Wear and biological response to wear debrisof artificial joints remain the major concerns in total hip arthroplasty (THA) [1].Silicon carbide reinforced alumina, Al2O3-SiCw,can be considered as a candidate for hip implants due to its high hardnessand toughness, aswell as chemical inertness. In this study, thewear and friction properties of Al2O3-SiCw areinvestigated by pin-on-disc experiments, with Hank’s Buffered Salt Solution(HBSS) as lubricant. Comparisons with BIOLOX®delta,the most commonly used ceramic in THA, under the same test conditions are made as well.

京都大学 / 0048 / 新制・課程博士 / 博士(地域研究) / 甲第17839号 / 地博第157号 / 新制||地||53(附属図書館) / 30654 / 京都大学大学院アジア・アフリカ地域研究研究科東南アジア地域研究専攻 / (主査)教授 小林 繁男, 教授 河野 泰之, 准教授 竹田 晋也, 准教授 古澤 拓郎 / 学位規則第4条第1項該当 / Doctor of Area Studies / Kyoto University / DFAM

With more young adults requiring total hip arthroplasties the need for bone saving implants becomes more important. The Zimmer Fitmore is a new bone saving implant that utilizes an implantation technique that reduces the damage to the muscle tissue allowing for patients to have a short recovery time as well as a new design that allows it to rest on the medial cortex. There has been anecdotal evidence that this device leads to early revision within six months of implantation due to failures occurring in the medial cortex. The main goal of this study was to computationally model the Zimmer Fitmore and compare it to the ML Taper to see if the failures are due to the design of the implant. The models were created using CT scans of the implants and the same implantation process was simulated for each. Two sizes for the cortical bone thickness, 4mm and 10mm, were used and contrasted with each other. The 10mm cortical thickness model showed that v the strains experienced by the Zimmer Fitmore femur were higher than that of the ML Taper. The 4mm model did not fully complete the simulation, but the results that were obtained showed an increased strain in Gruen zone 7. These results show that the design, not implantation method, could be to blame for the need for early revision when using the Zimmer Fitmore.

I want to present a prospective evaluation of one-year results in patients undergoing total hip arthroplasty from a minimally invasive antero-lateral approach (THA MIS-AL). And I want also to compare, by means of biochemical markers, the operative invasiveness of standard total hip replacement with that of the minimally invasive anterolateral (MIS-AL) approach.At one year after surgery we evaluated the quality of life by 60 patients using SF-36 questionaire and we compared the results with standard anterolateral approach and regional standard.

Title: Effect of physiotherapy to reduce the length of hospital stay in patients with total hip arthroplasty: a literature review Objective: The purpose of this thesis is to research and compare available studies investigating the effect of extra physiotherapy in reducing the length of stay for patients with total hip arthroplasty. In addition, to make a compilation of available sources about issue of the hip, total hip arthroplasty in terms of anatomy, kinesiology and biomechanics and length of hospital stay. Methods: This diploma thesis has descriptively-analytical character and is structured in the form of literary review. Results: Physiotherapy decreases length of stay in patients with total hip arthroplasty. Future research could address a specific group of subjects and the issue of cost-effectiveness in reducing the length of hospital stay by physiotherapy. Key words: Hip joint, total joint replacement, THA, physiotherapy, length of stay

透過主角兼敘事者奧芙弗雷德 (Offred) 的信件書寫，愛特伍 (Margaret Atwood)《使女故事》(The Handmaid's Tale, 1986) 一書回憶並訴說過往的故事。奧芙弗雷德的敘事打破順時性，呈現了斷裂與曖昧難解的狀況，點出了敘事者對於其所訴說的過去缺乏完整的理解。本論文從創傷敘事的角度分析《使女故事》，試圖探究奧芙弗雷德敘事中缺乏連貫的起因。 本論文分成五章來探討奧芙弗雷德的敘事，以期完整呈現小說中創傷敘事與語言、書信模式所交織成的複雜關係。第一章介紹《使女故事》的梗概與相關評論，並說明本論文所使用的理論架構。第二章以傅柯 (Michel Foucault) 的語言理論，探討語言與權力統治的關係與其在「反烏托邦」(dystopia) 世界中所承擔的角色，進而分析奧芙弗雷德如何一步步地取回了原本被禁用的語言，透過敘事釋放潛藏的溝通慾望。第三章則透過佛洛伊德 (Sigmund Freud) 的創傷理論與後續發展的創傷敘事研究，檢視奧芙弗雷德令人困惑的敘事。第四章藉由巴赫汀 (Mikhail Bakhtin) 的對話論 (dialogism) 分析書信模式在奧芙弗雷德敘事 (narration)／重構 (reconstruction) 中的影響與作用。最後，第五章討論愛特伍在文本末章〈史料〉("Historical Notes") 呈現對書信編輯一角的翻轉，並點出奧芙弗雷德對於敘事的堅持來自於她對於溝通與生存的期望。 / Through the narrator-protagonist Offred's letter-composition, Margaret Atwood's The Handmaid’s Tale (1986) unfolds as Offred recalls her past to tell the story. Offred's narrative is not chronological, but elusive and fragmentary. The scattered narrative fragments indicate Offred's incomplete understanding of the past. The present thesis seeks to explore the intricate cause of Offred’s narrative fragments by reading The Handmaid's Tale as a trauma narrative. To gain a full picture of Offred's trauma narrative, the thesis is divided into five chapters. Chapter I introduces The Handmaid's Tale and its literature reviews and explicates the theoretical approaches used in the thesis. With the introduction of Foucauldian discourse on language, Chapter II focuses on the role of language in relation to power in dystopia. In addition, the chapter illustrates the process of Offred's gradual regaining of the denied language and embarking on her narrative expedition, seeking to communicate. Meanwhile, Chapter III focuses on Offred’s puzzle-like narrative, inspecting her narrative through the lens of the Freudian trauma theory and trauma narrative. Chapter IV analyzes the function of the epistolary form in Offred's reconstruction of the past with the Bakhtinian dialogism. Finally, Chapter V discusses Atwood's revision of the role of the editor demonstrated in the epilogue "Historical Notes" of The Handmaid's Tale and concludes with Offred's longing for communication and survival that propels her act of storytelling.

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Discussion around the concept of Corporate Social Responsibility (CSR) re-intensified in the 1990s as a response to the increasing power of large corporations, the regulatory vacuum left by neoliberal market deregulation and the changing nature of the state in the context of globalization. This dissertation analyzes the constitution of CSR, grounded in political economy and situated in the context of globalization, and identifies CSR as a constitutive element of global governance. Claims made about the potential business contribution to social and economic development in developing regions are largely unsubstantiated and little is known about the impact of CSR on the people it is supposed to benefit. Mainstream literature strips CSR from its context and assumes that practice can be standardized and the results quantified. The qualitative case study analyzes the contextual practice and impact of CSR activities by EnCana Corporation, Canada’s largest independent oil and gas company, on Indigenous peoples and settler communities in Ecuador, and on the Dene Tha’ First Nation in Canada. Analysis of EnCana’s definition and implementation of CSR reveals a conflicting narrative, attempting to reconcile competitive capitalism with broad moralistic principles and ethics. Corporate culture prioritized the business case and the assumption that triple bottom line goals are compatible and mutually reinforcing. Findings from the case study demonstrate that corporate ideology remained constant across the company’s operations in the two countries, allowing adaptation of its CSR practices only within a certain range of possibilities. The case study provides evidence that EnCana Corporation had to adapt its CSR practice in response to specific articulations of local social-economic and political contexts. Specifically, CSR practices responded first, to national development goals and state capacity; and second, to Indigenous and communal resources and strategies. The findings further suggest that CSR practice creates fragile dependencies, subjecting social, ecological and social justice objectives to economic imperatives. Two important processes contribute to the creation of fragile dependencies. First, at the business-society interface, citizens are conceptualized as stakeholders; second, participation in decision-making becomes institutionalized as a limited form of consultation, often delegated to project proponents, without sufficient involvement of the state.

Made available in DSpace on 2016-04-27T16:57:08Z (GMT). No. of bitstreams: 1 Denilson Goncalves Pereira.pdf: 7924777 bytes, checksum: 477a51645572c92238dd48b6a98b1d8e (MD5) Previous issue date: 2011-05-26 / Secretaria da Educação do Estado de São Paulo / The present work is part of a project that aims to examine how teaching proposal in the classroom can be organized and developed, exploring the everyday contexts in other areas of knowledge and of mathematics itself, with a view to building some expectations learning. Our research involves three mathematics teachers from public schools in São Paulo, each one with a class of Grade 3 High School, during the night, totaling 122 students. The guest teachers work in school EE Padre Anchieta located in Diadema (SP). The project aims to contribute to the professional development of teachers in a consistent manner which is intended to be his practice in the classroom, through a strategy of closely linking theory, teaching practice and research. Through the collaborative work and the hypothetical learning trajectory (HLT), we believe that teachers can reflect about their teaching practice, focusing on a teaching strategy in which the student is motivated to investigate and assign meaning to their learning autonomously. After the teachers know the whole project and the primary HLT by the teacher researcher, with assistance from teachers applicators, that develop a course in class. During this stage, the researcher observed and recorded with audio recordings and notes, teachers reported applicators, along with the protocols of the students, which occurred in each proposed activity, pointing out the mistakes, difficulties, interactions, assumptions that were questioned in elaboration of the trajectory and other observations / O presente trabalho faz parte de um projeto que tem por objetivo analisar o modo como podem ser organizadas e desenvolvidas propostas didáticas em sala de aula, explorando contextos do cotidiano, de diversas áreas de conhecimento e da Matemática, com vistas a contemplar algumas expectativas de aprendizagem. Nossa pesquisa envolve três professores de Matemática da rede pública estadual paulista, cada qual com uma turma da terceira série do Ensino Médio, período noturno, totalizando 122 alunos. Os professores convidados atuam na E.E. Padre Anchieta, localizada em Diadema. O projeto visa a contribuir para o desenvolvimento profissional dos professores de forma coerente com o que se pretende que seja sua prática em sala de aula, mediante uma estratégia de estreita articulação entre teoria, prática docente e pesquisa. Por meio de uma trajetória hipotética de aprendizagem (THA) e do trabalho colaborativo, acreditamos que o professor pode refletir sobre sua prática docente, privilegiando uma estratégia de ensino na qual o aluno seja motivado a investigar e atribuir significado a sua aprendizagem de forma autônoma. A THA preliminar foi elaborada pelo professor pesquisador, com a contribuição dos professores aplicadores, e cada um destes a desenvolveu em uma turma. Nessa etapa, o pesquisador fez observações e registro, por meio de gravações de áudio e anotações, enquanto os professores aplicadores relataram, junto com os protocolos dos alunos, o que ocorreu em cada atividade proposta, apontando os erros, dificuldades, interações, hipóteses que foram questionadas na elaboração da trajetória, além de outras observações

<p><strong>Background: </strong>Total joint arthroplasty (TJA) is considered the treatment of choice to alleviate pain and improve function of patients with osteoarthritis. However,recent evidence suggests that a significant proportion of patients continue to report pain, or worsening of their symptoms well after their joint replacement. We call this chronic pain “<em>phantom joint pain</em>” as it persists despite the fact hat the affected joint has been replaced.</p> <p>Chronic pain of neuropathic origin may be a consequence of surgery or in patients with osteoarthritis (OA); there may be a combination of nociceptive and neuropathic pain (NP) mechanisms. As there are no definitive physiological indicators for NP or gold standards for diagnosis, Guidelines on Neuropathic Pain Assessment advocate the use of screening tools to evaluate the patient’s pain experiences and potentially characterize various pain features.</p> <p>Despite suggestions that phantom joint pain post TJA is a common problem there is limited information about its prevalence among Canadians. To date there are no studies that have characterized neuropathic vs. non- neuropathic chronic pain features in a TJA population.</p> <p><strong>Purpose: </strong>The purpose of this work was to determine the<em> </em>prevalence of chronic pain following total hip (THA) or knee (TKA) arthroplasty, and to identify the proportion of the cohort with chronic pain whose symptoms suggested the pain was of neuropathic origin. In addition we evaluated the ability of the NP Subscale of the McGill pain questionnaire [NP-MPQ (SF-2)] to identify individuals with NP vs. Non NP in the TJA population.</p> <p><strong>Methods:</strong> A retrospective cohort study (2-4 years post joint replacement) of 148 participants with primary unilateral TJAidentified from a large joint arthroplasty database (n=1143). Chronic pain was defined as post surgical pain reported 6-12 months following surgery to be 3 or higher (out of 5) on the Oxford Hip/Knee Scores, and that pain was the same or worse than reported preoperatively. A postal survey was used to administer the NP-MPQ (SF-2)and the Self-Administered Leeds Assessment of Neuropathic Signs and Symptoms (S–LANSS) (1.5-3.5 years post TJA). S-LANSS was the “non reference standard” for classification of neuropathic pain. Human research ethics approvals from Sunnybrook Health Sciences Centre and McMaster University/Hamilton Health Sciences were obtained prior to the study.</p> <p><strong>Results</strong>: The response rate to the postal survey to identify those with chronic pain of neuropathic origin was 53%. Thirteen percent of individuals experienced chronic pain; among individuals with chronic pain, neuropathic subtype was found in 28% (S-LANSS ≥ 12) - 43% [NP-MPQ (SF-2) ≥ 0.91]. Receiver Operating Characteristic (ROC) analysis for NP-MPQ (SF-2) yielded an area under the curve of 0.89 (95% CI: 0.82, 0.97). A cut off score of 0.91 NP-MPQ (SF-2),<strong> </strong>maximized sensitivity (89.5%) and specificity (75.0%). Our results revealed moderate correlation (r=0.56; 95% CI: 0.40, 0.68) between the S-LANSS and NP-MPQ (SF-2)scores in patients with NP post TJA.</p> <p><strong>Conclusion: </strong>Based on our results, a considerable percentage of individuals (13%) experience chronic pain following TKA and THA. Moreover, among individuals with chronic pain symptoms, a significant proportion (28-43%) of those experience pain that appears to have a neuropathic component, even 1.5 to 3.5 years following surgery.Overall prevalence of NP in TJA was 3.3 to 4.5%. The NP-MPQ (SF-2)subscale demonstrated “good” discriminatory ability, thus it might be useful in identifying patients with NP following TJA. Moderate association exists between the scales and this could affect prevalence rates in studies; or diagnosis of NP of individual patients based on the criterion used.</p> / Master of Science (MSc)