Objective: Severe burn injuries are associated with a rapid escalating hypermetabolic state and catabolism of muscle mass. To ameliorate this process a standardized approach using pharmacological and non-pharmacological interventions was implemented within a single burns center. Whilst individual components of this standardized package are well documented in the literature, their collective or bundled effect has not as yet been assessed. The aim of this study was to evaluate the efficacy of this standardized bundle of metabolic modulators and assess the safety of including the anabolic steroid oxandrolone within it. Methods: This retrospective observational study constituted all patients in whom the metabolic bundle including oxandrolone therapy was applied. The other elements of the metabolic bundle consisted of early surgical burn excision within seven days to completion, early active mobilization, increased ambient room temperature, expediated carbohydrate and protein rich enteral feeding with glutamine and trace element supplements (such as copper and zinc). Finally, administration of propranolol as a non-selective beta-blocker. Data collection was through review of the patient data management system focusing on the outcome criteria and hepatic blood values. Results: The study looked at fifty consecutive patients meeting the inclusion criteria. Median patient age and burned total body surface area (TBSA) were 62 years [51.75; 73] and 33.75 % [24.75; 51] respectively with an abbreviated burn severity index (ABSI) of 10 [9; 10.25]. Definitive surgical burn wound excision was completed in 44 patients [88 %] within 7 days. 39 patients (78 %) received propranolol over a therapeutic period of 29 days [19; 44]. Glutamine was supplemented in 45 patients (90 %), while zinc and copper were applied to 42 (84 %) and 31 (62 %) respectively. Significant low zinc values were noted at therapeutic onset (6.5 mmol/ l [4.7; 7.9]) requiring sustained substitution over 37.5 days [22; 46.75]). In respect of the inclusion criteria, all patients received oxandrolone at 20mg/day [20; 20]. This was commenced on day 6.5 [4; 14] post burn injury and continued over 26 days [19; 31]. Despite a transitory elevation of hepatic enzyme values (ALT, GGT), these were only clinically relevant (>10µmol/l*S) in 2.4 % and 4.6 % of all measurements respectively. None were sufficiently of concern to merit cessation of treatment. Conclusion: The application of a standardised bundle of metabolic treatment options of severe burns injured patients is reliable, repeatable and safe. Potential concerns of oxandrolone treatment regarding hepatic compromise remain unfounded.:Introduction Epidemiology of severe burns injuries in the Federal Republic of Germany The hypermetabolic and catabolic state Therapeutic approach Non-pharmacological therapy Early surgical intervention Ambient temperature Enteral feeding in burns patients Occupational and physiotherapy in burns patients Pharmacological therapy Insulin Propranolol Oxandrolone Oxandrolone in the Federal Republic of Germany Metabolic bundle Materials and Methods Subjects and study design Ethical approval Burn care protocol Oxandrolone and the metabolic bundle Data collection Statistical analysis Objective of study Publication Summary References Appendix Declaration of independent scientific contribution, conception and execution of publication Declaration of independent scientific contribution towards dissertation Curriculum vitae Acknowledgements and thanks

In a profession such as social work, where one is responsible for dealing with the ills of society and meeting the needs of other individuals, such emotional detachment and estrangement from others is antithetical to the purpose of the field and eminently destructive to those seeking and needing assistance. With the current push for accountability, factors such as burnout or alienation from one's work become of crucial importance. In addition, burnout leads to a high rate of absenteeism and job turnover (Minihan, 1980). This too decreases cost effectiveness and the quality of service, matters of extreme concern in a field designed to serve the needs of individuals in society and to do so on limited funds and resources. Thus, alienation is of paramount importance to the field of social services and can no longer be ignored or relegated to a back seat in terms of study and research. Current literature in the field of social work deals only with the subjective expression of alienation; it has omitted linking the psychological with the social-structural aspects of alienation: indeed, with linking burnout to alienation itself. This study proposes to begin to fill this gap. What conditions in the structure of the work place and/or society cause or are correlated with the expression of alienation? It is this question which we endeavor to pursue.

The purpose of this study was to investigate the reliability, subscale intercorrelations, and validity of the Administrator Role Perception Inventory (ARPI), an instrument developed by the investigator and a co-author in the year preceding the study. The ARPI is a 50 item, Likert-type scale which reflects variables thought to be associated with burn-out: expectation, motivation, accomplishment, psycho-physical state, and relationships. Another variable, previously unresearched, was also included; it is the variable of "time" and reflects a negative time orientation, a longing for the "good old days." The inventory was mailed to all of the 2,113 active members of the Confederation of Oregon School Administrators during the middle of August, 1982. The return rate for the ARPI was 62 percent. Analysis of the data showed that the ARPI has an internal consistency of .91. The coefficients for the subscales fell between .70 and .85. As expected, there were substantial intercorrelations among the subscales, ranging from a low of .31 to a high of .63. Total ARPI scores and the subscale scores were correlated with measures of self-perceived burnout, desire for early retirement, and felt job stress. All of these correlations were in the expected direction, were significant at the .001 level, and ranged from -.41 to -.59. It was concluded that the Administrator Role Perception Inventory is comparable to measurement instruments similar in purpose and format.

A new mathematical model has been developed along with a new parameter estimation routine using surface temperature and heat flux measurements to estimate blood perfusion and thermal resistance in living tissue. Dynamic thermal measurements collected at the surface of the sensor before and after imposing a dynamic thermal cooling event are used with the model to estimate the blood perfusion, thermal resistance and core temperature. The Green\'s function based analytical solution does not require calculation of the whole tissue temperature distribution, which was not the case for the previous models. The result from the new model was proved to have better and more consistent results than previous models. The new model was validated to solve one of the unsolved biomedical problems which is the ability of detecting burn severity. The method was tested with a phantom perfusion system. The results matched known blood perfusion and thermal resistance values. The method was also tested with burns on animal models. Inflammation effects associated with the burns were studied using a newly developed term called the Burn Factor. This correlated with the severity of imposed burns. This work consists of three journal papers. The first paper introduces the mathematical model and its validation with finite-difference solutions. The second paper validates the physical aspects of the usage of the model with thermal measurement in detecting simulated burned layers and the associated perfusion. The third paper demonstrates the ability of the model to use thermal measurements to detect different burn severity of an animal model and to study the healing process. / Ph. D.

The diploma thesisfocuseson the issue of depression,anxiety and quality of life in adult patients after burn trauma. The literature review section presents current scientific studies that apply to the diagnosis,prevalence,treatmentand selectedrisk factorsfordepressionand anxiety in this patient population. This part of the thesis also deals with the definition and methodsof assessing the quality of life in patients with burns, including factors that may affect the subjectively perceived quality of life in this population. The empirical part aims to identify patients with MDE and GAD according to M.I.N.I. and to examine risk factors not only for these mental disorders but also for reduced quality of life. Furthermore, the research focuses on the validation of the visual analog screening method of Emotional Thermometers in patients after burn trauma. A total of 292 hospitalized patients with burns participated in the study, of which 27 (9 %) met the diagnostic criteria for MDE (current, past, recurrent). 10 patients (3.5 %) met the diagnostic criteria of GAD. Statistically significant predictors of MDE are: antidepressant use and surprisingly a lower extent of burns. The use of antidepressants and unexpectedly a less frequent occurrence of burns in visible places of body (head, neck, upper limbs)...

Fusion Science and Technologyの条件：出版後6ヶ月内は掲載不可、ANS Scientific Publicationsを引用すること・ANSのwebsiteへのリンクを付けること、ボリューム番号・ページ番号・イシュウと年も含めること、Copyrigh (date) by the American Nuclear Society, La Grange Park, Illinois.を述べること。 / 京都大学 / 0048 / 新制・課程博士 / 博士(エネルギー科学) / 甲第19827号 / エネ博第333号 / 新制||エネ||67(附属図書館) / 32863 / 京都大学大学院エネルギー科学研究科エネルギー変換科学専攻 / (主査)教授 長﨑 百伸, 教授 小西 哲之, 教授 水内 亨 / 学位規則第4条第1項該当 / Doctor of Energy Science / Kyoto University / DGAM

A dissertation submitted to the Faculty of Arts, University of the Witwatersrand Johannesburg, in partial fulfillment of the requirements for the degree of Master of Arts in Clinical Psychology. Johannesburg, June, 1991. / This study investigates the coping style employed by people in the helping professions, who are experiencing the phenomenon known as Burnout. Burnout is conceptualized as one of the serious negative. sequelae of prolonged stress evolved by demanding occupational situations which involve work with people. Investigation is made of the hypothesis that the coping behaviours a person employs in response to stress will be influenced by degree of burnout reported. It was found that emotion focused coping is positively correlated with emotional exhaustion and depersonalization - burnout components. problem focused coping is positively correlated with a second coping style, that of seeking social support. / AC2017

Coolant application is critically important in grinding, preventing workpiece damage and increasing the quality of manufactured components. However, delivery of grinding fluids is difficult to achieve, due to issues unique to grinding processes such as the air layer that surrounds the wheel. Coherent jets, which maintain their shape over a significant distance, are one of the most effective methods of coolant delivery and a significant amount of research has been devoted to developing them. Results of this work, which has largely focused on contoured nozzles, have been modest. Inspired by laminar fountains and wind tunnel design, the present work focuses on the development of a coherent, laminar jet. The developed jet possesses extreme coherence, and appears to resemble a glass rod with its stability and clarity. Investigations were carried out, comparing the coherence and cooling ability of the developed system to that of a commercially available coherent nozzle. Models for the structure of the air layer and to predict the conditions necessary for a jet to penetrate the air layer were also developed. The developed jet outperformed the commercial system both in terms of coherence and manufacturing productivity. The model was validated with experimental values, and appears to provide excellent agreement to those results. This work details the background, design, and experimentation involved in creating these innovative systems. / Thesis / Master of Applied Science (MASc)

Alcohol is the most abused drug in the United States and most frequently performed assay in forensic laboratories. Alcohol is routinely present in biological specimens from fatal residential fires and forensic toxicologists must interpret if these individuals are impaired by determination of their blood alcohol concentrations on post-incineration blood collected at autopsy. There is no known data available to confirm or refute blood alcohol concentrations and impairment in fire-related deaths. Ethyl glucuronide (EtG), a non-volatile minor ethanol metabolite, may provide a better biomarker for ethanol consumption prior to burn injury. The literature does not address the possibility that ethanol or EtG concentrations are altered in fire deaths. A Sprague Dawley rat model was employed to determine if ethanol and EtG concentrations in blood, liver, heart, and kidney were altered after burn injuries using two incineration models with varying durations and temperatures. Blood and tissues were analyzed for ethanol by gas chromatography and EtG by enzyme immunoassay. Other measurements including organ weights, lower hindquarter weights, and blood glucose concentrations were chosen for analysis to determine the mechanism by which the blood and organ ethanol and EtG concentrations are altered in burnt corpses. The rodent provided an excellent model for studying the biotransformation of ethanol to EtG and the effects of burn injury on ethanol and EtG concentrations. Our study revealed that blood ethanol concentrations were not significantly altered by burn injury but tissue ethanol concentrations were altered by burn injury. EtG concentrations were found to be altered in blood and tissue specimens in both incineration models. Our data suggest that the change in ethanol and EtG concentrations may be correlated to higher core body temperatures from burn injury and not changes in organ weight. Determining if blood ethanol concentrations are altered in burnt corpses is important for forensic toxicologists to conclude if victims were impaired at the time of death. The knowledge gained from these experiments will help forensic toxicologists by confirming the current interpretation that blood ethanol concentrations are not altered in fire deaths and provide a better understanding for the interpretation of impairment in burn deaths.

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