Книги з теми "Integral losses"

Fluid and circulatory management is an integral part of the peri-operative care of critically-ill patients. Precisely estimating the volumetric needs of post-operative patients remains difficult. While the majority of patients tolerate intra-operative fluid loss easily, patients with reduced physiological reserve present more of a challenge. Targeting specific physiological goals and optimizing haemodynamics with fluids and inotropes, means outcomes of these patients can be improved. This approach is often referred as goal-directed therapy (GDT). ‘Individualized goal-directed therapy’ can vary in timing, monitoring techniques, and endpoints used. The emergence of minimal invasive devises has allowed us to integrate cardiac output monitoring as a safe and reliable tool in the routine care of high risk patients. This dynamic assessment of haemodynamics provides a reliable technique to assess volume responsiveness and guide fluids to optimize cardiac output and oxygen delivery.

This chapter discusses four general features of modern Orthodox epistemology of theology—ontologism, apophaticism, integral knowledge, and the noetic implications of theosis—and the contributions of individual Orthodox authors, including Berdyaev, Bulgakov, Florensky, Florovsky, Frank, Khomiakov, Lossky, Solovyov, and Zizioulas. Ontologism is a philosophical stance that subordinates epistemology to metaphysics; apophaticism is an attitude towards the mystery of God with implications for theories of religious language, religious experience, and metaphysics; a theory of integral knowledge challenges one-sided epistemologies developed in modernity; and the idea of theosis indicates human participation in the life of God, which has implications for the process of coming to know God. Gavrilyuk highlights the retrieval by Orthodox neopatristic theologians of important pre-modern epistemological insights as well as their contributions to personalism, reliabilism, and social and virtue epistemology that remain unknown in Western scholarly literature.

Ali Smith is one of the most exuberant and Ovidian of contemporary writers, as was revealed particularly by her rewriting of the myth of Iphis and Ianthe in Girl Meets Boy. This chapter focuses on three of her later works—Artful, Public Library, and Autumn—where her reworking of Ovid becomes integral to her condemnation of recent government policies in the UK, including a healthcare postcode lottery, the closure of hundreds of public libraries, and the Brexit referendum. Ovidian wordplay and humour infuses Smith’s mordant wit as she attacks the inequalities she perceives within British society, even as Ovidian pathos deepens the melancholy of her sense of loss.

This conclusion reflects on the conflation of empathetic realism and tragic space inside and outside black churches in Chicago. It examines complex issues of ownership, displacement, and tragedy that make the black church fulfill many needs regarding refuge and racial affirmation. It considers various sites of black tragedy in Chicago, citing as an example Pilgrim Baptist Church which burned to the ground on January 7, 2006, resulting in the loss of historically significant murals, a historic landmark, and many primary documents concerning the birth of gospel music. The author places this loss in the context of “tragic tourism,” arguing that it is part of a lineage of “tragic Black spaces” in Chicago that also connect to other such sites across the country and across history. She notes that many black churches have been set on fire due to racial intimidation. She ends the discussion by emphasizing the integral role of black suffering in the activation of empathy and the diverse and shifting publics for its imagery.

The chapter argues that all forms of heritage are at risk from population and development pressures within the Anthropocene. We lose our sense of place in the age of solastalgia, as natural and built heritage, the integral parts of loved home environments, are lost. No amount of citizen collaboration or soliphilia can save heritage from desolation when government and corporate power values profit over all other forms of value. The concept of the Symbiocene is proposed as an antidote to the Anthropocene. However, in the Symbiocene, heritage will remain an ironic and elusive experience. This is because the full reunification of human praxis with life support systems will produce almost no distinctive signature on Earth that could be highlighted as exclusively “human” heritage. Heritage as something that defies the natural “beauty of decay” will be a deliberate, educative act of creation.

Habitat loss and fragmentation are the main threats to the cheetah. Current dogma on cheetah conservation maintains that most protected areas are not large enough to sustain viable populations because the cheetah is wide ranging and especially vulnerable to interspecific competition. The emphasis has been on promoting coexistence with humans and in concentrating efforts outside protected areas. Here it is argued that the establishment and maintenance of large nature reserves should be the priority and that a triage approach should be applied to identifying suitable areas over a spectrum of landscapes for the conservation of ecological processes of which the cheetah is an integral part. Ecotourism and philanthropy are important aspects of conservation funding, and the divisive question of fencing needs to be addressed. Conserving cheetahs outside protected areas is most useful where this might facilitate the maintenance of corridors between functional ecosystems with all their species components.

Based on case studies, the book creates a multidisciplinary conversation on the gendered vulnerabilities resulting from extractive industries and toxic pollution, and also charts the resilience and courage of women as they resist polluting industries, fight for clean water and seek to protect the land. While ecumenical in scope, the book takes its departure from the concept of integral ecology introduced in Pope Francis’ encyclical Laudato Si’. The first three sections of the book focus on the social and ecological challenges facing minoritized women and their communities that are related to mining, pollutants and biodiversity loss, and toxicity. The final section of the book focuses on the possibilities and obstacles to global solidarity. All chapters offer a cross disciplinary response to a particular local situation, tracing the ways ecological destruction, resulting from extraction and toxic contamination, affects the lives of women and their communities. The book pays careful attention to the political, economic, and legal structures facilitating these life-threatening challenges. Each section concludes with a response from a ‘practitioner’ in the field, representing an ecclesial organization or NGO focused on eco-justice advocacy in the global South, or minority communities in the global North.

From natural disasters to private funerals, digital media are playing a central role in the documentation and commemoration of shared significant events and individual loss experiences. Yet few studies have fully engaged with the increasing role mobile media play in making meanings related to traumatic events across different individual and collective contexts. Haunting Hands provides the first in-depth study into understanding the role of mobile media in memorialization and bereavement as a cultural and social practice. Throughout the chapters in this book, we explore how mobile devices are both expanding upon older forms of memory-making and creating new channels for affective cultures whereby the visual, textual, oral, and haptic manifest in new ways. Encompassing everything from phones to tablets, mobile media are not only playing a key role in how we represent and remember life, but also in how we negotiate the increasingly integral role of the digital within rituals in and around death. Haunting Hands posits how, during times of distress, mobile media can assist, accompany, and at times augment the disruptive terrain of loss. The book expands upon debates in the area of online memorialization in that the mobile device itself takes prominence, not only for its communicative or social function, but also for the ways in which it can contain as well as generate an intimate space within it. In this way, the device becomes an important companion for mobile-emotive grief as the bereaved engage with emotionally charged digital content in solitary, sometimes secretive, and sometimes shared ways.

Chapter 5 discusses the ‘short separation bubble’ that forms at the leading edge of an aerofoil when the angle of attack reaches a certain value. It then suggests that the process of the formation of the bubble is described by the Marginal Separation theory, which represents a special version of the triple-deck theory. It then covers how, in this case, the viscous-inviscid interaction problem may be reduced to an integro-differential equation for the skin friction. It discusses how by solving this equation not only the transition from attached to separated flow in the boundary layer be predicted, but also the well-known phenomenon of the ‘bubble bursting’ that leads to a sudden loss of the lift produced by an aerofoil.

Since 1990, the European states have confronted tensions in balancing security of supply imperatives and equipment affordability constraints in procuring advanced weapons systems. Security of supply is equated with the retention of a national defence technological and industrial base (DTIB). Correspondingly, intergenerational cost increases in weapons production have progressively eroded the affordability of maintaining autonomous DTIBs, leading to the internationalization of what were formerly considered ‘national’ defence firms. This chapter challenges the argument of some analysts that these structural factors will lead inevitably to loss of control by national governments over weapons production and the inexorable rise of a globalized defence industry. It demonstrates instead that the European states do exercise significant agency in national defence procurement and industrial policy such that national DTIB protection still prevails, which explains why EU attempts to integrate and foster a strategically autonomous European defence technological and industrial base (EDTIB) have hitherto failed.

Blood is a dynamic fluid consisting of cellular and plasma components undergoing constant regeneration and recycling. Like most physiological systems, the concentrations of these components are tightly regulated within narrow limits under normal conditions. In the critically-ill population, however, haematological abnormalities frequently occur and are largely due to non-haematological single- or multiple-organ pathology. Haematopoiesis originates from the pluripotent stem cell, which undergoes replication, proliferation, and differentiation, giving rise to cells of the erythroid, myeloid, and lymphoid series, as well as megakaryocytes, the precursors to platelets. The haemostatic system is responsible for maintaining blood fluidity and, at the same time, prevents blood loss by initiating rapid, localized, and appropriate blood clotting at sites of vascular damage. This system is complex, comprising both cellular and plasma elements, i.e. platelets, coagulation and fibrinolytic cascades, the natural intrinsic and extrinsic pathways of anticoagulation, and the vascular endothelium. A rapid, reliable, and inexpensive method of examining haematological disorders is the peripheral blood smear, which allows practitioners to assess the functional status of the bone marrow during cytopenic states. Red blood cells, which are primarily concerned with oxygen and carbon dioxide transport, have a normal lifespan of only 120 days and require constant erythropoiesis. White blood cells represent a summation of several circulating cell types, each deriving from the hematopoietic stem cell, together forming the critical components of both the innate and adaptive immune systems. Platelets are integral to haemostasis, and also aid our inflammatory and immune responses, help maintain vascular integrity, and contribute to wound healing.

Radiation considerations are an integral part of the practice of nuclear cardiac imaging. Concern regarding radiation has increased in recent years, reflected in statements by many professional societies, and likely attributable both to rapid growth in use of nuclear cardiology as well as high doses received by some nuclear cardiology patients. The fundamental principles of medical radiological protection are justification (ensuring that the right test is performed for the right patient at the right time), optimization (ensuring that the test is performed in the right manner), and dose limitation, which while applicable to healthcare workers is not operative regarding patients. Three "As" facilitate and serve as an organizing principle for justification: awareness, appropriateness, and audit. Awareness incorporates knowledge of the benefits and risks of testing involving radiation and effective communication of these to the patient. Appropriateness in nuclear cardiology can be assessed using the American College of Cardiology's appropriateness criteria. Methods that have been demonstrated to improve appropriateness include using a collaborative learning model, a point-of-order decision support tool, and a multifaceted intervention including threatened loss of insurance coverage. A variety of strategies should be considered for optimization to ensure patient-centered imaging. These including strategic selection of both the protocol, e.g. selecting a stress-first protocol and performing stress-only imaging in patients without a high pre-test probability of abnormal findings on stress imaging, or using PET, and also the administered activity, e.g. by using weight-based dosing and/or software- or hardware-based advances in camera technology. Special considerations are required for pregnant, nursing, and pediatric patients.

This introductory chapter to the section on management of osteoarthritis (OA) emphasizes the need for a full assessment of the patient, not just in terms of joint symptoms and examination findings but a full holistic assessment of the person, including the impact of OA on their life, their illness perceptions of OA, and the presence of comorbidities. An individualized package of care can then be developed. Patients should be fully informed about OA and fully involved in all management decisions. Apart from education, which is an ongoing not one-off process, other core treatments to be considered in every person with OA are exercise (both strengthening and aerobic) and strategies to reduce adverse mechanical factors, including weight loss if overweight or obese. Topical non-steroidal anti-inflammatory drugs are the safest analgesic drug to try first for peripheral joint OA. Other treatments can be selected as required from a wide range of drug and non-pharmacological options, to address the needs of the individual. The patient requires regular follow-up for reassessment and re-adjustment of management as required. Currently there are sparse data on predictors of response to treatment, limiting a stratified medicine approach. Caveats to the research evidence for OA and its transition to clinical practice are discussed, and one way of improving this (reporting overall treatment effect and the proportion attributable to placebo in clinical trials) is presented. Optimizing contextual effects, which are an integral part of any treatment and which may explain the majority of improvement that a patient experiences for their OA, is emphasized as a key aspect of care.

This book offers an original account of intellectual change in nineteenth-century Britain, by exploring the rich relationship between historical thought and religious debate in Victorian culture. It recovers the twofold process by which the growth of progressive ideas of history transformed religious traditions across British Protestantism, and by which religious debate profoundly shaped Victorian ideas of history. Adopting a remarkably wide contextual perspective which embraces believers and unbelievers, Anglicans and nonconformists, and writers from different parts of the British Isles, and situating British debates in relation to their European and especially German Idealist intellectual surroundings, the study reveals that contemporary conceptions of progress integrally relied upon competing understandings of religious history. It argues that, in the wake of religious revival, the Victorian intellectual mainstream came to terms with religious diversity, changing ethical sensibilities, and new kinds of knowledge by locating these phenomena within providential, spiritualised, and developmental understandings of human time. A secular counter-culture, however, disturbed this internally-differentiated consensus by grounding progress in the advance of the scientific method and the retreat of metaphysics. The book thus explores the ways in which divisions within British liberalism were fundamentally related to divisions over the nature of the religious past. It also demonstrates that religious debate drove the process by which different kinds of historicism acquired cultural authority in Victorian Britain – and began to lose it.

Adaptive governance is defined by a focus on decentralized decision-making structures and procedurally rational policy, supported by intensive natural and social science. Decentralized decision-making structures allow a large, complex problem like global climate change to be factored into many smaller problems, each more tractable for policy and scientific purposes. Many smaller problems can be addressed separately and concurrently by smaller communities. Procedurally rational policy in each community is an adaptation to profound uncertainties, inherent in complex systems and cognitive constraints, that limit predictability. Hence planning to meet projected targets and timetables is secondary to continuing appraisal of incremental steps toward long-term goals: What has and hasn’t worked compared to a historical baseline, and why? Each step in such trial-and-error processes depends on politics to balance, if not integrate, the interests of multiple participants to advance their common interest—the point of governance in a free society. Intensive science recognizes that each community is unique because the interests, interactions, and environmental responses of its participants are multiple and coevolve. Hence, inquiry focuses on case studies of particular contexts considered comprehensively and in some detail.Varieties of adaptive governance emerged in response to the limitations of scientific management, the dominant pattern of governance in the 20th century. In scientific management, central authorities sought technically rational policies supported by predictive science to rise above politics and thereby realize policy goals more efficiently from the top down. This approach was manifest in the framing of climate change as an “irreducibly global” problem in the years around 1990. The Intergovernmental Panel on Climate Change (IPCC) was established to assess science for the Conference of the Parties (COP) to the U.N. Framework Convention on Climate Change (UNFCCC). The parties negotiated the Kyoto Protocol that attempted to prescribe legally binding targets and timetables for national reductions in greenhouse gas emissions. But progress under the protocol fell far short of realizing the ultimate objective in Article 1 of the UNFCCC, “stabilization of greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference in the climate system.” As concentrations continued to increase, the COP recognized the limitations of this approach in Copenhagen in 2009 and authorized nationally determined contributions to greenhouse gas reductions in the Paris Agreement in 2015.Adaptive governance is a promising but underutilized approach to advancing common interests in response to climate impacts. The interests affected by climate, and their relative priorities, differ from one community to the next, but typically they include protecting life and limb, property and prosperity, other human artifacts, and ecosystem services, while minimizing costs. Adaptive governance is promising because some communities have made significant progress in reducing their losses and vulnerability to climate impacts in the course of advancing their common interests. In doing so, they provide field-tested models for similar communities to consider. Policies that have worked anywhere in a network tend to be diffused for possible adaptation elsewhere in that network. Policies that have worked consistently intensify and justify collective action from the bottom up to reallocate supporting resources from the top down. Researchers can help realize the potential of adaptive governance on larger scales by recognizing it as a complementary approach in climate policy—not a substitute for scientific management, the historical baseline.

The study is funded by Doha International Family Institute (DIFI), a member of Qatar Foundation, and is a collaboration between the Muslim Resource Centre for Social Support and Integration of London, Ontario; University of Guelph, Ontario; and University of Calgary, Alberta, all located in Canada; and the Doha International Family Institute, Qatar. The study received research ethics approval from the University of Guelph and the University of Calgary. This study aims to assess the impact of pre- and post-migration on marital relationships and family dynamics for Arab refugee families resettled in Canada. The study also examines the role of professional service providers in supporting these Arab refugee families. The unique experiences of Arab families displaced from their countries due to war and political conflict, and the various hardships experienced during their stay in transit countries, impact their family relations and interactions within the nuclear family context and their interconnectedness with their extended families. Furthermore, these families encounter various challenges within their resettlement process that interrupt their integration. Understanding the impact of traumatic experiences within the pre-migration journey as well as the impact of post-migration stressors on recently settled Arab refugee families in Canada provides insight into the shift in spousal and family relationships. Refugee research studies that focus on the impact of pre-migration trauma and displacement, the migration journey, and post-migration settlement on family relationships are scarce. Since the majority of global refugees in recent years come from Arab regions, mainly Syria, as a result of armed conflicts, this study is focused on the unique experiences of Arab refugee families fleeing conflict zones. The Canadian role in recently resettling a large influx of Arab refugees and assisting them to successfully integrate has not been without challenges. Traumatic pre-migration experiences as a result of being subjected to and/or witnessing violence, separation from and loss of family members, and loss of property and social status coupled with experiences of hardships in transit countries have a profound impact on families and their integration. Refugees are subjected to individual and collective traumatic experiences associated with cultural or ethnic disconnection, mental health struggles, and discrimination and racism. These experiences have been shown to impact family interactions. Arab refugee families have different definitions of “family” and “home” from Eurocentric conceptualizations which are grounded in individualistic worldviews. The discrepancy between collectivism and individualism is mainly recognized by collectivist newcomers as challenges in the areas of gender norms, expectations regarding parenting and the physical discipline of children, and diverse aspects of the family’s daily life. For this study, we interviewed 30 adults, all Arab refugees (14 Syrian and 16 Iraqi – 17 males, 13 females) residing in London, Ontario, Canada for a period of time ranging from six months to seven years. The study participants were married couples with and without children. During the semi-structured interviews, the participants were asked to reflect on their family life during pre-migration – in the country of origin before and during the war and in the transit country – and post-migration in Canada. The inter - views were conducted in Arabic, audio-recorded, and transcribed. We also conducted one focus group with seven service providers from diverse sectors in London, Ontario who work with Arab refugee families. The study used the underlying principles of constructivist grounded theory methodology to guide interviewing and a thematic analysis was performed. MAXQDA software was used to facilitate coding and the identification of key themes within the transcribed interviews. We also conducted a thematic analysis of the focus group transcription. The thematic analysis of the individual interviews identified four key themes: • Gender role changes influence spousal relationships; • Traumatic experiences bring suffering and resilience to family well-being; • Levels of marital conflict are higher following post-migration settlement; • Post-migration experiences challenge family values. The outcome of the thematic analysis of the service provider focus group identified three key themes: • The complex needs of newly arrived Arab refugee families; • Gaps in the services available to Arab refugee families; • Key aspects of training for cultural competencies. The key themes from the individual interviews demonstrate: (i) the dramatic sociocul - tural changes associated with migration that particularly emphasize different gender norms; (ii) the impact of trauma and the refugee experience itself on family relation - ships and personal well-being; (iii) the unique and complex aspects of the family journey; and (iv) how valued aspects of cultural and religious values and traditions are linked in complex ways for these Arab refugee families. These outcomes are consist - ent with previous studies. The study finds that women were strongly involved in supporting their spouses in every aspect of family life and tried to maintain their spouses’ tolerance towards stressors. The struggles of husbands to fulfill their roles as the providers and protec - tors throughout the migratory journey were evident. Some parents experienced role shifts that they understood to be due to the unstable conditions in which they were living but these changes were considered to be temporary. Despite the diversity of refugee family experiences, they shared some commonalities in how they experi - enced changes that were frightening for families, as well as some that enhanced safety and stability. These latter changes related to safety were welcomed by these fami - lies. Some of these families reported that they sought professional help, while others dealt with changes by becoming more distant in their marital relationship. The risk of violence increased as the result of trauma, integration stressors, and escalation in marital issues. These outcomes illustrate the importance of taking into consideration the complexity of the integration process in light of post-trauma and post-migration changes and the timespan each family needs to adjust and integrate. Moreover, these families expressed hope for a better future for their children and stated that they were willing to accept change for the sake of their children as well. At the same time, these parents voiced the significance of preserving their cultural and religious values and beliefs. The service providers identified gaps in service provision to refugee families in some key areas. These included the unpreparedness of professionals and insufficiency of the resources available for newcomer families from all levels of government. This was particularly relevant in the context of meeting the needs of the large influx of Syrian refugees who were resettled in Canada within the period of November 2015 to January 2017. Furthermore, language skills and addressing trauma needs were found to require more than one year to address. The service providers identified that a longer time span of government assistance for these families was necessary. In terms of training, the service providers pinpointed the value of learning more about culturally appropriate interventions and receiving professional development to enhance their work with refugee families. In light of these findings, we recommend an increased use of culturally integrative interventions and programs to provide both formal and informal support for families within their communities. Furthermore, future research that examines the impact of culturally-based training, cultural brokers, and various culturally integrative practices will contribute to understanding best practices. These findings with regard to refugee family relationships and experiences are exploratory in their nature and support future research that extends understanding in the area of spousal relationships, inter - generational stressors during adolescence, and parenting/gender role changes.