Zugl.: Passau, Univ., Diss., 2009

Diss. Univ. Köln, 2007.

A lavagem das mãos é reconhecida como uma das medidas mais importantes para prevenir as Infecções Hospitalares. Este estudo teve como objetivo comparar a execução e verificar a adesão aos passos da técnica de lavagem das mãos por alunos dos 2º, 3º e 4º anos de um Curso de Graduação em Enfermagem. A amostra constituiu-se de 113 alunos que estavam cumprindo estágio em instituições de saúde do município de São Paulo. Os dados foram coletados por meio de observação direta para a qual foi utilizado um instrumento em forma de “check-list” com os passos da técnica de lavagem das mãos, conforme recomendação do Ministério da Saúde do Brasil. Os resultados foram estatisticamente trabalhados, permitindo constatar que: a) os alunos dos 2º e dos 3º anos obtiveram melhor desempenho na execução da técnica de lavagem das mãos, com diferença estatisticamente significante, quando comparados ao 4º ano nos passos da técnica: “retirou jóias”, “esfregou palma com dorso”, “esfregou espaços interdigitais”, “esfregou polegar” e “esfregou unhas”. Apenas no item “fechou a torneira com papel toalha” o 4º ano apresentou-se melhor que os 2º e 3º anos; b) a adesão aos passos da técnica de lavagem das mãos dos alunos de todos os anos do curso foi muito baixa, pois na metade dos passos que compõe a técnica, os alunos apresentaram adesão menor que 50%; c) A porcentagem de alunos que executou TODOS OS PASSOS da técnica de lavagem das mãos CORRETAMENTE foi muito baixa, apenas 8,8%. Concluiu-se que os alunos do 4º ano obtiveram o pior desempenho e adesão muito baixa em quase todos os passos da técnica de lavagem das mãos, quando comparados aos dos 2º e 3º anos / Handwashing is known as one of the most important measures in preventing hospital-acquired Infections. This study had the objective of comparing the performance and verifying the adhesion of students from the 2nd, 3rd and 4th years of the Graduation nursing course to the steps of this technique. The sample was made of 113 students who were under the internship program in health institutions in the city of Sao Paulo. The data were collected through unobtrusive observation based on an instrument in a check-list form with all the steps of the hands-washing technique, as suggested by the Brazilian Health Ministry. The results were statistically treated showing that: a) the students from the 2nd and 3rd years had better results in the execution of the handwashing technique, with a significant statistical difference, when compared to the students from the 4th year considering the steps: “jewelry-removing”, “rubbed the palm of the hand with its back”, ”rubbed spaces between fingers”, “rubbed thumb” and “rubbed nails”. Considering the item “closing the faucet with a paper towel” the students from the 4th year were better than the ones from the second and third years; b) the students from all years of graduation the 2nd, 3rd and 4th years showed low adhesion to the hands-washing technique steps, once they presented the adhesion to less than 50% of the steps; c) The percentage of students who performed ALL THE STEPS of the handwashing technique CORRECTLY was very low, only 8.8%. It was concluded that the students from the 4th years in almost all had the worst performance and the lowest adhesion to the hands-washing technique when compared to the students from the 2nd and 3rd years

O estudo da responsabilidade civil dos administradores de companhias abertas na doutrina nacional trata usualmente dos deveres fiduciários, do ato regular de gestão e da teoria ultra vires, da culpa ou dolo do administrador, das ações ut universi e ut singuli e da solidariedade entre a responsabilidade do administrador e a da companhia. Poucos abordam as causas extintivas dessa responsabilidade, e raro são os que tratam da hipótese de exclusão de responsabilidade do artigo 159, § 6º, da Lei nº 6.404/76. Como a disciplina dos deveres fiduciários prevista na lei societária brasileira tem forte influência do Direito norte-americano, buscou-se na legislação, doutrina e jurisprudência daquele país os fundamentos necessários à melhor interpretação e aplicação da regra de exclusão e, em especial, na business judgment rule, doutrina que protege os administradores contra responsabilização por prejuízos à companhia decorrentes de decisões por eles adotadas, proteção esta também conferida pela hipótese do artigo 159, § 6º, da Lei nº 6.404/76, ao administrador leal e de boa-fé. / The study of corporate directors civil liability in national doctrine usually deals with fiduciaries duties, regular management act and the ultra vires theory, directors malpractice or deceit, ut universi and ut singuli actions and solidarity between directors and companies responsibility. Few address the extinctive causes of such liability, and rare are those who address the liability exclusion hypothesis of the Article 159, § 6º, of the Law n. 6.404/76. Whereas that the fiduciary duties discipline provided for in Brazilian corporate law has strong influence of American law, was sought in the legislation, doctrine and jurisprudence of that country the fundamentals for a better understanding and application of the exclusion rule and, particularly, in the business judgment rule, a doctrine that protects directors against liability for damages to the company arising from their acts, protection also afforded by the Article 159, § 6º, of the Law n. 6.404/76, to the loyal and good faith director.

The market of portable digital audio players (DAPs) have literally exploded the last couple of years. Other markets has grown as well. PDAs, GPS receivers, mobile phones, and so on. This resulted in more advanced ICs and SoCs becoming publically available, eliminating the need for in-house ASICs, thus enableing smaller actors to enter the markets. This thesis explores the possibilities of developing a low power, hand-held device on a very limited budget and strict time scale. This thesis report also covers all the steps taken in the development procedure.

Depuis son émergence, la médecine nucléaire ne cesse d’évoluer. A la fois diagnostique et thérapeutique, elle occupe une place importante dans la stratégie médicale moderne. L’imagerie nucléaire consiste après injection au patient d’un radiotraceur, à détecter le rayonnement émis. Elle donne accès quantitativement à la fonctionnalité des organes ou à la localisation de structures cibles telles que des lésions tumorales. Cette imagerie a naturellement intégré les procédures chirurgicales en particulier en cancérologie (en pré et per opératoire). On parle de chirurgie radioguidée. Cette dernière permet de localiser lors du geste chirurgical les structures radiomarquées devant être retirées.Les avancées technologiques au niveau des radiopharmaceutiques et en instrumentation sont à l’origine de nouvelles stratégies de radioguidages pouvant cibler de petites structures. L’imagerie par rayonnement gamma reste la plus répandue et la mieux adaptée. On assiste au développement de dispositifs d’imagerie gamma portables miniaturisés permettant un contrôle visuel en per opératoire. Ces dispositifs sont prometteurs mais doivent être évalués.Un état des lieux des différentes procédures en chirurgie radioguidée et des imageurs utilisés en clinique est réalisé dans cette thèse.Le laboratoire Imagerie et Modélisation en Neurobiologie et Cancérologie (UMR 8165) développe de longue date de nouvelles approches de détection miniaturisée pour les différents types de rayonnement. Parmi celles-ci le prototype de deuxième génération appelé TReCam.Cette mini gamma caméra présente un champ de vue de 4,9 x 4,9 cm2 et intègre des technologies d’imagerie directement issues de la physique des particules. Elle est formée d’un collimateur à trous parallèles, d’un scintillateur continu LaBr3 (Ce) lu par un photomultiplicateur multi-anode et son électronique. Le système d’acquisition donne au chirurgien un affichage en temps réel de l’image radioactive.Ce travail de thèse a consisté également à évaluer la place des imageurs portables en chirurgie radioguidée, en particulier mammaire, à travers l’évaluation de la procédure SNOLL (repérage par marquage ɣ de la tumeur (T) et des ganglions sentinelles (GS)) avec TreCam. Il a reposé sur trois parties.Un premier volet a visé l’optimisation des performances de TReCam pour favoriser la localisation de structures peu radioactives dans des temps d’exposition de l’ordre de la dizaine de secondes. Pour ce faire, différentes stratégies d’optimisation des performances ont été mises en place au niveau du collimateur, de l’électronique et des algorithmes de traitement (dont réseaux de neurones) pour améliorer l’homogénéité de la détection.Le deuxième volet visait à objectiver les performances cliniques de TReCam pour la procédure SNOLL et situer les limites de son exploitation. A l’aide de simulations menées sur la plateforme GATE et modélisant la scène opératoire au plus près de la réalité clinique, nous avons montré que TreCam peut détecter des GS jusqu’à 4,5 cm de profondeur et situé à 4 cm de la T. L’impact du temps de pose n’est pas important. Par contre, le choix de la bonne fenêtre en énergie est primordial.Enfin, le troisième volet concrétise l’ambition interdisciplinaire de cette thèse. Il est consacré à l’évaluation clinique de TReCam à travers l’étude de son apport à la procédure SNOLL mammaire. Cette étude prospective interventionnelle incluant de 47 patientes (22 procédures SNOLL utilisant TReCam aux différents temps de la procédure et 25 procédures SNOLL standard). Les résultats ont montré un intérêt qualitatif à l’utilisation de TReCam en apportant un confort visuel lors de la procédure en complément de la sonde monopixel.Ce travail a montré l’intérêt de tels imageurs en chirurgie radioguidée mais aussi situé leurs limites actuelles. Des efforts de développement doivent être poursuivis tant au niveau des détecteurs qu’au niveau des radiopharmaceutiques utilisés pour le repérage. / Since its emergence in the middle of the twentieth century, nuclear medicine continues to evolve. At the same time diagnostic and therapeutic, it occupies an increasingly important place in the modern medical strategy. Nuclear imaging consists of injecting the patient with a radio-tracer to detect the radiation emitted. It provides quantitative access to the functionality of organs or the location of target structures such as tumor lesions. This imaging has been naturally integrated into surgical procedures, particularly in oncology (preoperatively and then intraoperatively). It is called radio-guided surgery. It makes possible to locate the radioactive target which will be removed during surgery.Technological advances in radiopharmaceutical instrumentation are driving new strategies that can target small structures. Gamma-ray imaging remains the most widespread and the most suitable. We are witnessing the development of miniaturized portable gamma imaging devices that allow visual control during surgery. These devices are promising but need to be evaluated.A short state-of-the-art of the various procedures in radioguided surgery and imagers used clinically is carried out in this thesis.For many years, the Imaging and Modeling in Neurobiology and Oncology Laboratory (UMR 8165) has been developing new miniaturized detection approaches for different types of radiation. Among them is the second-generation prototype called TReCam.This mini gamma camera has a field of view of 4.9 x 4.9 cm2 and integrates imaging technologies directly from particle physics. It consists of a collimator with parallel holes, a continuous scintillator LaBr3 (Ce) read by a multi-anode photomultiplier (PSPMT) and its electronics. The acquisition system gives the surgeon a real-time display of the radioactive image.This thesis work also consisted in evaluating the place of portable imagers in radioguided surgery, in particular mammary surgery, through the evaluation of the SNOLL procedure (identification of the tumor (T) and the sentinel lymph nodes (GS) by γ-labeling) with TreCam. It is based on three parts.The first part aimed at optimizing the performance of TReCam to improve the localization of lowradioactive structures with exposure times of around 10 seconds. To do this, different performance optimization strategies have been implemented in the collimator, electronics and processing algorithms (including neural networks) to improve the homogeneity of the detection. These performances were compared to those of a prototype developed at IMNC and integrating a new generation of photodetectors: the SiPM.The second part aimed to objectify the clinical performance of TReCam in the SNOLL procedure and to situate the limits of its exploitation. Using simulations conducted on the GATE platform and modeling the operating scene closer to clinical reality, we have shown that TreCam can detect GS up to 4.5 cm deep and located 4 cm from the T. Impact of the exposure time is not important. On the other hand, choosing the right energy window is essential.Finally, the third part concretizes the interdisciplinary ambition of this thesis. It is devoted to clinical evaluation of TReCam through the study of its contribution to the SNOLL breast procedure. This prospective interventional study included 47 patients (22 SNOLL procedures using TReCam at different times of the procedure and 25 standard SNOLL procedures). The results showed a qualitative interest in the use of TReCam by bringing a visual comfort during the procedure and must be used in addition to the monopixel probes.This work has shown the interest of such imagers in radioguided surgery but also set their current limits. Development efforts must be pursued at the level of both detectors and radiopharmaceuticals used for tracking.

No description available.

Inledning: Muskelstyrka i höftregionen är en viktig fysisk färdighet inom fotboll dels ur ett prestationsperspektiv, dels för skadeprevention. Trots detta saknas normativa isometriska styrkevärden för höftadduktorer och - abduktorer hos damfotbollsspelare. Syfte: Syftet med denna tvärsnittsstudie var att undersöka den isometriska höftstyrkan i adduktion, unilateralt och bilateralt, samt höftabduktion unilateralt med en handhållen dynamometer hos skadefria damfotbollsspelare. Metod: 29 friska damfotbollsspelare på elitnivå inkluderades i studien. Den isometriska höftstyrkan mättes vid ett tillfälle på försäsongen med en handhållen dynamometer. Höftadduktion och -abduktion mättes unilateralt i en sidliggande position och den bilaterala höftadduktorstyrkan mättes i ett squeeze-test i en ryggliggande position. Ett tillägg av en extern fixation av dynamometern applicerades vid testtillfället. Resultat: Styrkevärden (medelvärde, SD ±) var: höftabduktion dominant ben 1,94 ± 0,3 Nm/kg, icke-dominant ben 1,81± 0,3 Nm/kg, höftadduktion dominant ben 1,61 ± 0,3 Nm/kg, icke-dominant ben 1,51 ± 0,3 Nm/kg, squeeze-test 4,11 ± 0,5 N. Styrkekvot adduktion/abduktion var 0,83 dominant ben och 0,84 icke-dominant ben. Det dominanta benet var signifikant starkare (p<0,05) i både höftadduktion och -abduktion, 7 % respektive 8 %. Konklusion: För damfotbollsspelare var det dominanta benet signifikant starkare i både höftadduktion och -abduktion. Höftabduktorerna var signifikant starkare än adduktorerna i både det dominanta och icke-dominanta benet med en styrkekvot adduktorerna/abduktorerna på 0,83 respektive 0,84. / Introduction: Hip strength is an important physical factor in soccer for both performance and for injury prevention. Despite this normative isometric strength values are lacking for hip adduction and abduction in healthy women’s soccer players. Aim: The aim of this cross-sectional study was to examine the isometric hip strength in adduction, unilateral and bilateral, and hip abduction unilateral with a handheld dynamometer in healthy women's soccer players. Methods: 29 healthy female elite soccer players were included in the study. The isometric hip strength was measured one time in the pre-season with a hand-held dynamometer. Hip adduction and abduction were measured unilaterally in a side lying position and the bilateral hip adductor strength was measured in a squeeze test in a supine position. An addition of an external fixation of the dynamometer was applied during testing. Results: Strength values (mean, SD ±) were: hip abduction dominant leg 1,94 ± 0,3 Nm/kg, non-dominant leg 1,81± 0,3 Nm/kg, hip adduction dominant leg 1,61 ± 0,3 Nm/kg, non-dominant leg 1,51 ± 0,3 Nm/kg, squeeze-test 4.11 ± 0.5 N. The strength ratio of adduction/abduction were 0,83 dominant leg and 0,84 non-dominant leg. The dominant leg was significantly stronger (p<0,05) in both hip abduction and adduction, 7 % and 8 %, respectively. Conclusion: For women’s soccer players the dominant leg was significantly stronger in both hip abduction and adduction. The hip abductors were significantly stronger than the adductors in both the dominant and non-dominant leg with a strength ratio adductor/abductor 0,83 and 0,84 respectively.

This thesis, a biography of the French actress, Anna Held (1873-1918), is an attempt to place her in proper perspective in American history. Essentially a record of Miss Held from birth to death, it highlights many events that made her famous. Included are examples of publicity generated by her manager-husband, Florenz Ziegfeld, Jr. Much credit can be awarded Ziegfeld for his expertise in publicity stunts and promotion. Undue praise, however, has been attributed to him for the origin of the Ziegfeld Follies and the success of Anna Held. Anna was a Continental success long before she met him. His promotion introduced her to the American public, but her prodding and financing made Ziegfeld and the Follies a success. Through the years the name "Anna Held" has almost been forgotten. The research was contingent upon examination of primary source material in Los Angeles, New York and Cambridge, Massachusetts. The eighty-five year old surviving daughter of the famous actress graciously consented to interviews that proved indispensable to the research. The research methodology involved assemblage of material, including news clippings, articles and books. The fortunate personal contact provided a clearing house for verifying or disaffirming information. As a famous personality, the truth about Anna Held is hidden in the legend. Her daughter, Liane Carrera, has suggested that this treatise be titled: "What They Said About Anna Held."

本研究之主旨為透過「併購交易比較法」探討日本市場「未公開發行公司」之流動性折價幅度。綜觀現存文獻中，衡量流動性折價的實證研究方法有「首次公開發行比較法」、「限制性股票比較法」與「退場之市場倍數期望值比較法」。由於上述研究方法皆有其缺失之處，因此本研究沿用Koeplin, Sarin, and Shapiro[2000]提出之「併購交易比較法」以併購交易之市場倍數衡量「未公開發行公司」之折價幅度。更進一步藉由建構「參考配對組合」，為併購標的為「未公開發行公司」之交易案尋找一組與其在相同國家、交易年份、產業與類似規模之併購標的為「公開發行公司」交易案，計算各市場倍數之流動性折價幅度。 本研究檢視西元1998年至2007年，共十年間於日本發生之併購交易，並限制為控制性股權交易。最終可得樣本為146個配對組合，平均流動性折價幅度為22%～30%。經由橫斷面迴歸分析發現，所觀察到的流動性價差隨「未公開發行公司」特性與產業不同而有所差異。產業別之研究分析發現，「建築業」為六大產業中各市場倍數所計算的流動性折價幅度最深者；「金融、保險及不動產業」，則為六大產業中各市場倍數所計算的流動性折價幅度最小者。交易年份別之研究發現，各市場倍數計算出的流動性價差所呈現的趨勢與日本市場歷年來併購交易案數量呈現「反向關係」，即當併購交易熱絡期間，「流動性價差」走降；而於併購交易案較為冷卻期間，「流動性價差」則上升。對於若為高成長的大型公司，其流動性折價幅度則將大幅低於其他條件之公司。由本研究之實證結果顯示，投資人爾後於評價「流動性之價差」時，將不宜應用單一折價幅度於所有「未公開發行公司」。 / Little is known about valuation of privately held companies, for which the fact that there is no sufficient information and no ready market. In general, investors will pay less for one there is no ready market compared to one that is readily marketable, ceteris paribus. Then we all accept that a private firm’s value will be reduced for lack of marketability, applying the value of the discount is a difficult matter. To the best of our knowledge, research in the past decades has relied on “IPO Approach”, “Restricted stock approach”, and “Expected exit multiple approach”. Those approaches have inherent drawbacks so this study follows the current approach of Koeplin, Sarin, and Shapiro (2000) to use a matching technique. This study uses “reference portfolio” to construct control portfolios of acquisitions of public companies for each acquisition of private companies. For 146 comparable reference portfolio between 1998 and 2007 in Japan, the average discount is 22%～30%. Our cross-sectional analysis shows, however, that the discount observed varies with the characteristics of the firm and with the industry. This study breaks down the discount by industry, with the highest discount found in construction and the lowest in finance, insurance and real estate. We also found discount decreases during hot M&A years and increases during cold M&A years. For large and growth private firms, the discount tends to be much smaller. Overall, our findings suggest that using constant discount across private firms is wrong.