869 resultados para Coordinated and Multiple Views


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We report a rare case of a 50 year old man with renal squamous cell carcinoma (SCC) who first came to our attention with renal colic and fever not responding to antibiotic or analgesic treatment. He had a long history of kidney stones, but had not undergone any imaging in the last 5 years. Physical examination revealed tenderness and a palpable mass in the right flank and lumbar region. A whole body CT scan was performed, revealing an 11 cm mass in the right kidney infiltrating the inferior vena cava. There were areas of calcification within the mass and multiple stones within the renal pelvis. The tumor was considered unsuitable for resection according to radiological and clinical criteria. The mass was biopsied percutaneously under CT guidance and histological examination revealed squamous cell carcinoma of the renal pelvis. The patient was treated with neoadjuvant chemotherapy and embolization of the renal artery. He died one month after diagnosis. To our knowledge this is the second reported case in the world of renal SCC infiltrating the inferior vena cava and with kidney stones.

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Only recently, during the past five years, consumer electronics has been evolving rapidly. Many products have started to include “smart home” capabilities, enabling communication and interoperability of various smart devices. Even more devices and sensors can be remote controlled and monitored through cloud services. While the smart home systems have become very affordable to average consumer compared to the early solutions decades ago, there are still many issues and things that need to be fixed or improved upon: energy efficiency, connectivity with other devices and applications, security and privacy concerns, reliability, and response time. This paper focuses on designing Internet of Things (IoT) node and platform architectures that take these issues into account, notes other currently used solutions, and selects technologies in order to provide better solution. The node architecture aims for energy efficiency and modularity, while the platform architecture goals are in scalability, portability, maintainability, performance, and modularity. Moreover, the platform architecture attempts to improve user experience by providing higher reliability and lower response time compared to the alternative platforms. The architectures were developed iteratively using a development process involving research, planning, design, implementation, testing, and analysis. Additionally, they were documented using Kruchten’s 4+1 view model, which is used to describe the use cases and different views of the architectures. The node architecture consisted of energy efficient hardware, FC3180 microprocessor and CC2520 RF transceiver, modular operating system, Contiki, and a communication protocol, AllJoyn, used for providing better interoperability with other IoT devices and applications. The platform architecture provided reliable low response time control, monitoring, and initial setup capabilities by utilizing web technologies on various devices such as smart phones, tablets, and computers. Furthermore, an optional cloud service was provided in order to control devices and monitor sensors remotely by utilizing scalable high performance technologies in the backend enabling low response time and high reliability.

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Happier employees are more productive. Organizations across industry, no doubt, try to improve their employees’ happiness with the objective to achieve higher profitability and company value. While this issue has drawn increasing attention in high tech and other industries, little is known about the happiness of project management professionals. More research is needed to explore the current situation of workplace happiness of project management professionals and the driving factors behind it. This thesis explores the workplace happiness (subjective well-being) of project management professionals based on the exploratory statistical analysis of a survey 225 professionals in the state of Maryland, conducted in October 2014. The thesis applies Structural Equation Modeling and multiple regression analysis to the dataset and shows no significant impact of gender, age, work experience, and some other demographic traits on workplace happiness, also named well-being. Statistically significant factors for workplace happiness include: creating pleasant work environment, promoting open organization and well-managed team, and good organization to work for. With respect to the reliability of self-reporting, the study finds that the comprehensive appraisal tool designed by Happiness Works and New Economics Foundation can give a more reliable happiness evaluation. Two key factors, i.e. career perspectives and free to be self, can help alleviate the overconfidence of workplace happiness.

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Aim This paper will report findings from the first phase of an evaluation of a new e-health intervention designed to allow mothers to ‘see’ their baby in neonatal care (NNU) when they are not able to be with them. The intervention, MyLittleOne, involves a web-camera being placed over the incubator in NNU, which transmits a real-time video wirelessly to a coupled tablet device at the mother’s bedside. Guided by the MRC Framework for the Development and Evaluation of Healthcare Interventions (MRC, 2008), the aim was to explore parent and professional views of the technology and make recommendations for its future development, use and evaluation. Methods A qualitative approach was adopted, guided by a critical realist perspective (McEvoy and Richards, 2003). The study took place in a Level 3 NNU in Scotland. Participants were recruited purposively and included parents (n = 33) and a range of health professionals working in neonatal and postnatal care (n = 21). The data were collected during semi-structured individual, paired and small group interviews and were analysed thematically using NVivo v10. Results The majority of parents and professionals spoke positively about MyLittleOne. Perceptions were that: use of the technology assisted bonding and responsiveness; it promoted the recovery process following birth; and, for mothers who wished to breast-feed, being able to see their baby on the tablet device encouraged the ‘let-down’ reflex. An additional benefit was that siblings and others who may not be able to visit the NNU were able to see the baby. In contrast, for a small number of mothers, viewing their baby remotely appeared to increase their levels of anxiety. Switching off the camera during a medical procedure and back on after the procedure was completed was found to be problematic, at times and in different ways, for both parents and professionals. Conclusions Findings from this preliminary evaluation will guide future developments of the technology, including its use in family homes following the mother’s discharge. The findings will also inform the design of a feasibility study and subsequent RCT to assess the impact of MyLittleOne on a range of psychological indicators of postnatal adjustment.

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Importance: critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. Objective: to evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post–intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. Design, Setting, and Participants: a parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. Interventions: during the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. Main Outcomes and Measures: the Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Results: median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, −0.2 [95% CI, −1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, −0.1 [95% CI, −3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, −3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. Conclusions and Relevance: post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.

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Low-temperature magneto-photoluminescence is a very powerful technique to characterize high purity GaAs and InP grown by various epitaxial techniques. These III-V compound semiconductor materials are used in a wide variety of electronic, optoelectronic and microwave devices. The large binding energy differences of acceptors in GaAs and InP make possible the identification of those impurities by low-temperature photoluminescence without the use of any magnetic field. However, the sensitivity and resolution provided by this technique rema1ns inadequate to resolve the minute binding energy differences of donors in GaAs and InP. To achieve higher sensitivity and resolution needed for the identification of donors, a magneto-photoluminescence system 1s installed along with a tunable dye laser, which provides resonant excitation. Donors 1n high purity GaAs are identified from the magnetic splittings of "two-electron" satellites of donor bound exciton transitions 1n a high magnetic field and at liquid helium temperature. This technique 1s successfully used to identify donors 1n n-type GaAs as well as 1n p-type GaAs in which donors cannot be identified by any other technique. The technique is also employed to identify donors in high purity InP. The amphoteric incorporation of Si and Ge impurities as donors and acceptors in (100), (311)A and (3ll)B GaAs grown by molecular beam epitaxy is studied spectroscopically. The hydrogen passivation of C acceptors in high purity GaAs grown by molecular beam epitaxy (MBE) and metalorganic chemical vapor deposition (MOCVD) 1s investigated using photoluminescence. Si acceptors ~n MBE GaAs are also found to be passivated by hydrogenation. The instabilities in the passivation of acceptor impurities are observed for the exposure of those samples to light. Very high purity MOCVD InP samples with extremely high mobility are characterized by both electrical and optical techniques. It is determined that C is not typically incorporated as a residual acceptor ~n high purity MOCVD InP. Finally, GaAs on Si, single quantum well, and multiple quantum well heterostructures, which are fabricated from III-V semiconductors, are also measured by low-temperature photoluminescence.

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Stressful life events early in life, including symptoms of mental disorders or childhood maltreatment, may increase risk for worse mental and physical health outcomes in adulthood. The purpose of this dissertation was to examine the effects of childhood Attention Deficit Hyperactivity Disorder (ADHD) symptoms and maltreatment experience on two adult outcomes: obesity and alcohol use disorder (AUD). Mediational effects of adolescent characteristics were explored. This dissertation used Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health. In Paper 1 (Chapter 3), we investigated the association between multiple types of child maltreatment and adult objective (body mass index; BMI) and subjective (self-rated) obesity, as well as mediating effects by adolescent characteristics including depressive symptoms and BMI. Results showed that after adjusting for sex, race/ethnicity, and maternal education, physical maltreatment was moderately associated with adulthood obesity as measured by BMI and self-reported obesity, while sexual maltreatment was more strongly associated with the objective measure but not the subjective measure. The indirect effects of mediation of adolescent BMI and depressive symptoms were statistically significant. In Paper 2 (Chapter 4), the objective was to examine mediation by adolescent depressive symptoms, alcohol consumption, peer alcohol consumption, and delinquency in the relationship between ADHD symptoms and adult AUD. The indirect effects of mediation of adolescent delinquency, alcohol consumption, and peer alcohol consumption were statistically significant in single and multiple mediator models. In Paper 3 (Chapter 5), the objective was to assess the joint effects of maltreatment/neglect on adult AUD. After adjusting for sex, race/ethnicity, child maltreatment, and parental AUD, ADHD symptoms were significantly associated with increased odds of AUD. There was no strong evidence of multiplicative interaction by maltreatment. This association was stronger for males than females, although the interaction term was not statistically significant. This dissertation adds to the literature by examining relationships between several major public health problems: ADHD symptoms, childhood maltreatment, AUD, depressive symptoms, and obesity. This project has implications for understanding how early life stress increases risk for later physical and mental health problems, and identifying potential intervention targets for adolescents.

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Knowledge is one of the most important assets for surviving in the modern business environment. The effective management of that asset mandates continuous adaptation by organizations, and requires employees to strive to improve the company's work processes. Organizations attempt to coordinate their unique knowledge with traditional means as well as in new and distinct ways, and to transform them into innovative resources better than those of their competitors. As a result, how to manage the knowledge asset has become a critical issue for modern organizations, and knowledge management is considered the most feasible solution. Knowledge management is a multidimensional process that identifies, acquires, develops, distributes, utilizes, and stores knowledge. However, many related studies focus only on fragmented or limited knowledge-management perspectives. In order to make knowledge management more effective, it is important to identify the qualitative and quantitative issues that are the foundation of the challenge of effective knowledge management in organizations. The main purpose of this study was to integrate the fragmented knowledge management perspectives into the holistic framework, which includes knowledge infrastructure capability (technology, structure, and culture) and knowledge process capability (acquisition, conversion, application, and protection), based on Gold's (2001) study. Additionally, because the effect of incentives ̶̶ which is widely acknowledged as a prime motivator in facilitating the knowledge management process ̶̶ was missing in the original framework, this study included the importance of incentives in the knowledge management framework. This study also identified the relationship of organizational performance from the standpoint of the Balanced Scorecard, which includes the customer-related, internal business process, learning & growth, and perceptual financial aspects of organizational performance in the Korean business context. Moreover, this study identified the relationship with the objective financial performance by calculating the Tobin's q ratio. Lastly, this study compared the group differences between larger and smaller organizations, and manufacturing and nonmanufacturing firms in the study of knowledge management. Since this study was conducted in Korea, the original instrument was translated into Korean through the back translation technique. A confirmatory factor analysis (CFA) was used to examine the validity and reliability of the instrument. To identify the relationship between knowledge management capabilities and organizational performance, structural equation modeling (SEM) and multiple regression analysis were conducted. A Student's t test was conducted to examine the mean differences. The results of this study indicated that there is a positive relationship between effective knowledge management and organizational performance. However, no empirical evidence was found to suggest that knowledge management capabilities are linked to the objective financial performance, which remains a topic for future review. Additionally, findings showed that knowledge management is affected by organization's size, but not by type of organization. The results of this study are valuable in establishing a valid and reliable survey instrument, as well as in providing strong evidence that knowledge management capabilities are essential to improving organizational performance currently and making important recommendations for future research.

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This study answers to How scenario analysis could help acquiring companies to reduce uncertainty in the acquisition process? It is due to the mismatch between academic world’s caveat emptor and business world’s eagerness to pursue acquisitions that motivated this study. Acquisitions are as popular as ever, thus, managing the uncertainty surrounding these transactions is relevant. This study creates a generic theoretical model with a strategy-level scope. Thus, the study does not discuss nor does it seek answers to operational issues related in both fields. This study is explorative and constructivist in nature. It discusses briefly the concepts and relatedness of risk and uncertainty and establishes a hierarchy between these two: Risks being a “sub-section” of uncertainty, although not with clear boundaries. Acquisition theory follows the process view that understands acquisitions as a process with various levels – some strategic, some operational. Scenario analysis is presented as tool for management to enrich their strategic discussion and understand their future options. The empirical data collection is done through interviewing. The results are reflected on literature on strategic management, scenario literature, and on a consultancy’s report picturing firm’s strategies in accordance with their acquisition processes. The study has an abductive approach as it tries to combine multiple views and generates discussion between literature review, interviews, the report, and second round of literature. The model suggests three propositions: First, at the strategic decision making level, when the decision whether or not to pursue an acquisition growth strategy has been made, it provides firms new data and enriches the strategic discussion. Second, when the acquisition strategy has been created, it can be applied as a tool to measure possible acquisition targets against the backdrop of the first set of scenarios. Third, due to the scenario analysis’ requirement to include people with various backgrounds and from multiple levels of the corporate hierarchy, it could help managers to avoid biases stemming from hubris.

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Background and aims: Head injury (HI) is a cause of cognitive impairment within the homeless population (Hwang et al, 2008). One study reported that over a 30-year period, the prevalence of hospitalised HI was 5.4 times higher in the homeless than in the general population (McMillan et al, 2015). This study explores the perceptions of homeless adults who have sustained a HI and their views regarding the relevance of HI to their homeless status. Methods: Participants were seven homeless adults with a moderate or severe HI. They were asked to talk about their journey to homelessness and in particular, to reflect on any perceived links between HI and their homeless status. The data were analysed using Interpretative Phenomenological Analysis (IPA). Results and conclusions: Emerging themes included: impairment following HI; substance misuse, feeling let down by services and difficult relationships with family. Evidence for the role of HI in precipitating and maintaining homelessness was found. Despite this, co-morbid difficulties complicate the picture. Four out of seven participants viewed substance misuse as their primary difficulty. This illustrates the need for in-depth assessment within this population in order to ensure that difficulties are fully understood and that the correct supports/ interventions are offered.

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This thesis identifies and defines the new African sovereignty. It establishes a modern sovereignty in Africa hatched from the changing nature of sovereignty in which countries come together at various levels or grades of partial surrender of national sovereignty in order to work closer together for their mutual advantage and benefit. To this end, the narrative zooms in on the central issues within the realms of money matters whereby a new model of monetary sovereignty and monetary solutions is designed in an attempt to ease the recurring tensions and challenges of modern national sovereignty in the continent of Africa. As such, this discussion will offer a historical journey through the constitution of sovereignty, to the birth of the nation state and international public law. It develops the theory of the changing nature of sovereignty within the modern state and opens new lines of inquiry for Africa. In this regard, it draws from juxtaposing and mixing elements of regional and global financial integration as well as retaining national financial sovereignty features to form this new design which I dub continental sovereignty. At its core, the thesis will deal with the legal aspects that stem from the co-mingling of legal systems of nation states and communities at the regional and global levels within the context of financial integration. The argument is that the rule of law remains sacrosanct in monetary management. Effective financial integration is the result of properly structured and managed legal frameworks with robust laws and institutions whether at a national, regional or global level. However, the thesis reveals that in order to avoid undermining the progress of Africa’s financial integration project, any solution for Africa must be immersed within a broader global solution where development issues are addressed and resolved and Africa can form a more central part in all relevant international discussion fora. The work will expound these issues by applying them within a regional and global context, with the state of affairs in Africa forming the nucleus. This application consequently presents the six key themes of the thesis which will be considered therein. They are: a.) regional advantage: which exploits the possibilities of deeper and further financial integration between smaller communal arrangements; b.) regional risk and exposure: the extent to which this deeper form of financial integration can spiral out of control if effected too quickly and too ambitiously; c.) global advantage: which considers the merits of global financial integration and the influence exerted by financial laws on the global financial architecture; d.) global risk and exposure: which considers the challenges of global financial integration especially within the background of the Global Financial Crisis 2007-2008; e.) African challenge: which considers the extent to which this analysis impacts the African economic and financial integration agenda; and f.) development challenge: which examines the extent to which global development issues impact the African solution (continental sovereignty) and the need for any solution for the continent to be roped into a broader global solution within which Africa can form an important part. Even though the thesis requests an optimistic undertone on the progress made so far, it unearths the African problem of multiple national sovereignty and multiple overlapping regional sovereignty constituted as the ‘spaghetti bowl’ dilemma. As such, the unique contribution to knowledge on financial integration in Africa can be echoed in these words: Africa‘s financial integration agenda has had little success in authenticating a systematic and dependable legal framework for monetary management. Efforts made have been incomplete, substandard, and not carefully followed through particularly reflected in the impuissant nature of the judicial enforcement mechanisms. Thus, the thesis argues that, any meaningful answer to the problems dogging the continent is inter alia deeply entrenched within a new form of cooperative monetary sovereignty. In other words, the thesis does not prescribe the creation of new laws; rather it advocates the effective enforcement of existing laws.

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Within the last few years, disabled people have become the target of government austerity measures through drastic cuts to welfare justified through the portrayal of benefit claimants as inactive, problem citizens who are wilfully unemployed. For all that is wrong with these cuts, they are one of many aspects of exclusion that disabled people face. Attitudes towards disability are deteriorating (Scope, 2011) and disabled people are devalued and negatively positioned in a myriad of ways, meaning that an understanding of the perceptions and positioning of disability and the power of disabling practices is critical. This thesis will examine how Bourdieu’s theoretical repertoire may be applied to the area of Disability Studies in order to discern how society produces oppressive and exclusionary systems of classification which structures the social position and perceptions of disability. The composite nature of disability and multiple forms of exclusion and inequality associated with it benefits from a multipronged approach which acknowledges personal, embodied and psychological aspects of disability alongside socio-political and cultural conceptualisations. Bourdieu’s approach is one in which the micro and macro aspects of social life are brought together through their meso interplay and provides a thorough analysis of the many aspects of disability.

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We report on a robust symmetry between the Polish and the Japanese sequence of syntactic projections in what superficially looks like different domains, namely verbal prefixes (Polish) and multiple verbs (Japanese). This paralellism strongly supports the thesis about the finegrained sequence of positions in syntax, namely that there exists the functional sequence of syntactic heads (fseq) which is invariantly ordered by UG (see e.g. Cinque (1999)) and the surface differences among particular langauges in the order of elements that instantiate this fseq result solely from movement (not from the variation in fseq itself).

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To date, adult educational research has had a limited focus on lesbian, gay, bisexual and transgendered (LGBT) adults and the learning processes in which they engage across the life course. Adopting a biographical and life history methodology, this study aimed to critically explore the potentially distinctive nature and impact of how, when and where LGBT adults learn to construct their identities over their lives. In-depth, semi-structured interviews, dialogue and discussion with LGBT individuals and groups provided rich narratives that reflect shifting, diverse and multiple ways of identifying and living as LGBT. Participants engage in learning in unique ways that play a significant role in the construction and expression of such identities, that in turn influence how, when and where learning happens. Framed largely by complex heteronormative forces, learning can have a negative, distortive impact that deeply troubles any balanced, positive sense of being LGBT, leading to self- censoring, alienation and in some cases, hopelessness. However, learning is also more positively experiential, critically reflective, inventive and queer in nature. This can transform how participants understand their sexual identities and the lifewide spaces in which they learn, engendering agency and resilience. Intersectional perspectives reveal learning that participants struggle with, but can reconcile the disjuncture between evolving LGBT and other myriad identities as parents, Christians, teachers, nurses, academics, activists and retirees. The study’s main contributions lie in three areas. A focus on LGBT experience can contribute to the creation of new opportunities to develop intergenerational learning processes. The study also extends the possibilities for greater criticality in older adult education theory, research and practice, based on the continued, rich learning in which participants engage post-work and in later life. Combined with this, there is scope to further explore the nature of ‘life-deep learning’ for other societal groups, brought by combined religious, moral, ideological and social learning that guides action, beliefs, values, and expression of identity. The LGBT adults in this study demonstrate engagement in distinct forms of life-deep learning to navigate social and moral opprobrium. From this they gain hope, self-respect, empathy with others, and deeper self-knowledge.

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Background: Recently eye effects of Diabetes Mellitus (DM) are an important concern due to increase in its trend especially in developing countries. Objectives: To assess the awareness related to eye effects of DM and its prevention practices among people with diabetes. Methods: This cross sectional study was conducted from January 2013 to April 2013 in Villupuram district of Tamil Nadu, India. All 105 people with diabetes from the service area of two sub-centres were included. Data on socio demographic details, history of DM, awareness on systemic complications of DM, effects of DM on eyes, practice on regular blood check-up, eye examination and source of information were collected by interview technique using a structured questionnaire. Univariate and multiple logistic regression analysis were done to assess the association of awareness of eye examination with socio-demographic variables. Results: Mean age of the study population was 56.7 years. About 93 people with diabetes (88.6%) tested their blood sugar at least once in every 3 months. About 80 people with diabetes (76.2%) were aware of at least one systemic complication of DM. Although 78 (74.3%) people with diabetes were aware that DM could affect the eyes, majority of this group (68, 87.2%) did not know the specific effects of DM on eyes. In this group, about 28(35.9%) people with diabetes were not aware of the reasons for eye effects, while others mentioned that persistent high blood sugar level (n=26, 33.3%), longer duration of DM (n=14, 17.9%) and lifestyle (n=10, 12.8%) were the reasons for the eye effects of DM. Only 31 (29.5%) of them knew that their eyes must be regularly examined. People with diabetes who had post-secondary and above (>10th standard) level of education had significantly higher awareness on examination of eye (Adjusted OR=19.63). Conclusion: Although awareness of people with diabetes on systemic effects of DM was more, their awareness on specific eye effects and need for regular screening was low. Systematic efforts are required to increase awareness on eye effects and importance of regular screening in this population.