Comparison between transperineal ultrasound and digital dectection of levator ani trauma : can we improve the odds?

Aims To investigate the predictive ability of four digital assessment parameters to detect levator ani (LA) muscle defects (avulsion injury) and compare these to transperineal tomographic ultrasound images. Methods This was an observational study imbedded in a larger quasi-experimental cohort study for women with urinary incontinence. Seventy-two women, ≥60 years who had attended or were going to attend physiotherapy for treatment of urinary incontinence, were included in the study. Inclusion criteria from the parent study were symptoms of stress, urge or both types of urinary incontinence. The predictive ability of the following digital parameters: direct palpation of a discontinuity of the LA muscle from insertion on the pubic ramus; palpation of the distance between the muscle insertion sites; palpation of LA strength; palpation of LA tone, were analyzed against findings from tomographic transperineal ultrasound images. Correlation between methods was measured using Cohen's kappa for each of the individual parameters. Results Seventeen women (24%) presented with a complete or partial avulsion of the puborectalis muscle as diagnosed with tomographic ultrasound imaging. Nine women (13%) had complete avulsions, one of which was bilateral. The predictive ability of the digital assessment parameters varied from poor (k = 0.187, 95% CI [0.02–0.36]) to moderate (k = 0.569, 95% CI [0.31–0.83]). The new parameter of ‘width between insertion sites’ performed best. Conclusions Adding the parameter of “width between insertion sites” appears to enhance our ability to detect avulsion of the levator ani (LA) muscle by digital examination however it does not distinguish between unilateral or bilateral avulsion.

C-MEMS Based Micro Enzymatic Biofuel Cells

Miniaturized, self-sufficient bioelectronics powered by unconventional micropower may lead to a new generation of implantable, wireless, minimally invasive medical devices, such as pacemakers, defibrillators, drug-delivering pumps, sensor transmitters, and neurostimulators. Studies have shown that micro-enzymatic biofuel cells (EBFCs) are among the most intuitive candidates for in vivo micropower. In the fisrt part of this thesis, the prototype design of an EBFC chip, having 3D intedigitated microelectrode arrays was proposed to obtain an optimum design of 3D microelectrode arrays for carbon microelectromechanical systems (C-MEMS) based EBFCs. A detailed modeling solving partial differential equations (PDEs) by finite element techniques has been developed on the effect of 1) dimensions of microelectrodes, 2) spatial arrangement of 3D microelectrode arrays, 3) geometry of microelectrode on the EBFC performance based on COMSOL Multiphysics. In the second part of this thesis, in order to investigate the performance of an EBFC, behavior of an EBFC chip performance inside an artery has been studied. COMSOL Multiphysics software has also been applied to analyze mass transport for different orientations of an EBFC chip inside a blood artery. Two orientations: horizontal position (HP) and vertical position (VP) have been analyzed. The third part of this thesis has been focused on experimental work towards high performance EBFC. This work has integrated graphene/enzyme onto three-dimensional (3D) micropillar arrays in order to obtain efficient enzyme immobilization, enhanced enzyme loading and facilitate direct electron transfer. The developed 3D graphene/enzyme network based EBFC generated a maximum power density of 136.3 μWcm-2 at 0.59 V, which is almost 7 times of the maximum power density of the bare 3D carbon micropillar arrays based EBFC. To further improve the EBFC performance, reduced graphene oxide (rGO)/carbon nanotubes (CNTs) has been integrated onto 3D mciropillar arrays to further increase EBFC performance in the fourth part of this thesisThe developed rGO/CNTs based EBFC generated twice the maximum power density of rGO based EBFC. Through a comparison of experimental and theoretical results, the cell performance efficiency is noted to be 67%.

Study of Liquid Desiccant Air-Conditioning for High Performance Greenhouses

Greenhouses have become an invaluable source of year-round food production. Further development of viable and efficient high performance greenhouses is important for future food security. Closing the greenhouse envelope from the environment can provide benefits in space heating energy savings, pest control, and CO2 enrichment. This requires the application of a novel air conditioning system to handle the high cooling loads experienced by a greenhouse. Liquid desiccant air-conditioning (LDAC) have been found to provide high latent cooling capacities, which is perfect for the application of a humid greenhouse microclimate. TRNSYS simulations were undertaken to study the feasibility of two liquid desiccant dehumidification systems based on their capacity to control the greenhouse microclimate, and their cooling performance. The base model (B-LDAC) included a natural gas boiler, and two cooling systems for seasonal operation. The second model (HP-LDAC) was a hybrid liquid desiccant-heat pump dehumidification system. The average tCOPdehum and tCOPtotal of the B-LDAC system increased from 0.40 and 0.56 in January to 0.94 and 1.09 in June. Increased load and performance during a sample summer day improved these values to 3.5 and 3.0, respectively. The average eCOPdehum and eCOPtotal values were 1.0 and 1.8 in winter, and 1.7 and 2.1 in summer. The HP-LDAC system produced similar daily performance trends where the annual average eCOPdehum and eCOPtotal values were 1.3 and 1.2, but the sample day saw peaks of 2.4 and 3.2, respectively. The B-LDAC and HP-LDAC results predicted greenhouse temperatures exceeding 30°C for 34% and 17% of the month of July, respectively. Similarly, humidity levels increased in summer months, with a maximum of 14% of the time spent over 80% in May for both models. The percentage of annual savings in space heating energy associated with closing the greenhouse to ventilation was 34%. The additional annual regeneration energy input was reduced by 26% to 526 kWhm-2, with the implementation of a heat recovery ventilator on the regeneration exhaust air. The models also predicted an electrical energy input of 245 kWhm-2 and 305 kWhm-2 for the B-LDAC and HP-LDAC simulations, respectively.

Design, analysis and evaluation of sigma-delta based beamformers for medical ultrasound imaging applications

The inherent analogue nature of medical ultrasound signals in conjunction with the abundant merits provided by digital image acquisition, together with the increasing use of relatively simple front-end circuitries, have created considerable demand for single-bit  beamformers in digital ultrasound imaging systems. Furthermore, the increasing need to design lightweight ultrasound systems with low power consumption and low noise, provide ample justification for development and innovation in the use of single-bit  beamformers in ultrasound imaging systems. The overall aim of this research program is to investigate, establish, develop and confirm through a combination of theoretical analysis and detailed simulations, that utilize raw phantom data sets, suitable techniques for the design of simple-to-implement hardware efficient  digital ultrasound beamformers to address the requirements for 3D scanners with large channel counts, as well as portable and lightweight ultrasound scanners for point-of-care applications and intravascular imaging systems. In addition, the stability boundaries of higher-order High-Pass (HP) and Band-Pass (BP) Σ−Δ modulators for single- and dual- sinusoidal inputs are determined using quasi-linear modeling together with the describing-function method, to more accurately model the  modulator quantizer. The theoretical results are shown to be in good agreement with the simulation results for a variety of input amplitudes, bandwidths, and modulator orders. The proposed mathematical models of the quantizer will immensely help speed up the design of higher order HP and BP Σ−Δ modulators to be applicable for digital ultrasound beamformers. Finally, a user friendly design and performance evaluation tool for LP, BP and HP  modulators is developed. This toolbox, which uses various design methodologies and covers an assortment of  modulators topologies, is intended to accelerate the design process and evaluation of  modulators. This design tool is further developed to enable the design, analysis and evaluation of  beamformer structures including the noise analyses of the final B-scan images. Thus, this tool will allow researchers and practitioners to design and verify different reconstruction filters and analyze the results directly on the B-scan ultrasound images thereby saving considerable time and effort.

Lack of Association Between Haptoglobin Phenotype and Cystic Fibrosis Outcomes

Haptoglobin (Hp), a heme-Iron chelator, has different isoforms which are associated with variable tendency toward infections: Hp 1-1, Hp 2-1, and Hp 2-2. Cystic fibrosis (CF) outcomes are variable and influenced by genetic and environmental factors. The aim of this study was to determine whether Hp phenotype influenced disease severity in CF. One hundred forty-two CF patients from two centers were analyzed for Haptoglobin phenotype using gel electrophoresis of hemoglobin enriched serum. Clinical and microbiological data including bacterial colonization status, lung function, presence of CF-related diabetes and liver disease, rate of exacerbation, and mortality were compared between Hp phenotype groups. We found a trend toward less mucoid PA among Hp 2-2 (20.4 %) compared with Hp 1-1 and Hp 2-1 individuals (33.3 %), p = 0.317. Hp 2-2 individuals also had less antibiotic courses, and lower inflammatory markers without statistical significance. Haptoglobin phenotype is unlikely to be an important modifier of CF phenotype.

Modifiable lifestyle factors associated with risk of sessile serrated polyps, conventional adenomas, and hyperplastic polyps

Objective: To identify modifiable factors associated with sessile serrated polyps (SSPs), and compare the association of these factors to conventional adenomas (ADs) and hyperplastic polyps (HPs). Design: We utilized data from the Tennessee Colorectal Polyp Study, a colonoscopy-based case-control study. Included were 214 SSP cases, 1779 AD cases, 560 HP cases and 3851 polyp-free controls. Results: Cigarette smoking was associated with increased risk for all polyps and was stronger for SSPs than for ADs (OR 1.74. 95% CI: 1.16-2.62, for current vs. never, ptrend=0.008). Current regular use of nonsteroidal anti-inflammatories (NSAID) was associated with a 40% reduction in SSPs risk in comparison to never-users (OR 0.68, 95% CI 0.48-0.96, ptrend=0.03), similar to the association with AD. Red meat intake was strongly associated with SSPs risk (OR 2.59, 95% CI 1.41-4.74 for highest vs. lowest intake, ptrend<0.001) and the association with SSP was stronger than with AD (ptrend=0.003). Obesity, folate intake, fiber intake, and fat intake were not associated with SSP risk after adjustment for other factors. Exercise, alcohol use, and calcium intake were not associated with risk for SSPs. Conclusion: SSPs share some modifiable risk factors for ADs, some of which are more strongly associated with SSPs than ADs. Thus, preventive efforts to reduce risk for ADs may also be applicable to SSPs. Additionally, SSPs have some distinctive risk factors. Future studies should evaluate the preventive strategies for these factors. The findings from this study also contribute to an understanding of the etiology and biology of SSPs.

Um estudo teórico sobre o valor da marca de empresas consideradas inovadoras

O objetivo central deste trabalho é descrever a trajetória do valor da marca de empresas de alta tecnologia, consideradas inovadoras. Como objetivo específico pretende-se identificar as prováveis causas da variação de valor de mercado e de posicionamento da marca. O trabalho apresenta as razões do sucesso, estagnação, declínio e queda de um grupo de empresas escolhido em razão do crescimento ou declínio brusco. Trata-se de uma pesquisa descritiva e bibliográfica. Para tanto, foram escolhidas quinze das maiores empresas de Tecnologia da Informação e Telecomunicações, segundo ranking de valor de marca elaborado pelas agências Interbrand e BrandZ. Observa-se que as empresas implantaram estratégias orientadas à inovação, resultando em altos investimentos em P&D, dispendidos nas duas últimas décadas. As pesquisas utilizadas permitiram associar este estudo da trajetória e das variações no valor da marca das empresas às estratégias e direcionamentos de mercado nos últimos vinte anos, tais como: a aquisição da Compaq e da EDS pela HP, a trajetória de recuperação da Apple, a concorrência entre a Apple e a Nokia, em valor de mercado, e a permanência da centenária IBM em um setor constantemente ameaçado por novos entrantes.

Employer Branding idag : Attraktivitet genom sociala medier

The use of social media has during the last couple of years increased and is now a major part of most of the organizations marketing strategies. But how does this fit with the Employer Branding strategies? And how does this affect the organizational attractiveness as an employer? These were two of the questions we wanted to examine and analyze. In order to answer these questions, we conducted interviews with six different companies divided into 3 subgroups. The intention of this was to get a wider perspective of how the implementation of social media in the Employer Branding could work. And could this change the recruitment process? What we could see afterwards is that more time is spent on taking references online through social media sites. Some say it is more honest than the traditional references that the candidate got to choose. Other conclusions that we could find was that it is important to use social media in todays market but it is crucial to use it in a proper way. Companies must form a strategy based on their Employee Value Proposition in order to reach the wanted receivers using social media. It is also important that the Employee Value Proposition is based on the companies’ corporate values.

Caratterizzazione di resine epossidiche per materiali compositi realizzati in infusione ad alta pressione

I materiali compositi, grazie alla combinazione delle proprietà dei singoli componenti di cui sono costituiti, in particolare la coesistenza di elevate caratteristiche meccaniche e pesi ridotti, rivestono da tempo un ruolo fondamentale nell’industria aeronautica e nel settore delle competizioni automobilistiche e motociclistiche. La possibilità di progettare i materiali in funzione della loro applicazione, unita alla riduzione dei costi di produzione, permette una crescente diffusione del loro utilizzo e l’ampliamento delle applicazioni a moltissimi altri settori, sia per componenti di tipo strutturale, sia di tipo estetico. L’obiettivo della presente tesi è analizzare, attraverso una campagna sperimentale, il comportamento di diversi materiali realizzati con la tecnica di produzione HP-RTM, tramite prove di taglio interlaminare e flessione, al fine di verificare l’applicabilità di tale processo a prodotti strutturali, in modo da velocizzare i tempi di produzione e quindi di abbassare i costi, mantenendo al tempo stesso elevate proprietà meccaniche. Lo scopo di questa campagna quindi è fornire, attraverso lo studio di 30 serie di provini, il materiale migliore in termini di resistenza a flessione e taglio interlaminare; inoltre per ogni tipologia di materiale vengono descritte le diverse distribuzioni dei valori di rottura riscontrati, in modo da lasciare al progettista più libertà possibile nella scelta del materiale in base alle specifiche richieste per una determinata applicazione. Questo studio permette di analizzare l’influenza di ogni singolo componente (tipo di fibra, tipo di binder, presenza o assenza di IMR), all’interno della stessa resina.

Att undervisa i ett mångkulturellt klassrum : Fyra lärares erfarenheter av religionsundervisning

Charlotte Dahlström Att undervisa i ett mångkulturellt klassrum – fyra lärares erfarenheter av religionsundervisning. Pedagogiskt arbete III, 15 hp, Högskolan Dalarna. Temat för uppsatsen är religionsundervisning i ett klassrum med religiös mångfald sett ur perspektiv från fyra grundskolelärare. Studien fokuserar på vilka strategier lärarna har för att lära ut, hur de utnyttjar läroplanen, olika typer av läromedel samt om det finns utrymme för läraren att välja bort delar av innehållet i kursplanen när denne planerar sin undervisning. En kort presentation av de senaste två läroplanerna samt litteratur som behandlar religionsundervisning i skolan utgör bakgrunden till studien. Intervjuer med fyra lärare är det primära källmaterialet. Efter genomförd studie har det kommit fram att lärarna ser religiös mångfald i klassrummet som en stor fördel i undervisningen samt att läroplanen oftast ses som ett gott stöd vid själva planerandet av undervisningen. Vilka läromedel som används är högst individuellt och beror till stor del på lärarens egen förmåga att hålla sig ajour men även vilka ekonomiska förutsättningar ämnet ges. Avslutningsvis finns en bilaga med intervjufrågorna vilka ger en bild av vad informanterna fått ta ställning till när de intervjuats.

Efeitos da simpaticotomia endoscópica sobre as artérias carótidas e vertebrais na terapêutica cirúrgica da hiperidrose primária

Analisar, em pacientes submetidos a simpaticotomia videotoracoscópica para tratamento da Hiperidrose Primária (HP), as conseqüências hemodinâmicas da desnervação vascular das artérias carótidas e vertebrais após a trans-secção cirúrgica da cadeia simpática torácica (simpaticotomia), através da mensuração de parâmetros ultra-sonográficos. Método: Vinte e quatro pacientes portadores de HP submetidos a quarenta e oito simpaticotomias torácicas endoscópicas foram avaliados através da mensuração da velocidade de pico sistólico (VPS), velocidade de pico diastólico (VPD), índice de pulsatibilidade (IP) e índice de resistência (IR) nas artérias carótidas comuns, internas e externas, além da artéria vertebral bilateralmente usando o eco-doppler duplex scan. As avaliações foram realizadas antes da intervenção cirúrgica e trinta dias após o procedimento. O teste de Wilcoxon foi usado na análise das diferenças entre as variáveis antes e depois da simpaticotomia. Resultados: A simpaticotomia no nível de T3 foi a trans-secção mais realizada (95,83%), seja isoladamente (25%) ou associada a T4 (62,50%) ou a T2 (8,33%). Houve aumento significativo no IR e no IP da artéria carótida comum bilateralmente (p<0,05). A VPD da artéria carótida interna diminuiu em ambos os lados (p<0,05). A VPS e a VPD da artéria vertebral direita também aumentaram (p<0,05). Achados assimétricos foram observados, de modo que artérias do lado direito foram as mais freqüentemente afetadas. Conclusões: Alterações hemodinâmicas foram observadas nas artérias vertebral e carótida após simpaticotomia para tratamento de HP. VPS foi o parâmetro mais freqüentemente alterado, principalmente nas artérias do lado direito, representando alterações assimétricas significantes nas artérias carótida e vertebral. Entretanto, são necessárias pesquisas subseqüentes para verificar se essas alterações são definitivas ou temporárias, uma vez que as inferências clínicas somente terão validação se as alterações forem permanentes

Consumo de oxígeno en hipotermia, durante circulación extracorpórea, en cirugías de niños con cardiopatías congénitas complejas en Canarias: perfiles cinéticos e implicaciones fisiológicas

Programa de doctorado: Avances en Medicina Interna. La fecha de publicación es la fecha de lectura

L'habilitation psychologique et l'engagement affectif envers l'organisation, le superviseur et la tâche : examen du rôle modérateur de l'âge

Le contexte de travail actuel rend l’engagement affectif (EA) des employés envers l’organisation à la fois essentiel et difficile à maintenir. De plus, la présence simultanée de plusieurs générations dans les milieux de travail entraîne un questionnement sur la façon dont les pratiques de gestion devraient ou non être adaptées pour répondre aux besoins spécifiques de chaque groupe d’âge. La recherche a permis d’établir que l’habilitation psychologique (HP) des employés est un levier prometteur pour favoriser l’EA envers l’organisation, en permettant à l’employé de répondre à ses besoins de sens, de compétence, d’autonomie et d’influence. Le rôle de chacune des dimensions spécifiques de l’HP dans le développement de l’EA a toutefois été peu étudié, de même que son impact sur l’engagement envers le superviseur et la tâche. De plus, même s’il a été suggéré que les employés de différents groupes d’âge présentaient des attentes et besoins différents sur le plan de l’habilitation psychologique au travail, peu d’études empiriques ont été réalisées sur le sujet. Avec un échantillon de 247 employés d’un établissement québécois du réseau de la santé, la présente recherche avait pour objectifs 1) de confirmer le lien entre l’HP globale et l’EA envers l’organisation, le superviseur et la tâche, 2) de vérifier la contribution relative de chacune des quatre dimensions de l’HP (sens, autonomie, compétence, influence) dans la prédiction de l’EA au travail et 3) de déterminer si l’âge modère la relation entre l’HP et l’EA au travail. Les résultats de l’étude ont permis de confirmer que le niveau d’HP globale prédit l’EA envers l’organisation, le superviseur et la tâche. Plus spécifiquement, le sens, la compétence et l’influence permettent de prédire l’EA envers l’organisation, l’autonomie et l’influence prédisent l’EA envers le superviseur, alors que le sens et l’autonomie prédisent l’EA envers la tâche. Dans la présente étude, l’âge ne jouait pas de rôle modérateur entre l’HP et l’EA au travail. Ces résultats suggèrent que les pratiques organisationnelles favorisant l’état d’HP sont un levier important et susceptible de favoriser l’engagement affectif des employés envers l’organisation, le superviseur et la tâche, et ce, indépendamment de l’âge des employés.

U-Pb SHRIMP zircon dating of high-grade rocks from the Upper Allochthonous Terrane of Bragança and Morais Massifs (NE Portugal); geodynamic consequences

Bragança and Morais Massifs are part of the mega-klippen ensemble of NW Iberia, comprising a tectonic pile of four allochthonous units stacked above the Central-Iberian Zone autochthon. On top of this pile, the Upper Allochthonous Terrane (UAT) includes different high-grade metamorphic series whose age and geodynamic meaning are controversial. Mafic granulites provided U–Pb zircon ages at 399±7 Ma, dating the Variscan emplacement of UAT. In contrast,U–Pb zircon ages of ky- and hb-eclogites, felsic/intermediate HP/HT-granulites and orthogneisses (ca. 500–480 Ma) are identical to those of gabbros (488 ± 10 Ma) and Grt-pyroxenites (495 ± 8 Ma) belonging to a mafic/ultramafic igneous suite that records upper mantle melting and mafic magma crustal underplating at these times. Gabbros intrude the high-grade units of UAT and did not underwent the HP metamorphic event experienced by eclogites and granulites. These features and the zircon dates resemblance among different lithologies, suggest that extensive age resetting of older events may have been correlative with the igneous suite emplacement/crystallisation. Accordingly, reconciliation of structural, petrological and geochronological evidence implies that the development and early deformation of UAT high-grade rocks should be ascribed to an orogenic cycle prior to ≈500 Ma. Undisputable dating of this cycle is impossible, but the sporadic vestiges of Cadomian ages cannot be disregarded. The ca. 500–480 Ma time-window harmonises well with the Lower Palaeozoic continental rifting that trace the VariscanWilson Cycle onset and the Rheic Ocean opening. Subsequent preservation of the high heat-flowregime, possibly related to the Palaeotethys back-arc basin development (ca. 450–420 Ma), would explain the 461 ± 10 Ma age yielded by some zircon domains in felsic granulites, conceivably reflecting zircon dissolution/ recrystallisation till Ordovician times, long before the Variscan paroxysm (ca. 400–390 Ma). This geodynamic scenario suggests also that UAT should have been part of Armorica before its emplacement on top of Iberia after Palaeotethys closure.

Tris(2-ethylhexyl) trimellitate (TOTM) as a potential industrial reference fluid for viscosity at high temperatures and high pressures: New viscosity, density and surface tension measurements

Tris(2-ethylhexyl) trimellitate (TOTM) was recently suggested as a reference fluid for industrial use associated with high viscosity at elevated temperature and pressure. Viscosity and density data have already been published on one sample covering the temperature range (303-373) K and at pressures up to about 65 MPa. The viscosity covered a range from about (9 to 460) mPa s. In the present article we study several other characteristics of TOTM that must be available if it were to be adopted as a standard. First, we present values for the viscosity and density obtained with a different sample of TOTM to examine the important feature of consistency among different samples. Vibrating-wire viscosity measurements were performed at pressures from (5 to 100) MPa, along 6 isotherms between (303 and 373) K. Density measurements were carried out from (293 to 373) K up to 68 MPa, along 4 isotherms, using an Anton Paar DMA HP vibrating U-tube densimeter. Secondly, we report a study of the effect of water contamination on the viscosity of TOTM, performed using an Ubbelhode viscometer under atmospheric pressure. Finally, in order to support the use of TOTM as a reference liquid for the calibration of capillary viscometers, values of its surface tension, obtained by the pendant drop method, are provided. (C) 2016 Elsevier B.V. All rights reserved.