京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第18827号 / 理博第4085号 / 新制||理||1587(附属図書館) / 31778 / 京都大学大学院理学研究科生物科学専攻 / (主査)准教授 森 哲, 教授 沼田 英治, 教授 高橋 淑子 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DFAM

Einleitung: Für die Messung der "Narkosetiefe" werden vorwiegend Parameter des Elektroenzephalogramms (EEG) untersucht, welche offenbar keine Aussage zur Unterdrückung von Bewegungen auf Schmerzreize treffen können. Dies ist auch wenig verwunderlich, da Untersuchungen an Tieren die Ausschaltung einer Bewegung auf Schmerzreiz durch Anästhetika auf der spinalen Ebene erwarten lassen. Der spinale H-Reflex, ein elektrisch ausgelöster, monosynaptischer Reflex, wurde bereits zur Überwachung der Unterdrückung von Bewegungen während der Narkose vorgeschlagen. Diese Arbeit diente der vergleichenden Untersuchung der H-Reflex-Amplitude mit EEG-Parametern unter Sevofluran-Narkosen. Es wurden Konzentrations-Wirkungs-Kurven ermittelt, sowie die Eignung als Parameter zur Vorhersage von Bewegungen auf schmerzhafte Reize überprüft. Weiterhin sollte der Effekt des schmerzhaften Reizes auf die H-Reflex-Amplitude selbst aufgeklärt werden. Methodik: Nach Zustimmung der Ethikkommission und schriftlicher Einwilligung wurden 28 Patientinnen in die Studie eingeschlossen. Sie wurden präoperativ untersucht. Nach anfänglicher Vertiefung bis zur Toleranz einer Larynxmaske, wurde die Narkose mit Hilfe der "up-and-down"-Methode auf einen Wert nahe der minimalen alveolären Konzentration (MAC) eingestellt. Nach mindestens 15 Minuten konstanter Konzentration wurde von einem "steady-state" ausgegangen und am volaren Unterarm ein elektrisch ausgelöster Schmerzreiz (Tetanus-Reiz, 60 mA) appliziert. Für die Ermittlung der Konzentrations-Wirkungs-Kurve diente ein pharmakokinetisch-pharmadynamisches Modell, welches auf einem sigmoidalen Emax-Modell beruht. Die Eignung eine Bewegung vorherzusagen wurde anhand der "Prediction Probability" (PK-Wert) überprüft. Ergebnisse: Bei 14 Patientinnen konnte der H-Reflex kontinuierlich über die gesamte Messperiode ausgelöst werden. Die Wachwerte betrugen für die H-Reflex-Amplituden 6,5 (+/- 4,1 SD) mV. Sevofluran unterdrückt die H-Reflex-Amplituden konzentrationsabhängig. Die Unterdrückung konnte gut durch das sigmoidale Modell dargestellt werden (Median - r^2 = 0,96). Die Unterdrückung der H-Reflex-Amplitude unterliegt einer signifikant steileren Konzentrations-Wirkungs-Beziehung als die der EEG-Parameter spektrale Eckfrequenz 95 (SEF95) und bispektraler Index (BIS). Die H-Reflex-Amplitude konnte Bewegungen auf einen Schmerzreiz mit einer PK von 0,74 vorhersagen, während mittels der EEG-Parameter SEF95 und BIS lediglich zufällige Aussagen bezüglich stattfindender Bewegungen getroffen werden können. Der Schmerzreiz veränderte die H-Reflex-Amplitude, das spontane frontale Elektromyogramm und die Herzfrequenz, nicht jedoch die kortikal abgeleiteten Parameter BIS und SEF95. Schlussfolgerung: Aus dieser Arbeit ergeben sich Hinweise, dass die Unterdrückung von Bewegungen auf schmerzhafte Reize und die Unterdrückung der H-Reflex-Amplitude durch Sevofluran eng verknüpft sind. Auch wenn kein kausaler Zusammenhang besteht, so würde dies die hohe Vorhersagekraft der H-Reflex-Amplituden für Bewegungen auf Schmerzreiz erklären. Sie ist zur Überwachung der Unterdrückung von groben gezielten Bewegungen während einer Narkose geeignet. Mittels H-Reflex-Amplituden können Aktivierungen des Rückenmarkes registriert werden, welche auf kortikaler Ebene nicht sichtbar werden. Zukünftige auf dem H-Reflex basierende Studien können weitere Einsichten in die Mechanismen der Anästhesie liefern und behilflich an der Erarbeitung von Richtlinien zur optimalen Medikamentendosierung sein. / Introduction: The measurement of "depth of anesthesia" is mostly done by parameters of the electroencephalogram (EEG), which can not make a statement about the suppression of movement due to painful stimulation. This is not surprising, looking at recent animal studies that assume the anesthetic induced unresponsiveness to noxious stimulation at the side of the spinal cord. The spinal H-reflex, an electric induced, monosynaptical reflex has been proposed to monitor the suppression of movements during anesthesia. This dissertation shows a comparative examination of the H-reflex-amplitude and parameters of the EEG under anesthesia with sevoflurane. Concentration-response functions have been determined, the prediction of movement to painful stimulation has been tested. Also the effect of the painful stimulus itself on the H-reflex-amplitude has been discovered. Methods: After approval of the institutional review board and informed consent were obtained, 28 patients were included into this study. The examination has been done prior to surgery. After induction of anesthesia until a laryngeal mask was tolerated, sevoflurane was decreased to a level close to minimum alveolar concentration (MAC) using the "up-and-down" method. After at least 15 minutes of constant sevoflurane concentration a "steady-state" was assumed and a painful electrical stimulation (tetanic stimulus of 60mA) was applied. The concentration-response functions were determined using pharmacokinetic and pharmacodynamic modeling, based on a sigmoid Emax model. To estimate and compare the predictive value of the parameters, prediction probability Pk was calculated. Results: On 14 patients the H-reflex could been measured continuously throughout the study period. At awake level, H-reflexes had a mean amplitude of 6,5 (+/- 4,1 SD) mV. Sevoflurane depresses the H-reflex-amplitude in a concentration dependent way, which was well modeled by the sigmoid Emax model (median r^2 = 0,96). The depression of the H-reflex-amplitude underlies a significant steeper concentration-response function as the EEG-parameters spectral edge frequency (SEF95) and bispectral index (BIS). H-reflex-amplitude could predict movement on to painful stimulation with a Pk value of 0,74, whereas EEG-parameters could only make statements, concering upcoming movements, by chance. The painful stimulation changed H-reflex-amplitude, frontal recorded electromyogram and heart-frequency but not the cortical recorded parameters BIS and SEF95. Conclusions: Results indicate that the suppression of movement and the suppression of the H-reflex-amplitude caused by sevoflurane are close connected. Although it does not imply a causual connection, it would explain the high predictive value of the H-reflex-amplitude for motor responses to noxious stimuli. H-reflex-amplitude can be used to monitor the suppression of gross purposeful movements during sevoflurane anesthesia. Using H-reflex-amplitude spinal activation can be registered, which are not seen on cortical level. Coming up studies based on the H-reflex can help to get more insights into the mechanisms of anesthesia and help to develop guidelines for optimal drug dosing.

Quick-service restaurant owners who fail to apply effective business strategies could risk business closure within the first 5 years of operations. The purpose of this multiple case study was to explore effective strategies that independent quick-service restaurant owners used to sustain business longer than the first 5 years. Resource-based theory was the conceptual framework for this study. Data were collected via semistructured interviews with 6 owners of independent quick-service restaurants in the southern region of the United States who sustained their businesses longer than the first 5 years, and from the review of business documents pertaining to sustainability. Data were also collected using business artifacts such as job descriptions, menus, websites, social media platforms, and business licenses, and analyzed using methodological triangulation. Member checking was used to help ensure reliability and validity of the interpretations. Six key themes emerged from the data: organization value, customer required excellence, financial perspective, human assets, physical operating materials, and technological prowess. The 6 themes aligned with the 5 types of internal resources established in the conceptual framework. The implications of this study for positive social change include the potential to support the welfare of the local citizens and owners of quick-service restaurants across the United States by providing strategies necessary to increase business survival rates, improve job sustainability, and encourage job creation.

L'architecture spatiale du désert est un principe d'unité par lequel se noue d'une façon novatrice, la rencontre de Jean-Marie Gustave Le Clézio, Ibrahim Al Koni et Rachid Boudjedra, au travers de Désert, La Petite Waw et Timimoun. Une telle topographie apparaît dans ces romans, qui prend pour point de départ le désert, lieu de la transparence et d’un possible retour vers un centre mythique d’avant la création. Ce choix permet d'apprécier les perspectives d'une quête initiatique, d'une géopoétique isomorphe de « lieu de l'u‑topie, du non lieu », qui se constitue chez nos auteurs comme un espace originel et original, foyer de création, tentative de dépassement vers un absolu, qui rejoint, d'une certaine manière, le pôle mythologique du « Paradis perdu » dans le contexte d'un imaginaire cosmique. Ce point central, s'inscrit à la fois au plus profond du désert et de l'être, offre en reflet la vision d'un espace qui abolit toutes les limites et englobe le monde entier? Le texte ici, est une réécriture, une épopée inversée, de la Genèse, la négation de son itinéraire? L'étude interroge les lieux vierges évoqués par le désert : qu'en est-il de leur actualisation au fil des œuvres, et aussi, de leur répercussion sur le tissu même de l'écriture? L'écriture est-elle une destinée à assumer et une lumière à atteindre dans l'alchimie du bonheur parfait? Est-ce que ce lieu de l'expérience transfiguratrice, cet espace de la Terre Promise se révèle être une immensité heureuse? Notre démarche s'intéresse aussi, aux images primordiales suscités par ce voyage vers l'origine pour examiner des thèmes très divers, mais qui obéissent à la même structure. En analysant d'une part, la nature de la dualité des couples opposés, complémentaires, insécables (racines-exil, nature-ville, masculinité-féminité, langage-silence, rêve-réalité, vie-mort, instant-éternité) et d'autre part, les éléments invariants qui la sous-tendent et ses trames fécondes (aventures et épreuves, espace-temps particulier, traversée et errance); un portrait plus profond se fait jour. / The spatial architecture of the desert is a principle of unity which is tied by an innovative way of meeting Jean-Marie Gustave Le Clézio, Ibrahim Al Koni and Rachid Boudjedra through Desert, Little Waw and Timimoun. Such topography appears in these novels, which takes as its starting point the desert instead of transparency and a possible return to a mythical center before creation.      This choice allows to assess the prospects for an initiatory quest, a geopoetic isomorphic "instead of utopia, the non-place" which is among our authors as an original space and the original home of creation, attempt to overrun an absolute, which joined in some way, the pole mythological "Paradise Lost" in the context of a cosmic imaginary. This central point fits both deep in the desert and be reflected in the vision provides a space that abolishes all limits and encompasses the whole world? The text here is a rewriting an epic reverse of Genesis, a denial of his route?       The study questions the virgin places mentioned by the desert what about updating them over the works, and also their impact on the fabric of writing? Writing is her destiny to fulfill and achieve a light in the alchemy of perfect happiness? Is this place transfiguring experience this space to the Promised Land is proving to be an immense happy?      Our approach is also interested, the primordial images generated by this journey to examine the origin of very diverse topics, but follow the same structure. By analyzing the one hand, the nature of the duality of opposing pairs, complementary, indivisible (root-exile, nature-city, masculinity-femininity, language, silence, dream-reality, life and death, time-eternity), and on the other hand, the invariant elements that underlie and fruitful fields (adventures and hardships, space-time particular, crossing and wandering), a deeper portrait emerges.

Dans un contexte fortement ségrégué, l’étude des pratiques résidentielles et des mobilités quotidiennes laisse transparaitre des inégalités importantes entre individus et permet d’appréhender les différentes contraintes auxquelles se confrontent les habitants. L’analyse des inégalités de mobilité dans la ville de Recife, qui a été centrée sur les personnes âgées des quartiers populaires afin d’atténuer les effets majeurs de la hiérarchie sociale, soulève le rôle important des caractéristiques du lieu de résidence, de l’étendue des réseaux sociaux ou encore de l’état de santé des habitants dans la réalisation de pratiques différentiées sur le territoire. A travers une enquête par entretiens menée dans trois zones pauvres de la ville (Brasilit, Cordeiro et Vila Arraes) la thèse propose ainsi de mettre en lien les pratiques résidentielles, lesmobilités quotidiennes et les stratégies des habitants afin de mieux comprendre les inégalités observées. Les résultats de la recherche indiquent une tendance aux faibles mobilités des aînés notamment en raison des contraintes éprouvées au quotidien mais aussi en raison d’une volonté à limiter les déplacements contraignants et à réduire les mobilités quotidiennes. Ce dernier constat a progressivement orienté notre étude vers l’analyse des formes d’ « immobilité » sur le lieu de résidence en tentant de saisir les enjeux de ces pratiques sur les conditions de vie des habitants. / In a highly segregated context, the study of residential practices and daily mobility point significant inequalities between individuals and allows to understand the various constraints people are facing. The analysis of inequalities mobility in the city of Recife, centred on elderly people who lives in popular neighbourhoods to mitigate significant effects of social hierarchy, raises the main characteristics of the place of residence of the extent of social or state of health of the people in achieving differentiated practices in the territory networks. Using interviews survey conducted in three poor areas of the city (Brasilit, Cordeiro and Vila Arraes), the thesis proposes to link residential practices, daily mobility and strategies of people to better understand the observed inequalities. The results shows a trend to low mobility of elderly people in particular because of the constraints encountered in everyday life. This trend is explained by desire to limit the constrained mobilities and reduce the daily mobility. This finding gradually leads to focus our study on analysing the forms of ‘immobility’ in the place of residence while trying to understand the issues of these practices on the lives of residents. / Num contexto altamente segregado, o estudo das mobilidades residenciais e quotidianas revela desigualdades significativas entre os indivíduos e permite identificar as dificuldades de cada pessoa. A análise das desigualdades de mobilidade na cidade de Recife, com foco na população idosa das áreas pobres da cidade para atenuar os efeitos da hierarquia social, aponta a importância das características do lugar de residência, das redes sociais ou ainda da saúde dos habitantes no desenvolvimento de práticas diferenciadas no espaço urbano. A pesquisa realizada em três áreas pobres da cidade (Brasilit, Cordeiro e Vila Arraes) propõe articular as práticas residenciais com as mobilidades quotidianas e as estratégias dos habitantes para assim compreender as desigualdades observadas nessa escala. Os resultados da pesquisa indicam uma tendência de baixa mobilidade dos idosos, especialmente por causa das dificuldades encontradas no cotidiano, mas também por causa de uma vontade de limitar os deslocamentos constrangedores e reduzir a mobilidade diária. Esta última observação tem focado progressivamente nosso estudo na análise das formas de "imobilidade" tentando apreender os rebatimentos dessas práticas nas condições de vida dos habitantes.

This thesis examines the representation of temporary migrants in the OCVID-19 pandemic in New Zealand. The aim of the study is to understand how the pandemic effected this early decision making by the New Zealand Parliament in correlation with migration, more specific, the temporary migrants who are stuck within New Zealands borders. These issues can be linked with shock mobility, more specific, with immobility within shock. The material is analysed with the WPR method. The study concludes that there is a changing discourse and a changing representation of the temporary migrants. Where at first the New Zealand citizens have to be protected, later on in the discourse the migrants need to be helped and it is followed by financial gain that the temporary migrants bring with their labour and spending. The findings create a contribution in the field of shock mobility, with a focus on the immobility within shock mobility.

This thesis explores the role of environmental perceptions and activism in migration decision-making within the context of a country highly vulnerable to climate change. It focuses on a case study of young climate activists in Bangladesh, and their aspirations for staying or moving. The qualitative data were collected through semi-structured interviews. For analysis of migration decisions, the study utilizes a theoretical framework of aspirations and capabilities by De Haas (2021), while incorporating concepts of Hirschman’s (1978) “voice” and Robins’(2022) “duty to loyalty”. The study reveals that climate activists are aware of and concerned about environmental changes, but do not perceive them as immediate threat to their current livelihoods. While they face daily challenges and witness the vulnerability of communities, they express hope and actively choose to stay in their country. Activism serves them to voice their concern and help their community. The constant interaction between the environmental perceptions and activism, shapes their capacity to envision a better future and enhances their aspirations for staying in their motherland

Critically ill patients can be prescribed bed rest as a therapeutic intervention. Immobility from bed rest can cause neuromuscular deconditioning and weakness. Preventing immobility by implementing mobilization activities may prevent these complications from occurring. Currently, mobility protocols are lacking. The purpose of this literature review is to analyze the evidence related to mobilizing patients in the Intensive Care Unit (ICU). In the future, a standard mobility protocol should be instituted for critically ill patients indicating when and how to begin mobilization. The efficacy of mobility protocols relies on an interdisciplinary team for positive outcomes to prevent complications of inactivity and promote patient safety. Future implementation of mobilization can decrease patients' lengths of stay and extensive rehabilitation from inactivity. Nursing education, practice and research should focus on interventions to prevent complications of immobility by identifying mobilization techniques, safety approaches and the use of protocols.

This study explores the intergenerational transmission of neighborhoods for the 1981 cohort of the Swedish population, focusing on the impact of parental neighborhoods on the neighborhood outcomes of young adults. Using Swedish register-based longitudinal data, the research traces the life courses of parents and their children through their neighborhood trajectories. The findings reveal that despite an overall low rate of immobility, there is a noticeable similarity in neighborhoods across generations. Residential mobility from parental neighborhoods often occurs within adjacent neighborhood poverty rankings. However, non-European migrants exhibit higher rates of neighborhood immobility and lower upward mobility compared to their European and Swedish counterparts, highlighting the influence of migrant background. Moreover, higher parental socioeconomic status mitigates the negative effects of growing up in disadvantaged neighborhoods, whereas reliance on social benefits exacerbates these effects, particularly for individuals with non-European backgrounds. Thus, despite a general trend of residential mobility, the combined impact of economic vulnerability and migrant background continues to contribute to socioeconomic residential segregation in Sweden.

The purpose for undertaking this case study of the Shi'a in Lebanon is threefold. First, as a hypothesis-generating case study, its objective is to formulate relevant hypotheses about religious resurgence and religious terrorism. This study achieves this objective by formulating 14 general and nine special hypotheses, and testing and confirming the latter. Second, the purpose of this study is also to explore the trajectory of the Lebanese Shi'a's sectarian mobilization. This exploration permits the conceptualization of geocultural immobility and its effect upon a religious minority. It deduces that the Lebanese Shiga's geo-cultural immobility is directly related to their active religious resurgence. The third purpose is to study the changes in the objectives and tactics of a religious minority, that of the Muslim Shi'a in Lebanon. This research is able, via its primary and secondary data, to show a relationship between the Lebanese Shiga's religious resurgence and their use of religious terrorism. This study introduces the concept of geo-cultural immobility. A minority's geo-cultural immobility is identified as an imposed low geographic mobility within a nation with low cultural pluralism. It establishes the Lebanese Shi'a's geo-cultural immobility, to which it attributes their religious resurgence. This Lebanese Shi'a religious resurgence is proven in this research to produce zealots needed by religious terrorist organizations. This study also introduces and defines religious terrorism as violent acts performed by elements of a religious organization or sect, growing out of a commitment to communicate a divine message. It distinguishes between religious terrorism, secular terrorism, and fighters for religious freedom, which are based on the actors' motives, affinities, and consciousness of the maliciousness of their acts. The primary and secondary data and the quasi-experiment in this research support its special hypotheses. They indicate a statistical correlation between eight Lebanese Shi'a cultural and religious attributes: (1) age, (2) marital status, (3) extent of Shi'a Imam's militancy, (4) personal religious commitment and religious resurgence, (5) zealotry, (6) geo-cultural immobility, (7) imprisonment of family members, and (8) willingness to commit terrorism.