Lau Tsz Chung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 57-66). / Text in English; abstracts in English and Chinese. / Lau Tsz Chung. / Acknowledgement --- p.i / Abstract --- p.ii / Table of contents --- p.v / List of Figures --- p.viii / List of Tables --- p.x / Introduction --- p.1 / Background --- p.1 / Statement of Problem --- p.3 / Research Question --- p.4 / Significance of the Study --- p.4 / Theoretical Contribution --- p.4 / Practical Contribution --- p.5 / Review of Literature --- p.7 / Load carrying on Level Ground --- p.7 / Research Method Involved --- p.8 / Modified Gait Pattern During Load Carriage --- p.9 / Trunk Posture --- p.10 / Low Back Pain --- p.11 / Posture and Back Pain --- p.12 / Load Carrying Studies in Children --- p.14 / Stair Walking --- p.15 / Compared with Level Walking --- p.15 / Temporal Characteristics --- p.17 / Kinematics Measurement --- p.18 / Stair Dimensions --- p.19 / Stair Walking with Load Carriage --- p.21 / Physiological Studies --- p.21 / Biomechanical Studies --- p.21 / Methodology --- p.24 / Design --- p.24 / Subject --- p.24 / Instrumentation --- p.25 / Motion Analysis System --- p.25 / School Bag --- p.25 / Experimental Set-up --- p.25 / Procedure --- p.26 / Term Definition --- p.27 / Data Analysis --- p.27 / Results --- p.29 / Ascending Stair --- p.29 / Posture --- p.29 / Effect on Load Weight --- p.29 / Effect on Load Carrying Method --- p.30 / Velocity --- p.30 / Parameters of Lower Extremities --- p.30 / Descending Stair --- p.31 / Posture --- p.31 / Effect on Load Weight --- p.31 / Effect on Load Carrying Method --- p.31 / Velocity --- p.32 / Parameters of Lower Extremities --- p.32 / Trend --- p.32 / Summary --- p.33 / Discussion --- p.35 / Ascending Stair --- p.35 / Posture --- p.35 / Different Load Weights --- p.35 / Different Carrying Methods --- p.39 / Velocity --- p.40 / Descending Stair --- p.42 / Posture --- p.42 / Velocity --- p.46 / Parameters of Lower Extremities --- p.47 / Trend --- p.48 / Back Pain --- p.49 / Recommended Carrying Load Method and Weight for Children --- p.50 / Limitations of the Study --- p.52 / Further Study --- p.53 / Conclusion --- p.56 / References --- p.57 / Appendix --- p.67 / Appendix A - The experimental Set-up --- p.67 / Appendix B - Subject Consent Form --- p.68 / Appendix C - Figures and Tables --- p.71

No description available.

La Ulcera Venosa (UV) es una patología crónica, que afecta aproximadamente a un 1-2% de la población mayor y adulta en los países desarrollados y demanda, importantes costes, en atención a los tratamientos prolongados y variados, inversión de tiempos por parte de profesionales de la salud, consumo de grandes volúmenes de materiales. Se ha constatado que la calidad de vida relacionada con la salud (CVRS) de las personas con UV está afectada negativamente. La medición de CVRS permite, en gran medida, contribuir a mejorar la calidad del cuidado. En España no se dispone de instrumentos de medida específicos CVRS en personas con UV y de medida de la evolución hacia la cicatrización en pacientes con UV, que hayan sido validados mediante la investigación. Disponer de estas herramientas ayudaría a la toma de decisiones y a aumentar la calidad de los cuidados con este tipo de pacientes. / Objetivo General: Determinar CVRS de los pacientes con UV y analizar como la evolución clínica de la herida influye en las distintas dimensiones de la CVRS, mediante la aplicación de instrumentos específicos de medida para tal fin. / Material y Método: El estudio se realizó en tres fases: FASE 1: Revisión bibliográfica y sistemática en las principales bases de datos de ciencias de la salud MEDLINE (a través PubMed y Webspirs), PsycINFO, COCHRANE, CINAHL, LILACS, FECYT, EMBASE y CUIDEN entre 2003 y 2008. Se utilizaron las palabras clave: Leg ulcer, score, quality of life, instrument and tool, con sus correspondientes conectores booleanos. La calidad de las publicaciones fue evaluada mediante CASP Guide (Critical Appraissal Skill Programme y the JBI SUMARI (The Joanna Briggs Institute 2008) herramienta para la evaluación crítica de estudios cualitativos y cuantitativos. / FASE 2: La versión original del cuestionario CCVUQ, que incluye 21 preguntas, se ha adaptado al castellano siguiendo la metodología de traducción y retrotraducción y el establecimiento de equivalencias semánticas culturales. Se efectuaron ajustes considerados menores a partir de los aportes y las sugerencias de expertos y de los pacientes, que no afectó la esencia, de las preguntas originales, pero necesarios para la comprensión de la población local. / FASE 3: estudio de validación, observacional y de medidas repetidas, durante 6 semanas. Se estima una muestra de 105 pacientes. Se calcula consistencia interna mediante alfa de Cronbach, fiabilidad test-retest entre el inicio y la segunda semana, validez concurrente con el SF12.v2 y sensibilidad al cambio mediante ANOVA de medidas repetidas. Para la validez de constructo se realizó un análisis factorial confirmatorio. / Resultados: FASE 1: 22 estudios fueron incluidos, los cuales utilizaron métodos cuantitativos y cualitativos. El dolor se destacó como el hallazgo más prevalerte que afecta la CVRS en los estudios los instrumentos genéricos más utilizados: SF36 y sus adaptaciones, el Nottingham Health Profile y Euroqol-5. En cuanto a los instrumentos específicas de CVRS en UV se encontraron: Hyland, Cardiff Wound Impact Schedule and Charing Cross Venous Leg Ulcer Questionnaire. Dos nuevos instrumentos específicos para UV fueron encontrados Sheffield Preference-Based Venous Leg Ulcer 5D. Se confirma el impacto negativo de las UV en la CVRS, el cual es medido con una variedad de instrumentos específicos, sin embargo por sus valores psicométricos el más adecuado es el Charing Cross Venous Ulcer Questionnaire CCVUQ. / FASE 2: Se obtuvo una versión satisfactoria de la versión española del CCVUQ que es semántica y culturalmente equivalente a la versión original inglesa. En el proceso de adaptación participó un grupo de expertos en heridas crónicas y un grupo de pacientes con úlceras venosas, quienes a partir de los criterios de evaluación de ítems: precisión, claridad y comprensión asignaron resultados de aceptabilidad en el escenario de aplicación del 94% a la totalidad de los ítems como Índice de Validez de Contenido (IVC). / FASE 3: se incluyen 60 pacientes, en su mayoría mujeres (66,7%), con mediana de edad de 78 años. El 75% de las lesiones eran recurrentes con una antigüedad mediana de 2,14 años. La consistencia interna para el CCVUQ-e es alta (alfa>0,80), para el PUSH-e es baja. Ambos instrumentos tienen buena fiabilidad test-retest (CCVUQ-e ICC: 0,71, PUSH-e ICC: 0,97). Se confirma el modelo factorial de 4 dimensiones. Hay buena correlación entre el SF12.v2 y el CCVUQ-e. La sensibilidad al cambio es buena para los dos instrumentos de medida (diferencia de -44,3 puntos para el CCVUQ-e). / Conclusiones: queda confirmada la validez, fiabilidad y sensibilidad al cambio del CCVUQ-e. En el caso del PUSH-e solo se puede confirmar la sensibilidad al cambio a partir de la segunda semana de tratamiento. Además, se confirma que los pacientes con UV tienen mala CVRS cuando esta es medida con el CCVUQ-e y con el SF12 V2 pero que esta mejora cuando mejora el estado de la UV.

INTRODUCTION: Cerebral Palsy (CP) is a sensorimotor disorder characterized by dysfunctional motor coordination, balance problems, and loss of selective motor control. Motor coordination exhibited as co-contraction, has been subjectively quantified using gait analysis, but recent studies have begun to objectively analyze the amount of co-contraction by collecting electromyography (EMG) data. Center of pressure excursion (COPE) measurements collected during a single leg standing test (SLST) have shown to be more valid measurements of balance in populations with motor disabilities than a SLST alone. A recent study has correlated increased COPE velocity with a lower fall risk as determined by reported fall frequency, suggesting a more objective measure of fall risk. The current study aimed to determine if the fall risk calculated by COPE velocity in children with CP is correlated with co-contraction index value in various muscle synergy groups. It was hypothesized that i) co-contraction index values will differ between high and low fall risk groups, ii) there will be preferential activation of different synergy groups within the high and low fall risk groups, and iii) there will be a negative and direct correlation between COPE velocity and co-contraction index values for all synergy groups. METHODS: Fall risk grouping was determined by average COPE velocity values calculated from previously reported fall frequency groups. Balance ability was determined by COPE measurements during a SLST on a force plate. Muscle synergy groups were determined by common muscle pairings at the hip, knee and ankle. Co-contraction indices were determined from linear envelopes plotted from muscle group EMG data. An independent t-test was run on muscle synergy groups between high and low fall risk groups. Nonparametric Analysis of Variance (ANOVA) and Tukey post-hoc tests were run on the high and low fall risk groups separately to determine differences in co-contraction index value within high and low fall risk groups. A Pearson correlation analyzed COPE velocity and co-contraction index value. RESULTS: No significant differences in muscle synergy between the high and low fall risk groups were found (p = 0.476, 0.076, 0.064, 0.364). The ANOVA and Tukey post-hoc tests for high fall risk group found significant differences in co-activation index value between the sagittal hip and frontal hip groups (p = 0.022) and sagittal hip and ankle groups (p = 0.016). Low fall risk group was found to have significant differences between the sagittal hip and frontal hip groups (p = 0.038) and frontal hip and knee groups (p = 0.012). Weak and negative correlations were found between COPE velocity and both knee and ankle groups (r = -0.309, -0.323, p = 0.059, 0.050). Negligible and insignificant correlations were found between frontal hip and sagittal hip synergies and COPE velocity ((r = 0.013, -0.068, p = 0.475, 0.367). CONCLUSION: There is insufficient evidence to claim that muscle group activations are different depending on fall risk grouped by COPE velocity. It is not currently possible to correlate COPE velocity to a specific synergy group recruitment. However, data do suggest that sagittal hip and knee strategies are recruited more than ankle and frontal hip strategies during SLST.

<p><strong>Bakgrund: </strong>Smärta vid svårläkta ben- och fotsår är ett vanligt förekommande problem som ofta är underbehandlad. Smärta påverkar sårläkningen negativt och är ett komplext hälsoproblem. Smärta kan ses utifrån olika dimensioner vilka påverkar personen på olika sätt. <strong>Syfte:</strong> Syftet var att beskriva hur personer upplever smärta vid svårläkta ben- och fotsår. <strong>Metod:</strong> En allmän litteraturstudie baserad på kvalitativa empiriska studier. <strong>Resultat:</strong> De olika upplevelserna av smärta delades in i tre huvudkategorier; upplevelser av konstant smärta, upplevelser av oförståelse samt upplevelser av själslig smärta. Det framkom att personer med svårläkta ben- och fotsår upplever konstant smärta och hur den konstanta smärtan påverkade vardagen. Oförståelse från närstående och vårdpersonal ledde till frustration och påverkade självkänslan negativt. Själslig smärta framträdde i form av hopplöshet, ångest, skuld och skam samt ett förändrat socialt liv. <strong>Slutsats: </strong>Sjuksköterskan bör identifiera de olika dimensionerna av smärta som skapar en ond cirkel vid svårläkta ben- och fotsår. Sjuksköterskan bör ha en helhetssyn och försöka bryta den onda cirkeln av konstant smärta, hopplöshet och oförståelse.</p> / <p><strong>Background: </strong>Pain in hard-to-heal leg- and foot ulcers is a problem of frequent occurrence and is often under-treated. Pain affects the wound healing negatively and is a complex health problem. There are different dimensions of pain which affects the person in various ways. <strong>Aim:</strong> The aim of the study was to describe the personal experience of pain in hard-to-heal leg- and foot ulcers. <strong>Method:</strong> A literature review based on qualitative empirical studies. <strong>Results: </strong>The different experiences of pain were divided into three head categories; experiences of constant pain, experiences of incomprehension and experiences of emotional pain. The result showed that persons with hard-to-heal leg- and foot ulcers experienced constant pain and how it influenced the every-day-living. Incomprehension was experienced from relatives and health professionals and led to experiences of frustration. Incomprehension had a negative impact on the self-esteem. Emotional pain was illustrated by experiences of hopelessness, guilt and shame, anxiety and changed social life. <strong>Conclusions: </strong>The nurse should identify the different dimensions of pain that creates a vicious circle of pain with hard-to-heal leg- and foot ulcers. The nurse should have a holistic view and try to break the vicious circle of constant pain, hopelessness and incomprehension.</p>

Im Rahmen dieser Doktorarbeit wurden die Hangkarbonate von zwei miozänen heterozoischen Karbonatsystemen näher untersucht: die Malta Inselgruppe (zentrales Mittelmeer) und das Marion Plateau (Nordost Australien, ODP Leg 194). Die Auswirkungen der mittelmiozänen Abkühlung (Mi3), die auf 13.6 Ma datiert wird und starken Einfluß auf die Sauerstoffisotopenkurve hatte, in den oben genannten Flachwassersystemen stellten das Ziel dieser Arbeit dar. Dieses Abkühlungsereignis beeinflußte außerdem sehr stark die ozeanographischen und klimatischen Muster, die im weiteren Verlauf zum modernen Eishausklima führten. So steht insbesondere die Vereisung von Ostantarktika mit diesem Ereignis in Verbindung. Diese Arbeit untersucht den Einfluß dieses Ereignisses auf Flachwassersysteme, um vorliegende Untersuchungen in Tiefwassersystemen zu ergänzen und so zum globalen Verständnis des miozänen Klimawechsels beizutragen.<br /> <br /> Die Profile auf der Maltainselgruppe wurden mit Hilfe von Kohlenstoff- und Sauerstoffisotopen Auswertungen im Gesamtgestein, Gesamtgesteinmineralogie, Tonmineralanalyse und organischer Geochemie untersucht. Durch einen Wechsel von karbonatischeren zu tonigeren Sedimenten beeinflußte das mittelmiozäne Abkühlungsereignis die Sedimentation in diesem Gebiet sehr stark. Weiterhin wurde beobachtet, daß jede Phase der antarktischen Vereisung, nicht nur das mittelmiozäne Hauptereignis, zu einem erhöhten terrigenen Eintrag in den Hangsedimenten der Maltainselgruppe führte. Akkumulationsraten zeigen, daß dieser erhöhte terrigene Eintrag den einzelnen Vereisungsperioden zusammenhängt und die karbonatischen Sedimente durch tonreiche Sedimente &ldquo;verunreinigt&rdquo; wurden. Das daraufhin entwickelte Modell erklärt diesen erhöhten terrigenen Eintrag mit einer nordwärtigen Verlagerung der innertropischen Konvergenzzone durch die Bildung von kalten, dichten Luftmassen, die zu verstärkten Niederschlägen in Nordafrika führten. Diese verstärkten Niederschläge (oder verstärkter afrikanischer Monsun) beeinflußten die kontinentale Verwitterung und den Eintrag, mit der Folge, daß verstärkt terrigene Sedimente im Bereich der Hangsedimente der Maltainselgruppe abgelagert wurden. Die tonreichen Intervalle weisen Ähnlichkeiten zu sapropelischen Ablagerungen auf, was mit Hilfe der Spektral analyse des Karbonatgehalts und der geochemischen Analyse des organischen Materials gezeigt wurde. <br /> <br /> Auf dem Marion Plateau wurden die Sauerstoff- und Kohlenstoffisotopenkurven anhand von Foraminiferen der Gattung Cibicidoides spp. rekonstruiert. Der Karbonatgehalt wurde mit Hilfe einer chemischen Methode (Coulometer) ermittelt. Genauso wie die Sedimente der Maltainselgruppe beeinflußte das mittelmiozäne Abkühlungsereignis (Mi3) auch die Sedimente auf dem Marion Plateau. So kam es bei 13,8 Ma, in etwa zur Zeit der Vereisung von Ostantarktika, zu einem Abfall der Karbonatakkumulationsraten. Weiterhin traten Änderungen in der Zusammensetzung der Sedimente auf, so nehmen neritische Karbonatfragmente ab, der planktische Foraminiferengehalt nimmt zu und es wurden verstärkt Quarz und Glaukonit abgelagert. Ein überraschendes Ergebnis ist die Tatsache, daß der große N12-N14 Meeresspiegelabfall um 11,5 Ma die Akkumulationsraten der Karbonate auf dem Hang nicht beeinflußte. Dieses Ergebnis ist umso erstaunlicher, da Karbonatplattformen normalerweise sehr sensitiv auf Meeresspiegeländerungen reagieren. Der Grund, warum sich die Karbonatakkumulationsraten schon um 13,6 Ma (Mi3) und nicht erst um 11,5 Ma (N12-N14) verringerten, liegt in der Tatsache, daß die ozeanischen Strömungen die Karbonatsedimentation auf dem Hang des Marion Plateau schon im Miozän kontrollierten. Das mittelmiozäne Ereignis (Mi3) erhöhte die Stärke diese Strömungen und als eine Ursache wurde die Karbonatakkumulation auf den Hängen reduziert. Die Amplitude des N12-N14 Meeresspiegelabfalls liegt bei 90 m unter der Berücksichtigung der Sauerstoffisotopendaten aus der Tiefsee und Berechnungen des Meeresspiegels anhand des &ldquo;coastal onlaps&rdquo;, die während Leg 194 gemacht wurden. Die Isotopendaten dieser Arbeit weisen hingegen auf einen verringerten Meeresspiegelabfall von 70 m hin.<br /> <br /> Als allgemeine Schlußfolgerung kann gesagt werden, daß der mittelmiozäne Klimaumschwung die Karbonatsysteme zumindest an den beiden untersuchten Lokalitäten beeinflußt hat. Allerdings waren die Auswirkungen sehr von den unterschiedlichen lokalen Gegebenheiten abhängig. Insbesondere wirkten sich die Anwesenheit einer Landmasse (Malta) und die Abwesenheit einer Barriere vor den Einflüssen des offenen Ozeans (Marion Plateau) stark auf die Ablagerung der Karbonate aus. / This study investigated the slope carbonates of two Miocene carbonate systems: the Maltese Islands (in the Central Mediterranean) and the Marion Plateau (Northeastern Australia, drilled during ODP Leg 194). The aim of the study was to trace the impact of the Miocene cooling steps (events Mi1-Mi6) in these carbonate systems, especially the Mi3 event, which took place around 13.6 Ma and deeply impacted the marine oxygen isotope record. This event also profoundly impacted oceanographic and climatic patterns, eventually leading to the establishment of the modern ice-house world. In particular, East Antarctica became ice covered at that period. The rational behind the present study was to investigate the impact that this event had on shallow water systems in order to complement the deep-sea record and hence acquire a more global perspective on Miocene climate change.<br /> <br /> The Maltese Islands were investigated for trends in bulk-rock carbon and oxygen isotopes, as well as bulk-rock mineralogy, clay minerals analysis and organic geochemisty. Results showed that the mid Miocene cooling event deeply impacted sedimentation at that location by changing sedimentation from carbonate to clay-rich sediments. Moreover, it was discovered that each phase of Antarctic glaciation, not just the major mid Miocene event, resulted in higher terrigenous input on Malta. Mass accumulation rates revealed that this was linked to increased runoff during periods when Antarctica was glaciated, and thus that the carbonate sediments were &ldquo;diluted&rdquo; by clay-rich sediments. The model subsequently developed to explain this implies feedback from Antarctic glaciations creating cold, dense air masses that push the ITCZ Northward, thus increasing precipitation on the North African subcontinent. Increased precipitation (or stronger African monsoon) accelerated continental weathering and runoff, thus bringing more terrigenous sediment to the paleo-location of the slope sediments of Malta. Spectral analysis of carbonate content and organic matter geochemical analysis furthermore suggest that the clay-rich intervals are similar to sapropelic deposits.<br /> <br /> On the Marion Plateau, trends in oxygen and carbon isotopes were obtained by measuring Cibicidoides spp foraminifers. Moreover, carbonate content was reconstructed using a chemical method (coulometer). Results show that the mid Miocene cooling step profoundly affected this system: a major drop in accumulation rates of carbonates occurs precisely at 13.8 Ma, around the time of the East Antarctic ice sheet formation. Moreover, sedimentation changes occurred at that time, carbonate fragments coming from neritic environments becoming less abundant, planktonic foraminifer content increasing and quartz and reworked glauconite being deposited. Conversely, a surprising result is that the major N12-N14 sea-level fall occurring around 11.5 Ma did not impact the accumulation of carbonates on the slope. This was unexpected since carbonate platform are very sensitive to sea-level changes. The model developed to explain that mass accumulation rates of carbonates diminished around 13.6 Ma (Mi3 Event) instead of 11.5 Ma (N12-N14 event), suggests that oceanic currents were controlling slope carbonate deposition on the Marion Plateau prior to the mid-Miocene, and that the mid Miocene event considerably increase their strength, hence reducing the amount of carbonate being deposited on slope sites. Moreover, by combining results from deep-sea oxygen isotopes with sea-level estimates based on coastal onlaps made during Leg 194, we constrain the amplitude of the N12-N14 sea-level fall to 90 meters. When integrating isotopic results from this study, this amplitude is lowered to 70 meters.<br /> <br /> A general conclusion of this work is that the mid Miocene climatic shift did impact carbonate systems, at least at the two locations studied. However, the nature of this response was highly dependant on the regional settings, in particular the presence of land mass (Malta) and the absence of a barrier to shelter from the effects of open ocean (Marion Plateau).

A method for high performance output voltage control of a four-leg inverter based three-phase transformerless UPS is proposed. Voltage control loop is employed and the method employs stationary frame resonant filter controllers for the fundamental and harmonic frequency components. A capacitor current feedback loop provides active damping and enhances the output voltage dynamic performance. The controller design and implementation details are given. Linear and nonlinear loads for balanced and unbalanced load operating conditions are considered. The steadystate and dynamic performance of the UPS are investigated in detail. A scalar PWM method with implementation simplicity and high performance is proposed and implemented. The control and PWM methods are proven by means of theory, simulations, and experiments.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(論文) 学位授与年月日:平成4年3月25日 井戸田仁氏の博士論文として提出された

Bakgrund: Smärta vid svårläkta ben- och fotsår är ett vanligt förekommande problem som ofta är underbehandlad. Smärta påverkar sårläkningen negativt och är ett komplext hälsoproblem. Smärta kan ses utifrån olika dimensioner vilka påverkar personen på olika sätt. Syfte: Syftet var att beskriva hur personer upplever smärta vid svårläkta ben- och fotsår. Metod: En allmän litteraturstudie baserad på kvalitativa empiriska studier. Resultat: De olika upplevelserna av smärta delades in i tre huvudkategorier; upplevelser av konstant smärta, upplevelser av oförståelse samt upplevelser av själslig smärta. Det framkom att personer med svårläkta ben- och fotsår upplever konstant smärta och hur den konstanta smärtan påverkade vardagen. Oförståelse från närstående och vårdpersonal ledde till frustration och påverkade självkänslan negativt. Själslig smärta framträdde i form av hopplöshet, ångest, skuld och skam samt ett förändrat socialt liv. Slutsats: Sjuksköterskan bör identifiera de olika dimensionerna av smärta som skapar en ond cirkel vid svårläkta ben- och fotsår. Sjuksköterskan bör ha en helhetssyn och försöka bryta den onda cirkeln av konstant smärta, hopplöshet och oförståelse. / Background: Pain in hard-to-heal leg- and foot ulcers is a problem of frequent occurrence and is often under-treated. Pain affects the wound healing negatively and is a complex health problem. There are different dimensions of pain which affects the person in various ways. Aim: The aim of the study was to describe the personal experience of pain in hard-to-heal leg- and foot ulcers. Method: A literature review based on qualitative empirical studies. Results: The different experiences of pain were divided into three head categories; experiences of constant pain, experiences of incomprehension and experiences of emotional pain. The result showed that persons with hard-to-heal leg- and foot ulcers experienced constant pain and how it influenced the every-day-living. Incomprehension was experienced from relatives and health professionals and led to experiences of frustration. Incomprehension had a negative impact on the self-esteem. Emotional pain was illustrated by experiences of hopelessness, guilt and shame, anxiety and changed social life. Conclusions: The nurse should identify the different dimensions of pain that creates a vicious circle of pain with hard-to-heal leg- and foot ulcers. The nurse should have a holistic view and try to break the vicious circle of constant pain, hopelessness and incomprehension.

No description available.