Ressecções hepáticas com oclusão vascular aferente: análise de fatores de risco

OBJETIVO: O controle da perda sangüínea nas cirurgias de ressecção hepática está associado à diminuição dos índices de morbimortalidade. As técnicas para minimizar a hemorragia transoperatória são aquelas associadas à redução do fluxo sangüíneo ao fígado, através da oclusão vascular aferente (manobra de Pringle) ou exclusão vascular total do órgão. O objetivo deste estudo foi o de avaliar uma série de hepatectomias parciais com oclusão do fluxo sangüíneo aferente, em pacientes portadores de doenças benignas e malignas. MÉTODOS: Foram analisadas 60 hepatectomias em 59 pacientes com clampeamento do pedículo hepático quanto a possíveis fatores de risco para morbidade e mortalidade, a relação entre o tempo de isquemia hepática e a variação das transaminases, tempo de protrombina e bilirrubinas, e destes, com a evolução pós-operatória. RESULTADOS: A prevalência de complicações pós-operatórias foi de 43,3% e a mortalidade de 6,7%. O fator de risco significativo para mortalidade foi tempo cirúrgico mais prolongado. Para a morbidade pós-operatória, os fatores de risco foram idade acima de 60 anos, cirurgia por neoplasia maligna, parênquima hepático anormal, perda sangüínea necessitando reposição de mais de uma unidade de sangue e outra cirurgia abdominal concomitante. Na análise multivariada por regressão logística, estes fatores de risco foram reduzidos para parênquima hepático anormal. CONCLUSÕES: O tempo de isquemia não apresentou relação com a morbimortalidade pós-operatória. A variação das transaminases foi mais acentuada nos casos com maior tempo de isquemia, porém essas retornaram aos níveis pré-operatórios em aproximadamente uma semana. A variação das transaminases não foi diferente entre os pacientes com e sem morbidade pós-operatória.

Isquemia e reperfusão hepática total associada ao estado de choque hemorrágico controlado: efeitos no seqüestro de neutrófilos no íleo terminal e cólon sigmóide do rato

OBJETIVO: Estudar os efeitos da isquemia e reperfusão hepática total sobre acúmulo de neutrófilos no íleo terminal e cólon sigmóide de ratos, em condições de normalidade e submetidos ao estado de choque hemorrágico controlado. MÉTODO: 32 ratos Wistar, machos, foram divididos em quatro grupos de oito animais cada: grupo Sham, submetido aos procedimentos padrões com um período de 60 minutos de observação; grupo Choque, submetido a choque hemorrágico controlado (PAM = 40mmHg, 20min) seguido de reposição volêmica (Ringer lactato + sangue, 3:1) e reperfusão (60min); grupo Pringle, submetido à isquemia hepática total (15min.) e reperfusão (60min); grupo Total submetido a choque hemorrágico controlado (20min) seguido de reposição volêmica (Ringer lactato + sangue, 3:1), isquemia hepática (15min) e reperfusão (60min). Após o sacrifício dos animais, procedeu-se à contagem de neutrófilos nos segmentos intestinais. RESULTADOS: Na contagem de neutrófilos no íleo terminal, apenas o grupo Choque diferiu dos demais (p<0.001) os quais não diferiram entre si (Sham 1.33 ± 0.55, Choque 5.48 ± 2.65, Pringle 2.47 ± 1.38, Total 2.44 ± 0.56) e, no cólon sigmóide, o grupo Choque diferiu apenas do grupo Sham (p = 0.021), sem diferença entre os demais (Sham 0.66 ± 0.44, Choque 2.08 ± 1.11, Pringle 1.04 ± 0.71, Total 1.21 ± 1.03). CONCLUSÃO: Diferentemente do estado de choque hemorrágico controlado, a isquemia hepática de 15 minutos, seguida de 60 minutos de reperfusão, não causou acúmulo significativo de neutrófilos no íleo terminal e cólon sigmóide.

Isquemia e reperfusão hepática total associada ao estado de choque hemorrágico controlado: efeitos no seqüestro de neutrófilos no fígado do rato

OBJETIVO: O propósito deste trabalho experimental foi estudar os efeitos da isquemia e reperfusão hepática total sobre o acúmulo de neutrófilos no fígado de ratos, em condições de normalidade e submetidos ao estado de choque hemorrágico controlado. MÉTODO: Trinta e dois ratos Wistar, machos, foram divididos em quatro grupos de oito animais cada: grupo Controle, submetido à laparotomia com um período de 60 minutos de observação; grupo Choque, submetido a choque hemorrágico controlado (PAM = 40 mmHg, 20 min.) seguido de reposição volêmica (Ringer lactato + sangue, 3:1) e reperfusão (60 min.); grupo Pringle, submetido a isquemia hepática total (15 min.) e reperfusão (60 min.); grupo Total submetido a choque hemorrágico controlado (15 min.) seguido de reposição volêmica (Ringer lactato + sangue, 3:1) mais isquemia hepática total (15 min.) e reperfusão (60 min.). A dosagem do lactato arterial e déficit de base foram utilizados para caracterizar o estado de choque hemorrágico com baixa perfusão tecidual. Após a morte dos animais, procedeu-se à contagem de neutrófilos no tecido hepático. RESULTADOS: Na contagem de neutrófilos no fígado o grupo Pringle diferiu dos grupos Choque e Total, os quais não diferiram entre si (Controle 10,30±3,20; Choque 13,94±2,84; Pringle 7,00±3,40; Total 12,45±3,65). CONCLUSÃO: Em ratos submetidos a estado de choque hemorrágico controlado, associado à isquemia hepática total de 15 minutos, seguido de 60 minutos de reperfusão, não ocorreu acúmulo significativo de neutrófilos no fígado.

Trisegmentectomia hepática direita por videolaparoscopia

INTRODUÇÃO: Em 2007 os autores descreveram a primeira hepatectomia direita por videolaparoscopia realizada no Brasil. Hepatectomia direita ampliada, também conhecida como trisegmentectomia direita, é procedimento altamente complexo e implica em grande retirada do volume hepático. Os autores descrevem a primeira trisegmentectomia direita por videolaparoscopia realizada no Brasil. TÉCNICA: O paciente é colocado em posição supina em decúbito lateral esquerdo. O cirurgião se coloca entre as pernas da paciente. Utilizamos cinco trocartes, três de 12 mm e dois de 5 mm. Devido à embolização prévia da veia porta direita, o hilo hepático não é dissecado. O pedículo portal direito é seccionado com grampeador laparoscópico de carga vascular por meio de acesso intra-hepático, segundo técnica previamente descrita pelos autores. A seguir procede-se a mobilização do fígado direito seguido de dissecção da veia cava retro-hepática e secção da veia hepática direita. Estes passos são realizados sem manobra de Pringle. O fígado é seccionado com combinação de bisturi harmônico e grampeador endoscópico. O pedículo do segmento 4 é seccionado dentro do fígado. O espécime é retirado por meio de incisão supra-púbica e a área cruenta é revista para verificar hemostasia. O procedimento é encerrado e dreno de sistema fechado é posicionado junto à área cruenta. CONCLUSÃO: Trisegmentectomia hepática direita por videolaparoscopia é procedimento factível e seguro e deve ser considerado para pacientes selecionados. Este procedimento deve ser realizado em centros especializados e por cirurgiões com experiência tanto em cirurgia hepática como cirurgia laparoscópica avançada.

Kulttuurin merkitys spekulatiivisen fiktion kääntämisessä

Tutkielma käsittelee kulttuurin merkitystä spekulatiivisessa fiktiossa eli sitä, miten genre vaikuttaa tekstin kulttuurisidonnaisten kohtien kääntämiseen. Spekulatiivinen fiktio käsitetään usein lähes irralliseksi siitä kulttuurista, jossa se on syntynyt. Tämän tutkimuksen tarkoituksena on kuitenkin osoittaa, ettei näin ole. Spekulatiivinen fiktio ei ole siis erillinen syntykulttuuristaan, vaan vaikutussuhde on itse asiassa molemminpuolinen: kulttuuri ottaa paitsi vaikutteita, mutta myös sanastoa spekulatiivisesta fiktiosta. Koska spekulatiivinen fiktio on erityisesti Suomessa terminä uudehko, sen määritteleminen on olennainen osa tutkimusta. Spekulatiivisen fiktion yhteneväisyyksiä ja eroavaisuuksia aiempiin genreihin, kuten tieteiskirjallisuuteen ja fantasiakirjallisuuteen, käsitellään tutkimuksen alkuosassa. Spekulatiivisen fiktion määrittelyn yhteydessä referoidaan Heather Urbanskin ’painajaismalleja’, joihin spekulatiivisen fiktion teokset voidaan lajitella sen mukaan, millaisia syntykulttuurinsa pelkoja ja kauhuskenaarioita ne kuvastavat. Jälkimmäinen osa keskittyy kulttuurin merkitykseen spekulatiivisessa fiktiossa ja siihen, miten mahdolliset viittaukset teoksen lähdekulttuurin vaikuttavat käännösten tulkintaan. Tutkimuksen kaunokirjallisina lähdeteksteinä toimivat kolme Johanna Sinisalon suomenkielistä novellia ja niiden englanninkieliset käännökset, sekä Hannu Rajaniemen englanninkielinen romaani The Quantum Thief ja sen suomennos. Molemmat kirjailijat ovat suomenkielisiä, mutta Sinisalo kirjoittaa omalla äidinkielellään suomeksi kun taas Rajaniemi kirjoittaa englanniksi. Tästä syystä kohdeyleisön ja -kulttuurin erot tulevat esille heidän teoksiaan verrattaessa. Tämän tutkimuksen perusteella on selvää, että myös spekulatiivisen fiktion kaltaisessa, reaalimaailmasta irrallisessa genressä alkuperäisteoksen lähdekulttuurilla on merkitystä. Jos käännöstä tehtäessä ei oteta huomioon kulttuurisidonnaisia tekijöitä kuten alluusioita ja reaalioita, käännöksen lukija menettää ainakin osan teoksen taustalla olevista merkityksistä ja saattaa jopa hämmentyä epäselvistä viittauksista. Spekulatiivisen fiktion tutkimus on Suomessa vasta alkutekijöissään ja erityisesti suomalaisten kirjoittajien teokset jäävät helposti ulkomaisten, tunnetumpien kirjailijoiden varjoon. Myös spekulatiivisen fiktion ja kulttuurin välinen yhteys ansaitsisi tarkempaa perehtymistä laajemmalla aineistolla.

Valoisia ja vetisiä virkkeitä. Lyyrinen kertoja ja toksinen diskurssi 2010-luvun kotimaisessa proosassa

Pro gradu -tutkielmani käsittelee kotimaisen nykykirjallisuuden lyyristä kerrontaa. Työssäni olen kehitellyt uutta lyyrisen kertojan käsitettä kirjallisuusanalyysin avuksi. Lyyrinen kertoja rakentaa ja välittää lyyristä kerrontaa. Luen lyyrisen kerronnan piirteitä ja lyyrisen kertojan toimintaa esiin teoksista Auringon asema (2002), valoa valoa valoa (2011) ja Teemestarin kirja (2012). Lyyrisyyden ja kerronnallisuuden sekoituksista syntyviä tekstejä ovat aiemmin tutkineet muun muassa Nil Korkut, James Phelan ja Heather Dubrow. Kotimaisessa kirjallisuudentutkimuksessa lyyristä proosaa ja lyyristä kerrontaa on tarkasteltu vasta vain vähän. Tuon tutkielmallani narratologian piiriin kokonaan uuden käsitteen, lyyrinen kertoja. Lyyrisen kertojan avulla voidaan lyyristä proosaa tarkastella monitasoisesti keskittymällä sekä teosten sisältöön että kielen materiaalisiin ulottuvuuksiin, esimerkiksi rytmiin, äänteellisyyteen ja metafiktioon. Tutkielmassani vaikuttaa uusmaterialistinen ja posthumanistinen filosofia eli tekstin ja maailman sekä inhimillisen ja ei-inhimillisen yhdessäajattelu. Työssäni on myös läsnä ekokritiikki ja materiaalinen ekokritiikki, joka huomioi ei-inhimillisten toimijoiden vaikutukset maailmassamme. Käytän Karen Baradin intra-aktion käsitettä ja Lawrence Buellin määrittämää toksista diskurssia. Ajattelen tutkielmani kaunokirjallisia teoksia aktiivisina toimijoina. Teostoimijoilla on vaikutusta siihen, miten ymmärrämme maailmaa. Auringon asema käsittelee transnationalisuutta ja laajentaa käsitystä suomalaisuudesta. valoa valoa valoa -teos ja Teemestarin kirja haastavat lukijat ajattelemaan maapallon tulevaisuutta ja kyseenalaistamaan ihmisen ympäristöjä tuhoavan toiminnan. Tutkielmani teostoimijat vaikuttavat lukijoihin lyyrisesti kertoen, jolloin niiden sanoman vaikuttavuus voimistuu. Niiden kerronnan lyyrisyydessä vaikuttavat ei-inhimilliset toimijat, kuten valo ja vesi. Tutkielmani osoittaa, että lyyrisen kertojan käsite mahdollistaa lyyrisen proosan sisällön, tyylin, muodon ja aiheiden yhteisvaikutusten tarkastelun monitasoisesti.

1977 Women's Novice Crew

From left to right. Dave Commerford (Coach), Lori Abernathy, Tina Dubanow, Heather White, Judy Brunskill, Nancy Tuffin (Coxie), Debbie Coughlin, Yvonne Hojow, Sue Pinder, and Heather Moyer

1978 - 79 Varsity Women

From left to right. Top: Ann Fenton, Tammy Biernacki, Heather White, Lisa Tiffney, Tony Biernacki (Coach), Betty Borda, Debbie Coughlin, Martha Robson, and Marie Herdan. Bottom: Nancy Tuffin.

Citizen Jane : exploring the relationship between gender and cellular phones in societies of control

In this thesis, I argue that the mutually productive relationship between women (as gendered subjects) and cellular phone technology is one of control. Women use cellular phones to organize, manage and otherwise control the multiplicity of tasks required of them on a daily basis. At the same time, through using cell phones, women participate in regimes of control including surveillance and persistent connection. I explore this relationship at the level of everyday practice, and conclude by speculating about this relationship at a wider level of social control and organization. This argument emerges from the critical approach suggested by Slack and Wise (2005), who argue that technology and culture are inseparable. They provide articulations and assemblages as tools of analysis. I situate this analysis more broadly within Foucault's (1991) work on govemmentality, in its modem form of societies of control (Deleuze, 1995b).

Evaluating three self-help smoking cessation interventions for post-secondary smokers : a randomized controlled trial on six Ontario campuses

Objective. Smoking prevalence is highest among the young adult cohort. Postsecondary students are no exception. Although many students intend to quit smoking, no research has established what methods best promote reductions in, or complete abstinence from smoking. This randomized controlled trial examined the effectiveness of three self-help smoking cessation interventions. Method. On six post-secondary campuses, 483 smokers who voluntarily accessed Leave The Pack Behind (a tobacco control initiative) were randomly assigned to one of three smoking cessation interventions: One Step At A Time (a 2-booklet, *gold standard' program for adults); Smoke|Quit (a newly-developed 2-booklet program for young adult students); and usual care (a 'Quit Kit' containing a booklet on stress management, information about pharmacological quitting aides and novelty items). All participants also received one proactive telephone support call from a peer counsellor. During the study, 85 participants withdrew. The final sample of 216 students who completed baseline questionnaires and 12-week follow-up telephone interviews was representative of the initial sample in terms of demographic characteristics, and smokingquitting- related variables. Results. Whether participants quit smoking depended upon treatment condition, ^(2, N=2\6) = 6.34, p = .04, with Smoke|Quit producing more successfijl quitters (18.4%) than One Step At A Time (4.5%) or the Quit Kit (1 1.4%). On average, participants had quit 53.46 days, with no significant difference across treatments. Selfefficacy also increased. Use of the intervention or other quitting aides was not associated with treatment condition. Among the 191 participants who did not quit smoking, treatment condition did not influence outcomes. Overall, 46.2% had made a quit attempt. Significant decreases in weekly tobacco consumption and increases in self-efficacy to resist smoking were observed from baseline to follow-up. Conclusion. Post-secondary institutions represent a potentially final opportunity for age-targeted interventions. Self-help resources tailored to students' social and contextual characteristics will have considerable more impact than stage-only tailored interventions. Both reduction and abstinence outcomes should be emphasized to positively support students to stop smoking.

A comprehensive examination of adolescent gambling

The purposes of this study were: a) to examine the prevalence and consequences associated with adolescent gambling, b) to examine the factors which influence adolescent gambling,. c) to detennine what factors discriminate among four groups of gamblers (no-risk/non-gamblers, low-risk gamblers, at-risk gamblers, and high-risk/problematic gamblers), and d) to examine the relation of gambling to nine other risk behaviours (i.e., alcohol use, smoking, marijuana use, hard drug use, sexual activity, minor delinquency, major delinquency, direct aggression, and indirect aggression). Adolescents (N = 3,767) from 25 secondary schools completed a twohour survey that assessed involvement in risk be~aviours as well as potential predictors from a wide range of contexts (school, neighbourhood, family, peer, and intrapersonal). The majority of adolescents reported gambling, although the frequency of gambling participation was low. The strongest predictors/discriminators of gambling involvement were gender, unstructured activities, structured activities, and risk attitudes/perceptions. In addition, the examination of the co-occurrence of gambling with other risk behaviours revealed that for high-risk/problem gamblers, the top three most frequent co-occurring high-risk behaviours were direct aggression, minor delinquency and alcohol. This study was the first to examine the continuum of gambling involvement (i.e., non-gambling to high risk/problematic gambling) using a comprehensive set ofpotential predictors with a large sample of secondary school students. The findings of this study support past research and theories (e.g., Theory of Triadic Influence) which suggest the importance ofproximal variables in predicting risk behaviors. The next step, however, will be to examine the direct and indirect 1 effects of the ultimate (e.g., temperament), distal (e.g., parental relationship), and proximal variables (e.g., risk attitudes/perceptions) on gambling involvement in a longitudinal study.

Effect of combined care nursing on patient satisfaction, staff satisfaction, and quality of care /

This research evaluates the effect of combined care nursing on three outcomes: i) patient satisfaction; ii) staff satisfaction; and iii) quality of care. Oakville-Trafalgar Memorial Hospital was in the early planning stages of changing to combined care nursing from the traditional method of providing separate postpartum and nursery care to mothers and babies. The opportunity existed to evaluate formally the change to combined care. There were three hypotheses to be investigated. Data were collected from four sources: patient surveys, staff surveys, informal interviews, and internal hospital documents. Both quantitative and qualitative data were analyzed. The surveys were administered on three different occasions to patients and staff. Other sources of data included informal interviews with patients and staff who responded to the surveys, and chart audits.The study findings revealed that the majority of respondents had increased levels of satisfaction and perceptions of increased quality of care following implementation of combined care. These findings, related to combined care and the role of change in its implementation and evaluation, indicate that there are no right or easy answers about how to make new ideas become reality in a smooth, pleasant way.

An examination of learning resulting from a transition from a directed to a self-directed work environment

~ This study focuses on the process of self-directed learning that individuals go through as they adapt to new work situations. This is a study of how one critical incident, specifically the transition from a traditional office structure to a home office structure, affected employees and what their learning process was as they adapted to the new environment. This study has 3 educational foundations: adult learning, self-directed learning, and the social context from which the learning will occur. Six women and 2 men were interviewed approximately 1 year following the transition. Analysis of the data revealed 5 themes of: impacts of the self-directed environment on participants' personal lives, their roles, skill set, productivity, and the physical environment; support offered by the organization, family, and office administration; personal development, specific learning needs, and personal skills; boundaries as they relate to family and work; and skill set and orientation requirements of new home office employees. The findings revealed the learning processes of the 8 participants. The learning processes of these participants were discussed within a theoretical framework of the learners, their immediate surroundings, and the larger social environment. The results indicated that the transition from a directed work environment to a self directed work environment is a complex, interrelated process. An element found throughout the theoretical framework is that of control. A second critical element is the need for participants to have a clearly defined work role and an opportunity to engage in discussion with peers and the community. Further findings reinforced the importance of climate and found that the physical environment is a key factor in a successful selfdirected work environment. The findings of this study revealed that no one factor makes an individual function successfully in a self-directed work environment, but that it is a complex interplay among the leamer, their immediate surroundings, and the social environment that will have the greatest impact on success. Recommendations are made which can be used to guide organizational leaders in facilitating employees' transition from a directed to a self-directed work environment. Additionally, recommendations are made for further research in the area of self-directed work environments.

Quantum Monte Carlo : some theoretical and numerical studies

In Part I, theoretical derivations for Variational Monte Carlo calculations are compared with results from a numerical calculation of He; both indicate that minimization of the ratio estimate of Evar , denoted EMC ' provides different optimal variational parameters than does minimization of the variance of E MC • Similar derivations for Diffusion Monte Carlo calculations provide a theoretical justification for empirical observations made by other workers. In Part II, Importance sampling in prolate spheroidal coordinates allows Monte Carlo calculations to be made of E for the vdW molecule var He2' using a simplifying partitioning of the Hamiltonian and both an HF-SCF and an explicitly correlated wavefunction. Improvements are suggested which would permit the extension of the computational precision to the point where an estimate of the interaction energy could be made~

Self-presentational motives in eating disorders : a known groups difference approach

Self-presentation reflects the processes by which individuals attempt to monitor and control the impressions others form of them (Schlenker & Leary, 1982). Concerns over impressions conveyed have been linked to numerous health behaviors (Crawford & Eklund, 1994; Martin, Leary, & O'Brien, 2001). The present study investigated the role of cognitive manifestations of dispositional and situational self presentational motivation (SPM) in 131 females with known groups differences on a measure of eating disorders. Participants were classified as in-treatment (IN = 39); at risk (AT = 46); and not at risk (NOT = 46) for eating disordered behaviour. Each participant completed The Brief Fear of Negative Evaluation Scale (FNE; Leary, 1983), the Public Self-Consciousness Scale (PSC; Fenigstein, Sheier, & Buss, 1975), and the Social Physique Anxiety Scale (SPA; Hart, Leary, & Rejeski, 1989), as measures of dispositional SPM. Situational SPM was assessed through Self-Presentational Efficacy (SPE; Gammage, Hall, & Martin, 2004), and the Exercise Motivation Inventory-2 (Markland & Ingeldew, 1997). Significant differences emerged on the measure of eating disorder behaviour between AT and NOT. To determine if group differences existed on measures of trait SPM an ANOVA was conducted. Results indicated that the NOT group experienced less FNE, PSC and SPA than the IN and AT groups, and the AT group experienced less FNE and PSC than the IN group. Pearson bivariate correlations were conducted on measures of trait SPM and EMI-2 subscales theoretically linked to SPM. It was found that FNE, PSC and SPA were all positively correlated with weight management for the NOT group. To determine if group differences existed on selfpresentational exercise motives independent samples I-tests were conducted. Results revealed that the AT group was more motivated to exercise for weight management, and appearance, and social recognition than the NOT group. To determine if group differences existed on the state measure of self-presentational efficacy a series of ANOVA's were conducted. Results revealed that the NOT group experienced significantly greater self-presentational efficacy expectancy and self-presentational outcome value than the AT group. Finally, a discriminant function analysis was conducted to determine if trait SPM would predict group membership. Results revealed that 63.4% of participants were correctly classified, with SPA, PSC, and FNE differentiating the NOT group from the AT and IN groups and FNE and PSC differentiating the AT group from the IN group. Thus self-presentation motivation appears to have an influence on females who have an eating disorder and those at risk for an eating disorder. Potential applications of the influence of self-presentational motives on eating disorders and future research directions are discussed.