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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
411

Cynism gentemot förändringar på arbetsplatsen / Cynicism towards changes in the workplace

Strömqvist, Patrik January 2024 (has links)
Detta kandidatarbete i psykologi undersöker motstånd mot förändringar på arbetsplatsen med fokus på cynism gentemot förändringar genom en jämförande studie mellan svenska offentliga organisationer och en tidigare genomförd australiensisk studie. Studien använder begreppet cynism för att analysera medarbetarnas attityder gentemot förändringar och utforskar dess två underdimensioner: pessimism och dispositionell tillskrivning. Studien visar på att det finns en skillnad mellan det svenska och det australienska urvalet, där det svenska urvalet är mer cyniskt inställt gentemot förändringar än det australiensiska. Däremot identifierar studien inte att det finns en skillnad mellan personer med högre utbildningsnivå jämfört med lägre utbildningsnivå eller med personer med mer arbetlivserfarenhet jämfört med lägre arbetslivserfarenhet rörande hur cyniska de är gentemot förändringar på arbetsplatsen. / This undergraduate thesis in psychology explores resistance to changes in the workplace, focusing on cynicism towards changes through a comparative study between Swedish public organisations and a previously conducted Australian study. The study utilises the concept of cynicism to analyse employees' attitudes towards changes and explores its two sub-dimensions: pessimism and dispositional attribution. The study indicates that there is a difference between the Swedish and Australian samples, where the Swedish sample is more cynical towards changes than the Australian one. However, the study does not identify a difference between individuals with higher levels of education compared to those with lower levels of education, or among individuals with more working life experience compared to those with less working life experience in terms of how cynical they are towards workplace changes. Keywords:
412

Three essays on corporate governance in the hospitality industry

Li, Yuan 14 November 2019 (has links)
The hospitality industry, with its dynamic business environment, has experienced unprecedented disruption and reconfiguration due to the emergence and success of sharing economy firms and online travel agencies. This turbulence calls for effective governance structures that can motivate managers to act in their shareholders' best interests. Despite the importance of effective corporate governance for firm performance and the topic receiving extensive scholarly attention in the management and finance literatures, there seem to be several gaps and mixed findings in the hospitality academic field. To facilitate scholarly advancement, identify gaps in the current knowledge base, and provide direction for future research, in the first essay I undertake a systematic review of research on corporate governance in the hospitality literature. Based on 115 peer-reviewed articles published since 1961, I identify 21 themes explored by scholars, and find that topics related to institutional ownership, executive compensation determinants, board size, and merger and acquisition (MandA) outcomes are commonly examined, whereas topics related to family ownership, debt, and regulation/law are seldom explored. This review contributes to the literature by taking stock of what we know and offering a one-stop-shop for scholars to understand and extend corporate governance literature published in the hospitality field. While evidence in the general business literature suggests that targets, instead of acquirers, are better off after the acquisition, limited studies in the hospitality industry have shown that both bidders and targets are better off after the merger, suggesting that MandAs are more successful in the hospitality industry than in other industries. In the second essay, I empirically examine whether this is indeed the case and what may explain the potential discrepancy in merger performance. Using a comparative study design and a comprehensive sample over 41 years, I find that overall acquirers gain from MandAs, and hospitality MandAs outperform non-hospitality MandAs. Bidders in the hospitality industry are more likely than non-hospitality bidders to acquire large, related targets, using an all-cash mode of payment. Except for industry relatedness, relative size, cash payment, and unlisted target are all positively related to merger performance. This study contributes to the literature by identifying several factors that can explain the differences in MandA performance between hospitality and non-hospitality firms. Despite the fact that MandAs are frequently pursued as a growth strategy in the hospitality industry, their effect on chief executive officer (CEO) compensation has not been systematically examined. Considering that CEO compensation is an important topic related to firm performance, management, and social responsibility, in the third essay I examine the relationship between MandAs and CEO compensation in a sample of hospitality firms consisting of 1,514 firm-year observations over a period of 27 years. The regression analyses find that CEO compensation is significantly higher in the year after large acquisitions; well-governed firms identified via tenure, the Entrenchment-index, and board independence pay their CEOs higher post-acquisition than poorly-governed firms; the fraction of equity-based compensation is unrelated to MandA propensity; and the fraction of cash-based compensation is negatively related to MandA propensity. The additional analyses indicate that CEOs are rewarded for positive stock returns but not penalized for negative stock returns, and even more so in well-governed firms after acquisition. This study finds that MandAs and corporate governance are determinants of CEO compensation and the form of CEO compensation matters to acquisition decisions in hospitality firms. The findings are of importance for shareholders and the board of directors to design compensation plans that align the interests of managers and shareholders. / Doctor of Philosophy / The hospitality industry, with its dynamic business environment, has experienced unprecedented disruption and reconfiguration due to the emergence and success of sharing economy firms and online travel agencies. This turbulence calls for effective governance structures that can motivate managers to act in their shareholders' best interests. Despite the importance of effective corporate governance for firm performance and the topic receiving extensive scholarly attention in the management and finance literatures, there seem to be several gaps and mixed findings in the hospitality academic field. To facilitate scholarly advancement, identify gaps in the current knowledge base, and provide direction for future research, in the first essay I undertake a systematic review of research on corporate governance in the hospitality literature, and find that topics related to institutional ownership, executive compensation determinants, board size, and merger and acquisition (MandA) outcomes are commonly examined, whereas topics related to family ownership, debt, and regulation/law are seldom explored. This review contributes to the literature by taking stock of what we know and offering a one-stop-shop for scholars to understand and extend corporate governance literature published in the hospitality field. In the second essay, I empirically examine whether MandAs are more successful in the hospitality industry than in other industries and what may explain the potential discrepancy in merger performance. I find that overall acquirers gain from MandAs, and hospitality MandAs outperform non-hospitality MandAs. Bidders in the hospitality industry are more likely than non-hospitality bidders to acquire large, related targets, using an all-cash mode of payment. Except for industry relatedness, relative size, cash payment, and unlisted target are all positively related to merger performance. This study contributes to the literature by identifying several factors that can explain the differences in MandA performance between hospitality and non-hospitality firms. In the third essay I examine the relationship between MandAs and CEO compensation in a sample of hospitality firms, and find that CEO compensation is significantly higher in the year after large acquisitions; well-governed firms identified via tenure, the Entrenchment-index, and board independence pay their CEOs higher post-acquisition than poorly-governed firms; the fraction of equity-based compensation is unrelated to MandA propensity; and the fraction of cash-based compensation is negatively related to MandA propensity. The additional analyses indicate that CEOs are rewarded for positive stock returns but not penalized for negative stock returns, and even more so in well-governed firms after acquisition. This study finds that MandAs and corporate governance are determinants of CEO compensation and the form of CEO compensation matters to acquisition decisions in hospitality firms. The findings are of importance for shareholders and the board of directors to design compensation plans that align the interests of managers and shareholders.
413

Balancing Performance and Usage Cost: A Comparative Study of Language Models for Scientific Text Classification / Balansera prestanda och användningskostnader: En jämförande undersökning av språkmodeller för klassificering av vetenskapliga texter

Engel, Eva January 2023 (has links)
The emergence of large language models, such as BERT and GPT-3, has revolutionized natural language processing tasks. However, the development and deployment of these models pose challenges, including concerns about computational resources and environmental impact. This study aims to compare discriminative language models for text classification based on their performance and usage cost. We evaluate the models using a hierarchical multi-label text classification task and assess their performance using primarly F1-score. Additionally, we analyze the usage cost by calculating the Floating Point Operations (FLOPs) required for inference. We compare a baseline model, which consists of a classifier chain with logistic regression models, with fine-tuned discriminative language models, including BERT with two different sequence lengths and DistilBERT, a distilled version of BERT. Results show that the DistilBERT model performs optimally in terms of performance, achieving an F1-score of 0.56 averaged on all classification layers. The baseline model and BERT with a maximal sequence length of 128 achieve F1-scores of 0.51. However, the baseline model outperforms the transformers at the most specific classification level with an F1-score of 0.33. Regarding usage cost, the baseline model significantly requires fewer FLOPs compared to the transformers. Furthermore, restricting BERT to a maximum sequence length of 128 tokens instead of 512 sacrifices some performance but offers substantial gains in usage cost. The code and dataset are available on GitHub. / Uppkomsten av stora språkmodeller, som BERT och GPT-3, har revolutionerat språkteknologi. Dock ger utvecklingen och implementeringen av dessa modeller upphov till utmaningar, bland annat gällande beräkningsresurser och miljöpåverkan. Denna studie syftar till att jämföra diskriminativa språkmodeller för textklassificering baserat på deras prestanda och användningskostnad. Vi utvärderar modellerna genom att använda en hierarkisk textklassificeringsuppgift och bedöma deras prestanda primärt genom F1-score. Dessutom analyserar vi användningskostnaden genom att beräkna antalet flyttalsoperationer (FLOPs) som krävs för inferens. Vi jämför en grundläggande modell, som består av en klassifikationskedja med logistisk regression, med finjusterande diskriminativa språkmodeller, inklusive BERT med två olika sekvenslängder och DistilBERT, en destillerad version av BERT. Resultaten visar att DistilBERT-modellen presterar optimalt i fråga om prestanda och uppnår en genomsnittlig F1-score på 0,56 för alla klassificeringsnivåer. Den grundläggande modellen och BERT med en maximal sekvenslängd på 128 uppnår ett F1-score på 0,51. Dock överträffar den grundläggande modellen transformermodellerna på den mest specifika klassificeringsnivån med en F1-score på 0,33. När det gäller användningskostnaden kräver den grundläggande modellen betydligt färre FLOPs jämfört med transformermodellerna. Att begränsa BERT till en maximal sekvenslängd av 128 tokens ger vissa prestandaförluster men erbjuder betydande besparingar i användningskostnaden. Koden och datamängden är tillgängliga på GitHub.
414

Do More Females In Power Generate Economic Growth? : Panel data analysis of female parliamentary representation and economic growth in the West, Russia and Central Asia

Skog, Viktor, Dahl, Marcus January 2024 (has links)
The purpose of this paper was to analyze the effect of representation of women in parliamentsand economic growth in three different regions. The regions which were analyzed wereEurope, Latin America, Russia and Central Asia. Based on previous research’s results, thequestion whether women in parliamentary settings affect economic growth and wealth wasexamined. A regression model adapted to panel data analysis was used on data obtained fromreliable sources like the World Bank and the UN. The variables used in the regression modelwere real GDP per capita, real GDP per capita growth, share of females in parliamentarypositions, trade, investment and Women, Business and the Law index (WBL). Justification ofthe variables are based in previous research which alludes to theoretical economicalframeworks. This study contributes to the institutional variable of the WBL indicator. Due tothe scale of the study, the results have varied across different regions, but the overall relationbetween women in power and economic growth was deemed positive. Explicit normsregarding accessibility to economical, political and judicial institutions have a greater impacton real GDP per capita than female parliamentary representation.
415

Vergelykende studie na die kerklike diens van genesing

Pieterse, Cornelius Louwrens 11 1900 (has links)
Text in Afrikaans / Die kerklike diens van genesing bet deur die geskiedenis uitgestaan as een van die aktiwiteite van die kerk van Jesus Christus wat vanwee verskillende redes voortdurend in die brandpunt was. Die afgelope dekades is gekenmerk deur die toename van gelowiges uit verskillende denominasies en groepe wat by die nadenke oor en beoefening van die diens van genesing in die kerk betrokke geraak bet. Die toename bet meegebring dat die kerklike diens van genesing op verskillende wyses (praktyke) beoefen is en dat verskillende redes as regverdiging daarvoor aangebied is. Onderliggend hieraan le bepaalde teoriee waarvan die beoefenaars soms bewus was, en soms nie. Die huidige navorsing ondersoek die teoriee en praxes van verskillende genesingsbedienings binne 'n bepaalde akademiese en kerklike raamwerk. In die verband is 'n vergelykende studie deur middel van 'n kwalitatiewe ondersoek na die werk van twee uiteenlopende instansies gedoen, naamlik die London Healing Mission ( wat onder toesig van die Anglikaanse kerk funksioneer en daarom 'n vaste tradisie bet), en die Vineyard Christian Fellowship van Boise, in die VSA, wat 'n jong gemeente is, en by die sogenaamde 'Third Wave' beweging inpas. Die teoriee en praktyk van elke bediening word in die studie ge!dentifiseer en met mekaar vergelyk. Uit hierdie vergelyking word verskillende gevolgtrekkings gemaak, onder andere oor die bestaansreg van die kerklike diens van genesing en die formaat wat dit behoort aan te neem. Sekere opmerkinge word op grond van die navorsingsresultate gemaak wat in die Pinkster, Charismatiese en Gerefonneerde kerke asook vir die kerk in die algemeen, van waarde kan wees. Die navorsingsresultate word gebruik om 'n bedieningsmodel vir die genesingsbediening in die kerk te ontwerp. Die ondersoek word afgesluit met aanbevelings met die oog op moontlike toekomstige navorsing. / Throughout history the healing ministry has been one of the outstanding activities of the church of Jesus Christ which remained continuously and for various reasons the focal point of attention. The past decades were characterized by an escalation of believers from different denominations and groups who became involved in the meditation and practicing of the healing ministry in the church. This escalation has resulted in the healing ministry being practiced in multiple ways and various reasons being given as justification for doing so. This was done in the presence of underlying theories of which the practitioners were either consciously or subconsciously aware or unaware of. The present research explores the theories and practices of the healing ministry within a particular academic and ecclesiastical context. A comparative study was undertaken by means of a qualitative investigation covering the work of two divergent institutions namely: The London Healing Mission (which is supervised by the Anglican Church and therefore has a specific tradition) and the Vineyard Christian Fellowship, Boise, USA, which is a 'new' congregation and fits in with the so called Third Wave movement. The theories and practices of both these ministries are identified and compared with one another. Various conclusions are reached through this comparison, referring amongst others to the healing ministry's right of existence and the format in which it should be practiced. Remarks that are being·made with regard to the results of the research should be of value to the Pentecostal, Charismatic and Reformed churches in particular, but to the Church in general as well. These results are also used to design a ministering model for the healing ministry. The study concludes with certain recommendations for possible future research. / Philosophy, Practical & Systematic Theology / Th. D. (Praktiese Teologie)
416

Patent ownership : rights to employee inventions

McBride, Vanessa Ann 11 1900 (has links)
A patent is an intellectual property right granted as a reward for the labours of the inventor so as to commercially exploit the invention in return for disclosure of the invention. The benefits of the patent system find perfect expression in the employment situation since the employer is better equipped to exploit the invention through provision of resources and capital whereas the employee is provided with an opportunity to develop his technical know-how. A comparative study of the laws pertaining to employee inventions in the United Kingdom, Federal Republic of Germany and the United States of America reveals a variety of approaches to the subject of employee inventions. The approach of the South African law on the subject is inadequate and legal reform is a necessity. The recommendations for such reform encapsulates a blend of the best features of each of the three national approaches to employee inventions. / Mercentile Law / LL. M. (Law)
417

Komparacija kliničkog i patološko-morfološkog nalaza akutnog respiratornog distres sindroma / Comparison of clinical and pathomorphological finding in acute respiratory distress syndrome

Lovrenski Aleksandra 17 July 2015 (has links)
<p>Akutni respiratorni distres sindrom (ARDS) predstavlja klinički sindrom koji se manifestuje te&scaron;kom respiratornom insuficijencijom sa razvojem akutnog edema pluća u odsustvu znakova popu&scaron;tanja leve polovine srca. S obzirom da ovaj sindrom ima heterogenu etiologiju, progresivan tok i visoku stopu mortaliteta, pravovremena i tačna dijagnoza esencijalna je u primeni efektivne i rane terapije, a samim tim i u pobolj&scaron;anju prognoze bolesti. Cilj ove doktorske disertacije bio je da se ispita povezanost kliničke i patohistolo&scaron;ke dijagnoze ovog sindroma, kao i da se analiziraju i uporede vrednosti kliničkih parametara neophodnih za postavljanje dijagnoze ARDS-a sa patohistolo&scaron;kim parametrima o&scaron;tećenja plućnog tkiva. Studija je obuhvatila 67 pacijenata Instituta za plućne bolesti Vojvodine koji su umrli pod kliničkom slikom ARDS-a i/ili kod kojih je na obdukciji patohistolo&scaron;ki dokazan ARDS. Za postavljanje kliničke dijagnoze ARDS-a kori&scaron;ćeni su kriterijumi The American-European Consensus Conference iz 1994. Nakon semikvantitativne analize patohistolo&scaron;kih parametara difuznog alveolarnog o&scaron;tećenja određivan je histolo&scaron;ki stadijum ARDS-a i svi pacijenti podeljeni su u dve grupe: I grupa - pacijenti u eksudativnoj fazi i II grupa - pacijenti u proliferativnoj fazi difuznog alveolarnog o&scaron;tećenja. Formirane grupe pacijenata upoređivane su u odnosu na vrednosti kliničkih parametara 12h pre smrtnog ishoda. U cilju procene prisustva komorbiditeta analizirani su indeks telesne mase (engl. body mass index- BMI) i podaci o prethodno dijagnostikovanoj arterijskoj hipertenziji. Kod svih pacijenata uključenih u studiju upoređivane su kliničke dijagnoze sa obdukcionim nalazom. Za klasifikaciju autopsijskih dijagnoza kori&scaron;ćena je Goldman-ova klasifikacija. Na osnovu provedenog istraživanja, do&scaron;lo se do zaključka da slaganje klinički dijagnostikovanih i patohistolo&scaron;ki potvrđenih slučajeva ARDS-a iznosi 68%. Senzitivnost kliničke dijagnoze ARDS-a iznosi 82%, a pozitivna prediktivna vrednost 80%. Pacijenti sa nalazom eksudativne faze DAD-a u plućnom tkivu su u najvećem procentu imali klinički težak ARDS, dok su se pacijenti sa nalazom proliferativne faze sindroma če&scaron;će manifestovali pod kliničkom slikom srednje te&scaron;kog ARDS-a, odnosno utvrđeno je da postoji statistička povezanost između nižih vrednosti PaO2/FiO2 i teže faze ARDSa. Patohistolo&scaron;kom analizom promena u plućnom tkivu nađeno je da najvažnija obeležja eksudativne faze ARDS-a predstavljaju: hijaline membrane, edem i krvarenje, dok su se kao najvažnija obeležja proliferativne faze ARDS-a izdvojili: proliferacija pneumocita tipa II, intersticijalna i mutilantna fibroza i organizirajuća pneumonija. Kod pacijenata sa kliničkom dijagnozom ARDS-a kod kojih ARDS nije i patohistolo&scaron;ki dokazan, najče&scaron;ći nalaz na plućima bila je fibrinozno-purulentna bronhopneumonija. Analizom etiolo&scaron;kih faktora koji doprinose razvoju ovog sindroma otkriveno je da je ARDS najče&scaron;će nastao kao posledica delovanja direktnih/pulmonalnih činilaca: pneumonije i virusa gripa H1N1. Najzastupljeniji komorbiditeti prisutni kod pacijenata sa ARDS-om bili su sistemska hipertenzija i gojaznost. Najzad, kod svih pacijenata uključenih u istraživanje upoređivane su kliničke dijagnoze sa obdukcionim nalazom i na osnovu Goldman-ove klasifikacije kliničke dijagnoze i obdukcioni nalaz slažu se u 72% slučajeva. Rezultati ove studije mogli bi se upotrebiti u daljim istraživanjima kako bi omogućili bolji dijagnostički pristup ovom problemu, a samim tim i bolji terapijski pristup i smanjivanje stope mortaliteta.</p> / <p>Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by severe respiratory failure with development of acute pulmonary edema in the absence of left heart failure signs. Since this syndrome has a heterogeneous etiology, progressive course and high mortality, timely and accurate diagnosis is essential in the implementation of effective and early treatment, and therefore in improving the prognosis of the disease. The aim of this PhD thesis was to examine the association between clinical and pathohistological diagnosis of this syndrome, as well as to analyze and compare the values of clinical parameters necessary for the diagnosis of ARDS with pathohistological parameters of diffuse alveolar damage. The study included 67 patients of the Institute for Lung Diseases who died under clinical picture of ARDS and / or in which, at the autopsy, pathohistological diagnosis of ARDS was set. To set up a clinical diagnosis of ARDS the criteria of the American-European Consensus Conference in 1994 were used. After a semi-quantitative analysis of histopathological parameters of diffuse alveolar damage, all patients were divided into two groups: Group I - patients in the exudative stage and Group II - patients in the proliferative phase of diffuse alveolar damage. Formed groups of patients were compared with respect to clinical parameters values 12 h before death. In order to assess the presence of comorbidities body mass index (BMI) and data on previously diagnosed arterial hypertension were analyzed. In all patients included in the study the clinical diagnosis were compared with autopsy findings according to Goldman&#39;s classification. According to this study, agreement of clinically diagnosed and histologically confirmed cases of ARDS is 68%. The sensitivity of clinical diagnosis of ARDS is 82%, and positive predictive value is 80%. Patients with exudative phase of DAD most frequently had a severe form of ARDS, whereas patients with proliferative phase often manifested with moderate form of ARDS, ie it was found that there is a statistical association between lower values PaO2 / FiO2 and more severe phase of ARDS. Pathological analysis of changes in lung tissue revealed that the most important characteristics of exudative phase of ARDS are: hyaline membrane, edema and bleeding, while the most important features of the proliferative phase of ARDS are: the proliferation of type II pneumocytes, interstitial fibrosis and mutilating and organizing pneumonia. In patients with a clinical diagnosis of ARDS in which ARDS was not pathohistologically proven, the most common finding in the lungs was fibrinous-purulent bronchopneumonia. The analysis of etiological factors that contribute to the development of this syndrome discovered that ARDS usually develop as a result of pulmonary factors: pneumonia and influenza virus H1N1. The most common comorbidities present in patients with ARDS were systemic hypertension and obesity. Finally, in all patients included in the study clinical diagnosis and autopsy findings were compared and based on Goldman&#39;s classification clinical diagnosis and autopsy findings are in agreement in 72% of cases. The results of this study could be used in further research to enable better diagnostic approach to this problem, and therefore a better therapeutic approach and reducing mortality rates.</p>
418

Mezinárodní srovnání léčby alkoholismu v České republice, Belgii a Ugandě / International comparison of alcohol abuse treatment in the Czech Republic, Belgium and Uganda

Brtníková, Vendula January 2016 (has links)
Background: Alcohol addiction is a widespread social problem worldwide. Countries with high prevalence of alcohol consumption try to react on this situation. Addiction treatment is closely determined by public health and the health care system of each country, which define its role. Aims: The main aim of this study is a description of comparison focused on alcohol abuse treatment in the Czech Republic, Belgium and Uganda. Secondary aim is to understand basic principles of treatment in chosen countries through qualitative research methods and the insight into advantages and disadvantages of treatment programs. Methods: The concept of the study is based on a qualitative research methodology. The starting point of this research was an analysis of interviews conducted by David Kalema with patients treated in medical facilities in Belgium and Uganda. Also semi-structured interviews were conducted with patients of two mental hospitals in the Czech Republic. The selection method used in this study was a purposeful sampling method. Research was carried out with 12 respondents from the Czech Republic, 10 from Belgium and 10 from Uganda. The final data was analyzed according to the procedures of grounded theory. Results: One of the major factors identified was the function of case management approach in...
419

Srovnání české a ruské deklinace podstatných a přídavných jmen se zaměřením na výuku češtiny pro cizince / Comparison of Czech and Russian Declension of Nouns and Adjectives with a Focus on Teaching Czech for Foreigners

Kulich, Karel January 2019 (has links)
Title: Comparison of Czech and Russian Declension of Nouns and Adjectives with a Focus on Teaching Czech for Foreigners Author: Mgr. Karel Kulich Department: Institute of Czech Language and Theory of Communication, Faculty of Arts, Charles University Supervisor: PhDr. Jiří Hasil, Ph.D. Abstract: The submitted thesis deals with Czech language as a foreign language in the field of Czech declension system of nouns and adjectives in comparison with the Russian system, and the issue of acquiring these language structures in the target group of Russian-language foreigners. This group of foreigners is a part of a large number of foreign students studying at Czech universities and other schools, so the topic of the paper is highly up-to-date. According to the findings of the linguists, the similarity of language structures may be the cause of the so-called interference errors. In a more general sense, it is the issue of homonymy, which is described, for example, by V. Skalička in connection with the development and termination of declension. In the linguistic comparison, the role of homonymity of desinential morphemes is related to their unequal functional load. The author claims to provide a thorough knowledge of Czech and Russian declension based on comparative study. The goals of the thesis include description...
420

Estudo randomizado para o tratamento da rigidez pós-traumática do cotovelo: liberação cirúrgica versus reabilitação / Randomized trial for the treatment of posttraumatic elbow stiffness: surgical realise versus rehabilitation

Guglielmetti, Cesar Luiz Betoni 15 April 2019 (has links)
INTRODUÇÃO: Pacientes com rigidez pós-traumática do cotovelo que falharam à fisioterapia convencional têm como possibilidades de tratamento protocolos de reabilitação associado ao uso de órtese ou à liberação cirúrgica do cotovelo. Na literatura não existem artigos comparativos entre essas duas formas de tratamento. O objetivo primário deste estudo foi comparar a amplitude de movimento de flexoextensão do cotovelo entre os pacientes submetidos ao tratamento cirúrgico ou à reabilitação. Os objetivos secundários foram comparar os resultados clínicos, de acordo com a escala \"Mayo Elbow Performance Score\", o questionário \"Disability of Arm, Shoulder and Hand\" e a escala visual analógica de dor, além de comparar o ganho absoluto e relativo da flexoextensão, a flexão e extensão máxima, a amplitude de pronossupinação e a taxa de complicações. MÉTODOS: Estudo clínico randomizado, com avaliador cego, de pacientes com rigidez póstraumática do cotovelo que apresentaram falha ao tratamento fisioterápico convencional. Os pacientes foram alocados aleatoriamente em dois grupos de tratamento: conservador e cirúrgico. O grupo conservador foi submetido ao protocolo de reabilitação envolvendo a equipe de terapia ocupacional, com exercícios e alongamentos associados ao uso de órteses estáticas seriadas de extensão, dinâmicas de flexão, além de sessões de movimentação contínua passiva. O grupo cirúrgico foi submetido à liberação cirúrgica por via posterior, seguido do mesmo protocolo de reabilitação do grupo conservador. As escalas clínicas foram aplicadas pré-operatoriamente, aos 3 e 6 meses de seguimento. A amplitude de movimento foi avaliada nos mesmos períodos e adicionalmente com 6 semanas. As complicações foram avaliadas até os 6 meses de tratamento. O desfecho primário do estudo foi a amplitude de movimento de flexoextensão aos 6 meses de seguimento. RESULTADOS: Trinta pacientes foram incluídos no estudo, sendo 15 em cada grupo. A amplitude de movimento de flexoextensão do cotovelo, ao final dos 6 meses de seguimento, foi de 108,4º para o grupo cirúrgico e de 88,1º para o grupo conservador (p=0,002). O ganho absoluto e relativo da flexoextensão do cotovelo aos 6 meses foram respectivamente de 17,2º e 26,8% para o grupo conservador e de 40,8º e 58,8% para o grupo cirúrgico (p < 0,001). A pontuação da escala visual analógica de dor, escala \"Mayo Elbow Performance Score\" e o questionário \"Disability of Arm, Shoulder and Hand\" foram respectivamente de 4,4, 70,6 e 35,3 para o grupo conservador e de 3,9, 77,3 e 27,6 para o grupo cirúrgico (p=0,486, p=0,342 e p=0,361). O grupo conservador apresentou uma complicação, enquanto o grupo cirúrgico quatro (p=0,598). CONCLUSÕES: A liberação cirúrgica do cotovelo associada ao protocolo de reabilitação resultou em uma maior amplitude de flexoextensão, além de um maior ganho absoluto e relativo quando comparada à reabilitação isolada após 6 meses. A extensão máxima obtida foi superior no grupo cirúrgico, sem diferença para a flexão máxima e amplitude de movimento de pronossupinação. Os grupos não diferiram nas escalas funcionais e na taxa de complicações / INTRODUCTION: Patients with post-traumatic elbow stiffness who have failed conventional physiotherapy have two options of treatment: rehabilitation protocols associated with the use of bracing or surgical elbow release. In the literature there are no comparative studies between those forms of treatment. The primary objective of this study was to compare the elbow flexion-extension range of motion between patients submitted to surgical treatment or rehabilitation. The secondary objectives were to compare the clinical outcomes according to the Mayo Elbow Performance Score, the Disability of Arm, Shoulder and Hand questionnaire and the visual analogue pain scale, in addition to comparing the absolute and relative gain of elbow flexion-extension, maximal flexion and extension, pronosupination range of motion and complications rate. METHODS: Randomized clinical trial with blind evaluator of patients with post-traumatic elbow stiffness who presented failure to conventional physiotherapeutic treatment. Patients were randomly assigned to two treatment groups: non surgical and surgical. The non surgical group was submitted to a rehabilitation protocol involving the occupational therapy team, with exercises and stretching associated with the use of serial extension static braces, dynamics braces and continuous passive movement sessions. The surgical group was submitted to surgical release, followed by the same protocol of rehabilitation of the non surgical group. The clinical scales were applied preoperatively, at 3 and 6 months of follow-up. The range of motion was assessed at the same periods and additionally at 6 weeks. Complications were assessed up to 6 months of treatment. The study primary outcome was the flexion-extension range of motion at 6 months of follow-up. RESULTS: Thirty patients were included in the study, 15 in each group. The elbow flexion-extension range of motion at 6 months of follow-up was 108.4º for the surgical group and 88.1º for the non surgical group (p=0.002). The absolute and relative gain of elbow flexion-extension at 6 months were 17.2º and 26.8% for the non surgical group and 40.8º and 58.8% for the surgical group (p < 0.001). The visual analogue pain scale, the Mayo Elbow Performance Score and the Disability of Arm, Shoulder and Hand questionnaire were respectively 4.4, 70.6 and 35.3 for the non surgical group and 3.9, 77.3 and 27.6 for the surgical group (p=0.486, p=0.342 and p=0.361). The non surgical group presented one complication, while the surgical group had four (p=0.598). CONCLUSIONS: The elbow surgical release associated with the rehabilitation protocol resulted in a greater flexion-extension range of motion and greater absolute and relative gain when compared to the isolated rehabilitation after 6 months. The maximal extension obtained was superior in the surgical group, with no difference for maximal flexion and pronosupination range of motion. The groups did not differ on functional scales and complication rates

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