22 resultados para Analgesia multimodal
em Doria (National Library of Finland DSpace Services) - National Library of Finland, Finland
Resumo:
Supply chains are becoming increasingly dependent on information ex-change in today’s world, and any disruption can cause severe repercus-sions to the flow of materials in the chain. The speed, accuracy and amount of information are key factors. The aim in this thesis is to address a gap in the research by focusing on information exchange and the risks related to it in a multimodal wood supply chain operating between the Baltic States and Finland. The study involved interviewing people engaged in logistics management in the supply chain in question. The main risk the interviewees identified arose from the sea logistics system, which held a lot of different kinds of information. The threat of breakdown in the Internet connection was also found to hinder the operations significantly. A vulnerability analysis was carried out in order to identify the main actors and channels of infor-mation flow in the supply chain. The analysis revealed that the most important and therefore most vulnerable information-exchange channels were those linking the terminal superintendent, the operative managers and the mill managers. The study gives a holistic picture of the investigated supply chain. Information-exchange-related risks varied greatly. One of the most frequently mentioned was the risk of information inaccuracy, which was usually due to the fact that those in charge of the various functions did not fully understand the consequences for the entire chain.
Resumo:
The general goal of the present work was to study whether spatial perceptual asymmetry initially observed in linguistic dichotic listening studies is related to the linguistic nature of the stimuli and/or is modality-specific, as well as to investigate whether the spatial perceptual/attentional asymmetry changes as a function of age and sensory deficit via praxis. Several dichotic listening studies with linguistic stimuli have shown that the inherent perceptual right ear advantage (REA), which presumably results from the left lateralized linguistic functions (bottom-up processes), can be modified with executive functions (top-down control). Executive functions mature slowly during childhood, are well developed in adulthood, and decline as a function of ageing. In Study I, the purpose was to investigate with a cross-sectional experiment from a lifespan perspective the age-related changes in top-down control of REA for linguistic stimuli in dichotic listening with a forced-attention paradigm (DL). In Study II, the aim was to determine whether the REA is linguistic-stimulus-specific or not, and whether the lifespan changes in perceptual asymmetry observed in dichotic listening would exist also in auditory spatial attention tasks that put load on attentional control. In Study III, using visual spatial attention tasks, mimicking the auditory tasks applied in Study II, it was investigated whether or not the stimulus-non-specific rightward spatial bias found in auditory modality is a multimodal phenomenon. Finally, as it has been suggested that the absence of visual input in blind participants leads to improved auditory spatial perceptual and cognitive skills, the aim in Study IV was to determine, whether blindness modifies the ear advantage in DL. Altogether 180-190 right-handed participants between 5 and 79 years of age were studied in Studies I to III, and in Study IV the performance of 14 blind individuals was compared with that of 129 normally sighted individuals. The results showed that only rightward spatial bias was observed in tasks with intensive attentional load, independent of the type of stimuli (linguistic vs. non-linguistic) or the modality (auditory vs. visual). This multimodal rightward spatial bias probably results from a complex interaction of asymmetrical perceptual, attentional, and/or motor mechanisms. Most importantly, the strength of the rightward spatial bias changed as a function of age and augmented praxis due to sensory deficit. The efficiency of the performance in spatial attention tasks and the ability to overcome the rightward spatial bias increased during childhood, was at its best in young adulthood, and decreased as a function of ageing. Between the ages of 5 and 11 years probably at first develops movement and impulse control, followed by the gradual development of abilities to inhibit distractions and disengage attention. The errors especially in bilateral stimulus conditions suggest that a mild phenomenon resembling extinction can be observed throughout the lifespan, but especially the ability to distribute attention to multiple targets simultaneously decreases in the course of ageing. Blindness enhances the processing of auditory bilateral linguistic stimuli, the ability to overcome a stimulus-driven laterality effect related to speech sound perception, and the ability to direct attention to an appropriate spatial location. It was concluded that the ability to voluntarily suppress and inhibit the multimodal rightward spatial bias changes as a function of age and praxis due to sensory deficit and probably reflects the developmental level of executive functions.
Resumo:
Day surgery has gained a large popularity during the last decades. In Finland, 57% of the elective procedures, and 50% at Turku University Hospital, were already conducted on day basis during 2012. The steady growth of day surgery is mostly due to an increased safety in perioperative care and cost-effectiveness. The development of surgical techniques and anaesthetic methods has advanced the modern day surgery and extended the repertory of the procedures for use in day surgery operations. Day surgery also offers certain benefits like reduced risk for hospital-related infections, stress and confusion. Patient satisfaction, regarding several issues, is high. Most concerns and complaints are related to postoperative pain, nausea and vomiting pain and nausea. Pain can hamper recovery and pain management is a crucial factor for hospital discharge. Appropriate pain treatment is effective, safe, easy and economical. A procedure-specific approach and an individually planned, multimodal analgesia should be the basis of modern pain management. The main aim of this thesis was to evaluate the effectiveness and safety of anaesthetic technique and methods in pain treatment of orthopaedic day case surgery, and following conclusions were made. Unilateral spinal block was achieved using hyperbaric bupivacaine with a small dose of clonidine but clonidine prolonged the block. Continuous subacromial bupivacaine was found to be safe but conferring only moderate efficacy in pain care after shoulder arthroscopy. Transdermal fentanyl, 12 g/h, as part of multimodal analgesia, offered a safe and easy option to pain management in this patient group. However, after forefoot surgery, it did not reduce pain any further. In general, pain scores in all patient groups were low and the need for rescue opioid moderate.
Resumo:
Avhandlingens primära syfte är att upprätta en förståelse för visuell kompetens som en del av visuell litteracitet inom multimodal digital kommunikation i undervisningen. Avhandlingens sekundära syfte är att ur ett pedagogiskt perspektiv lyfta fram visuell litteracitet och visuell kompetens i multimodala diskussioner kring digital pedagogik. Forskningen är kvalitativ och har både teoretisk och empirisk förankring. Den empiriska studien har en fenomenologisk metodansats. Visuell kompetens innebär att visuell läsning behärskas, vilket förutsätter fungerande vokabulär, kritiskt förhållningssätt och kunskaper i läsning och tolkning och användning av bilder. Den visuella grammatikteorin innefattar bildens syntax och semantik. Bilden är ett kontextbundet fenomen, där kontexten berör sociala aspekter, bildens fysiska omgivning samt innehåll. Det empiriska resultatet är att visuell inverkan i undervisningen präglar förberedelser och lektionsmål, berör visuell kommunikationskompetens, inkluderar visuella element som verktyg, strävar involvera flera element i inlärningen och strävar efter att undvika passiva demonstrationer som undervisningsmetod. Bilder behövs som kommunikativt stöd, som inlärningsmetod och som en del i aktivitetspedagogisk undervisning. Genom stöd från läraren kan barnet nå visuell litteracitet som ett kompetensmål, vilket kan ske genom multimodal undervisning.
Resumo:
En este trabajo de fin de máster se investiga qué impacto tuvo la Marca Finlandia en el uso de las artes finlandesas en Focus – economía y tecnología, una revista publicada por el Ministerio de Asuntos Exteriores de Finlandia durante los años más profundos de la crisis económica 2008-2013. En 2008 el Ministro de Asuntos Exteriores de entonces, Alexander Stubb, designó una delegación para desarrollar la marca país de Finlandia, fruto de un proceso del que se presentó en 2010 un documento llamado Tehtävä Suomelle! (¡Misión para Finlandia!), cuyo objetivo fue concretar el diseño y las funciones de la Marca Finlandia. Este trabajo se enfoca en la utilización del arte y de artistas finlandeses en el material creado para apoyar la promoción de la imagen del país y, en última instancia, su competividad económica. Para tener en cuenta el contexto del material objeto de estudio, presentamos el concepto de la marca país y distintos planteamientos teóricos para su realización. Siendo una estrategia estatal polémica, recorremos los puntos de crítica más importantes sobre esta práctica promocional. También nos familiarizamos con la historia de la promoción nacional antes de introducir el presente proyecto, la Marca Finlandia, y sus objetivos. En la parte teórica se presentan los conceptos relevantes para el estudio: el discurso y su análisis crítico, enfatizando su capacidad ideológica para mantener y crear relaciones del poder muy a menudo desiguales. Ya que nuestro material de estudio empírico está compuesto de publicaciones físicas con dimensiones textuales, visuales y hápticas, nuestro método de investigación es observar críticamente estas relaciones desde la perspectiva multimodal. En la parte empírica del trabajo analizamos la composición de la comunicación multimodal del material imprimido, producido por el Ministerio de Asuntos Exteriores de Finlandia y sus socios de cooperación. Las revistas anuales Focus– Economía y tecnología se enfocan en noticias y artículos sobre los sectores de la economía y tecnología, pero también incluyen contenido sobre el diseño, la música, la moda, la arquitectura y la danza finlandeses. En nuestro análisis recorremos los campos verbales y visuales utilizados en las revistas para investigar de qué manera se presentaban las artes finlandesas en la operación de Marca Finlandia. Detectamos representaciones textuales, resaltaciones visuales y la combinación de ambos, lo que servía a las metas preterminadas y la imagen requerida por la delegación diseñadora de la marca país. Las revistas compartían el discurso en común que corría paralelo con los objetivos de la Marca Finlandia, que a su vez se puede ver como parte del discurso hegemónico neoliberal en general.
Resumo:
The present thesis is a study of movie review entertainment (MRE) which is a contemporary Internet-based genre of texts. MRE are movie reviews in video form which are published online, usually as episodes of an MRE web show. Characteristic to MRE is combining humor and honest opinions in varying degrees as well as the use of subject materials, i.e. clips of the movies, as a part of the review. The study approached MRE from a linguistic perspective aiming to discover 1) whether MRE is primarily text- or image-based and what the primary functions of the modes are, 2) how a reviewer linguistically combines subject footage to her/his commentary?, 3) whether there is any internal variation in MRE regarding the aforementioned questions, and 4) how suitable the selected models and theories are in the analysis of this type of contemporary multimodal data. To answer the aforementioned questions, the multimodal system of image—text relations by Martinec and Salway (2005) in combination with categories of cohesion by Halliday and Hasan (1976) were applied to four full MRE videos which were transcribed in their entirety for the study. The primary data represent varying types of MRE: a current movie review, an analytic essay, a riff review, and a humorous essay. The results demonstrated that image vs. text prioritization can vary between reviews and also within a review. The current movie review and the two essays were primarily commentary-focused whereas the riff review was significantly more dependent on the use of imagery as the clips are a major source of humor which is a prominent value in that type of a review. In addition to humor, clips are used to exemplify the commentary. A reviewer also relates new information to the imagery as well as uses two modes to present the information in a review. Linguistically, the most frequent case was that the reviewer names participants and processes lexically in the commentary. Grammatical relations (reference items such as pronouns and adverbs and conjunctive items in the riff review) were also encountered. There was internal variation to a considerable degree. The methods chosen were deemed appropriate to answer the research questions. Further study could go beyond linguistics to include, for instance, genre and media studies.
Resumo:
Sensor-based robot control allows manipulation in dynamic environments with uncertainties. Vision is a versatile low-cost sensory modality, but low sample rate, high sensor delay and uncertain measurements limit its usability, especially in strongly dynamic environments. Force is a complementary sensory modality allowing accurate measurements of local object shape when a tooltip is in contact with the object. In multimodal sensor fusion, several sensors measuring different modalities are combined to give a more accurate estimate of the environment. As force and vision are fundamentally different sensory modalities not sharing a common representation, combining the information from these sensors is not straightforward. In this thesis, methods for fusing proprioception, force and vision together are proposed. Making assumptions of object shape and modeling the uncertainties of the sensors, the measurements can be fused together in an extended Kalman filter. The fusion of force and visual measurements makes it possible to estimate the pose of a moving target with an end-effector mounted moving camera at high rate and accuracy. The proposed approach takes the latency of the vision system into account explicitly, to provide high sample rate estimates. The estimates also allow a smooth transition from vision-based motion control to force control. The velocity of the end-effector can be controlled by estimating the distance to the target by vision and determining the velocity profile giving rapid approach and minimal force overshoot. Experiments with a 5-degree-of-freedom parallel hydraulic manipulator and a 6-degree-of-freedom serial manipulator show that integration of several sensor modalities can increase the accuracy of the measurements significantly.
Resumo:
Metaheuristic methods have become increasingly popular approaches in solving global optimization problems. From a practical viewpoint, it is often desirable to perform multimodal optimization which, enables the search of more than one optimal solution to the task at hand. Population-based metaheuristic methods offer a natural basis for multimodal optimization. The topic has received increasing interest especially in the evolutionary computation community. Several niching approaches have been suggested to allow multimodal optimization using evolutionary algorithms. Most global optimization approaches, including metaheuristics, contain global and local search phases. The requirement to locate several optima sets additional requirements for the design of algorithms to be effective in both respects in the context of multimodal optimization. In this thesis, several different multimodal optimization algorithms are studied in regard to how their implementation in the global and local search phases affect their performance in different problems. The study concentrates especially on variations of the Differential Evolution algorithm and their capabilities in multimodal optimization. To separate the global and local search search phases, three multimodal optimization algorithms are proposed, two of which hybridize the Differential Evolution with a local search method. As the theoretical background behind the operation of metaheuristics is not generally thoroughly understood, the research relies heavily on experimental studies in finding out the properties of different approaches. To achieve reliable experimental information, the experimental environment must be carefully chosen to contain appropriate and adequately varying problems. The available selection of multimodal test problems is, however, rather limited, and no general framework exists. As a part of this thesis, such a framework for generating tunable test functions for evaluating different methods of multimodal optimization experimentally is provided and used for testing the algorithms. The results demonstrate that an efficient local phase is essential for creating efficient multimodal optimization algorithms. Adding a suitable global phase has the potential to boost the performance significantly, but the weak local phase may invalidate the advantages gained from the global phase.
Resumo:
Oxycodone is an opioid used in the treatment of moderate or severe pain. It is principally metabolized in the liver by cytochrome P450 3A (CYP3A) enzymes whereas approximately 10% is metabolized by CYP2D6. Little is known about the interactions between oxycodone and other drugs, herbals and nutritional substances. In this work the effects of CYP3A inducers rifampicin and St. John’s wort and CYP3A inhibitors voriconazole, grapefruit juice, ritonavir and lopinavir/ritonavir were investigated on the pharmacokinetics and pharmacodynamics of oxycodone. All studies were randomized, balanced, placebo-controlled crossover clinical studies in healthy volunteers. The plasma concentrations of oxycodone and its metabolites were determined for 48 hours and pharmacodynamic parameters were recorded for 12 hours in each study. Pharmacokinetic parameters were calculated by noncompartmental methods. Rifampicin decreased the plasma concentrations, analgesic effects, and oral bioavailability of oral oxycodone. St. John’s wort reduced the concentrations of oxycodone and diminished the self-reported drug effect. Voriconazole increased the exposure to oral oxycodone by 3.6-fold whereas grapefruit juice, which inhibits predominantly the intestinal CYP3A, elevated the mean concentrations of oxycodone by 1.7-fold. Ritonavir and lopinavir/ritonavir increased the mean AUC of oxycodone by 3.0- and 2.6-fold, respectively, and prolonged its elimination half-life. In spite of increased oxycodone plasma concentrations during concomitant administration of CYP3A inhibitors, the analgesic effects were not increased. These studies show that the induction or inhibition of CYP3A alters the pharmacokinetics and pharmacologic effects of oxycodone. The exposure to oxycodone decreased after induction and increased after inhibition of CYP3A. As a conclusion, the clinicians should avoid concomitant administration of CYP3A inducers or inhibitors and oral oxycodone. If this is not possible, they should be prepared to interactions leading to impaired analgesia after CYP3A inducers or increased adverse effects after CYP3A inhibitors and oral oxycodone.
Resumo:
Visual art practice has generally been described as a lonely affair, thinking about what an artist has experienced in the outside world. This study is an inquiry into a visual art practice of another kind: the relational one. The research purpose is twofold. The first purpose is to shed light on a visual artist’s conceptions of art, education and scholarship. The second purpose is to by reasoning on imagination and a rhizomatic formation interpret the relations created between art, multimodality and literacy learning as an aesthetic approach to education. By inquiry into a specific collaborated long-term art practice, the study conveys how the meaning making elements of an arts based learning practice gradually transform an artist’s and a teacher’s concepts of art education to an aesthetic approach to education. In the art practice examined the typical Finnish rye bread and a poem have represented a cultural theme that has been elaborated through art conventions. The poem and the rye bread have in the art practice been articulated as cultural representations of as well as symbolic projections on the Swedishspeaking minority culture in Finland. The study connects art informed inquiry to a hermeneutic research rationale where the research reasoning is generated through a rhizomatic alliance between empiric data and theories. The reasoning is constructed as an interpretation pattern that expands throughout the study. The study arguments that the rhizome as an aesthetic formation can be appropriate to refer to when articulating arts based meaning making and when creating arts based educational strategies, dialogues, aesthetic learning and multimodal literacy in education. The study investigates an aesthetic approach to research in education, which means that the art practice surveyed is interpreted through articulation appropriate to poetic aspects of art, education and research.
Resumo:
Patients treated in intensive care units require sedation and analgesia. However, sedative drugs also have potential adverse effects, and there is no single ideal sedativeanalgesic drug for these patients. Dexmedetomidine is an apha2-adrenoceptor agonist licenced for sedation of intensive care patients and patients undergoing surgery and other invasive procedures. Several routes of parenteral administration (intravenous, intramuscular, subcutaneous and intranasal) have been utilized. In the present series of studies, the pharmacokinetics and pharmacodynamics of intranasally administered dexmedetomidine as well as the gastrointestinal effects of intravenous dexmedetomidine were determined in healthy volunteers. Pharmacokinetics of dexmedetomidine during long lasting, high-dose infusions were characterized in intensive care patients. The bioavailability of intranasal dexmedetomidine was relatively good (65%), but interindividual variation was large. Dexmedetomidine significantly inhibited gastric emptying and gastrointestinal transit. In intensive care patients, the elimination half-life of dexmedetomidine was somewhat longer than reported for infusions of shorter duration and in less ill patients or healthy volunteers. Dexmedetomidine appeared to have linear pharmacokinetics up to the studied dose rate of 2.5 μg/kg/h. Dexmedetomidine clearance was decreasing with age and its volume of distribution was increased in hypoalbuminaemic patients, resulting in a longer elimination half-life and context-sensitive half-time. Intranasally administered dexmedetomidine was efficacious and well tolerated, making it appropriate for clinical situations requiring light sedation. The clinical significance of the gastrointestinal inhibitory effects of dexmedetomidine should be further evaluated in intensive care patients. The possibility of potentially altered potency and effect duration should be taken into account when administering dexmedetomidine to elderly or hypoalbuminaemic patients.
Resumo:
Supply chain risk management has emerged as an increasingly important issue in logistics as disruptions in the supply chain have become critical issues for many companies. The scientific literature on the subject is developing and in many respects the understanding of it is still in its infancy. Thus, there is a need for more information in order for scholars and practitioners to understand the causalities and interrelations that characterise the phenomenon. The aim of this dissertation is to narrow this gap by exploring key aspects of supply chain risk management through two maritime supply chains in the immediate region of the Gulf of Finland. The study contributes to the field in three different ways. Firstly, it facilitates the identification of risks on different levels of the supply chain through a systematic analysis of the processes and actors, and of the cognitive barriers that limit the actors’ visibility and their understanding of the operations and the risks involved. There is a clear need to increase collaboration and information exchange in order to improve visibility in the chain. Risk management should be a collaborative effort among the individual actors, aimed at obtaining a holistic picture. Secondly, the study contributes to the literature on risk analysis through the use of systemic frameworks that illustrate the causalities and linkages in the system, thereby making it easier to perceive the vulnerabilities. Thirdly, the study enhances current knowledge of risk control in identifying actor roles, risk visibility and risk controllability as being among the key factors determining risk-management effectiveness against supply-chain vulnerability. This dissertation is divided into two parts. The first part gives a general overview of the relevant literature, the research design and the conclusions of the study, and the second part comprises six research publications. Case-study methodology with systematic combining approach is used, where in-depth interviews, questionnaires and expert panel sessions are the main data collection methods. The study illustrates the current state of risk management in multimodal maritime supply chains, and develops frameworks for further analysis. The results imply that there are major differences between organizations in their ability to execute supply chain risk management. Further collaboration should be considered in order to facilitate the development of systematic and effective management processes.