CENTROS DE EXCELENCIA EN ENFERMERÍA DE REHABILITACIÓN: UN SUEÑO A ALCANZAR.

This paper sumarizes the theoretical approach to, and outcomes from, the project entitled: "Development of Centres of Excellence in Rehabilitation Nursing Services," which took place between the years 1995 and 2001. The project was led by Doris Grinspun, at the time Director of Nursing at Mount Sinai Hospital in Toronto, Canada. In 1996 the project moved to the Registered Nurses’ Assiociation of Ontario where Grinspun was appointed Executive Director. The project was funded by the Pan American Health Organization (PAHO). Participating countries included: Chile, Colombia, Cuba and México. The paper explores the concept of “Centres of Excellence” and highlights the afinity of this concept with Paulo Freire’s pedagogical approach. From this perspective, the article offers lessons learned which could be transfered to health care organizations in the area of rehabilitation and more specifically rehabilitation of person’s in a state of comma.En este artículo presentamos el enfoque teórico y resultados del proyecto “Desarrollo de Centros de Excelencia en Servicios de Enfermería en Rehabilitación”, llevado a cabo entre los años 1995 y 2001, a través de una red colaboradora de países del sur y del norte de América. Protagonistas en este proyecto fueron el Hospital Monte Sinaí (Toronto, Canadá), la Organización Profesional de Enfermeras de Ontario (RNAO), la Organización Panamericana de la Salud (OPS) y centros hospitalarios en Chile, Colombia, Cuba y México. Exploramos aquí el concepto de los Centros de Excelencia y resaltamos su sintonía con propuestas pedagógicas propias de América Latina, como la de la educación liberadora de Paulo Freire. Desde esa perspectiva, el presente artículo resalta algunas lecciones que pueden ser transferidas a las instituciones de salud en el área de rehabilitación, especialmente del paciente en coma

Adaptive tearing and cracking of thin sheets

This paper presents a method for adaptive fracture propagation in thin sheets. A high-quality triangle mesh is dynamically restructured to adaptively maintain detail wherever it is required by the simulation. These requirements include refining where cracks are likely to either start or advance. Refinement ensures that the stress distribution around the crack tip is well resolved, which is vital for creating highly detailed, realistic crack paths. The dynamic meshing framework allows subsequent coarsening once areas are no longer likely to produce cracking. This coarsening allows efficient simulation by reducing the total number of active nodes and by preventing the formation of thin slivers around the crack path. A local reprojection scheme and a substepping fracture process help to ensure stability and prevent a loss of plasticity during remeshing. By including bending and stretching plasticity models, the method is able to simulate a large range of materials with very different fracture behaviors. Copyright © ACM

Moving frames applied to shell elasticity

Exterior calculus and moving frames are used to describe curved elastic shells. The kinematics follow from the Lie-derivative on forms whereas the dynamics via stress-forms.Comment: 20 pages, 1 figur

Non-smooth developable geometry for interactively animating paper crumpling

International audienceWe present the first method to animate sheets of paper at interactive rates, while automatically generating a plausible set of sharp features when the sheet is crumpled. The key idea is to interleave standard physically-based simulation steps with procedural generation of a piecewise continuous developable surface. The resulting hybrid surface model captures new singular points dynamically appearing during the crumpling process, mimicking the effect of paper fiber fracture. Although the model evolves over time to take these irreversible damages into account, the mesh used for simulation is kept coarse throughout the animation, leading to efficient computations. Meanwhile, the geometric layer ensures that the surface stays almost isometric to its original 2D pattern. We validate our model through measurements and visual comparison with real paper manipulation, and show results on a variety of crumpled paper configurations

From the discrete to the continuous - towards a cylindrically consistent dynamics

Discrete models usually represent approximations to continuum physics. Cylindrical consistency provides a framework in which discretizations mirror exactly the continuum limit. Being a standard tool for the kinematics of loop quantum gravity we propose a coarse graining procedure that aims at constructing a cylindrically consistent dynamics in the form of transition amplitudes and Hamilton's principal functions. The coarse graining procedure, which is motivated by tensor network renormalization methods, provides a systematic approximation scheme towards this end. A crucial role in this coarse graining scheme is played by embedding maps that allow the interpretation of discrete boundary data as continuum configurations. These embedding maps should be selected according to the dynamics of the system, as a choice of embedding maps will determine a truncation of the renormalization flow.Comment: 22 page

Implementing nursing best practice guidelines: Impact on patient referrals

<p>Abstract</p> <p>Background</p> <p>Although referring patients to community services is important for optimum continuity of care, referrals between hospital and community sectors are often problematic. Nurses are well positioned to inform patients about referral resources. The objective of this study is to describe the impact of implementing six nursing best practice guidelines (BPGs) on nurses' familiarity with patient referral resources and referral practices.</p> <p>Methods</p> <p>A prospective before and after design was used. For each BPG topic, referral resources were identified. Information about these resources was presented at education sessions for nurses. Pre- and post-questionnaires were completed by a random sample of 257 nurses at 7 hospitals, 2 home visiting nursing services and 1 public health unit. Average response rates for pre- and post-implementation questionnaires were 71% and 54.2%, respectively. Chart audits were completed for three BPGs (n = 421 pre- and 332 post-implementation). Post-hospital discharge patient interviews were conducted for four BPGs (n = 152 pre- and 124 post-implementation).</p> <p>Results</p> <p>There were statistically significant increases in nurses' familiarity with resources for all BPGs, and self-reported referrals to specific services for three guidelines. Higher rates of referrals were observed for services that were part of the organization where the nurses worked. There was almost a complete lack of referrals to Internet sources. No significant differences between pre- and post-implementation referrals rates were observed in the chart documentation or in patients' reports of referrals.</p> <p>Conclusion</p> <p>Implementing nursing BPGs, which included recommendations on patient referrals produced mixed results. Nurses' familiarity with referral resources does not necessarily change their referral practices. Nurses can play a vital role in initiating and supporting appropriate patient referrals. BPGs should include specific recommendations on effective referral processes and this information should be tailored to the community setting where implementation is taking place.</p

Folding and crumpling adaptive sheets

Figure 1: Crumpling a sheet of paper is a challenging process to simulate as it produces geometry with both sharp creases and smooth areas. We efficiently resolve the emerging detail in the material through adaptive remeshing. We present a technique for simulating plastic deformation in sheets of thin materials, such as crumpled paper, dented metal, and wrinkled cloth. Our simulation uses a framework of adaptive mesh refinement to dynamically align mesh edges with folds and creases. This framework allows efficient modeling of sharp features and avoids bend locking that would be otherwise caused by stiff in-plane behavior. By using an explicit plastic embedding space we prevent remeshing from causing shape diffusion. We include several examples demonstrating that the resulting method realistically simulates the behavior of thin sheets as they fold and crumple