881 resultados para mapping the current state


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Diplomityö on tehty Mikkelin ammattikorkeakoululle tavoitteenaan kartoittaa kyseisen organisaation innovaatiotoiminnan nykytila. Tunnistamalla innovaatiotoiminnan puutteet sekä hyvät käytännöt, voidaan toimintaa kehittää määrätietoisesti. Nykytilan kartoitus toteutettiin käytäntölähtöisen innovaatiotoiminnan näkökulmasta käsin. Työn teoreettinen tausta rakentuu ammattikorkeakoulujen TKI-toiminnan muutoksen, innovaatioiden ja innovaatiotoiminnan käytäntölähtöisyyden ympärille. Empiirinen aineisto kerättiin kyselytutkimuksen avulla, joka toteutettiin Mikkelin ammattikorkea-koulun henkilöstölle keväällä 2012. Tehdyssä tutkimuksessa oli kvalitatiivisen tutkimus-menetelmän lisäksi piirteitä kvantitatiivisesta tutkimusmenetelmästä, johtuen kyselyssä esitettyjen kysymysten luonteesta. Tutkimustulosten perusteella innovaatiotoiminnan nykytila ja siihen vaikuttavat tekijät kyettiin kuvaamaan. MAMKin innovaatiotoimintaan liittyvistä osa-alueista osassa käytännöt ja puitteet tukivat käytäntölähtöistä innovaatiotoimintaa, mutta myös selkeitä kehityskohteita havaittiin. Suurimmat kehityskohteet liittyivät sisäiseen verkostoitumiseen sekä henkilöstön ja opiskelijoiden innovaatiopotentiaalin täysimääräiseen hyödyntämiseen. Saatujen tulosten perusteella esitettiin keinoja innovaatiotoiminnan tehostamiseksi ja kehittämiseksi. Saadut tulokset ja niiden pohjalta annetut kehitysehdotukset luovat hyvät lähtökohdat Mikkelin ammattikorkeakoulun innovaatiotoiminnan kehittämiselle.

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The purpose of the study is to determine general features of the supply chain performance management system, to assess the current state of performance management in the case company mills and to make proposals for improvement – how the future state of performance management system would look like. The study covers four phases which consist of theory and case company parts. Theoretical review gives understanding about performance management and measurement. Current state analysis assesses the current state of performance management in the mills. Results and proposals for improvement are derived from current state analysis and finally the conclusions with answers to research questions are presented. Supply chain performance management system consists of five areas: perfor-mance measurement and metrics, action plans, performance tracking, performance dialogue and rewards, consequences and actions. The result of the study revealed that all mills were quite average level in performance management and there is a room for improvement. Created performance improvement matrix served as a tool in assessing current performance management and could work also as a tool in the future in mapping the current state after transformation process. Limited harmonization was revealed as there were different ways to work and manage performance in the mills. Lots of good ideas existed though actions are needed to make a progress. There is also need to harmonize KPI structure.

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In 1997, the Adoption and Safe Families Act shifted from the preservation of families to an emphasis on safety, permanency, and well-being through expediting the termination of parental rights, establishing exceptions to the reasonable efforts clause of preserving the family, and fiscal incentives for finalizing adoptions. The current project assessed the role of a full service array in achieving the outcomes set forth in ASF A. Concept mapping was utilized to elicit information from participants (both urban and rural) regarding the identified research question. Participants recognized family preservation versus safety, community connections, mandates versus reality, and worker recruitment and retention as critical components for meeting ASFA goals. Perceived importance and level of success in implementing these services was also highlighted. Recommendations supported through the data are also provided.

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Purpose: The aim of this educational poster is to introduce the technical principles of cerebral perfusion CT and to provide examples of its clinical applications and potential limitations in the everyday emergency practice. Methods and materials: Cerebral perfusion CT is a well established investigatory tool for many vascular and parenchymal brain dysfunctions. CT perfusion maps allow a semiquantitative assessment of cerebral perfusion. Results: Currently, cerebral perfusion CT has a pivotal role in differentiating reversible from irreversible ischemic parenchymal insult besides its integral role in grading vasospasm after subarachnoid hemorrhage. Furthermore, cerebral perfusion CT can be coupled to acetazolamide administration in order to assess the cerebrovascular reserve capacity before performing extra-/intra-cranial bypass surgery in patients with cerebral vascular insufficiency. Cerebral perfusion CT can also identify diffuse abnormalities of cerebral perfusion in children with traumatic brain injury showing a low initial GCS in order to predict the final outcome regarding the late occurrence of irreversible parenchymal damage. Cerebral Perfusion CT is also able to detect focal parenchymal perfusion abnormalities in acute epileptic seizures. Conclusion: Cerebral perfusion CT can be integrated in the management of many vascular, traumatic and functional disorders of the brain.

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More than 60% of neuroendocrine tumours, also called carcinoids, are localised within the gastrointestinal tract. Small bowel neuroendocrine tumours have been diagnosed with increasing frequency over the past 35 years, being the second most frequent tumours of the small intestine. Ileal neuroendocrine tumours diagnosis is late because patients have non-specific symptoms. We have proposed to illustrate as an example the case of a patient, and on its basis, to make a brief review of the literature on small bowel neuroendocrine tumours, resuming several recent changes in the field, concerning classification criteria of these tumours and new recommendations and current advances in diagnosis and treatment. This patient came to our emergency department with a complete bowel obstruction, along with a 2-year history of peristaltic abdominal pain, vomits and diarrhoea episodes. During emergency laparotomy, an ileal stricture was observed, that showed to be a neuroendocrine tumour of the small bowel.

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During the last two decades, endoscopic endonasal approach has completed the minimally invasive skull base surgery armamentarium. Endoscopic endonasal skull base surgery (EESBS) was initially developed in the field of pituitary adenomas, and gained an increasing place for the treatment of a wide variety of skull base pathologies, extending on the midline from crista galli process to the occipitocervical junction and laterally to the parasellar areas and petroclival apex. Until now, most studies are retrospective and lack sufficient methodological quality to confirm whether the endoscopic endonasal pituitary surgery has better results than the microsurgical trans-sphenoidal classical approach. The impressions of the expert teams show a trend toward better results for some pituitary adenomas with the endoscopic endonasal route, in terms of gross total resection rate and probably more comfortable postoperative course for the patient. Excepting intra- and suprasellar pituitary adenomas, EESBS seems useful for selected lesions extending onto the cavernous sinus and Meckel's cave but also for clival pathologies. Nevertheless, this infatuation toward endoscopic endonasal approaches has to be balanced with the critical issue of cerebrospinal fluid leaks, which constitutes actually the main limit of this approach. Through their experience and a review of the literature, the authors aim to present the state of the art of this approach as well as its limits.

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Aim  Background The expected benefit of transvaginal specimen extraction is reduced incision-related morbidity. Objectives A systematic review of transvaginal specimen extraction in colorectal surgery was carried out to assess this expectation. Method  Search strategy The following keywords, in various combinations, were searched: NOSE (natural orifices specimen extraction), colorectal, colon surgery, transvaginal, right hemicolectomy, left hemicolectomy, low anterior resection, sigmoidectomy, ileocaecal resection, proctocolectomy, colon cancer, sigmoid diverticulitis and inflammatory bowel diseases. Selection criteria Selection criteria included large bowel resection with transvaginal specimen extraction, laparoscopic approach, human studies and English language. Exclusion criteria were experimental studies and laparotomic approach or local excision. All articles published up to February 2011 were included. Results  Twenty-three articles (including a total of 130 patients) fulfilled the search criteria. The primary diagnosis was colorectal cancer in 51% (67) of patients, endometriosis in 46% (60) of patients and other conditions in the remaining patients. A concurrent gynaecological procedure was performed in 17% (22) of patients. One case of conversion to laparotomy was reported. In two patients, transvaginal extraction failed. In left- and right-sided resections, the rate of severe complications was 3.7% and 2%, respectively. Two significant complications, one of pelvic seroma and one of rectovaginal fistula, were likely to have been related to transvaginal extraction. The degree of follow up was specified in only one study. Harvested nodes and negative margins were adequate and reported in 70% of oncological cases. Conclusion  Vaginal extraction of a colorectal surgery specimen shows potential benefit, particularly when associated with a gynaecological procedure. Data from prospective randomized trials are needed to support the routine use of this technique.

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Panel at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

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Presenta el modo en que se ha tratado el tema del Estado en la CEPAL, senala críticas que el mismo ha provocado, esboza la manera en que debería reformularse dicho tema a la luz de las circunstancias políticas actuales de la región y de los requisitos de una estrategia de desarrollo autónoma, equitativa y democrática.

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This paper presents a pulsewidth modulation dc-dc nonisolated buck converter using the three-state switching cell, constituted by two active switches, two diodes, and two coupled inductors. Only part of the load power is processed by the active switches, reducing the peak current through the switches to half of the load current, as higher power levels can then be achieved by the proposed topology. The volume of reactive elements, i.e., inductors and capacitors, is also decreased since the ripple frequency of the output voltage is twice the switching frequency. Due to the intrinsic characteristics of the topology, total losses are distributed among all semiconductors. Another advantage of this converter is the reduced region for discontinuous conduction mode when compared to the conventional buck converter or, in other words, the operation range in continuous conduction mode is increased, as demonstrated by the static gain plot. The theoretical approach is detailed through qualitative and quantitative analyses by the application of the three-state switching cell to the buck converter operating in nonoverlapping mode $(D < 0.5)$. Besides, the mathematical analysis and development of an experimental prototype rated at 1 kW are carried out. The main experimental results are presented and adequately discussed to clearly identify its claimed advantages. © 1986-2012 IEEE.

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After 75 years of invasive and over 50 years of interventional cardiology, cardiac catheter-based procedures have become the most frequently used interventions of modern medicine. Patients undergoing a percutaneous coronary intervention (PCI) outnumber those with coronary artery bypass surgery by a factor of 2 to 4. The default approach to PCI is the implantation of a (drug-eluting) stent, in spite of the fact that it improves the results of balloon angioplasty only in about 25% of cases. The dominance of stenting over conservative therapy or balloon angioplasty on one hand and bypass surgery on the other hand is a flagrant example of how medical research is digested an applied in real life. Apart from electrophysiological interventions, closure ot the patent foramen ovale and percutaneous replacement of the aortic valve in the elderly have the potential of becoming daily routine procedures in catheterization laboratories around the world. Stem cell regeneration of vessels or heart muscle, on the other hand, may remain a dream never to come true.

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Myocardial tissue engineering aims to repair, replace, and regenerate damaged cardiac tissue using tissue constructs created ex vivo. This approach may one day provide a full treatment for several cardiac disorders, including congenital diseases or ventricular dysfunction after myocardial infarction. Although the ex vivo construction of a myocardium-like tissue is faced with many challenges, it is nevertheless a pressing objective for cardiac reparative medicine. Multidisciplinary efforts have already led to the development of promising viable muscle constructs. In this article, we review the various concepts of cardiac tissue engineering and their specific challenges. We also review the different types of existing biografts and their physiological relevance. Although many investigators have favored cardiomyocytes, we discuss the potential of other clinically relevant cells, as well as the various hypotheses proposed to explain the functional benefit of cell transplantation.

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This descriptive study assesses the current status of mental illness in Bendel State of Nigeria to determine its implications for mental health policy and education. It is a study of the demographic characteristics of psychiatric patients in the only two modern western psychiatric facilities in Bendel State, the various treatment modalities utilized for mental illness, and the people's choice of therapeutic measures for mental illness in Bendel State.^ This study investigated ten aspects of mental illness in Bendel State (1) An increase of the prevalence of mental illness (psychiatric disorder) in Bendel State. (2) Unaided, unguided, and uncared for mentally ill people roaming about Bendel State. (3) Pluralistic Treatment Modalities for mentally ill patients in Bendel State. (4) Traditional Healers treating more mentally ill patients than the modern western psychiatric hospitals. (5) Inadequate modern western psychiatric facilities in Bendel State. (6) Controversy between Traditional Health and modern western trained doctors over the issue of possible cooperation between traditional and modern western medicine. (7) Evidence of mental illness in all ethnic groups in Bendel State. (8) More scientifically based and better organized modern western psychiatric hospitals than the traditional healing centers. (9) Traditional healers' level of approach with patients, and accessibility to patients' families compared with the modern western trained doctors. (10) An urgent need for an official action to institute a comprehensive mental health policy that will provide an optimum care for the mentally ill in Bendel State, and in Nigeria in general.^ Of the eight popular treatment modalities generally used in Bendel State for mental illness, 54% of the non-patient population sampled preferred the use of traditional healing, 26.5% preferred the use of modern western treatment, and 19.5% preferred religious healers.^ The investigator concluded at this time not to recommend the integration of Traditional Healing and modern western medicine in Nigeria. Rather, improvement of the existing modern western psychiatric facilities and a proposal to establish facilities to enable traditional healing and modern western medicine to exist side by side were highly recommended. ^