées à leur domicile, un état de l'art des systèmes existants est réalisé. Ceci donne lieu à la conception d'un système multi capteurs de diagnostic et de classification de situations complexes. Ce dernier s'appuie sur différents capteurs non invasifs placés dans l'habitat et sur la personne. Les données collectées permettent par l'intermédiaire d'un algorithme de fusion, de classifier l'activité de la personne. Dans le cas de situations critiques, le système informe automatiquement les secours. Le dispositif développé a fait l'objet d'une validation par l'intermédiare de tests fonctionnels et d'expérimentations en laboratoire. / In 2050, the elderly population over 65-years-old, will represent about 20% of the world's population. Getting older is an opportunity, but unfortunately it also makes people dependent. This dependence requires help, sometimes permanent, from relatives, health professionals and in the worst case may cause a placement of the elderly in a nursing home. Unfortunately, this kind of help is not, and will not be, sufficient to allow every elderly person to live the rest of their life in the respect of human dignity. A potential technological support can be found with automatic detection systems which help detect critical situations. Of course, this kind of system will not replace human help, but only support them. The goal of this thesis is to develop an integrated systemwhich can meet these expectations. After a review of the critical situations of the elderly living independently at home, a bibliography of the existing systems of detection is done. This analysis will help to design a multi sensor analysis and classification system of critical situations detection. The latter is based on different kinds of non invasive sensors located in the homes of the elderly. Experimental data allows to classifying the activity of the elderly thanks to a data fusion algorithm. In case of a critical situation, the alarmsystem will automatically alert the emergency platform. This system was also tested thanks to functional and laboratory experiments.

La mémoire présente une étude numérique des trajectoires non-verticales d’objets en chute ou en ascension libre dans un fluide newtonien initialement au repos. Une méthode numérique originale combinant une discrétisation spatiale spectrale et la décomposition du domaine a été implémentée à cet effet. Le code obtenu a été exploité pour apporter de nouvelles connaissances sur des objets fixes et objets libres. Pour les objet fixes, ellipsoïdes et cylindres, l’étude très complète des divers états de la transition a permis d’établir un lien entre le scénario de transition de la sphère et du disque infiniment mince. La simulation numérique d’objets libres a apporté des résultats très complets sur la chute de disques minces et de cylindres de faible épaisseur. Plusieurs questions soulevées dans les travaux précédents ont trouvés des réponses claires. Une étude paramétrique exhaustive, jamais abordée précédemment, portant sur des ellipsoïdes est décrite dans le dernier chapitre du mémoire. / The manuscript presents a numerical study of non-vertical trajectories of bodies fallingor rising freely in a Newtonian fluid initially at rest. The original numerical methodcombining a spectral spatial discretization and the decomposition of the domain wasimplemented. The developed code was used to study fixed and freely moving objects. Forthe fixed bodies, spheroids and cylinders, a very complete study of various transitionalregimes was carried out and established a link between the transition scenario of a sphereand of a disc. The numerical simulation of free bodies brought about the results onpath instabilities of discs and cylinders of small thickness. Several questions raised inprevious studies were clearly answered. An exhaustive parametric study, that has never beentaken up before, of freely moving spheroids is described in the last chapter of the manuscript.

Análises mineralógicas, petrográficas e de palinofácies são registradas em um leito de tonstein associado a camadas de carvão na Jazida do Faxinal, Rio Grande do Sul, Brasil. A integração dos dados revestiu-se de grande importância para atribuir uma origem vulcânica para este argilito caolinítico. O tonstein é uma rocha quase monominerálica, composta predominantemente por caolinita antigênica. Dispersos na massa caolinítica ocorrem os minerais piroclásticos: paramorfos de quartzo-ß bipiramidais euédricos, “splinters” de quartzo transparente, zircão idiomórfico, apatita euédrica, alanita e pseudomorfos de sanidina, os quais são considerados como uma suíte restrita de minerais vulcânicos de tonsteins distais que preservaram durante a diagênese. Os minerais primários e suas feições texturais, bem como as relações de campo, indicam uma origem vulcânica de queda para essa camada. O estudo de palinofácies, inédito para este tipo de rocha, evidenciou uma composição diferenciada da matéria orgânica estruturada ao longo do perfil do tonstein. Análises estatísticas do querogênio de diferentes níveis da camada de tonstein indicaram altas percentagens de fitoclastos (xilema e epiderme) associados à menor representatividade de palinomorfos. Análises microestratigráficas destes níveis demonstraram que a saturação e a precipitação dos palinomorfos foram altamente influenciadas pelo intenso processo de queda de cinzas. O nível basal caracteriza-se por densos aglomerados de esporos e polens, enquanto o topo é marcado pela preservação de fragmentos de colônias de algas Botryococcus evidenciando uma deposição subaquosa desta camada. Alguns fragmentos de epiderme (cutículas) evidenciam, por sua coloração, acentuada alteração termal. Esses dados possibilitaram vincular as peculiaridades do mecanismo de deposição e preservação da matéria orgânica com o processo de formação do tonstein relacionado à rápida precipitação de cinzas vulcânicas. O tonstein intercalado em camada de carvão indica um episódio de sedimentação de tefra durante a deposição da seqüência portadora de carvão no Permiano Inferior no sul da Bacia do Paraná. / Mineralogical and palynofacies analyses are reported from a tonstein layer interbedded with coal seams in the Faxinal coalfield, Rio Grande do Sul, Brazil. Integration of data has far reaching significance for attributing a volcanic origin for this kaolinitic claystone bed. The tonstein is almost monomineralic rock, composed mainly by authigenic kaolinite. Scattered in the kaolinitic mass primary pyroclastic minerals occur: euhedral beta-quartz paramorphs and waterclear quartz splinters, idiomorphic zircons, apatite, allanite and sanidine pseudomorphs; considered as a restricted suite of silicic volcanic minerals of the distal tonsteins which preserved during diagenesis. The primary minerals and their textural features, as well as the field relations, indicate a volcanic air-fall origin. Analyses of the kerogens from different levels of tonstein layer indicate high percentages of phytoclasts combined with very low palynomorph percentages. Microstratigraphic analyses of the tonstein profile demonstrated that saturation and precipitation of palynomorphs were highly influenced by the intense ash-fall process. The preservation of Botryococcus colonies at the top of the tonstein evidenced the subaqueous deposition of this bed. The brown color of several cuticle fragments and tracheids was linked to thermal alteration. The tonstein interbedded in a coal seam indicates an episode of tephra sedimentation during the deposition of the coal-bearing sequence of the Lower Permian in the southern Paraná Basin.

Um dos maiores problemas na utilização de ensaios geotécnicos de laboratório está na obtenção de amostras indeformadas. Os solos moles estão entre os mais difíceis de amostrar e há um grande trabalho de pesquisa no desenvolvimento de técnicas de amostragem. A fim de obter amostras de alta qualidade para o estudo do comportamento do material do depósito, foi desenvolvido nesta pesquisa uma modificação do Equipamento de Amostragem Japonês e foram adaptadas algumas das técnicas utilizadas para amostragem indeformada. O processo usual de extrusão de solo de dentro do tubo amostrador foi substituído pelo corte transversal do tubo, o que reduz a perturbação do solo. Para facilitar esta operação, os tubos foram construídos de latão (substituindo o aço inoxidável original). O depósito sedimentar objeto de estudo desta dissertação foi escolhido por ter apresentado em ensaios de campo um índice de sensibilidade (razão entre as resistências ao cisalhamento não drenadas indeformada e amolgada) bastante elevado, o que torna a sua amostragem cuidadosa ainda mais importante. A sensibilidade dos solos é um parâmetro importante em projetos de engenharia geotécnica, pois as deformações reduzem severamente a resistência ao cisalhamento não drenada nestes materiais. Foram utilizados diferentes ensaios de laboratório para permitir a determinação da resistência ao cisalhamento não-drenada do solo nas condições indeformada e amolgada, e para avaliação da sensibilidade (ensaio de cone de laboratório, ensaio de palheta de laboratório e ensaio triaxial), além de ensaios de caracterização do depósito. O depósito estudado apresenta lentes com dois materiais distintos (um argiloso e outro arenoso), entretanto apresentam ângulos de atrito interno semelhantes (~34°). Em ambos o solos as resistências ao cisalhamento não drenada foram baixas (Su ~10 kPa na condição indeformada e Su = 0,5 - 2,0 kPa na condição amolgada). A sensibilidade do material argiloso ficou em torno de 10 e no solo arenoso foi de aproximadamente 20. Análises qualitativas dos resultados indicam que as amostras coletadas pelo novo amostrador tiveram elevado grau de qualidade. Os resultados obtidos (a) confirmam o bom desempenho do novo equipamento amostrador; (b) permitiram determinar com precisão as resistências não-drenadas dos materiais; (c) comprovaram a grande sensibilidade das lentes arenosas; (d) ajudam a explicar o comportamento do depósito em campo. / One of the most difficult problems in the use of laboratory geotechnical tests is related to obtaining undisturbed samples. The soft soils are among the most difficult soils to sample and there is a great research effort in developing new sampling techniques. In order to obtain high quality samples for the study of the soil sensitivity, a modification of the Japanese thin-walled tube sampler has been build for this research and some modifications of the sampling techniques have been made. The conventional extrusion of the soil sample from the tube was substituted by a traverse cut of the tube in order to reduce the soil perturbation during its extraction. To make this operation easier, the material used for the tubes was brass (substituting the usual stainless steel). The sedimentary deposit studied on this research has been selected for having presented an high sensitivity on vane field tests (relation between peak and large deformation strengths) which gives even more importance to careful sampling. The sensitivity is an important parameter for geotechnical design as the deformations can severely reduce the undrained shear strength of these materials. Various laboratory testing techniques have been used to determine the undrained shear strength of these soils both in undisturbed and disturbed conditions (fall cone tests, lab vane tests and triaxial tests), besides characterization tests of the deposit. The studied deposit presents lenses of two distinct materials (clayey and sandy lenses), however they present similar internal angles of friction (~34°). In both soils the undrained shear strength are quite low (Su ~10 kPa in undisturbed condition and Su = 0,5 - 2,0 kPa in disturbed condition). The sensitivity of the clayey material is around 10 and around 20 in the sandy soil. Qualitative analyses of the results indicate that the samples taken with the new sampler have an high quality level. The results obtained (a) confirm the good performance of the sampler built; (b) allowed the undrained shear strength to be determined with precision; (c) showed the great sensitivity of the sandy lenses; (d) helped to explain the field behaviour of the soil.

The aim of this work is to introduce Gregory of Nyssa's doctrine of man as the image of God, based especially on his work Περ κατασκευ ς νθρώπουὶ ῆ ἀ (De hominis opificio). In his work Gregory created quite a systematic anthropological treatise based on Stoic sources, Biblical interpretations inspired by Philo of Alexandria and Origen, as well as on ancient medicine. In contrast to the ancient philosophical school views concerning human being, Gregory refuses the parallel of man as a small world and says that the dignity of man consists not in being similar to the created world, but to the Creator. There are many attributes that constitute human similarity to God, but especially due to the incomprehensibility man is the image of God. The incomprehensibility consists in human mind (νο ςῦ ) in which the human likeness to God can most apparently be recognized. It cannot be placed anywhere in the body and the connection between mind and body is, according to Gregory, unspeakable: the mind does not reside in any particular part of the body, but yet it acts in and is influenced by the whole body. The image of God is the whole mankind, from the first up to the last created human being. When the planned number of souls is completed, the time and everything that happens in time will come to an end. In the...