Endoluminal surgical triangulation: overcoming challenges of colonic endoscopic submucosal dissections using a novel flexible endoscopic surgical platform: feasibility study in a porcine model.

BACKGROUND: Colonic endoscopic submucosal dissection (ESD) is challenging as a result of the limited ability of conventional endoscopic instruments to achieve traction and exposure. The aim of this study was to evaluate the feasibility of colonic ESD in a porcine model using a novel endoscopic surgical platform, the Anubiscope (Karl Storz, Tüttlingen, Germany), equipped with two working channels for surgical instruments with four degrees of freedom offering surgical triangulation. METHODS: Nine ESDs were performed by a surgeon without any ESD experience in three swine, at 25, 15, and 10 cm above the anal verge with the Anubiscope. Sixteen ESDs were performed by an experienced endoscopist in five swine using conventional endoscopic instruments. Major ESD steps included the following for both groups: scoring the area, submucosal injection of glycerol, precut, and submucosal dissection. Outcomes measured were as follows: dissection time and speed, specimen size, en bloc dissection, and complications. RESULTS: No perforations occurred in the Anubis group, while there were eight perforations (50 %) in the conventional group (p = 0.02). Complete and en bloc dissections were achieved in all cases in the Anubis group. Mean dissection time for completed cases was statistically significantly shorter in the Anubis group (32.3 ± 16.1 vs. 55.87 ± 7.66 min; p = 0.0019). Mean specimen size was higher in the conventional group (1321 ± 230 vs. 927.77 ± 229.96 mm(2); p = 0.003), but mean dissection speed was similar (35.95 ± 18.93 vs. 23.98 ± 5.02 mm(2)/min in the Anubis and conventional groups, respectively; p = 0.1). CONCLUSIONS: Colonic ESDs were feasible in pig models with the Anubiscope. This surgical endoscopic platform is promising for endoluminal surgical procedures such as ESD, as it is user-friendly, effective, and safe.

Implementing The Good Friday Agreement: Overcoming Challenges and Obstacles

On April 10, 1998, history was made in Northern Ireland. Years of sectarian violence would end as the Belfast Agreement, known more popularly (and perhaps more fittingly due to the religious identities defining the two sides) as the Good Friday Agreement, was signed bringing peace to Northern Ireland (Northern Ireland Office, 2007). This paper will look at the Good Friday Agreement in detail. By analyzing the historical factors leading up to 1998, the Agreement itself, and the post-Agreement implementation stage,it is possible to pick out the relative successes and failures of the Agreement, and of its implementation.

Overcoming Challenges to Service Innovation Process Implementation in an SME

This case study research reports on a small and medium-sized (SME) business-to-business (B2B) services firm implementing a novel new service development (NSD) process. It provides accounts of what occurred in practice in terms of the challenges to NSD process implementation and how the firm overcame these challenges. It also considers the implications for NSD in this and other firms’ innovation practices. This longitudinal case study (18 months) was conducted “inside” the case organization. It covered the entire innovation process from the initiation to the launch of a new service. The primary method may be viewed as participant observation. The research involved all those participating in the innovation system in the firm, including decision-makers, middle managers and employees at lower hierarchical levels and the firm’s external networks. Implications for researchers and managers focusing on structured innovation models for the services sector are also presented.

Motivação intrinseca e extrinseca nas aulas de educação fisica

Universidade Estadual de Campinas . Faculdade de Educação Física

Locating home : the diverse experiences of recent newcomer youth and first generation youth within Ontario's education system

This study has found that youth who or whose parents had left their home country for fear-based reasons were less involved within their school and wider community than youth who left or whose parents left for reasons concerning their social mobility. Many existing studies focus on the challenges newcomer youth experience within the education system (see Anisef, Brown, Phythian, & Sweet, 2010), however through the use of qualitative methodologies this study expanded on the current literature by further examining why it is some youth are successful in overcoming such challenges, while others are not. This study supported what has been demonstrated in the literature regarding challenges faced by newcomer youth and resources to address such challenges. Despite challenges experienced within the education system, youth planned to complete secondary school and attend a postsecondary institution. However, not all youth anticipated remaining in Canada upon completion of their education, with youth or youth whose parents left their home country for fear-based reasons frequently discussing the possibility of returning to their or their parents' home country. Thus, perhaps these youth were less involved within their school, as their goal was not necessarily to establish or maintain connections within their community as they may have viewed residing in Canada as temporary. This finding has important implications, as there are benefits to involvement in extracurricular activities, which may assist youth in overcoming challenges encountered within the education system. Therefore, it would seem that youth who had or whose parents had left their home country for reasons concerning their social mobility may have be at an advantage within the education system with respect to their involvement in school. Perhaps then this differential involvement may at least partially explain why it is some newcomer youth are able to overcome challenges they experience in the education system, while others are not. Both policy and theoretical implications are discussed.

Policy Change in Comparative Contexts: Applying the Advocacy Coalition Framework Outside of Western Europe and North America

The advocacy coalition framework (ACF) is one of the most frequently applied theories of the policy process. Most applications have been in Western Europe and North America. This article provides an overview of the ACF, summarizes existing applications outside of Western Europe and North America, and introduces the special issue that features applications of the ACF in the Philippines, China, India, and Kenya. This article concludes with an argument for the continued application of the ACF outside of Western Europe and North America and a research agenda for overcoming challenges in using the ACF in comparative public policy research.

Problemas éticos identificados por enfermeiros na relação com usuários em situação crítica

O artigo apresenta os resultados da análise das questões éticas identificadas por enfermeiros perante usuários em situação crítica, de risco iminente de morte, e cuja sobrevivência depende de métodos avançados de vigilância, monitorização e terapêutica. As principais preocupações éticas dizem respeito à informação ao cliente, ao acompanhamento em fim de vida, à responsabilidade profissional em intervenções interdependentes; as temáticas reportam à decisão da pessoa (consentimento/recusa de proposta terapêutica), dilemas na informação, atuação nos processos de morrer e decisão de não tentar reanimar, respeito pelos direitos humanos em contextos desfavoráveis. Destacamos as dimensões do sentido de responsabilidade, da influência da consciência moral nas decisões, da deliberação de proteger o Outro em risco e da vivência de episódios profissionais de superação; finalmente, identificamos fatores mediadores na gestão das dificuldades éticas.

Relatório de Estágio

Este relatório assenta em três pilares essenciais relativos ao trabalho desenvolvido pela mestranda: a exploração teórica de temáticas educativas; a prática educativa supervisionada e o projeto de investigação em educação. No primeiro, analisam-se alguns temas relacionados com a ação docente: o professor enquanto profissional que reflete e investiga; e a indisciplina na sala de aula. No segundo, descreve-se a experiência de estágio da mestranda com a caracterização do contexto do Território Educativo de Intervenção Prioritário, onde a mesma lecionou, e com a reflexão das suas aulas supervisionadas. A sua intervenção educativa seguiu uma metodologia de cariz de investigação-ação, onde a reflexão serviu, destacadamente, para a alteração e o melhoramento das práticas educativas seguintes. O terceiro pilar apresenta o projeto de investigação desenvolvido pela formanda – Semáforo Nutricional: Pare, Olhe e Escolha. Este, inserido na área das Ciências Naturais, procurou potenciar a alteração de hábitos alimentares saudáveis, nos alunos do 1.º e 2.º Ciclo. Assim, fizeram-se sessões de sensibilização em dois contextos educativos e aplicaram-se questionários-testes, antes e depois dessas sessões. Os resultados deste projeto indiciam uma possível alteração dos seus hábitos alimentares. A formanda procurou estabelecer uma constante relação entre a teoria e a prática, fazendo uso dos saberes adquiridos, ao longo da licenciatura e do presente mestrado. Em suma, o relatório constitui uma síntese de todo o seu percurso formativo, no qual se retrata a evolução, a preparação e a superação de desafios, que um professor do 1.º e 2.º Ciclo do Ensino Básico deverá fazer face a cada momento.

Hidden in plain sight:low-literacy adults in a developed country overcoming social and educational challenges through mobile learning support tools

Illiteracy is often associated with people in developing countries. However, an estimated 50 % of adults in a developed country such as Canada lack the literacy skills required to cope with the challenges of today's society; for them, tasks such as reading, understanding, basic arithmetic, and using everyday items are a challenge. Many community-based organizations offer resources and support for these adults, yet overall functional literacy rates are not improving. This is due to a wide range of factors, such as poor retention of adult learners in literacy programs, obstacles in transferring the acquired skills from the classroom to the real life, personal attitudes toward learning, and the stigma of functional illiteracy. In our research we examined the opportunities afforded by personal mobile devices in providing learning and functional support to low-literacy adults. We present the findings of an exploratory study aimed at investigating the reception and adoption of a technological solution for adult learners. ALEX© is a mobile application designed for use both in the classroom and in daily life in order to help low-literacy adults become increasingly literate and independent. Such a solution complements literacy programs by increasing users' motivation and interest in learning, and raising their confidence levels both in their education pursuits and in facing the challenges of their daily lives. We also reflect on the challenges we faced in designing and conducting our research with two user groups (adults enrolled in literacy classes and in an essential skills program) and contrast the educational impact and attitudes toward such technology between these. Our conclusions present the lessons learned from our evaluations and the impact of the studies' specific challenges on the outcome and uptake of such mobile assistive technologies in providing practical support to low-literacy adults in conjunction with literacy and essential skills training. © 2013 Her Majesty the Queen in Right of Canada.

OVERCOMING INTERCULTURAL CHALLENGES IN INTERPRETING: A CASE STUDY ON CHINESE-ENGLISH CONFERENCE INTERPRETING

This exploratory case study examines the role of culture in Chinese-English conference interpreting. Given that there has been a lack of empirical research in understanding the role of culture in conference interpreting through the lens of intercultural communication frameworks, we know relatively little about conference interpreters’ experiences with intercultural communication challenges. This project helps address this research gap by investigating the types of intercultural communication challenges that Chinese-English conference interpreters experience and their strategies in managing those challenges. This study hears the voices of both professionals and postgraduate interpreting students. A total number of 27 participants were recruited for this research. Twenty professional conference interpreter were interviewed and seven interpreting students were organized for a focus group discussion. Grounded theory was used to analyze the participants’ observations and strategies in managing intercultural communication challenges when doing Chinese-English conference interpreting. The data analysis process led to the emergence of two procedural guidelines and one process – Interpreters’ Intercultural Mediation Process. The two procedural guidelines offer guidance for the interpreters to provide the most appropriate and effective service: meet with the clients beforehand and be prepared to offer intercultural insights when consulted. Interpreters are found to follow the Interpreters’ Intercultural Mediation Process to decide when and how to mediate intercultural communication challenges at work. This Process includes four criteria, seven intercultural challenges, and seven coping strategies. This study offers theoretical and applied contributions to our understanding of the role of culture in interpreting. By jointly applying frameworks from intercultural communication and interpreting studies to examine the conference interpreting process, this case study makes great efforts to connect the field of intercultural communication with the field of interpreting studies. This study identifies the types of intercultural differences that would lead to challenges in Chinese-English conference interpreting. It also contributes to the call for a cultural turn in interpreting studies. By learning the two procedural guidelines, conference interpreters can be better prepared for their work. By following the Interpreters’ Intercultural Mediation Process, conference interpreters can better anticipate and manage the intercultural challenges at work. This study also offers guidance on tailoring intercultural communication courses for postgraduate interpreting training programs.

Communication challenges in virtual teams – a case study of implementing computer-mediated communication technologies in inter-organisational virtual teams

This thesis seeks to answer, if communication challenges in virtual teams can be overcome with the help of computer-mediated communication. Virtual teams are becoming more common work method in many global companies. In order for virtual teams to reach their maximum potential, effective asynchronous and synchronous methods for communication are needed. The thesis covers communication in virtual teams, as well as leadership and trust building in virtual environments with the help of CMC. First, the communication challenges in virtual teams are identified by using a framework of knowledge sharing barriers in virtual teams by Rosen et al. (2007) Secondly, the leadership and trust in virtual teams are defined in the context of CMC. The performance of virtual teams is evaluated in the case study by exploiting these three dimensions. With the help of a case study of two virtual teams, the practical issues related to selecting and implementing communication technologies as well as overcoming knowledge sharing barriers is being discussed. The case studies involve a complex inter-organisational setting, where four companies are working together in order to maintain a new IT system. The communication difficulties are related to inadequate communication technologies, lack of trust and the undefined relationships of the stakeholders and the team members. As a result, it is suggested that communication technologies are needed in order to improve the virtual team performance, but are not however solely capable of solving the communication challenges in virtual teams. In addition, suitable leadership and trust between team members are required in order to improve the knowledge sharing and communication in virtual teams.

Overcoming the Complexity of Software Product Management

This thesis describes an approach to overcoming the complexity of software product management (SPM) and consists of several studies that investigate the activities and roles in product management, as well as issues related to the adoption of software product management. The thesis focuses on organizations that have started the adoption of SPM but faced difficulties due to its complexity and fuzziness and suggests the frameworks for overcoming these challenges using the principles of decomposition and iterative improvements. The research process consisted of three phases, each of which provided complementary results and empirical observation to the problem of overcoming the complexity of SPM. Overall, product management processes and practices in 13 companies were studied and analysed. Moreover, additional data was collected with a survey conducted worldwide. The collected data were analysed using the grounded theory (GT) to identify the possible ways to overcome the complexity of SPM. Complementary research methods, like elements of the Theory of Constraints were used for deeper data analysis. The results of the thesis indicate that the decomposition of SPM activities depending on the specific characteristics of companies and roles is a useful approach for simplifying the existing SPM frameworks. Companies would benefit from the results by adopting SPM activities more efficiently and effectively and spending fewer resources on its adoption by concentrating on the most important SPM activities.

International Entrepreneurship in Bottom of the Pyramid Markets – Overcoming institutional constraints

Bottom of the pyramid (BoP) markets are an underserved market of approximately four billion people living on under $5 a day in four regional areas: Africa, Asia, Eastern Europe and Latin America. According to estimations, the BoP market forms a $5 trillion global consumer market. Despite the potential of BoP markets, companies have traditionally focused on serving the markets of developed countries and ignored the large customer group at the bottom of the pyramid. The BoP approach as first developed by Prahalad and Hart in 2002 has focused on multinational corporations (MNCs), which were thought of as the ones who should take responsibility in serving the customers at the bottom of the pyramid. This study challenges this proposition and gives evidence that also smaller international new ventures – entrepreneurial firms that are international from their birth, can be successful in BoP markets. BoP markets are characterized by a number of deficiencies in the institutional environment such as strong reliance on informal sector, lack of infrastructure and lack of skilled labor. The purpose of this study is to increase the understanding of international entrepreneurship in BoP markets by analyzing how international new ventures overcome institutional constraints in BoP markets and how institutional uncertainty can be exploited by solving institutional problems. The main objective is divided into four sub objectives. • To describe the opportunities and challenges BoP markets present • To analyze the internationalization of INVs to BoP markets • To examine what kinds of strategies international entrepreneurs use to overcome institutional constraints • To explore the opportunities institutional uncertainty offers for INVs Qualitative approach was used to conduct this study and multiple-case study was chosen as a research strategy in order to allow cross-case analysis. The empirical data was collected through four interviews with the companies Fuzu, Mifuko, Palmroth Consulting and Sibesonke. The results indicated that understanding of the wider institutional environment improves the survival prospects of INVs in BoP markets and that it is indeed possible to exploit institutional uncertainty by solving institutional problems. The main findings were that first-hand experience of the markets and grassroots levels of information are the best assets in internationalization to BoP markets. This study highlights that international entrepreneurs with limited resources can improve the lives of people at the BoP with their business operations and act as small-scale institutional entrepreneurs contributing to the development of the institutional environment of BoP markets.

Challenges with minimising mercury pollution in the small-scale gold mining sector: Experiences from the Guianas

This paper examines the barriers to mitigating mercury pollution at small-scale gold mines in the Guianas (Guyana, French Guiana and Suriname), and prescribes recommendations for overcoming these obstacles. Whilst considerable attention has been paid to analysing the environmental impacts of operations in the region, minimal research has been undertaken to identify appropriate policy and educational initiatives for addressing the mounting mercury problem. Findings from recent fieldwork and selected interviews with operators from Guyanese and Surinamese gold mining regions reveal that legislative incapacity, the region's varied industry policy stances, various technological problems, and low environmental awareness on the part of communities are impeding efforts to facilitate improved mercury management at small-scale gold mines in the Guianas. Marked improvements can be achieved, however, if legislation, particularly that pertaining to mercury, is harmonised in the region; educational seminars continue to be held in important mining districts; and additional outlets for disseminating environmental equipment and mercury-free technologies are provided.