Cieľ práce: Cieľom teoretickej štúdie bolo stručne charakterizovať tím a tímovú prácu v zdravotníctve, jej hodnotenie a tiež prezentovať vybrané meracie nástroje použiteľné pre hodnotenie tímovej práce v zdravotníctve. Východiská práce: Ťažiskom práce boli validačné štúdie niekoľkých autorov (Kalisch, Weaver, Salas, 2009; Kalisch, Lee, Salas, 2010; Kalisch, Lee, Rochman, 2010, Shteynberg, Sexton, Th omas, 2005; Sexton, Helmreich, Neilands et al. 2006; Ryan, 2008, Ryan, Cott, 2008), ktorí sa zaoberali tvorbou meracích a hodnotiacich nástrojov pre skúmanie efektivity, funkčnosti a tímovej kultúry ošetrovateľských a/alebo multidisciplinárnych tímov v zdravotníctve. Použité metódy a spôsob analýzy: Analyticko-syntetickým prístupom boli analyzované v zahraničí publikované a validované meracie nástroje pre hodnotenie tímovej práce v zdravotníctve. Základ analýzy tvorili elektronické zdroje, ktoré boli získané pomocou rešerše v recenzovaných fulltextových online databázach (EBSCO, SCOPUS, Web of Knowledge). Záver: V súvislosti so zvyšujúcimi sa nárokmi na všetky druhy tímov pôsobiacich v oblasti zdravotníctva je žiaduce rozširovať vedomostnú základňu o špecifi ckej problematike fungovania tímu v zdravotníctve a o možnostiach hodnotenia jeho efektívnosti či funkčnosti. Pre uvedenie vybraných meracích nástrojov do praxe v tuzemských podmienkach je potrebná dôkladná národná validácia, ktorej proces sa v súčasnosti pripravuje., Aims: Th e aim of the theoretical studies was to briefl y characterize the team and the teamwork in health care, its evaluation and also to present the selected measurement tools useful for the evaluation of the teamwork in health care. Background: Th e focus of the work were the validation studies of diff erent authors (Kalisch, Weaver, Salas, 2009, Kalisch, Lee Salas, 2010, Kalisch, Lee, Rochman, 2010, Shteynberg, Sexton, Th omas, 2005, Sexton, Helmreich, Neilands et al. 2006, Ryan 2008, Ryan, Cott, 2008)who dealt with the creation of measurement and evaluation tools for examining the effi ciency, functionality and team culture of nursing and / or multidisciplinary teams in health care. Methods: Th e measurement tools for assessing teamwork in health care published and validated abroad have been analyzed analytically and synthetically. Th e core of the analysis was gathered through research of full-text on-line databses(EBSCO, SCOPUS, Web of Knowledge). Conclusion: In connection with the increasing demand for all types of teams working in the medical fi eld, it is necessary to expand the knowledge basis for the particular issues of the functioning of the team in health care and the possibilities of evaluating its eff ectiveness or functionality. For implementing the selected measurement tools into national practice a profound national validation must be carried out, the process of which is currently in preparation., Dana Dolanová, and Literatura
Úvod: Recidíva pectus excavatum je najzávažnejšou neskorou komplikáciou primárnej korekcie. V indikovaných prípadoch je možné pacientovi odporučiť rekorekciu modifikovanou Ravitchovou technikou (HMRR), alebo minimálne invazívnu korekciu (MIRPE). Práca sa zameriava na vyhodnotenie dostupných operačných techník u dospelých pacientov a adolescentov s recidívou pectus excavatum. Metódy: Autori retrospektívne vyhodnotili výsledky svojej práce. V období od júna 2006 do októbra 2014 odoperovali na Klinike hrudníkovej chirurgie 126 výkonov pre pectus excavatum. HMRR bolo metódou voľby v 51 prípadoch a MIRPE v 75. Korekcia pre recidívu pectus excavatum bola indikáciou pre 12 (9,5 %) výkonov u 11 pacientov. Tí absolvovali šesť korekcií technikou HMRR a 6 technikou MIRPE. HMRR ako primárny výkon podstúpilo 10 pacientov a MIRPE jeden. Medián veku súboru bol 23,5 (17−44) roku, medián odstupu od prvej operácie bol 9,5 (2−31) roku. Muži tvorili 75 % operantov. Výsledky: Napriek potrebe torakoskopickej adheziolýzy a implantácie dvoch dláh u všetkých pacientov sa MIRPE vyznačovala kratším operačným časom (120 vs. 172 min) a menším počtom komplikácií (16,7 % vs. 50 %). V skupine s HMRR sme zaznamenali tri komplikácie (ranový seróm, migráciu dlahy do perikardu s masívnym hemoperikardom, oddelenie priamych brušných svalov od sterna) a v skupine s MIRPE jednu (symptomatický fluidotorax). U pacienta s migráciou dlahy vznikla ďaľšia recidíva pectus excavatum. Nezaznamenali sme rozdiel v dľžke pooperačnej hospitalizácie. Záver: Napriek limitovaným skúsenostiam považujeme MIRPE v indikovaných prípadoch za bezpečnú a efektívnu techniku pri riešení recidívy u dospelých pacientov a adolescentov., Introduction: Recurrent pectus excavatum is the most serious late complication after primary repair. Redo open repair (Highly Modified Ravitch Repair, HMRR) or minimally invasive repair of pectus excavatum (MIRPE) are usually performed in indicated cases. This paper focuses on the evaluation of available redo surgical techniques in adult and adolescent patients with recurrent pectus excavatum. Methods: 126 operative corrections, predominantly in adult patients, were performed by the authors between June 2006 and October 2014. HMRR was the method of choice in 51 cases, and MIRPE in 75 cases. Recurrent pectus excavatum was the indication in 12 repair procedures (9.5%) in 11 patients. Prior repairs included HMRR in 10 patients and MIRPE in one case. Both HMRR and MIRPE were indicated as redo procedure in six cases. The median age in the redo group was 23.5 (17−44) years and the median interval between the primary correction and the redo procedure was 9.5 (2−31) years. The male to female ratio was 3:1. Results: The use of MIRPE resulted in shorter operation time (120 vs. 172 min). There was no difference in the length of postoperative hospitalisation. Three complications (50%) were recorded in the HMRR group (wound seroma, intrapericardial bar migration with hemopericardium, displaced rectus abdominis muscle) and one (16.7%) occurred in the MIRPE group (symptomatic fluidothorax). Conclusion: Despite our limited experience with both techniques in the treatment of recurrent pectus excavatum we believe that MIRPE should be regarded as a safe and effective technique for the redo repair in adolescent and adult patients., and M. Lučenič, M. Janík, R. Benej, A. Garchar, P. Juhos
Neoadjuvant concomitant chemoradiotherapy has become a standard treatment of locally advanced rectal adenocarcinomas (LARA). It leads to shrinkage of the tumor mass and subsequently to an increase in complete resections (R0 resections), increasing a feasibility of sphincter-sparing intervention avoiding colostomy. It is based on concurrent application of fluoropyrimidines (5-fluorouracil, capecitabine) and radiotherapy (45 - 50,4 Gy). It shows less acute toxicity and improves local control rate in comparison to adjuvant treatment. Unfortunately, neoadjuvant chemoradiotherapy is not beneficial for all patients. The treatment response ranges from a complete pathological remission (pCR, ypT0ypN0) to a resistance. It is reported that cca 15 percent of patients with advanced rectal cancer show pCR which is indicative of improved long-term prognosis. DESIGN: The following is a review of the significance of neoadjuvant concomitant chemoradiotherapy in the treatment algorithm of patients with LARA and summary of potentional clinical-pathological and molecular markers of response prediction to neoadjuvant therapy. The most important clinical studies concern serum tumor markers levels, clinical lymph node classification. The components of the carcinogenic pathways are explored, including oncogenes, tumor supressor genes, microsatellite instability (MSI) and potentional markers involved in apoptosis, angiogionesis, proliferation as well as metastasis and invasion, are reviewed. Finally, the role of specific enzymes associated with the metabolism of fluoropyrimidines are examined. CONCLUSIONS: No one marker has been consistently identified as clinically applicable. Studies designed to determine the potentional markers are hampered by various techniques as well as tumor heterogenity and recent scientific approach--studying individual molecular markers. Gene expression profiling analysis of multiple genes from the same tumor is becoming reality. We suppose that this assessment will lead in future in finding combination of markers for predicting prognosis and response to therapy in rectal cancer., Garajová Ingrid, Svoboda M., Slabý O., Kocáková L., Fabian P., Kocák I., Vyzula R., and Lit.: 71
Method of groundwater flow velocity determination in sand and gravel aquifer of Danube river is described in the paper. The solution in which seasonal changes of ground and river water temperatures are used is original. It gives good opportunity for solution of different hydrogeological and water management problems. The method application is demonstrated on the example of Sihoť well field in Bratislava Karlova Ves. Results were used in design ground water zones protection. and V príspevku je opísaná metóda určovania rýchlosti prúdenia podzemnej vody v náplavoch rieky Dunaj. Metodický postup, pri ktorom sú využité sezónne zmeny teploty podzemnej a povrchovej vody, je pôvodný a dáva pomerne veľké možnosti uplatnenia v hydrogeológii a vo vodárenstve. V príspevku je opísané využitie metódy v konkrétnych prírodnych podmienkach zdroja pitnej vody na ostrove Sihoť v Bratislave-Karlovej Vsi. Takto zídkané výsledky boli použité pri navrhovaní pásiem hygienickej ochrany zdroja.
Typing knowledge is capable to resolve Fitch’s knowability paradox. As I have argued elsewhere, Russellian typing knowledge is immune to the recently raised criticism of the typing approach. This paper focuses on a special form of the criticism proposing a revenge problem raised by Williamson, Hart and also Carrara with Fassio. The basic idea of the revenge Fitch’s paradox employs quantification over type levels. However, the formalism used by the critics is ambivalent. I concentrate only on its two most probable readings, explaining also quantification over types and quantification over orders. As I show in details, if such readings went through, they would violate the typing rules in a direct manner. Hence, there is no revenge for the Russellian typing approach to Fitch’s knowability paradox., Znalost psaní je schopna řešit paradox paradigmatu Fitch. Jak jsem se dohadoval jinde, znalosti ruského psaní jsou imunní vůči nedávno vznesené kritice přístupu k psaní. Tato práce se zaměřuje na speciální formu kritiky, která navrhuje, aby se Williamson, Hart a Carrara s Fassiem pokusili o pomstu. Základní myšlenka pomsty Fitchova paradoxu využívá kvantifikaci nad úrovněmi typu. Formalizmus použitý kritiky je však dvojznačný. Soustředím se pouze na dvě nejpravděpodobnější hodnoty, vysvětlující také kvantifikaci nad typy a kvantifikaci nad zakázkami. Jak ukážu podrobně, pokud by takové čtení proběhlo, porušily by pravidla psaní přímo. Není tedy pomsta za Russellianský typizační přístup k paradoxu znalostí Fitch., and Jiří Raclavský
Providing information on the impacts of climate change on hydrological processes is becoming ever more critical. Modelling and evaluating the expected changes of the water resources over different spatial and time scales can be useful in several fields, e.g. agriculture, forestry and water management. Previously a Budyko-type spatially distributed long-term climate-runoff model was developed for Hungary. This research includes the validation of the model using historical precipitation and streamflow measurements for three nested sub-catchments of the Zala River Basin (Hungary), an essential runoff contributing region to Lake Balaton (the largest shallow lake in Central Europe). The differences between the calculated (from water balance) and the estimated (by the model) mean annual evapotranspiration varied between 0.4% and 3.6% in the validation periods in the sub-catchments examined. Predictions of the main components of the water balance (evapotranspiration and runoff) for the Zala Basin are also presented in this study using precipitation and temperature results of 12 regional climate model simulations (A1B scenario) as input data. According to the projections, the mean annual temperature will be higher from period to period (2011–2040, 2041–2070, 2071–2100), while the change of the annual precipitation sum is not significant. The mean annual evapotranspiration rate is expected to increase slightly during the 21st century, while for runoff a substantial decrease can be anticipated which may exceed 40% by 2071–2100 relative to the reference period (1981–2010). As a result of this predicted reduction, the runoff from the Zala Basin may not be enough to balance the increased evaporation rate of Lake Balaton, transforming it into a closed lake without outflow.
Cieľ: Ochorenie detskej mozgovej obrny je možné označiť ako neurovývojové neprogresívne postihnutie mozgu, ktoré spôsobuje narušenie motorického vývoja dieťaťa. Veľmi často zasahuje do viacerých oblastí vývoja – kombinuje sa s mentálnym postihnutím, zmyslovými chybami a ovplyvňuje rozvoj komunikačných zručností. Cieľom štúdie bolo vytvoriť novú teóriu s použitím metaparadigmy ošetrovateľstva pomocou metódy „zakotvenej teórie“, ktorá by dokazovala opodstatnenosť a súvzťažnosť ošetrovateľskej starostlivosti so všetkými oblasťami života (fyzickej, psychickej, sociálnej, legislatívnej) u takto postihnutých detí. Metódy: V štúdii sme vypracovali komplexné kazuistiky troch prípadov. Na získavanie informácií sme zvolili metódu pološtandardizovaného rozhovoru a metódu štúdia zdravotnej dokumentácie oslovených osôb. Komplexné kazuistiky sme analyzovali metódou „zakotvenej teórie“. Výsledky: Informácie, ktoré sme získali z kazuistík nám poskytli cenné vyjadrenia, na základe ktorých sme vytvorili novú teóriu s použitím metaparadigmy ošetrovateľstva podľa metódy „zakotvenej teórie“, ktorá poukazuje na kauzalitu vzťahu ošetrovateľskej starostlivosti so všetkými oblasťami života (fyzickej, psychickej, sociálnej, legislatívnej) u detí so spastickou formou detskej mozgovej obrny. Zároveň poukazuje aj na potrebu multidisplinárnej spolupráce odborníkov z oblasti neurológie, fyzioterapie, psychológie, logopédie, špeciálnej pedagogiky i sociálnej oblasti v rámci interakcie s pacientom. Záver: Naša teória dokazuje, že kvalitná ošetrovateľská starostlivosť, komplexný multidisciplinárny prístup odborníkov z oblasti neurológie, fyzioterapie, psychológie, špeciálnej pedagogiky ako aj sociálnej starostlivosti môže zlepšiť podmienky života dieťaťa s mozgovou obrnou v celom holistickom rozsahu., Aim: Disease of cerebral palsy can be described as neurodevelopmental disability non-progressive brain, which causes disruption of motor development children. Oft en spans multiple areas of development – combined with intellectual disabilities, sensory defects, and aff ects the development of communications kills. Th e aim of the study was to develop a new theory using metaparadigm nursing, using a “grounded theory”, which would prove the validity and correlation nursing care to every sphere of life (physical, psychological, social, legislative) for those aff ected children. Methods: Are working-out complex casuist of three case. On inquiries are elect method semistructured conversation and method study health documentation title person. Complex casuist are analyzing method “grounded theory”. Results: Information that are acquirement us off er precious expression following those are create new theory with metaparadigm nursing by methods “grounded theory”, which mention causality relation nursing care with region life (physically, psychic, social, legislative) child with spastic form infantile cerebral palsy and which also points to the need for multidisciplinary cooperation experts in neurology, physiotherapy, psychology, speechtherapy, special education and social interaction with in the area of the patients. Conclusion: Our theory shows that quality nursing care, comprehensive multidisciplinary approach experts in neurology, physiotherapy, psychology, special education and social care can improve the living conditions of chilren with cerebral palsy in its holistic range., Marcela Poláková, Lucia Dimunová, and Literatura
The discrete state space representation of the cascade of linear reservoirs model was used in this case study as the basis for a multilinear flood routing model. The time distribution scheme of model inputs was employed in the setup of the multilinear model and the travel-time parameter of the model was allowed to vary with discharge. The relationship between the flood wave-speed and the discharge for a reach of the Morava River between Moravský Svätý Ján and Záhorská Ves was studied. Five empirical models of that relation have been considered that would fit the data and would be consistent with the physical interpretation of the factors determining the relation. Empirical relations between the wave-speed and discharge were derived for the given river reach using engineering reasoning, linear and nonlinear regression and artificial neural networks. These relationships were used to model the variability of the time parameter in the discrete linear cascade flow routing model. The performance of the multilinear model was verified on ten flood waves. The modelling results showed that the inclusion of empirical information on the variability of the wave-speed with discharge enables satisfactory accuracy of the prediction of the flood propagation process without needing to calibrate the model on pairs of input-output hydrographs. The problem of choosing an appropriate wave-speed discharge relationship was briefly discussed. and Jednou z možností riešenia transformácie povodňových vĺn v korytách tokov je používanie multilineárnych modelov, teda niekoľkých lineárnych modelov odpovedajúcich rôznym odtokovým situáciám. Cieľom prípadovej štúdie bolo preveriť parametrizáciu takejto schémy zohľadňujúcu zmenu postupovej doby vrcholov prietokových vĺn v závislosti na prietoku z hľadiska jeho aplikovateľnosti v podmienkach aluviálneho riečneho úseku s bočnými prítokmi. Za základ zavedenia multilinearity sme zvolili model kaskády lineárnych nádrží, ktorý sme formulovali v stavovom priestore. Použili sme schému tzv. časového delenia vstupov do multilineárneho modelu, pri ktorom sa na výpočte podieľajú rôzne lineárne submodely striedavo za sebou v sérii. Experimentálne sme overili niekoľko spôsobov odhadu závislosti postupovej rýchlosti vrcholov povodňových vĺn od vstupného prietoku do riečneho úseku na rieke Morava medzi profilmi Moravský Svätý Ján a Záhorská Ves. Odvodené závislosti sme použili na výpočet časového parametra multilineárneho modelu, ktorý sme verifikovali na desiatich prietokových vlnách. Výhodou riešenia s premenlivým časovým parametrom kaskády lineárnych nádrží je, že model lepšie napodobňuje vlastnosti riečneho úseku ako lineárny model s parametrami získanými kalibráciou modelu na rade povodňových vĺn, ktorá sa tak stáva prebytočnou.
The discrete state space representation of the Kalinin-Miljukov model was used as the basis for a multilinear discrete cascade flood routing model. The time distribution scheme of model inputs was employed in the setup of the multilinear model and the travel-time parameter of the model was allowed to vary with discharge. The relationship between travel-time and discharge for a reach of the Hron River between Brezno and Banska Bystrica was studied. Empirical models of that relation have been considered that would fit the data and would be consistent with the physical interpretation of the factors determining the relation. Seven such fitted empirical models were used to model the variability of the time parameter in the discrete state space representation of the Kalinin and Miljukov model. The performance of the multilinear model was verified on five flood waves. The modelling results showed that the inclusion of empirical information on the variability of the travel-time with discharge enables satisfactory accuracy of the prediction of the flood propagation process without needing to calibrate the model on pairs of input-output hydrographs. The choice of an appropriate travel-time discharge relationship was briefly discussed. and Jednou z možností riešenia transformácie povodňových vĺn v korytách tokov je používanie multilineárnych modelov, teda niekoľkých lineárnych modelov odpovedajúcich rôznym odtokovým situáciám. Cieľom štúdie bolo preveriť parametrizáciu takejto schémy zohľadňujúcu zmenu postupovej doby vrcholov prietokových vĺn v závislosti na prietoku z hľadiska jeho aplikovateľnosti v podmienkach horského toku s premenlivým bočným prítokom. Za základ zavedenia multilinearity sme zvolili model Kalinina a Miljukova, ktorý sme formulovali v stavovom priestore. Použili sme schému tzv. časového delenia vstupov do multilineárneho modelu, pri ktorom sa na výpočte podieľajú rôzne lineárne submodely striedavo za sebou v sérii. Vzhľadom na silný nemeraný bočný prítok viazali sme premenlivosť koeficienta k modelu na výstupný prietok riečneho úseku (na rozdiel od predošlých prác, kde sme použili vstup do riečneho úseku). Experimentálne sme overili niekoľko spôsobov odhadu tohto parametra pre transformáciu prietoku na Hrone medzi Breznom a Banskou Bystricou. Použili sme postupové doby odhadnuté z 28 historických prietokových vĺn a priemerné hodinové prietoky z Brezna, Mýta, Hronca a Banskej Bystrice z obdobia 1998 až 2002. Výhodou riešenia s pohyblivou postupovou dobou sa ukázalo, že jeden parameter modelu je odvodený z vlastností vstupno-výstupného správania sa riečneho úseku a priama kalibrácia modelu sa tak stáva prebytočnou.
This article engages critically with the theory of expression proposed by Mitchell S. Green in his Self-Expression (2007). In this book, Green argues that expressions are signals designed to convey information about mental states. By putting pressure on one of the examples Green uses in his book, I will challenge this thesis. I will then deepen this challenge by developing a contrast between two philosophical perspectives on expression, which I name the 'instrumental' and the 'descriptive'. I take Green’s theory of expression to be an exemplar of the instrumental perspective. Expression, in the instrumental perspective, is a means for transmitting information about mental states from organism to organism. The descriptive perspective I articulate with the help of Maurice Merleau-Ponty and Ludwig Wittgenstein. On the descriptive view, expression is (at least a part of) an answer to the question what it is so much as to have mental states and a living body. I suggest at the end of the article that if we remain within the instrumental perspective, we will not be able to use expression to satisfactorily answer this question.