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No. of bitstreams: 1 pinotti_kf_dr_bot.pdf: 7020764 bytes, checksum: fa87243e46f8244edc33c33d3eea6530 (MD5) Previous issue date: 2016-08-08 / Introdução: A técnica de fechamento convencional, após esternotomia mediana, para unir as duas partes do esterno, é realizada com fios de aço aplicando-se sutura simples ou sutura em forma de oito, no entanto, esta técnica tem sido associada a várias complicações pós-operatórias graves, tais como: deiscência da ferida, infecção esternal profunda, instabilidade esternal e mediastinite, principalmente em pacientes com fatores de risco, tais como portadores de osteoporose, diabetes, obesidade, entre outros. Novas estratégias para o fechamento de esternotomias medianas estão sendo propostas para tentar minimizar a incidência dessas complicações. Objetivos: Avaliar a eficácia de técnicas de fechamento esternal não convencional para a prevenção de complicações da ferida esternal após esternotomia mediana, comparando com o fechamento convencional. Métodos: A última pesquisa foi realizada nodia 15 de Setembro de 2015. Não houve restrições de linguagem. Os trabalhos foram obtidos a partir das seguintes fontes: Wounds Cochrane Grupo Especializada Register, Cochrane Central Register de Ensaios Controlados (CENTRAL), Ovid MEDLINE (1946 até o dia 15 de Setembro de 2015), Ovid EMBASE (1974 até o dia 15 de Setembro de 2015), EBSCO CINAHL (1982 até o dia 15 de Setembro de 2015) e LILACS (1982 até o dia 15 de Setembro de 2015). Foram pesquisados os registros de ensaios clínicos. Foram também rastreadas as listas de referências e contactados os autores necessários. Critério de seleção: dois revisores independentes identificaram os estudos para a inclusão. Foram incluídos estudos randomizados controlados de técnicas de fixação esternal após esternotomias, comparando métodos convencionais com métodos alternativos realizados com pessoas de qualquer idade, sexo e raça. Coleta e análise de dados: dois revisores extraíram independentemente os dados, avaliaram seu risco de viés e os desfechos para cada artigo. Para desfechos dicotômicos foi utilizada a razão de risco (RR) com intervalos de confiança (IC) de 95%. Para desfechos contínuos foram apresentados os resultados como diferenças de médias (MD) com intervalo de confiança (IC) de 95%. Resultados: Foram incluídos 23 estudos que envolveram 8741 pacientes. O maior risco de viés foi do mascaramento de participantes e pessoal, devido à natureza cirúrgica da intervenção. Houve uma diferença estatisticamente significativa favorecendo o fechamento não convencional, mas com uma baixa qualidade de evidência, quando analisados os desfechos: infecção profunda da ferida esternal (RR 0,24, IC95% 0,06-0,93; 16 estudos, 7559 participantes); instabilidade do esterno (RR 0,20, IC95% 0,07-0,56; 15 estudos, 5467 participantes); e tempo de ventilação mecânica (diferença média de -1,93 dias, IC 95% -3,77 a -0,10; 5 estudos, 1800 participantes). Não houve diferença nos desfechos: deiscência da ferida (RR 1,07, IC95% 0,60-1,89; 12 estudos, 6758 participantes); morte (RR 0,96, IC95% 0,64 a 1,45; 13 estudos, 4506 participantes); tempo de internação hospitalar (diferença média - 1,16 dias, IC 95% -3,15 a 0,83; 11 estudos, 4859 participantes); re-operação (RR 0,60, IC95% 0,23-1,60; 9 estudos, 5124 participantes); permanência na UTI (diferença média - 0,15 dias, IC 95% -0,37 a 0,07; 8 estudos, 5240 participantes); e mediastinite (RR 0,65, IC95% 0,18 a 2,39; 7 estudos, 3011 participantes). Houve diferença estatisticamente significante favorecendo a utilização de colete torácico pós-operatório, mas também com baixa qualidade de evidência, quando analisados os desfechos: infecção profunda da ferida esternal (RR 0,44, IC95% 0,25- 0,77; 3 estudos, 3510 participantes); tempo de internação hospitalar (diferença média - 5,16 dias, IC 95% -6,65 a -3,67; 2 estudos, 971 participantes); e reoperação (RR 0,43, IC95% 0,23 a 0,80; 2 estudos, 3289 participantes). Não houve diferença nos desfechos: deiscência da ferida (RR 1,07, IC95% 0,59-1,91; 3 estudos, 3510 participantes); instabilidade do esterno (RR 0,13, IC95% 0,01-1,22; 2 estudos, 971 participantes); e morte (RR 0,14, IC95% 0,02 a 1,16; 2 estudos, 971 participantes). Conclusões: Há alguma evidência, de baixa qualidade, de que o uso de métodos não convencionais, em pacientes de alto risco, pode reduzir a infecção profunda da ferida esternal, a instabilidade esternal e o tempo de ventilação mecânica no pós-operatório de esternotomia mediana, mas não há diferença quando se comparam as taxas de: morte, deiscência da ferida, mediastinite, reoperação, tempo de internação hospitalar ou internação em UTI. Existe uma baixa evidência de que o uso de colete torácico no pós-operatório pode reduzir a infecção profunda da ferida esternal, a reoperação e o tempo de internação hospitalar, mas não há diferença quando comparamos deiscência, instabilidade esternal e mortalidade. / Background: The standard closure technique after median sternotomy is to join the two parts of the sternum using steel wires with simple suture or figure-of-eight fashion wiring, however this tecnique has been associated with several serious postoperative complications, such as: wound dehiscence, deep sternal wound infection, sternal instability, mediastinitis, specially in patients with risk factors such as osteoporosis, diabetis, obesity, and others. New strategies for the closure of median sternotomies are being sought to try minimize the incidence of these complications. Objectives: Evaluate the efficacy and safety of non-conventional sternal closure techniques for preventing sternal wound complications following sternotomy, compared to the conventional closure. Methods: We ran the search on the 15 September 2015. There were no language restrictions. Trials were obtained from the following sources: the Cochrane Wounds Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (1946 to present), Ovid EMBASE (1974 to present), EBSCO CINAHL (1982 to present) and LILACS (1982 to present). We searched clinical trials registers. We also screened reference lists and contacted experts. Selection criteria: Two review authors independently identified studies for inclusion. We included randomized controlled trials of sternal fixation techniques following sternotomies, comparing standard methods with alternative methods conducted with people of any age, gender and race. Data collection and analysis: Two review authors, independently extracted data, assessed their risk of bias in the trials and outcomes for each trial. For dichotomous data we used the risk ratio (RR) with 95% confidence intervals (CI). For continuous data we presented the results as mean differences (MD) with 95% confidence intervals (CI). Results: We included 23 studies that involved 8741 people. The increased risk of bias was the blinding of participants and personnel, due to the surgical nature of the intervention. There were low quality of the evidence favoring non standard closure, when we analised the outcomes: deep sternal wound infection (DSWI) (RR 0.14, 95% CI 0.04 to 0.43; 16 studies, 7559 participants); sternal instability (RR 0.20, 95% CI 0.07 to 0.56; 15 studies, 5467 participants); and mechanical ventilation time (Mean difference 1.93 fewer days, 95% CI -3.77 to -0.10; 5 studies, 1800 participants). There was no difference in outcomes: wound dehiscence (RR 1.07, 95% CI 0.60 to 1.89; 12 studies, 6758 participants); death (RR 0.96, 95% CI 0.64 to 1.45; 13 studies, 4506 participants); hospital stay (Mean difference - 1.16 days, 95% CI -3.15 to 0.83; 11 studies, 4859 participants); reoperation (RR 0.60, 95% CI 0.23 to 1.60; 9 studies, 5124 participants); ICU stay (Mean difference - 0.15 days, 95% CI -0.37 to 0.07; 8 studies, 5240 participants); and mediastinitis (RR 0.65, 95% CI 0.18 to 2.39; 7 studies, 3011 participants). There were low quality of evidence favoring the use of post operative thoracic vest (corset), when we analised the outcomes: deep sternal wound infection (DSWI) (RR 0.44, 95% CI 0.25 to 0.77; 3 studies, 3510 participants); hospital stay (Mean difference 5.16 fewer days, 95% CI -6.65 to -3.67; 2 studies, 971 participants); and reoperation (RR 0.43, 95% CI 0.23 to 0.80; 2 studies, 3289 participants). There was no difference in outcomes: wound dehiscence (RR 1.07, 95% CI 0.59 to 1.91; 3 studies, 3510 participants); sternal instability (RR 0.13, 95% CI 0.01 to 1.22; 2 studies, 971 participants); and death (RR 0.14, 95% CI 0.02 to 1.16; 2 studies, 971 participants). Conclusions: There is low quality of the evidence that the use of non standard methods, in high risk patients, can reduce deep sternal wond infection, sternal instability and mechanical ventilation time on post operative median sternotomy, but there is no difference when we compare rates of: death, wound dehiscence, mediastinites, reoperation, hospital stay or ICU stay. There is low quality of the evidence that the use of post operative Thorax Vest (Corset) can reduce deep sternal wound infection, reoperation and hospital stay, but there is no difference when we compare wound dehiscence, sternal instability and death.

Methodical and detailed excavation of room and feature fill at Homol'ovi I pueblo has allowed for the study of structure and feature closure and dedication practices. At least six reoccurring ash closure deposit types have been identified, and several can be tied to the renewal and re-use of features, structures, and pueblo space. Other ritual closure deposits serve to cover and seal off space, and based on the various colors of sediment, ash, and objects used in the creation of elaborately layered structure and feature fill, the deposits are suggestive of conservation efforts that are connected to traditional Hopi cosmology, color symbolism, and religious ideology. Still other ash closure deposits may have been an element of ritual purification. A large number of plants have prominent roles in traditional Hopi ritual practices. This study specifically explores the plant taxa that are present within the six reoccurring ash closure deposit types, and Hopi ethnography and recent collaborative efforts are used to draw inferences between past and the present plant uses. The closure deposits are compared amongst each other, as well as against non-ritual deposits in an attempt to define patterns of plant use and ritual behavior.

Closure is one of the most important putative goals for highly structured Renaissance verse. Elements of structure—for example, sophisticated prosody or the embedding of a poem within a web of intertextual relationships—determine how poets work toward closure. This project explores how verse forms and genre manifest poets’ attempts to create resolution, and, significantly, how often the challenges of the process instead become the object of focus. Developing a New Formalist approach that focuses on how literary forms are inherently responsive (both to the social conventions that inform various genres and to the expressive goals of individual authors), I examine texts in four important Renaissance poetic genres: epyllion (William Shakespeare’s Venus and Adonis [1593]), satire (Joseph Hall’s Virgidemiae [1598, 1599]), religious lyric (George Herbert’s The Temple [1633]), and pastoral elegy (John Milton’s Epitaphium Damonis [1639] and Lycidas [1637, 1645]). These works illuminate some of the most significant strategies of authors who often meditate on the appeal of definitive, resolved conclusions and also on the complex ways their works become conditioned by the hope and struggle for resolution.

No description available.

No description available.

Lai Shiu-Ming, Jimmy. / "January 2004." / Thesis (M.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 157-163). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Constrained graph problems are about finding graphs respecting a given set of constraints. These problems occur in many areas. For example, security properties, biological reaction mechanisms, ecological predator/prey relationships, compiler code optimizations, and logic circuit fault diagnosis are just a few of the areas in which graph constraints play an important role. This thesis proposes a constraint programming approach for solving these problems. We present new constraints defined on top of the notions of domination and transitive closure, and their search algorithms. We have implemented these constraints in the state-of-the-art Gecode system and shown that they are competitive with or better than other approaches in realistic scenarios. / Les problèmes de graphes contraints concernent la recherche de graphes qui respectent un ensemble donné de contraintes. Ils apparaissent dans de nombreux domaines. Par exemple, la sécurité dans les logiciels, les méchanismes des réactions biologiques, les relations prédateur/proie en écologie, l'optimisation de code par les compilateurs, et le diagnostic de pannes dans des circuits logiques sont quelques-uns des domaines dans lesquels les contraintes de graphes jouent un rôle important. Cette thèse propose une approche basée sur la programmation par contraintes pour résoudre ces problèmes. Nous présentons de nouvelles contraintes définies sur les notions de domination et de clôture transitive, ainsi que leurs algorithmes de recherche. Nous avons implémenté ces contraintes dans le système de pointe Gecode, et avons montré notre approche compétitive et parfois meilleure que d'autres approches dans des cas réalistes.

Constrained graph problems are about finding graphs respecting a given set of constraints. These problems occur in many areas. For example, security properties, biological reaction mechanisms, ecological predator/prey relationships, compiler code optimizations, and logic circuit fault diagnosis are just a few of the areas in which graph constraints play an important role. This thesis proposes a constraint programming approach for solving these problems. We present new constraints defined on top of the notions of domination and transitive closure, and their search algorithms. We have implemented these constraints in the state-of-the-art Gecode system and shown that they are competitive with or better than other approaches in realistic scenarios. / Les problèmes de graphes contraints concernent la recherche de graphes qui respectent un ensemble donné de contraintes. Ils apparaissent dans de nombreux domaines. Par exemple, la sécurité dans les logiciels, les méchanismes des réactions biologiques, les relations prédateur/proie en écologie, l'optimisation de code par les compilateurs, et le diagnostic de pannes dans des circuits logiques sont quelques-uns des domaines dans lesquels les contraintes de graphes jouent un rôle important. Cette thèse propose une approche basée sur la programmation par contraintes pour résoudre ces problèmes. Nous présentons de nouvelles contraintes définies sur les notions de domination et de clôture transitive, ainsi que leurs algorithmes de recherche. Nous avons implémenté ces contraintes dans le système de pointe Gecode, et avons montré notre approche compétitive et parfois meilleure que d'autres approches dans des cas réalistes.

Due to the impact of globalization, enterprises have undertaken all possible cuts to survive. Fresh-outs have encountered obstacles entering job markets. Unemployment rate has reached its record high. The solution could be ¡§Invest & Emigrate Abroad¡¨ to create job opportunities for Taiwan people. This study ¡§The Impact of Foreign Investment and Emigration on the Unemployment¡¨ is to find ways for people from Taiwan to be employed abroad. With the assistance of Government, this would be a win-win solution for employers and work force in Taiwan. The purpose of this study is outlined below: 1. Providing solutions to lessen the impact of globalization which are causing closure and relocations of businesses. 2. Providing solutions to prevent mid-aged work force losing their jobs. 3. Encouraging educated workers to emigrate, this could in turn promote the image of Taiwan. 4. Assisting businesses to find opportunities abroad. 5. Emigrating to other countries can reduce unemployment rate and improve quality life in Taiwan. The research procedures and their flow are designed based on the objectives of this study. The sources of literature and the definitions of the issues are considered in designing the procedure. The research constructions then are planned according to the chosen research method. There are two research issues: A and B. Issue A: Would the perception of the factors which cause the closure of businesses and workers to lose jobs vary due to personal characteristics. Issue B: Would the perception of the important issues which cause businesses to close and workers to lose jobs vary due to personal characteristics.¡C The questionnaire consists of 31 questions. 450 copies were sent via mail or hand delivery. 331 responded and collected. 9 out of 331 were invalid. Valid rate is 73%. People randomly chosen to fill out the questionnaire or to be interviewed included those from manufacturing, construction, services, agriculture, governmental, and academic (incl. students) fields. 68% perceived that ¡§Invest & Emigrate Abroad¡¨ could help businesses and improve employment environment. The details of the results are as followed: Issue A¡GUsing factor analysis to operate measuring tool, we chose 4 major factors. According to the definitions¡]Organized Emigration with Special Task Officials¡BInvestment & Emigration improve investment environment¡BEmigration can reduce unemployment¡BPlanning Emigration & Investment Strategies and Changes of Policies¡^, the findings from Variation Analysis are¡G ¡]1¡^Organized Emigration with Special Task Officials: Investment & Emigration is highly interested by those who are currently employed. North America, South-East Asia, Mainland China, Europe, Australia, and North-East Asia are highly preferred to Africa. Male have stronger interest than Female. ¡]2¡^Investment & Emigration improves investment environment: As the scale of investment and capital, most prefer small/mid sizes. In this case, More Male think so than Female. ¡]3¡^Capitals on ¡§Emigration can reduce population and unemployment rate¡¨¡GAs far as ¡§using small/mid size capital to invest in big enterprises¡¨ more people from service industry show the support than those from governmental offices. ¡]4¡^Places to Invest & Emigrate on ¡§Planning Emigration & Investment Strategies and Changes of Policies¡¨¡G North America, South-East Asia, Mainland China, Europe, Australia, and North-East Asia are highly preferred. Male are more so than Female. Issue B¡GWould the perception of the important issues which cause the closure of businesses and workers to lose jobs vary due to personal characteristics? The results from Variation Analysis are¡G ¡]1¡^Providing businesses with the best investment environment: Workers with certain amount of education are preferred. Countries are crucial too. However the differences of preference among countries are insignificant. Age is an important consideration, yet the differences aren¡¦t significant. ¡]2¡^Looking to the governmental officials to reduce unemployment rate¡GNo significance ¡]3¡^Looking to the governmental officials to provide education and training¡GNo significance ¡]4¡^Providing Internal Affairs Ministry with solutions to reduce population¡G In terms of scope of investment: ¡§using small/mid size capital to invest in big enterprises¡¨, more professionals think it feasible, however¡Ano data refer to any significance among different sources. On the age issue, it is also feasible, however¡Ano data refer to any significance among different sources. ¡]5¡^¡§Organized Invest & Emigrate can promote the image of Taiwan¡¨¡GLocations are vital but no data refer to the differences among countries. Gender wise, Male has more significant response than Female. ¡]6¡^The relationship between the effective globalization of businesses and emigration policies¡¨¡GLocations are vital but no data refer to the differences among countries. Age is an important factor but no significance among various data. Profession wise: More governmental workers than in the industries. To sum up, the government ought to pass the ¡§Policies for Emigration Offices (EO)¡¨. EO then can plan ¡§ Optimal Invest & Emigrate Abroad¡¨. At the same time, with the very large scale of governmental infrastructure projects, there would be a great increase of employment opportunities. Thus, foreign labors would be reduced gradually. By the same token, the closure of businesses and unemployment rate would be reduced. The suggestions of this study are¡G 1. How to plan ¡uThe Optimum population¡vto emigrate to reduce unemployment rate. 2. How to plan ¡§Invest & Emigrate¡¨ in order to bring economic benefits to the subject countries 3. How to set up Special Task Offices in the Government for implementations. 4. How to organize strategic industry groups¡C 5. The implementation steps to realize the big project.

Psychological closure is the feeling that a life experience is complete and a part of the past (Beike, Adams, and Wirth-Beaumont 2007). While research on psychological closure primarily deals with traumatic or highly aversive life experiences, psychological closure is frequently experienced and sought after in more typical consumption settings. My dissertation extends our current knowledge about the role of psychological closure by exploring emotional, cognitive, perceptual, and behavioral implications of psychological closure across a broad range of consumer experiences. The first essay aims to demonstrate that closure makes events seem distant in time and probability through emotion. It also explores resulting consumer decisions such as warranty purchase intentions. The second essay proposes and tests how psychological closure of a consumer learning experience can lead to an abstract representation of that learning experience, and consequently a heightened sense of subjective knowledge. / text