20 resultados para shoulder girdle


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The principle feature in the evolution of the internet has been its ever growing reach to include old and young, rich and poor. The internet’s ever encroaching presence has transported it from our desktop to our pocket and into our glasses. This is illustrated in the Internet Society Questionnaire on Multistakeholder Governance, which found the main factors affecting change in the Internet governance landscape were more users online from more countries and the influence of the internet over daily life. The omnipresence of the internet is self- perpetuating; its usefulness grows with every new user and every new piece of data uploaded. The advent of social media and the creation of a virtual presence for each of us, even when we are not physically present or ‘logged on’, means we are fast approaching the point where we are all connected, to everyone else, all the time. We have moved far beyond the point where governments can claim to represent our views which evolve constantly rather than being measured in electoral cycles.
The shift, which has seen citizens as creators of content rather than consumers of it, has undermined the centralist view of democracy and created an environment of wiki democracy or crowd sourced democracy. This is at the heart of what is generally known as Web 2.0, and widely considered to be a positive, democratising force. However, we argue, there are worrying elements here too. Government does not always deliver on the promise of the networked society as it involves citizens and others in the process of government. Also a number of key internet companies have emerged as powerful intermediaries harnessing the efforts of the many, and re- using and re-selling the products and data of content providers in the Web 2.0 environment. A discourse about openness and transparency has been offered as a democratising rationale but much of this masks an uneven relationship where the value of online activity flows not to the creators of content but to those who own the channels of communication and the metadata that they produce.
In this context the state is just one stakeholder in the mix of influencers and opinion formers impacting on our behaviours, and indeed our ideas of what is public. The question of what it means to create or own something, and how all these new relationships to be ordered and governed are subject to fundamental change. While government can often appear slow, unwieldy and even irrelevant in much of this context, there remains a need for some sort of political control to deal with the challenges that technology creates but cannot by itself control. In order for the internet to continue to evolve successfully both technically and socially it is critical that the multistakeholder nature of internet governance be understood and acknowledged, and perhaps to an extent, re- balanced. Stakeholders can no longer be classified in the broad headings of government, private sector and civil society, and their roles seen as some sort of benign and open co-production. Each user of the internet has a stake in its efficacy and each by their presence and participation is contributing to the experience, positive or negative of other users as well as to the commercial success or otherwise of various online service providers. However stakeholders have neither an equal role nor an equal share. The unequal relationship between the providers of content and those who simple package up and transmit that content - while harvesting the valuable data thus produced - needs to be addressed. Arguably this suggests a role for government that involves it moving beyond simply celebrating and facilitating the on- going technological revolution. This paper reviews the shifting landscape of stakeholders and their contribution to the efficacy of the internet. It will look to critically evaluate the primacy of the individual as the key stakeholder and their supposed developing empowerment within the ever growing sea of data. It also looks at the role of individuals in wider governance roles. Governments in a number of jurisdictions have sought to engage, consult or empower citizens through technology but in general these attempts have had little appeal. Citizens have been too busy engaging, consulting and empowering each other to pay much attention to what their governments are up to. George Orwell’s view of the future has not come to pass; in fact the internet has insured the opposite scenario has come to pass. There is no big brother but we are all looking over each other’s shoulder all the time, while at the same time a number of big corporations are capturing and selling all this collective endeavour back to us.

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The late Michael Allen was a member of the famous Belfast Group, and one of the most authoritative critical voices on poetry from Northern Ireland, intimately part of the North’s poetic movement since the early 1960s. He taught at Queen’s University, where he was a colleague of Seamus Heaney and tutor to poets such as Paul Muldoon and Medbh McGuckian. Seamus Heaney called him ‘the reader over my shoulder’. Close Readings brings together interlinked critical writings which have crucially influenced approaches to Irish poetry during the last forty years. The book ends with an extended essay, hitherto unpublished: ‘Doubles, Twins and the Feminine: Development in the Poetry of Michael Longley’.

Close Readings contains a Foreword by Fran Brearton, which relates Michael Allen’s essays to continuing critical and cultural debates. Edna Longley’s Afterword offers a personal view of Allen’s involvement with poetry in Belfast.

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The problem-Musculoskeletal (MSK) symptoms are common within primary care but some GPs are not comfortable managing these; waiting times for hospital appointments are a major cause of patients’ complaints. Current UK healthcare policies emphasise a need for more community-based management. We aimed to pilot an innovative general practice-based clinic to improve the management of MSK and Sport and Exercise Medicine (SEM) symptoms within general practice.

The approach-This project was conducted in an inner-city practice of approximately 9,000 patients and 5 GP partners. The practice commissioned a novel monthly 4-hour clinic staffed by one GP with a specialist interest in MSK and SEM conditions. Each patient was allocated a 20-minute appointment. All primary care staff within the practice could refer any patient for whom they considered hospital referral appropriate, with no specific exclusion criteria. Management plans included injection therapy, exercise prescription and onward referral. After three months (August-October 2014) numbers of consultations, sources of referral, reasons for referral and management outcomes were described; patient satisfaction was assessed by questionnaire, offered to 10 randomly selected patients by reception staff and self-completed by patients. Costs of the clinic were compared to current options.

Findings- All patients (14 males; 21 females; aged 35-77 years), were seen within four weeks of referral (one third of orthopaedic referrals in 2013 waited over 9 weeks for appointment). Most were referred from other GPs; some came from physiotherapy and podiatry. Shoulder problems were the most frequent reason for referral. The commonest management option was steroid injection, with most patients being given advice regarding exercise and analgesia; there were 3 onward referrals (2 physiotherapy; 1 rheumatology).

Comparing August-October data in 2014 and 2013, total, orthopaedic and rheumatology referrals were reduced by 147, 2 and 3, respectively; within the practice MSK presentations and physiotherapy and x-ray referrals were 60, 47 and 90 fewer, respectively.

The cost per attendance at the clinic was £61; initial orthopaedic-ICAT assessments cost £82 and a consultant appointment £213.

Satisfaction questionnaires were returned by all 10 selected participants and provided positive feedback, expressing preference for community-based, rather than hospital, management.

Consequence- Our pilot study indicates that this novel service model has potential for efficient and effective management of MSK and SEM complaints in primary care, reducing the need for hospital referral and the clinical burden on general practices. The innovation deserves further evaluation in a full-scale trial to determine its generalisability to other practice settings and populations.

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We present photometric and spectroscopic observations of the interacting transient SN 2009ip taken during the 2013 and 2014 observing seasons. We characterize the photometric evolution as a steady and smooth decline in all bands, with a decline rate that is slower than expected for a solely Co-56-powered supernova at late phases. No further outbursts or eruptions were seen over a two year period from 2012 December until 2014 December. SN 2009ip remains brighter than its historic minimum from pre-discovery images. Spectroscopically, SN 2009ip continues to be dominated by strong, narrow (less than or similar to 2000 km s(-1)) emission lines of H, He, Ca, and Fe. While we make tenuous detections of [Fe II] lambda 7155 and [O I] lambda lambda 6300, 6364 lines at the end of 2013 June and the start of 2013 October, respectively, we see no strong broad nebular emission lines that could point to a core-collapse origin. In general, the lines appear relatively symmetric, with the exception of our final spectrum in 2014 May, when we observe the appearance of a redshifted shoulder of emission at +550 km s(-1). The lines are not blueshifted, and we see no significant near-or mid-infrared excess. From the spectroscopic and photometric evolution of SN 2009ip until 820 d after the start of the 2012a event, we still see no conclusive evidence for core-collapse, although whether any such signs could be masked by ongoing interaction is unclear.

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Context: The initial distribution of spin rates of massive stars is a fingerprint of their elusive formation process. It also sets a key initial condition for stellar evolution and is thus an important ingredient in stellar population synthesis. So far, most studies have focused on single stars. Most O stars are, however, found in multiple systems. 

Aims: By establishing the spin-rate distribution of a sizeable sample of O-type spectroscopic binaries and by comparing the distributions of binary subpopulations with one another and with that of presumed-single stars in the same region, we aim to constrain the initial spin distribution of O stars in binaries, and to identify signatures of the physical mechanisms that affect the evolution of the spin rates of massive stars. 

Methods: We use ground-based optical spectroscopy obtained in the framework of the VLT-FLAMES Tarantula Survey (VFTS) to establish the projected equatorial rotational velocities (νesini) for components of 114 spectroscopic binaries in 30 Doradus. The νesini values are derived from the full width at half maximum (FWHM) of a set of spectral lines, using a FWHM vs. νesini calibration that we derive based on previous line analysis methods applied to single O-type stars in the VFTS sample. 

Results: The overall νesini distribution of the primary stars resembles that of single O-type stars in the VFTS, featuring a low-velocity peak (at νesini<200 kms-1) and a shoulder at intermediate velocities (200 <νesini<300 kms-1). The distributions of binaries and single stars, however, differ in two ways. First, the main peak at νesini ~ 100kms-1 is broader and slightly shifted towards higher spin rates in the binary distribution than that of the presumed-single stars. This shift is mostly due to short-period binaries (Porb~<10 d). Second, the νesini distribution of primaries lacks a significant population of stars spinning faster than 300 kms-1, while such a population is clearly present in the single-star sample. The νesini distribution of binaries with amplitudes of radial velocity variation in the range of 20 to 200 kms-1 (mostly binaries with Porb ~ 10-1000 d and/or with q<0.5) is similar to that of single O stars below νesini~<170kms-1

Conclusions: Our results are compatible with the assumption that binary components formed with the same spin distribution as single stars, and that this distribution contains few or no fast-spinning stars. The higher average spin rate of stars in short-period binaries may either be explained by spin-up through tides in such tight binary systems, or by spin-down of a fraction of the presumed-single stars and long-period binaries through magnetic braking (or by a combination of both mechanisms). Most primaries and secondaries of SB2 systems with Porb~<10 d appear to have similar rotational velocities. This is in agreement with tidal locking in close binaries where the components have similar radii. The lack of very rapidly spinning stars among binary systems supports the idea that most stars with νesini~> 300kms-1 in the single-star sample are actually spun-up post-binary interaction products. Finally, the overall similarities (low-velocity peak and intermediate-velocity shoulder) of the spin distribution of binary and single stars argue for a massive star formation process in which the initial spin is set independently of whether stars are formed as single stars or as components of a binary system.