484 research outputs found
Narrative art and act in the fourth gospel: aspects of the Johannine point of view
Get PDFThis thesis assumes that the narrative form of the Fourth Gospel is important for understanding the Gospel's meaning. Narrative is a communicative transaction whereby meaning is transmitted from author to reader via the way the story is told. Meaning is also established by overt speech-acts, and the 'act' performed in the overall structuring of the story. It arises within a context of rule-governed speech behaviour which determines parameters and implications that inform understanding. The Gospel's narrative form meets with readers' conventional expectations about how it relates to ostensive historical reality. Factors internal and external help determine genre. Part one examines aspects of the Gospel's narrative art. The way in which the narrative situation varies over the course of the narrative is outlined. The implied author manipulates the narration to create a close association in the reader’s mind between the narrator and the beloved disciple. In John 3 the voice of the narrator merges with those of Jesus and John. These strategies have implications for the Gospel's theological meaning and the relationship of the implied author to the story world. Speech-act theory elucidates the narrative act by which the implied author conveys the Gospel's message and seeks to induce belief in the reader. Part two considers the Gospel's relationship to historical reference. Factors which influence a decision as to whether or not the Gospel is to be taken as fictional are examined, for example, whether aspects of the narration suggest fictional discourse and whether the speech-acts operate within a 'pretended' world. Descriptive categories for the Gospel as natural narrative and 'display text' are proposed, as is a flexible model of genre, which modulates the poles of 'fiction' and 'history'. An analysis of the Temple Cleansing pericope provides illustration of the Gospel’s status as an historically-based, theological display text
Palliative care in COVID-19
No full textPurpose of review The purpose of this paper is (1) to provide insight in the palliative care needs of patients with COVID-19; (2) to highlight the challenges of COVID-19 for palliative care; and (3) to highlight developments in COVID-19 palliative care. Recent findings Patients with serious COVID-19 have palliative care needs in all domains: physical, psychological, social and spiritual. COVID-19 palliative care is confronted with many challenges, including: the uncertain prognosis, resource limitations, challenges regarding advance care planning, lack of guidance, limited multidisciplinary collaboration, need for remote communication, restrictions in family visits, and burden for clinicians. Palliative care responded with many developments: development of services; integration of palliative care with other services; tools to support advance care planning, (remote) communication with patients and families, or spiritual care; and care for team members. Palliative care has an important role in this pandemic. Palliative care rapidly developed services and opportunities were found to support patients, families and clinicians. Further developments are warranted to face future demands of a pandemic, including integrated palliative care and education in palliative care skills across all specialties. Intervention studies are needed to enable evidence-based recommendations for palliative care in COVID-19
Palliative care needs of patients with advanced chronic organ failure
Get PDFThe number of patients with chronic life threatening diseases, such as heart or kidney failure is increasing. Today’s health care does not sufficiently meet the need for care of these patients, both physically and psychologically. Patients have clear preferences for reanimation and resuscitation, but doctors rarely inquire about these preferences. Patients were dissatisfied with the quality of the communication about care with their medical specialist in the last stage of life. This research identified many needs for care in patients with advanced chronic organ failure and these needs should be attended to in the care for these patients. Financially supported by the Astmafonds, Leusden; Proteion Thuis, Horn; CIRO+, Horn; Stichting wetenschapsbevordering verpleeghuiszorg, Utrecht; Stichting Weijerhorst, Maastricht
De oudere met acute verwardheid
Get PDFDe huisarts wordt geregeld gevraagd een oudere patiënt met acute verwardheid te beoordelen. Wanneer de patiënt of zijn omgeving acute verwardheid als bedreigend ervaart, zal de huisarts met urgentie om hulp gevraagd worden. Er is echter ook een groep ouderen die ernstig verward is, maar juist als gevolg van die verwardheid en bijkomende cognitieve problemen niet aan de bel trekt. Ook de omgeving merkt de verwardheid niet op. Deze groep vraagt extra alertheid van de huisarts en proactieve diagnostiek. Acute verwardheid bij ouderen kan verschillende oorzaken hebben, zoals acute gedragsproblematiek bij dementie (vaak door externe stressfactoren, zoals opname in een verzorgings- of verpleeghuis), (genees)middelenintoxicaties, (opvlamming van) een psychiatrisch ziektebeeld, CVA en een delier. In dit hoofdstuk gaat het alleen over het delier. Een delier is een belangrijk ziektebeeld, omdat het ingrijpende consequenties heeft voor de patiënt. Het is vaak een teken van pre-existente kwetsbaarheid met daarbij een stapeling van meerdere luxerende factoren of een ernstig onderliggend ziektebeeld. Na het doormaken van een delier in een ziekenhuis bestaat een groter risico op blijvende cognitieve problemen en overlijden. Na ontslag uit het ziekenhuis blijkt vaak sprake van een nog voortdurend delier; in een literatuuronderzoek bij vijftigplussers was dit 45 %. Betrouwbare data over hoe vaak een huisarts een delier ziet ontbreken. De prevalentie in de algemene populatie is ongeveer 0,5--1 %. Dit percentage stijgt met de leeftijd, met de mate van verzorging die iemand nodig heeft, met de woonsetting (verzorgingshuis, verpleeghuis) en met de aanwezigheid van dementie. Er zijn onderzoeken die aantonen dat maar liefst de helft van de gevallen van delier in het ziekenhuis gemist wordt. Mogelijk is dit in de eerste lijn niet anders
Protein stabilisation and controlled particulate production by supercritical fluid drying
No full textCarbon dioxide was used as a drying medium for the preparation of micro-size powders from aqueous solutions in a high-pressure spray-drying process. This technology was shown to be an alternative to traditional drying processes that could be successfully used for the dry formulation of therapeutic proteins, the preparation of stable amorphous products, the selective production of polymorphs and pseudomorphs, and the design of particles.Mechanical Maritime and Materials Engineerin
Programmatuur voor analyse van radarbeelden op het VGA-scherm: Task report
No full textDe radarbeelden zoals ze nu uit de processor van de SOLIDAR (SOLId state Delft Atmospheric Radar) komen bevatten nog ongewenste informatie (bijv, clutter). Om deze radarbeelden aan een nadere analyse te onderwerpen zijn twee programma’s geschreven. Het eerste programma (lijnselect) kan een lengte- en/of breedtedoorsnede van het radarbeeld maken. Het tweede programma (subselect) kan een rechthoekig deel uit het radarbeeld halen en vervolgens de kleursamenstelling in een histogram weergeven.Applied SciencesElectrotechniekTelecommunicatie- en Verkeersbegeleidingssysteme
Design and Prototype of the Range-Trie IP: Lookup in the HTX reconfigurable platform
No full textIn this thesis the design and FPGA implementation of the Range Trie with Longest Prefix Match and updates is completed and prototyped in an HTX reconfigurable system. The design and its implementation is an example of hardware/software co-design and supports hardware functions controlled by software using system calls. In the case of the Range Trie, the implementation is executed in hardware and controlled by software running in a Linux environment. The proposed hardware implementation of the Range Trie is compared to the Linux routing tables in terms of performance. Distinctions are made between test sets with and without updates, insertions and deletions of possible links. Various design improvements are proposed and incorporated into a Virtex 4 FPGA. For the Range Trie support in the HTX platform a suitable hardware-software interface is proposed and developed. The proposed additions and improvements lead to a functionally correct Range Trie prototype with software support for Linux. Compared to the Linux routing tables the throughput of the hardware implementation is about 47 times higher. This makes our FPGA Range Trie design a very interesting solution to the scalability problem from which the Internet and its core and edge routers are suffering.Computer EngineeringElectrical Engineering, Mathematics and Computer Scienc
The Sensitive Office: A demonstrator for sensing the enterprise environment
No full textThe Centre for Advanced Studies of IBM Amsterdam (IBM CAS) has an ambitious plan to revolutionize the workforce. Within the Inclusive Enterprise research line they aim to investigate and map the factors that influence employee well-being. Among these factors, we may find environmental factors that can be coupled to measurable quantities such as temperature, light intensity or humidity. IBM CAS approached the TU Delft to create a demonstrator for a system that can measure these quantities by using IoT devices, and collect the data that is produced by such measurements. Based on the wishes of IBM CAS, requirements at both a system- and a data-level have been composed. Existing solutions were found to be too specific for the fulfillment of a single goal, still in a prototypical state, licensed commercially nonviable, or targeted at a single platform. Based upon a literature study, investigation of previously mentioned existing solutions and thorough analysis of requirements, a client-server architecture was designed. The system architecture consists out of four components: (1) the sensor nodes, responsible for measuring, (2) the hub nodes, responsible for channeling data between the sensor node and the server, (3) the server, responsible for system configuration and data collection, and (4) the database, responsible for storing and providing access to this data. The constructed architecture is not limited to a single context, and can function as a framework for measurement systems. The strength of the design lies in its platform-independent nature, and its traceable data model. The system has been implemented on the Arduino and Android platform for the sensor node, Java for the hub node, and IBM Bluemix for the server. It has been thoroughly tested using platform-specific frameworks (e.g. JUnit with EclEmma, Mocha with Istanbul) and analyzed using static code analysis (e.g. Sonarqube, SIG evaluation), making it a product of high quality code. The system has been developed with the explicit intention of being continued upon in the future, to grow from a demonstrator into a commercial product.Web Information SystemsSoftware and Computer TechnologyElectrical Engineering, Mathematics and Computer Scienc
One-Year Stability of Care Dependency in Patients With Advanced Chronic Organ Failure
No full textObjectives Care dependency is a determinant of quality of life and survival among patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), or chronic renal failure (CRF). The objectives of this study were to explore the profiles of care dependency in patients with advanced COPD, CHF, or CRF; to study the changes in care dependency during 1-year follow-up; and to study whether 1-year changes in care dependency are comparable between patients with advanced COPD, CHF, or CRF. Design Longitudinal observational study. Participants Clinically stable patients with advanced COPD (n = 105), CHF (n = 80), or CRF (n = 80) were recruited at outpatient clinics of 7 Dutch hospitals. Measurements Patients were visited at home at baseline, and at 4, 8, and 12 months to assess demographic and clinical characteristics, comorbidities (Charlson comorbidity index), care dependency (Care Dependency Scale), mobility, health status, and symptom burden. Results COPD and CHF patients reported a higher baseline level of care dependency than patients with CRF. Care dependency differed between patients with COPD, CHF, or CRF in the items ‘getting (un)dressed,’ ‘hygiene,’ ‘contact with others,’ and ‘sense of rules/values.’ One-year follow-up was completed by 206 patients (77.7%). Patients with COPD were more likely to experience an increase in care dependency. An increase in care dependency was associated with higher age, higher number of hospital admissions, decrease in health status, and worsening of Charlson comorbidity index score. Conclusions Care dependency profiles differ between patients with COPD, CHF, or CRF. Patients with advanced COPD are at risk for a 1-year increase in care dependency. Regular assessment of care dependency and addressing care dependency in palliative care programs for patients with advanced COPD, CHF, or CRF are needed
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