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Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients
Charuhas V. Thakar,Annette Christianson,Peter Almenoff,Ron Freyberg
International Journal of Nephrology , 2013, DOI: 10.1155/2013/827459
Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients
Charuhas V. Thakar,Annette Christianson,Peter Almenoff,Ron Freyberg,Marta L. Render
International Journal of Nephrology , 2013, DOI: 10.1155/2013/827459
Abstract: In a multicenter observational cohort of patients-admitted to intensive care units (ICU), we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D) further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp) based on creatinine elevation after ICU admission but before dialysis initiation: Grp I ?>?0.3?mg/dL to <2-fold increase, Grp II ≥2 times but <3 times increase, Grp III ≥3-fold increase in creatinine, and Grp IV none or <0.3?mg/dl increase. Standardized mortality rates (SMR) were calculated by using a validated risk-adjusted mortality model and expressed with 95% confidence intervals (CI). 2,744 patients developed AKI-D during ICU stay; 36.7%, 20.9%, 31.2%, and 11.2% belonged to groups I, II, III, and IV, respectively. SMR showed a graded increase in Grp I, II, and III (1.40 (95% CI, 1.29–1.42), 1.84 (1.66–2.04), and 2.25 (2.07–2.45)) and was 0.98 (0.78–1.20) in Grp IV. In ICU patients with AKI-D, degree of creatinine elevation prior to dialysis initiation is independently associated with hospital mortality. It is the lowest in those experiencing minor or no elevations in creatinine and may represent reversible fluid-electrolyte disturbances. 1. Introduction Acute kidney injury (AKI) requiring dialysis is a serious complication in critically ill patients, bringing increased morbidity, mortality, and costs of care [1–4]. AKI requiring dialysis is usually considered the most severe form of kidney injury, and these patients have been conventionally regarded as a relatively “homogenous” group of patients, either when describing epidemiological information or while conducting clinical trials [5, 6]. However, studies examining interventions in dialysis patients (e.g., dialysis modality or frequency have not demonstrated unequivocal survival benefits [7–9]. It is well recognized that small changes in creatinine (mild-to-moderate AKI) independently predict mortality [10, 11]; we also recently reported that patients with AKI requiring dialysis represent a wider spectrum of severity of kidney injury, contrary to the prevalent notion [12]. Thus, it can be hypothesized that the degree of elevation of creatinine prior to initiating dialysis may discriminate risk-adjusted mortality, similar to the observations in nondialysis requiring AKI. The Acute Kidney Injury Network (AKIN) has issued standard definitions of AKI; currently, in these criteria, AKI requiring dialysis is classified as stage III (or severe) AKI [13]. The consensus panel also proposed that the examination of natural history
Diagrammatik und Wissensorganisation
Linda Treude,Sascha Freyberg
Libreas : Library Ideas , 2012,
Abstract: EinleitungDie Formen des Sichtbarmachens“ in der Wissenschaft reichen von Abbildungen“ über Modelle“ bis hin zu Simulationen“. Sie k nnen u.a. gezeichnet, fotografiert, geometrisch konstruiert oder durch Sensorik vermittelt, digital prozessiert werden. Ihre Funktionen erstrecken sich von der Orientierung bis hin zur (hypothetischen) Voraussage und somit auch vom überblick bis zur Evidenzsuggestion. Generell handelt es sich um vereinfachte (und vereinfachende) Darstellungen von (teilweise sehr komplexen) Sachverhalten, zu deren Verst ndnis sie beitragen sollen; daher k nnen sie bei Lernprozessen, d.h. in der Vermittlung und auch bei der Organisation von Wissen eine wichtige Rolle spielen. Diese kommt ihnen nun nicht nur zu, weil sie – wie in den mittelalterlichen Mnemotechniken – als Ged chtnisstützen für bekannte Sachverhalte dienen. Sondern resultiert auch aus ihrem Potenzial für die Entdeckung von neuen Zusammenh ngen. Der folgende Artikel diskutiert die Darstellungsform des Diagramms. Es wird hier mit dem Gedanken gespielt, dass die in der universalen Zeichentheorie von C.S. Peirce entwickelte Diagrammatik wichtige Impulse für eine Untersuchung des Zusammenhangs von Wissen und Bildlichkeit geben kann.
Annette Freyberg-Inan
Romanian Journal of European Affairs (RJEA) , 2010,
Abstract: The European Union (EU) is a singularly successful example of economic integration. To what extent it has also been a force for democracy- and how it can more clearly become one- are the key questions addressed in this article. Below, I first lay out how the values of prosperity, democracy, and equity are theoretically linked. Second, I show that the values of democracy and equity have been subordinate to aggregate prosperity in the process of both European integration and European Union enlargement. Not only do the EU's institutional structure and policy priorities reveal an imbalance in favor or the common market and in disfavor of a common fiscal and social policy as well as democratic accountability, EU strategy vis-à-vis candidate and accession countries reveals a disregard for the socio-economic implications of transition and for EU-fostered technocratic threats to democratic consolidation. While formal democracy of course remains a criterion for membership, EU conditionality on the whole conflicts with the development of democracy beyond minimal formal criteria. The institutional design and key policies of the enlarging EU thus clearly aim more at creating aggregate wealth than at ensuring social justice or popular empowerment. Greater awareness of the relevant choices among values should precede any further attempts at regional integration.
From “Employer-Employee” to “Family of Choice”: The Development of the Relationship between Philippine Worker Immigrants and Elderly Care Recipients  [PDF]
Pnina Ron
Advances in Aging Research (AAR) , 2015, DOI: 10.4236/aar.2015.42007
Abstract: The current study adds to the pool of findings regarding experiences of female Philippine work immigrants employed in elderly caregiving in Israel, as they cope with their role as caregivers. Based on an analysis of the qualitative interviews with 27 Philippine women, three themes emerged. The first is the manner in which these caregivers perceive the treatment and care they give their elderly employers, taking into account the initial stage of the professional relationship, the various types of support, and the employer-employee interactions. The second theme deals with the manner in which these caregivers perceive their role once the relationship with the elderly care recipient is established and the employer’s needs and preferences become familiar; that is, once there is a clear caregiver-client relationship. The third theme deals with the manner in which the caregivers perceive their relationship with their elderly employers and with the employers’ family members, and the way they believe their employer and family perceive their role as caregivers. This stage of the relationship they define as “family of choice”. The combination of the three themes presents a comprehensive picture of positive change in terms of the caregivers perception of their role, and a shift in the manner in which they perceive their employers: from a “source of income” to “parent”.
The Relationship between Attachment Styles in Adulthood and Attitudes towards Filial Responsibility: A Comparison between Three Generations of Arabs and Jewish Women  [PDF]
Pnina Ron
Psychology (PSYCH) , 2016, DOI: 10.4236/psych.2016.76077

Background: Care giving for an elderly parent is a universal developmental task, and in all societies is one of the women tasks; its expectations are considered norms known as filial responsibility. The aim of the study is to examine the possibility of connections between the attitudes toward filial responsibility to elderly parents and the attachment style in adulthood and age (generation) among women. Methods: The research participants were 63 Jewish and Arab university students, their mothers (N = 62) and their grandmothers (N = 63). Research instruments consisted of a self- report questionnaire, which revealed background characteristics, and measured attitudes toward filial responsibility, style of adult attachment; self-esteem; sense of mastery and, family support. Results revealed ethnicity differences as well as between-generations differences regarding normative attitudes toward filial responsibility, which may indicate a changing taking place in the Arab society’s approach concerning these attitudes. An additional finding brought to light the cross-generational differences in the relationship between the attachment style in adulthood and the attitudes regarding filial responsibility. Conclusion: It seems that in attitudes towards filial responsibility, Arab society is still traditional in terms of its approach to the institutions of clan and family mostly among the elderly Arab Muslims. All of the modern changes most likely have an effect on adults’ sense of filial responsibility, on social norms, and on familial traditions.

Precipitation patterns and moisture fluxes in a sandy, tropical environment with a shallow water table
M. R. Minihane,D. L. Freyberg
Hydrology and Earth System Sciences Discussions , 2011, DOI: 10.5194/hessd-8-8063-2011
Abstract: Identifying the dominant mechanisms controlling recharge in shallow sandy soils in tropical climates has received relatively little attention. Given the expansion of coastal fill using marine sands and the growth of coastal populations throughout the tropics, there is a need to better understand the nature of water balances in these settings. We use time series of field observations at a coastal landfill in Singapore coupled with numerical modeling using the Richards' equation to examine the impact of precipitation patterns on soil moisture dynamics, including percolation past the root zone and recharge, in such an environment. A threshold in total precipitation event depth, much more so than peak precipitation intensity, is the strongest event control on recharge. However, shallow antecedent moisture, and therefore the timing between events along with the seasonal depth to water table, also play significant roles in determining recharge amounts. For example, at our field site, precipitation events of less than 3 mm per event yield little to no direct recharge, but for larger events, moisture content changes below the root zone are linearly correlated to the product of the average antecedent moisture content and the total event precipitation. Therefore, water resources planners need to consider identifying threshold precipitation volumes, along with the multiple time scales that capture variability in event antecedent conditions and storm frequency in assessing the role of recharge in coastal water balances in tropical settings.
The autocorrelation function of the soft X-ray background
Andrzej M. Soltan,Michael J. Freyberg
Physics , 2000,
Abstract: The first positive detection of the X-ray background fluctuations at small angular scales is reported. ROSAT PSPC archive pointed observations are used to measure fluctuations at scales of 0.03 - 0.4 deg. The pointings have been selected from an area free from galactic contamination. At separations below 0.1 deg clusters of galaxies become a substantial source of the background fluctuations. The autocorrelation function of the fluctuations in the power law approximation has a slope of ~1 for all the data but is substantially flatter (with slope of ~0.7) when pointings containing bright clusters are removed. At separations 0.3 - 0.4 deg where the ACF estimates based on the ROSAT pointings and All-Sky Survey are available, both data sets give consistent results.
Language-Trained Animals: A Window to the “Black Box”  [PDF]
ron Franck
International Journal of Intelligence Science (IJIS) , 2012, DOI: 10.4236/ijis.2012.224020
Abstract: Animals have to process quantity of information in order to take decisions and adapt their behaviors to their physical and social environment. They have to remember previous events (learning), to cope with their internal (motivational and emotional) states and to display flexible behavioral responses. From a human point of view it is quite impossible to access all those information, not only because of the sensorial channels used that can vary but also because all the processing phase occurs in the “black box” and non-human animals are not able to express verbally what they think, feel or want. Though useful information might lie in the “collected data” (animal mind), extracting them into insightful knowledge with human-accessible form (clear meaning, no interpretation) presents a demanding and sophisticated undertaking. Several scientists decided to trained different individuals from several species (apes, dolphins, grey parrots, dogs) in order to teach them a new communicative system that they could share with us. Here, the different studies (techniques and species used) are presented, their constrains but also the main findings.
Changing the Paradigm  [PDF]
Ron W. Nielsen
Applied Mathematics (AM) , 2014, DOI: 10.4236/am.2014.513188

A simple but useful method of analysis of hyperbolic processes is presented and its application is illustrated by using the growth of human population in Africa, the economic growth in Western Europe and the examination of the fundamental postulates of the Unified Growth Theory. It is shown how this method can revolutionize the interpretation of the historical economic growth and the growth of human population and how it can help to understand the current growth. Examples used to illustrate the application of this method show that, contrary to the accepted interpretations, the Industrial Revolution and the accompanying unprecedented technological development had no impact on the economic growth even in Western Europe and that Galor’s Unified Growth Theory fails the scientific test.

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