This randomized, double-blind, placebo-controlled study was conducted to compare the effectiveness of intravenous acetaminophen vs. oral acetaminophen or placebo as an adjunct to opioids on lowering post-operative pain scores, discharge time, need for opioids, and opioid-related side effects, as well as assessing for any effects pain treatment has on embryological and pregnancy outcomes. Secondary analysis included identifying risk factors in patients that cause them to have worsening pain or minor relief from traditional pain management. This study was conducted at a single academic fertility center at Massachusetts General Hospital in Boston with a patient population of 159 English-speaking women between 18-43 years old, undergoing oocyte retrieval as a part of In Vitro Fertilization procedure. Participants were randomly placed in one of three treatment groups to receive either 1000mg IV acetaminophen and PO placebo (Group A), IV placebo, and 1000mg PO acetaminophen (Group B), or IV and PO placebo (Group C) as pain control before oocyte retrieval procedure. The primary outcomes measured were patient-reported post-operative visual analogue scale pain scores in the recovery room at 10 minutes, 30 minutes, and discharge time. Using these values to measure the effectiveness of each treatment at improving post-operative pain. To assess the relationship, if any, between demographical or clinical factors and pain, we analyzed what factors were common in those experiencing high or low pain. We used the Visual Analog Scale (VAS) which has patients rank pain from 1-10. For this analysis, low pain is defined as those whose 10-minute post-operative pain score was less than 5 (VAS score <5/10) and high pain as those whose 10-minute postoperative pain score is 5 or greater (VAS score 5+/10). Results showed that mean post-operative pain scores were similar between the study groups at 10 minutes (A:2.3, B: 2.6, C:2.8, p=0.51). Timing of discharge was also similar (A:60.1 mins, B: 58.8 mins, C:57.6mins; p=0.76). Although not statistically significant, the mean post-operative opioid dose for patients in group A was less than half of that in Group B and C (0.24mg vs. 0.59mg vs. 0.58mg; p=0.34) and fewer required rescue pain medication in the recovery room (4% vs. 19% vs. 15% respectively; p=0.24). There was a trend towards decreased side effects of constipation in Group A compared to Groups B and C (15% vs. 31% vs. 33%, respectively; p=0.07). There were no differences in embryological or early pregnancy outcomes between study groups. An analysis of predictors of pain, patients with BMI >/=30kg/m2 (obese) were more likely to report high post-operative pain (p=0.009). Prior abdominal surgeries, including pelvic laparoscopy and laparotomy, were associated with low post-operative pain (p=0.069 and p=0.025, respectively). Those who reported having pre-operative pain greater than zero were more likely to report lower postoperative pain (p=0.002). There was no significant relationship between race/ethnicity, infertility diagnosis, and procedure length and pain. This study's findings showed no significant difference between post-operative pain scores or discharge times in women undergoing oocyte retrieval when given IV acetaminophen, PO acetaminophen, or a placebo. There were severe findings that suggested that IV acetaminophen may reduce the need for post-operative narcotics and lead to fewer opioid-related side effects, however these findings while large were statistically insignificant. The predictors of higher post-operative pain we found, including high BMI, no prior history of abdominal procedures, and lack of pre-operative pain, indicate that further investigation into these predictors could be beneficial. This information may allow physicians and anesthesiologists to optimize their pain control.

No description available.

As the demand for liquidity risk management has increased, the importance of comprehensive liquidity assessments of exchanges has been highlighted. This thesis investigates the liquidity on the Nasdaq OMX Stockholm exchange by using daily end of day data. The transaction cost is evaluated using the Holden model and the price impact from trading is evaluated using the Illiq model. Considering the three segments; small cap, mid cap, and large cap, the results suggest that both the transaction cost and price impact is highest for small cap stocks and lowest for large cap stocks. It is also shown that the transaction cost has decreased between 2002-03-20 and 2012-01-06 for all three segments although the cost is increasing for the small cap segment again. No decrease in price impact over this time period could be found. The data behind the results has then been used to create a combined liquidity measure with the purpose of indicating the liquidity condition of a mutual fund. The combined measure can also be used to assess whether it is price impact or transaction cost that contributes most to the liquidity cost when liquidating stocks or reveal what stocks in a portfolio that are the most illiquid. It is hence suggested as a tool for assessing large portfolios.

Le diagnostic assisté par ordinateur du cancer du sein suscite de plus en plus un réel engouement en raison de la quantité sans cesse croissante d'images mammographiques issues des campagnes de dépistage. L'accent est mis sur les opacités mammaires en raison du risque élevé de cancer qui leur est associé. En effet, la variabilité des formes rencontrées et la difficulté à discerner les masses surtout quand ces dernières sont embarquées dans des densités importantes exigent une nouvelle stratégie plutôt adaptée aux cas les plus complexes à savoir les masses appartenant aux classes BI-RADS IV et V, c-à-d. respectivement les masses malignes spiculées et les distorsions architecturales. Dans ce travail, un système de diagnostic assisté par ordinateur entièrement automatique et conçu pour la segmentation et la classification des opacités dans les catégories bénigne/maligne ou graisseuse/dense, spécifiquement pour celles de type BI-RADS IV et V est abordé. Dans un premier temps, nous avons développé une approche de pré-traitement des images fondée sur l'apprentissage d'un dictionnaire parcimonieux sur les bases d'images, combiné à une réduction de dimension afin de supprimer de façon efficace et rapide le bruit de numérisation des images mammographiques présentes dans les bases utilisées pour concevoir notre système de diagnostic en comparaison des approches déjà existantes. Une fois les images pré-traitées, nous avons mis en place une procédure de segmentation non-supervisée des masses basée sur les champs de Markov et qui a l'avantage d'être à la fois plus rapide, plus efficace et plus robuste que les meilleures techniques de segmentation disponibles dans l'état-de-l'art. De plus, la méthode proposée s'affranchit de la variabilité des masses et ce quelque soit la densité de l'image. Dans l'idée de décrire convenablement les lésions malignes spiculées, nous avons conçu une méthode de segmentation des spicules qui présente la particularité de ne pas recourir à l'utilisation de descripteurs extraits manuellement dont les performances peuvent varier en fonction de leur qualité. L'approche proposée repose sur des hypothèses que nous avons formulées concernant l'aspect des spicules. Celles-ci nous ont conduits à développer un modèle Markovien combiné à une transformée de Radon locale pour extraire les structures curvilignes de l'image. Ensuite, nous servant d'un modèle a contrario, nous avons pu extraire les spicules de l'ensemble des structures détectées. Cette phase, vient clore la première partie de la conception de notre système, qui est en mesure d'extraire soit des masses spiculées, soit des distorsions architecturales. Afin de finaliser sa conception, nous avons procédé à la création d'un modèle d'aide à la décision qui, à l'inverse de ce qui s'est toujours fait dans l'état-de-l'art pour la discrimination des masses, procède à une extraction non-supervisée des descripteurs à l'aide d'une méthode issue du Deep learning, à savoir les réseaux de neurones à convolution. Les descripteurs extraits, sont ensuite utilisés dans un classifieur SVM pour apprendre un modèle. Ce modèle servira par la suite à la reconnaissance du cancer du sein. Les résultats obtenus pour chacune des étapes du système de diagnostic sont très intéressants et viennent combler un vide important dans la classification des masses en général et dans la distinction des masses malignes entre elles en particulier en se fondant sur trois niveaux de décision que sont la forme, la densité et les spicules. / Computer-aided diagnosis of breast cancer is raising increasingly a genuine enthusiasm because of the ever-increasing quantity of mammographic images from breast cancer screening campaigns. The focus is on breast masses due to the high risk of cancer associated with them. Indeed, the variability of shape encountered and the difficulty to discern the masses especially when theyare embedded in a high density require a new approach especially suited for the most complex cases namely the masses which belong to classes BI-RADS IV and V, i.e. spiculated breast mass and architectural distortion. In this work, a fully automatic computer-aided diagnosis system is designed for the segmentation and classification of breast mass especially for malignant masses of classes BI-RADS IV and BI-RADS V. Initially, we developped a pre-processing method combined with the reduction of the dictionary size in order to remove effectively and quickly the digitization noise of the mammographic images that make up the database used to design our computer-aided diagnosis system in comparison with the existing approaches. After the image pre-processing, we haveproposed an unsupervised segmentation method based on a Markov random field which has the advantage of being faster, more efficient and more robust than the state-of-art segmentation methods. Furthermore, the proposed method overcomes the variability of the breast masses whatever the image density. In purpose to describe correctly the spiculated malignant lesions, we proposed anapproach which avoid the computation and extraction of local features, and to rely on general-purpose classification procedures whose performance and computational efficiency can greatly vary depending on design and image characteristics. The proposed method is based on several assumptions on the structure of spicules as they appear in mammograms which have been reported in the literature. In order to make use of the above assumptions, the proposed method proceeds the following steps: first the mammogram is separated into patches onto which the curvilinear structures are discretized into segments due to Radon transform. Then, Markov modeling and contextual information are used to refine the segment positions and associate segments into curvilinear structures. Finally, spicules are detected based on a contrario model. This stage conclude the first part of the design of our computer-aided diagnosis system, that is able to extract both spiculated masses and architectural distortion. In order to complete the design of the diagnosis system, we carried out the creation of a decision support model which, contrary to what has always been done in the state-of-art for discrimination of the masses, conducts an unsupervised extraction of features through Deep learning approach - namely convolutional artificial neural networks -, combined with an SVM-type classifier. The obtained model is then stored and used as a classifier for breast cancer recognition tasks during the generalization phase. The results obtained for each step of the design of our system are very interesting and come to fill an important gap in the distinction of different type of malignant masses.

No description available.

No description available.

Child abuse and neglect in the United States resulted in 676,569 reports in 2011 (U.S. Dept. of Health and Human Services, 2012). Workers in this field struggle with low pay, high caseloads, inadequate training and supervision, and risk of violence, all of which contribute to worker burnout and poor worker retention rates. Worker self- efficacy is predictive of worker retention, job performance, and persistence in this difficult field. This paper reports the development of a new measure of self-efficacy from a sample of 395 child welfare workers. Factor analysis revealed two domains of self- efficacy, direct practice and indirect practice, which can be modestly predicted by worker characteristics upon hire and the training program the workers attend. Worker self- efficacy can be used to identify vulnerable workers who may be especially in need of strong supervisory support as well as understand who to target for recruitment. A review of the literature of self-efficacy in child welfare workers is included.

Syftet med denna kvalitativa studie har varit att undersöka hur två elevgrupper från gymnasiets IV program har uppfattat sin arbetsplatsförlagda utbildning (APU) samt det studiestöd som har erbjudits dem under sin skolgång. Metod som använts är djupintervju på den elevgruppen som gick sista gymnasieåret och telefonintervju på den elevgrupp som slutat gymnasiet året innan.Bägge undersökningsgrupperna var mycket nöjda med genomförandet och upplägget med APUn men många elever hade hoppats på att få någon slags anställning efter genomförandet, särskilt de elever som redan hade slutat gymnasiet. Många fick inte denna möjligheten och står därmed till Arbetsförmedlingens förfogande idag.Undersökningsgrupperna hade svårt att peka ut vad som var studiestöd för dem eftersom de under hela sin gymnasietid har varit omgärdad av stöd. Nästan alla uppskattade ändå möjligheten att få mer tid på sig att genomföra sina kurser och en av grupperna både fick och uppskattade möjligheten att få hjälp av assistent i klassrummet. Några i den äldre gruppen uttryckte missnöje över att det var stökigt i klassrummet, även de som hade orsakat det. Att få möjlighet till muntliga prov och mer enskild hjälp av lärare var bland annat andra önskemål från några i undersökningsgrupperna.Totalt sett var de flesta mycket nöjda med gymnasieprogrammets utbildning.Nyckelord: APU, stödåtgärder, gymnasiet, intervjuer.

En informationsfilm om IVbf och ett skriftligt arbete om IV och om hur man kan gå tillväga för att göra en informationsfilm / Information about the individual program through practical and writing work

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.