904 resultados para Surgical instruments and apparatus
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The introduction of online delivery platforms such as learning management systems (LMS) in tertiary education has changed the methods and modes of curriculum delivery and communication. While course evaluation methods have also changed from paper-based in-class-administered methods to largely online-administered methods, the data collection instruments have remained unchanged. This paper reports on a small exploratory study of two tertiary-level courses. The study investigated why design of the instruments and methods to administer surveys in the courses are ineffective measures against the intrinsic characteristics of online learning. It reviewed the students' response rates of the conventional evaluations for the courses over an eight-year period. It then compared a newly developed online evaluation and the conventional methods over a two-year period. The results showed the response rates with the new evaluation method increased by more than 80% from the average of the conventional evaluations (below 30%), and the students' written feedback was more detailed and comprehensive than in the conventional evaluations. The study demonstrated the possibility that the LMS-based learning evaluation can be effective and efficient in terms of the quality of students' participation and engagement in their learning, and for an integrated pedagogical approach in an online learning environment.
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This chapter is focussed on the various financial instruments and incentives that have been implemented in a range of countries to encourage sustainable developments in all property sectors. It is an area that has undergone substantial change globally since 2008. Sustainable property development has been impacted by the Global Financial Crisis, particularly with regards to the availability of private sector funding and the requirements of funders who now have a more cautious approach to risk. Sustainability, and sometimes a lack of it, is increasingly viewed as a risk in some markets; it is also seen as an area in which governments, through creation of markets and through the use of fiscal instruments can seek to speed up the pace at which the economics of sustainable development makes good business sense. However, it is not just governments that provide the incentive for sustainability- or the dis-incentive for non-sustainable behaviours.
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Building energy-efficiency (BEE) is the key to drive the promotion of energy saving in building sector. A large variety of building energy-efficiency policy instrument exist. Some are mandatory, some are soft scheme, and some use economic incentives from country to country. This paper presents the current development of implementing BEE policy instruments by examining the practices of BEE in seven selected countries and regions. In the study, BEE policy instruments are classified into three groups, including mandatory administration control instruments, economic incentive instruments and voluntary scheme instruments. The study shows that different countries have adopted different instruments in their practices for achieving the target of energy-saving and gained various kinds of experiences. It is important to share these experiences gained.
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There is a large amount of research conducted each year examining every aspect of the mechanics of the human body and its interaction with medical devices and the environment; from the cellular level through to the whole body. While, as researchers, we obtain great pleasure from conducting studies and creating new knowledge we need to keep in mind that while this is a good thing it is even better if this new knowledge can lead to improvement in the quality of life for individuals suffering from biomechanical disorders. Such that while commercialisation is a good aim, not all research leads to marketable outcomes. However, it can lead to improvements in surgical techniques and clinical practice. It is important for us to identify and promote how the outcomes of research lead to improvements in quality of care, as this is perhaps the most important outcome for individual patients.
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A systematic study of Ar ion implantation in cupric oxide films has been reported. Oriented CuO films were deposited by pulsed excimer laser ablation technique on (1 0 0) YSZ substrates. X-ray diffraction (XRD) spectra showed the highly oriented nature of the deposited CuO films. The films were subjected to ion bombardment for studies of damage formation, Implantations were carried out using 100 keV Arf over a dose range between 5 x 10(12) and 5 x 10(15) ions/cm(2). The as-deposited and ion beam processed samples were characterized by XRD technique and resistance versus temperature (R-T) measurements. The activation energies for electrical conduction were found from In [R] versus 1/T curves. Defects play an important role in the conduction mechanism in the implanted samples. The conductivity of the film increases, and the corresponding activation energy decreases with respect to the dose value.
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The aim of this study is to define and analyse the symbolism hidden in the gamelan music of the Central Javanese, especially in the Yogyakartanese wayang kulit shadow theatre. This dissertation is divided into two parts. The first part deals with the theory, history and practice of Central Javanese shadow theatre. It also presents the tone symbol theory on which this study is based of B. Y. H. Sastrapustaka, the court servant and musician of the sultan s palace of Yogyakarta. For historical comparison, other theories and phenomena that seem to have some connections with the previously mentioned tone symbol theory are presented here as well as the equipment of the shadow theatre, its music, musical instruments and the shadow theatre in general in literature. The theoretic-methodological basis of the study is an enlarged model of research of cultural music, in which a person in the centre of the model with his/her concepts and by his/her behaviour creates a work of art and receives criticism through feedback, while the process of reciprocal action dynamically affects the whole development of the culture in question. In connection with the concepts of the work of art, the manner of approach of this study is also semiotic as the tone symbol theory gives a particular meaning to each musical note. Thus the purpose of this study is to find answers to how the tone symbol theory manifests itself in practical music making, what its origin is, if it is well known or not, and whether shadow theatre music supports this theory. The second part of this dissertation deals with material collected through interviews and observations as well as representative samples of musical pieces for shadow theatre and their analyses. In relation to this a special tool for analysing gamelan music, developed for the purpose of this study, is also presented. Sufficiently versatile material on the essence and meaning of the shadow theatre collected from many puppet masters of an older generation, many of whom are no longer with us, constitutes an important part of this study. This study proves that the tone symbol theory of Sastrapustaka is of tantristic tradition from the Hindu-Javanese period before the 16th century and before the appearance of Islam in Java. The variants of the previously mentioned theory can be found also in other fields of Javanese advanced civilization, such as architecture and dance. But it seems that knowledge about the tone symbolism connected to the shadow theatre especially has only been preserved in the sultan s palace of Yogyakarta and its intimate circles. The outsider puppet masters surely follow the theory, but they do not necessarily know its origin. As a result of the musical analysis, it is obvious that the musical pieces used for the shadow theatre bear different kinds of symbolic meanings which only an initiated person can feel and understand. These meanings are closely related to the plot of the play at the moment.
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Surgical treatment of lumbar spinal stenosis (LSS) is a treatment option for those patients who remain severely symptomatic after a course of conservative treatment. Majority of the patients treated surgically enjoy good-to-excellent outcomes with respect to pain alleviation and functional recovery. However, between 20% and 40% of the patients who have surgery for LSS do not benefit from it. The knowledge of the psychological factors associated with recovery and treatment outcome is still scarce. The aim of this study was to assess LSS patients selected for surgical treatment. Specifically, the study assessed the prevalence of depression (Beck Depression Inventory, BDI) before surgical treatment and three months after the treatment. Also preoperative life satisfaction (four-item Life Satisfaction scale) of the LSS patients was studied. Furthermore, the patients satisfaction with surgery outcome at the three months postoperative stage was studied. One-fifth (20%) of the LSS-patients were found to have depression preoperatively. The patients assessments of the pain intensity or location were not associated with depression. The factors that did associate with depression were subjective disability of everyday living and poor life satisfaction. In addition to this, low sense of coherence and poor life satisfaction were associated with depression in logistic regression models. Significant associations were seen between preoperative depression and postoperative high disability scores, high symptom severity scores and higher pain intensity ratings. The patients with continuous depression (60% of the patients who had preoperative depression) showed less improvement in symptom severity, disability, pain and walking capacity than the patients who did not experience depression at any stage. In those patients who recovered from depression (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. One-fourth (25%) of the preoperative patients with LSS were found to be dissatisfied with life. The dissatisfied patients were significantly younger and had more self-reported somatic comorbidity. The dissatisfied patients had also elevated subjective disability scores and more extensive pain locations. Also lower coping resources and higher BDI scores were associated with life dissatisfaction. Younger age and somatic comorbidity were associated with life dissatisfaction in regression models. Two-thirds (66%) of the patients were at least clearly satisfied with the surgery outcome at three months postoperative stage. In group comparisons, the lack of physical, functional and emotional well-being was associated with the patients dissatisfaction with the surgery outcome. Younger age, postoperative symptom severity, disability and depression were independently associated with dissatisfaction with the surgery outcome. The results show that depression and psychological well-being are important factors with respect to LSS patients functional ability and recovery both before and three months after surgical treatment. Therefore, the clinical practice recommendations should include an assessment of depression
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Achieving sustainable consumption patterns is a crucial step on the way towards sustainability. The scientific knowledge used to decide which priorities to set and how to enforce them has to converge with societal, political, and economic initiatives on various levels: from individual household decision-making to agreements and commitments in global policy processes. The aim of this thesis is to draw a comprehensive and systematic picture of sustainable consumption and to do this it develops the concept of Strong Sustainable Consumption Governance. In this concept, consumption is understood as resource consumption. This includes consumption by industries, public consumption, and household consumption. Next to the availability of resources (including the available sink capacity of the ecosystem) and their use and distribution among the Earth’s population, the thesis also considers their contribution to human well-being. This implies giving specific attention to the levels and patterns of consumption. Methods: The thesis introduces the terminology and various concepts of Sustainable Consumption and of Governance. It briefly elaborates on the methodology of Critical Realism and its potential for analysing Sustainable Consumption. It describes the various methods on which the research is based and sets out the political implications a governance approach towards Strong Sustainable Consumption may have. Two models are developed: one for the assessment of the environmental relevance of consumption activities, another to identify the influences of globalisation on the determinants of consumption opportunities. Results: One of the major challenges for Strong Sustainable Consumption is that it is not in line with the current political mainstream: that is, the belief that economic growth can cure all our problems. So, the proponents have to battle against a strong headwind. Their motivation however is the conviction that there is no alternative. Efforts have to be taken on multiple levels by multiple actors. And all of them are needed as they constitute the individual strings that together make up the rope. However, everyone must ensure that they are pulling in the same direction. It might be useful to apply a carrot and stick strategy to stimulate public debate. The stick in this case is to create a sense of urgency. The carrot would be to articulate better the message to the public that a shrinking of the economy is not as much of a disaster as mainstream economics tends to suggest. In parallel to this it is necessary to demand that governments take responsibility for governance. The dominant strategy is still information provision. But there is ample evidence that hard policies like regulatory instruments and economic instruments are most effective. As for Civil Society Organizations it is recommended that they overcome the habit of promoting Sustainable (in fact green) Consumption by using marketing strategies and instead foster public debate in values and well-being. This includes appreciating the potential of social innovation. A countless number of such initiatives are on the way but their potential is still insufficiently explored. Beyond the question of how to multiply such approaches, it is also necessary to establish political macro structures to foster them.
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In 1916, the Jewish community of Boston established Beth Israel Hospital on Townsend Street in Roxbury to provide health care to immigrants in the area. Although accessible to everyone, the hospital provided Yiddish-speaking services for Eastern European Jewish immigrants and served kosher food, as well as conducted Jewish religious services. In 1928 the hospital entered into a teaching agreement with Harvard Medical School, Tufts University, and Simmons College. Shortly thereafter, the hospital moved to its current location in the Longwood area of Boston and expanded to a 220-bed operation. During 1935-1936, at the height of the Depression, Beth Israel spent 1.5 million dollars in free patient care and was only one of two local hospitals to offer health care to people on welfare. In 1996, Beth Israel Hospital merged with Deaconess Medical Center and became Beth Israel Deaconess Medical Center. This collection contains reports, pamphlets and hospital publications.
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Nature conservation in everyday life: Private landowners perceptions of and experiences on temporary nature conservation and its renewing process This study explores the legitimacy of official nature conservation of private lands. It describes how temporary nature conservation became a part of Finnish nature conservation policy and how forest owners perceived this tool and its usage. In addition, the study analyses forest owners' attitudes on official nature conservation. The study combines individual and official perspectives, and presents a nature conservation politics of everyday life. The theoretical background of the study is learning processes of environmentally responsible participation, and especially empowerment. Main methods in gathering the material for the study have been interviews and a survey. In the 1990 s, Finnish landowners opposed the implementation of nature conservation, especially conservation of shores and the establishment of the European-wide network of conservation areas (Natura 2000). After negative experiences on these conservation efforts, some private landowners were disempowered and some even rejected conservation completely. The Nature Conservation Act of 1996 launched an option to conserve nature officially for fixed time-periods. Use of such a policy tool did not immediately become a widely-used and appreciated conservation practice. During the following decade, however, it attracted remarkable attention within Finnish nature conservation policy discussions. The perspective of landowners began to be emphasised when local and regional organisations for nature conservation and forestry together defined the ideas of natural values trading. Later, the national governance process of the committee defining the Forest Biodiversity Programme for Southern Finland (METSO) institutionalised these ideas in one of its pilot projects. Landowners participated in the project of natural values trading by offering their forests for conservation, which reflects the increased acceptance and legitimacy of nature conservation on private forests. The central elements producing the legitimacy of natural values trading have been voluntariness, temporariness, and dialogue between nature conservation and forestry. Natural values trading analysed in the study is an example of new environmental policy instruments and its creation process represents governance in the implementation of nature conservation. It has increased the legitimacy of nature conservation policy of private forests in Finland. The results reveal the importance of participation and learning processes in the implementation of nature conservation policy, and the need to also pay attention to these processes in the future.
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Breast cancer is the most common form of potentially fatal cancer in women in the Western world. Better understanding of the breast cancer disease process together with developments in treatments have led to improved survival and reduced risk of recurrence, significantly influencing the acceptance of breast reconstructions as part of breast cancer treatment. Skin-sparing mastectomy followed by immediate breast reconstruction has proved superior to other forms of breast reconstruction in terms of aesthetic outcome. However, due to the relatively recent introduction of skin-sparing mastectomy concerns on the surgical and oncological safety of the operation persist. The aim of the present study is to evaluate the surgical and oncological safety of skin-sparing mastectomy and immediate breast reconstruction in a consecutive patient series with ensuing follow-up. Subsequent aims of the study are to examine possibilities of reducing surgical complications of the operation and to assess the feasibility of sentinel node biopsy together with immediate breast reconstruction. The study population comprises a consecutive series of patients having undergone skin-sparing mastectomy followed by immediate breast reconstruction at the Helsinki University Central Hospital between 1992 and 2006. In Study I, the hospital records of 207 patients, operated between 1992 and 2001, were analyzed for surgical complications and recurrences of breast cancer during follow-up. In Study II, 60 consecutive patients were randomized into either conventional diathermy or radiofrequency coagulation groups to examine possibilities of reducing skin-flap complications. Study III consists of 62 consecutive breast cancer patients evaluated for the feasibility of sentinel node biopsy simultaneously with immediate breast reconstruction. In Study IV, hospital records were analyzed to examine local recurrence of breast cancer in a consecutive series of 146 patients with Stage I or II disease. Post-operative complications in Study I included native skin-flap necrosis (10.1%), hematoma (10.1%), anastomose thrombosis (5.3%), infection (3.4%), hernia (2.6%) and loss of one microvascular flap (0.7%). The Stage I and II patients in Study IV had a local recurrence rate of 2.7%, an isolated regional lymph node recurrence rate of 2.1% and a systemic recurrence rate of 2.7%, during a mean follow-up time of 51 months. The Stage III patients in study I had a locoregional recurrence rate of 31.3% during follow-up. Radiofrequency coagulation in Study II did not decrease skin-flap complications when compared with conventional diathermy. An increased skin-flap complication rate in Study II was associated with smoking and the type of skin incision used. In Study III, eleven patients had tumor positive sentinel nodes, nine of which were detected intraoperatively. Skin-sparing mastectomy followed by immediate breast reconstruction is a safe procedure both surgically and oncologically, especially for early stage breast cancer. Tennis racket type incision is associated with an increased skin-flap complication rate. Sentinel node biopsy with intraoperative assessment of sentinel node metastases is feasible in patients undergoing immediate breast reconstruction.
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The lead based ferroelectric PbZr0.53Ti0.47O3 (PZT), (Pb0.90La0.10)TiO3 (PLT10) and (Pb0.80La0.20)TiO3 (PLT20) thin films, prepared by pulsed laser ablation technique, were studied for their response to the 70 MeV oxygen ion irradiation. The dielectric analysis, capacitance-voltage (C- V) and DC leakage current measurements were performed before and after the irradiation to high-energy oxygen ions. The irradiation produced considerable changes in the dielectric, C-V, leakage characteristics and induced some amount of amorphization. The PZT films showed partial recrystallization after a thermal annealing at 400 degrees C for 10 min. The phase transition temperature [T-c] of PLT20 increased from 115 degrees C to 120 degrees C. The DC conductivity measurements showed a shift in the onset of non-linear conduction region. The current density decreased by two orders of magnitude after irradiation. After annealing the irradiated films at a temperature of 400 degrees C for 10 min, the films partially regained the dielectric and electrical properties. The results are discussed in terms of the irradiation-induced amorphization, the pinning of the ferroelectric domains by trapped charges and the thermal annealing of the defects generated during the irradiation. (C) 2007 Elsevier B.V. All rights reserved.
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The ferroelectric Pb(Zr0.48Ti0.52)O-3 (PZT) thin films prepared by the pulsed laser deposition technique were studied for their response to high energy lithium ion irradiation through impedance spectroscopy. The Debye peaks, observed in the impedance and modulus plots of irradiatedfilms, shifts towards higher frequencies compared to those of unirradiated films. This is equivalent to the trend observed with increase in temperature in the unirradiated films due to the dielectric relaxation. The irradiated films showed a decrease in the grain resistance compared to the unirradiated films. The activation energy of dielectric relaxation increases from 1.25 eV of unirradiated film to 1.62 eV of irradiated film. The observed modifications in the irradiated film were ascribed to the modifications in the grain structure due to the high value of electronic energy loss.
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Counting-rate meters normally used for finding pulse frequencies are sluggish in their response to any rapid change in the pulse repetition frequency (P.R.F.). An instrument is described which measures each pulse interval and provides immediately afterwards an output voltage proportional to the reciprocal of interval duration. A response to a change in the P.R.F. as rapidly as is physically possible is obtained. The instrument has wide application in low level radiation detection and in several other fields especially for rapidly varying counting-rates.