14 research outputs found
Finalité et invention : perspectives architecturales et philosophiques
Seit der prominenten Stellung der utilitas in der vitruvianischen Trias wird die
Aufgabe von Architektur und ihr VerhÀltnis zum Entwurf theoretisch reflektiert.
Kategorien wie Zweck, Funktion oder commodité bilden dabei ebenso den
Kern der Disziplin wie sie zunÀchst im scheinbaren Widerspruch zu Freiheit
und Erfindung stehen. Dieses spannungsreiche VerhÀltnis manifestiert sich in
einer Vielzahl von GegensĂ€tzen: Normierung gegenĂŒber kĂŒnstlerischer Freiheit
â Schaffen von FreirĂ€umen fĂŒr die Nutzer der Architektur gegenĂŒber dem Ziel
einer PrĂ€gung des Menschen durch den Architekten â das Abbilden von Formen
und Strukturen aus den Bereichen der Natur, Technik oder Ăkonomie gegenĂŒber
einem schöpferischen Individualismus. Dieses produktive Wechselspiel von
Erfindung und Zweck verbindet in selten konsequenter Weise nicht nur die
Bereiche Architektur und Philosophie miteinander, sondern auch die Mikro-
und Makroebene eines Architekturdiskurses, der sich zwischen Baustelle und
theoretischer Reflexion entfaltet.Depuis la cĂ©lĂšbre formulation de lâutilitas au sein de la triade vitruvienne, la
tĂąche de lâarchitecture et sa relation au projet ont fait lâobjet dâune rĂ©flexion
théorique intense. Des catégories telles que la finalité, la fonction ou la
commoditĂ© forment le cĆur de la discipline en mĂȘme temps quâelles semblent
entrer en contradiction avec la libertĂ© dâinvention de lâarchitecte. Une telle
tension se manifeste dans de nombreuses oppositions: normalisation contre
libertĂ© artistique; crĂ©ation dâespaces pour le libre usage de lâarchitecture contre
volontĂ© dâimprĂ©gnation de lâexistence humaine par lâactivitĂ© de lâarchitecte;
reproduction de formes et de structures issues des domaines de la nature, de
la technique et de lâĂ©conomie contre individualisme crĂ©ateur. Cette interaction
productive entre invention et finalitĂ© permet non seulement de relier lâune Ă
lâautre lâarchitecture et la philosophie, et ce dâune maniĂšre particuliĂšrement
intéressante, mais également les niveaux microscopiques et macroscopiques du
discours architectural, qui se déploient entre le travail constructif sur le chantier
et la réflexion théorique
Adaptive servoventilation improves cardiac function and respiratory stability
CheyneâStokes respiration (CSR) in patients with chronic heart failure (CHF) is of major prognostic impact and expresses respiratory instability. Other parameters are daytime pCO2, VE/VCO2-slope during exercise, exertional oscillatory ventilation (EOV), and increased sensitivity of central CO2 receptors. Adaptive servoventilation (ASV) was introduced to specifically treat CSR in CHF. Aim of this study was to investigate ASV effects on CSR, cardiac function, and respiratory stability. A total of 105 patients with CHF (NYHA â„ II, left ventricular ejection fraction (EF) â€Â 40%) and CSR (apnoeaâhypopnoea index â„ 15/h) met inclusion criteria. According to adherence to ASV treatment (follow-up of 6.7 ± 3.2 months) this group was divided into controls (rejection of ASV treatment or usage <50% of nights possible and/or <4 h/night; n = 59) and ASV (n = 56) adhered patients. In the ASV group, ventilator therapy was able to effectively treat CSR. In contrast to controls, NYHA class, EF, oxygen uptake, 6-min walking distance, and NT-proBNP improved significantly. Moreover, exclusively in these patients pCO2, VE/VCO2-slope during exercise, EOV, and central CO2 receptor sensitivity improved. In CHF patients with CSR, ASV might be able to improve parameters of SDB, cardiac function, and respiratory stability
Gegevens delen, privacy en domeinoverstijgend werken: De AVG in de Lokale Persoonsgerichte Aanpak
Als gevolg van ontwikkelingen in het sociale en zorgdomein, zoals de decentralisatie van zorgtaken naar gemeenten en de âterug naar de wijkâ-beweging vanuit de ggz, is de noodzaak ontstaan om op lokaal niveau met politie en lokale partners vanuit verschillende domeinen samen te werken om overlast te verminderen en te voorkomen. Met het inzetten van een Lokale Persoonsgerichte Aanpak (Lokale PGA) wordt de integrale samenwerking tussen verschillende samenwerkingspartners bevorderd. De Lokale PGA is relatief nieuw en volop in ontwikkeling in veel Nederlandse gemeenten.
De complexiteit van de problematiek die vaak samengaat met het verstorende gedrag maakt dat handhaving en repressie (alleen) nauwelijks zullen helpen in het tegengaan en voorkomen van dit gedrag.Een domeinoverstijgende samenwerking, zoals bij de Lokale PGA, is dan ook nodig en maakt het mogelijk om de onderliggende problematiek aan te pakken en overlast en crimineel gedrag tegen te gaan
Sleep duration and quality in heart failure patients
Sleep-disordered breathing (SDB) is highly prevalent in patients with heart failure and reduced left ventricular ejection fraction (HF-REF). SDB is classified as predominant obstructive (OSA) or central (CSA) and may alter sleep duration, sleep quality, and quality of life. This study describes sleep quality and duration in well-characterized cohorts of these patients.
Two hundred fifty consecutive patients with HF-REF (NYHA class â„II, ejection fraction â€45%) underwent cardiac and pulmonary examination, plus full attended in-hospital overnight polysomnography (PSG). PSG recordings were performed according to current recommendations and underwent independent, blinded analysis at a core laboratory.
Patients with HF-REF and CSA were older and had more impaired cardiac function compared to those with OSA. With respect to sleep parameters, patients with CSA spent more time in bed than those with OSA (468 ± 52 vs 454 ± 46 min, p = 0.021) while sleep efficiency was lower (67 ± 14 vs 72 ± 13% of total sleep time (TST), p = 0.008). In addition, CSA patients spent more time awake after sleep onset (101 ± 61 vs 71 ± 46 min, p = 0.001) and had more stage N1 (light) sleep (33 ± 19 vs 28 ± 16% of TST, p = 0.017). Overall, the proportion of sleep spent in N3 (slow-wave/deep) sleep in HF-REF patients with SDB was low (4.1 ± 6.3% of TST) compared with healthy adults.
HF-REF patients with CSA compared to OSA have worse sleep efficiency and quality. This could result in less restorative sleep, changes in sympathovagal balance, and impaired resetting of important reflexes, which might contribute to worse cardiovascular outcomes in HF-REF patients with SDB
The New EU Regulation on In Vitro Diagnostic Medical Devices: Implications and Preparatory Actions for Diagnostic Laboratories
Afdeling Klinische Chemie en Laboratoriumgeneeskunde (AKCL
Impact of SERVE-HF on management of sleep disordered breathing in heart failure: a call for further studies
Sleep disordered breathing (SDB) (obstructive sleep apnea, central sleep apnea/Cheyne-Stokes respiration or the combination of both) is highly prevalent in patients with a wide variety of cardiovascular diseases including hypertension, arrhythmia, coronary artery disease, myocardial infarction and stroke (reviewed previously in the September issue of this journal). Its close association with outcomes in chronic heart failure with reduced ejection fraction (HF-REF) suggests that it may be a potential treatment target. Herein, we provide an update on SDB and its treatment in HF-REF