Introduction: Hysterectomy is the most common major gynecological operation in the Western World and approximately 5000 benign hysterectomies are performed in Sweden every year. Consequently it is a surgical procedure that affects many women. The procedure comprises challenges concerning perioperative health care, perceived postoperative symptoms, quality of life aspects and health economics. The concept of fast track is a multimodal strategy to reduce hormonal surgical stress response and achieve an enhanced postoperative recovery and is today considered to be evidence based in relation to colorectal surgery. Spinal anesthesia, as an important part of fast track, provides benefits of extended effect on analgesia and reduced postoperative morbidity. It is reasonable to believe that employing the strategies of fast track including spinal anesthesia could also provide substantial benefits for women requiring surgical removal of the uterus. Aims: To determine whether duration of hospital stay, presence and intensity of postoperative symptoms, duration of sick leave and cost-effectiveness differ between women undergoing benign fast track abdominal hysterectomy in spinal anesthesia with intrathecal morphine (SA) and in standard general anesthesia (GA). Material & Methods: 180 women participated in this open randomized multicenter study with five participating hospitals in the southeast region of Sweden. One hundred and sixty two completed the study; 82 women were randomized to SA and 80 to GA. A fast track model comprising premedication without sedatives, intravenous fluid regulation, analgesics based on non-opioids, pre-emptive antiemetic therapy, early enteral nutrition and mobilization and standard criteria for discharge were used. End points were duration of hospital stay, use of analgesics, perceived postoperative symptoms, occurrence of postoperative complications, duration of sick leave and health economic evaluations. Results: Duration of hospital stay did not differ between the two modes of anesthesia. Vomiting and pruritus occurred significantly more often after SA. Complication rates did not differ between groups. Women with SA experienced less overall discomfort and had a reduced need for opioids postoperatively. Abdominal pain, drowsiness and fatigue occurred less often and with lower intensity among the women in the SA group. Health related quality of life improved faster and the duration of sick leave was shorter in women after SA. Total costs (hospital costs plus costs for productivity loss) were lower for the SA group. Within the first 29 days after hysterectomy the women in the SA group gained more QALYs than women in the GA group. Conclusions: The duration of hospitalisation after fast track abdominal hysterectomy was less than 50 hours and mode of anesthesia did not influence this. SA displayed considerable advantages regarding postoperative symptoms and recovery. SA was considered cost-effective in comparison with GA due to lower total costs and more QALYs gained. Our study indicates that SA should be recommended as the first choice of anesthesia in benign abdominal hysterectomy.

Thesis (M.S.)--University of Tennessee, Knoxville, 2009. / Title from title page screen (viewed on Oct. 22, 2009). Thesis advisor: Kate Jones. Vita. Includes bibliographical references.

Les voies ferrées sont de plus en plus sollicitées: le nombre de trains à grande vitesse, leur vitesse et leur charge ne cessent d'augmenter, ce qui contribue à la formation de défauts de géométrie sur la voie. En retour, ces défauts de géométrie influencent la réponse dynamique du train et dégradent les conditions de confort. Pour garantir de bonnes conditions de confort, les entreprises ferroviaires réalisent des opérations de maintenance de la voie, qui sont très coûteuses. Ces entreprises ont donc intérêt à prévoir l'évolution temporelle des défauts de géométrie de la voie pour anticiper les opérations de maintenance, et ainsi réduire les coûts de maintenance et améliorer les conditions de transport. Dans cette thèse, on analyse l'évolution temporelle d'une portion de voie par un indicateur vectoriel sur la dynamique du train. Pour la portion de voie choisie, on construit un modèle stochastique local des défauts de géométrie de la voie à partir d'un modèle global des défauts de géométrie et de big data de défauts mesurés par un train de mesure. Ce modèle stochastique local prend en compte la variabilité des défauts de géométrie de la voie et permet de générer des réalisations des défauts pour chaque temps de mesure. Après avoir validé le modèle numérique de la dynamique du train, les réponses dynamiques du train sur la portion de voie mesurée sont simulées numériquement en utilisant le modèle stochastique local des défauts de géométrie. Un indicateur dynamique, vectoriel et aléatoire, est introduit pour caractériser la réponse dynamique du train sur la portion de voie. Cet indicateur dynamique est construit de manière à prendre en compte les incertitudes de modèle dans le modèle numérique de la dynamique du train. Pour identifier le modèle stochastique des défauts de géométrie et pour caractériser les incertitudes de modèle, des méthodes stochastiques avancées, comme par exemple la décomposition en chaos polynomial ou le maximum de vraisemblance multidimensionnel, sont appliquées à des champs aléatoires non gaussiens et non stationnaires. Enfin, un modèle stochastique de prédiction est proposé pour prédire les quantités statistiques de l'indicateur dynamique, ce qui permet d'anticiper le besoin en maintenance. Ce modèle est construit en utilisant les résultats de la simulation de la dynamique du train et consiste à utiliser un modèle non stationnaire de type filtre de Kalman avec une condition initiale non gaussienne / Railways tracks are subjected to more and more constraints, because the number of high-speed trains using the high-speed lines, the trains speed, and the trains load keep increasing. These solicitations contribute to produce track irregularities. In return, track irregularities influence the train dynamic responses, inducing degradation of the comfort. To guarantee good conditions of comfort in the train, railways companies perform maintenance operations of the track, which are very costly. Consequently, there is a great interest for the railways companies to predict the long-time evolution of the track irregularities for a given track portion, in order to be able to anticipate the start off of the maintenance operations, and therefore to reduce the maintenance costs and to improve the running conditions. In this thesis, the long-time evolution of a given track portion is analyzed through a vector-valued indicator on the train dynamics. For this given track portion, a local stochastic model of the track irregularities is constructed using a global stochastic model of the track irregularities and using big data made up of experimental measurements of the track irregularities performed by a measuring train. This local stochastic model takes into account the variability of the track irregularities and allows for generating realizations of the track irregularities at each long time. After validating the computational model of the train dynamics, the train dynamic responses on the measured track portion are numerically simulated using the local stochastic model of the track irregularities. A vector-valued random dynamic indicator is defined to characterize the train dynamic responses on the given track portion. This dynamic indicator is constructed such that it takes into account the model uncertainties in the train dynamics computational model. For the identification of the track irregularities stochastic model and the characterization of the model uncertainties, advanced stochastic methods such as the polynomial chaos expansion and the multivariate maximum likelihood are applied to non-Gaussian and non-stationary random fields. Finally, a stochastic predictive model is proposed for predicting the statistical quantities of the random dynamic indicator, which allows for anticipating the need for track maintenance. This modeling is constructed using the results of the train dynamics simulation and consists in using a non-stationary Kalman-filter type model with a non-Gaussian initial condition. The proposed model is validated using experimental data for the French railways network for the high-speed trains

A study was carried out in Canela, RS, including the application of instruments which evaluated the characteristics of the receiving region, the tourist profile, Canela s National Forest evaluation by the tourists the area around the FLONA and the National Forest area itself, with the objectives of evaluating the social function of this Unit of Conservation and its use a subsidy to ecotourism and environmental education. The methodology was based on the evaluation of 14 instruments, applied in eight phases of data collection. The results confirmed the vocation of Canela for tourism, based on its hotel infrastructure, food and drink, as well as furniture, chocolate and handcraft industries. The high season tourists (July and December) possess higher socio economic and cultural standards of living than the low season tourists (October and February). The area around Canela s National Forest formed by the Ulisses de Abreu uptown presented a neighborhood population formed by employed heads of the family, resident in the houses wooden, with a young family nucleus, due to the numbers of children present. The tourist was considered attraction to be its good accesses and regular signaling. Canela National Forest was appointed as a protected area with touristic potential. The evaluation of the Forest landscape by the tourists, in four periods, through landscape substitutes, demonstrated distinct differences of perception formed by two groups, the first of women and male teenagers, between 15-20 years old, and the second group, formed by the other men. The analysis of the view of twenty-two sub-landscapes proved to be the same multiples with half-limited reach and perception of the landscape determined three factors in the landscape perception such as, the factor, of scenery including the water and the scenic background, the anthropic factor, constituted by human performances and the color and the vegetation factor. The Visitors Center of Canela s National Forest registered the presence of visitors who were, in the majority, students and professors, from the Rio Grande do Sul state. The Forest structure showed deficiencies in technical staff, in its infrastructure and in the Visitors Centre. The Veado Track located in the interior of the Forest presented an inferior number of attractions in relation to the initial proposal, and these were found to be lacking in signaling. In the visual quality of the elements present in the Veado Track were perceived partially defined lines, organic forms, medium texture degree a random order, with colors of little variation and few green tonalities. Based on the climatic data a load capacity for the track was proposed depending on the season of the year and the size of the groups. The analysis of the attractions of Veado Track of determined the possibility of its use in ecotourism and its application in inherent subjects of environmental education. / Um estudo foi realizado na cidade de Canela, Rio Grande do Sul, Brasil, incluindo a aplicação de instrumentos que avaliaram as características da região receptora, o perfil do turista, a Floresta Nacional de Canela pelos turistas, o entorno da FLONA e a própria Floresta Nacional, com os objetivos de avaliar a função social desta Unidade de Conservação e sua utilização como subsídio ao Ecoturismo e a projetos de Educação Ambiental. A metodologia baseia-se na avaliação de quatorze instrumentos aplicados em 8 fases de condução da coleta de dados. Os resultados confirmaram a vocação da cidade de Canela para o turismo, baseado na sua infraestrutura hoteleira, alimentos e bebidas, além da indústria moveleira, de chocolate e do artesanato. Os turistas da alta temporada (julho e dezembro) possuem nível socioeconômico e cultural mais elevado que os turistas da baixa temporada (outubro e fevereiro). O entorno da FLONA formado pelo Bairro Ulisses de Abreu apresentou uma população formada por chefes de família empregados, residentes em casas de madeira, com o núcleo familiar jovem, dado ao número de crianças presentes. O atrativo turístico foi considerado quanto aos seus acessos como bom e com sinalização regular. A FLONA foi apontada como uma área de proteção com Potencial Turístico. A avaliação da paisagem da FLONA, pelos turistas, em quatro épocas, através de substitutivos da paisagem, demonstrou preferências distintas de percepção formando dois grupos, sendo o primeiro de mulheres e jovens do sexo masculino entre 15 a 20 anos e o segundo grupo, formado pelos demais homens. A análise das vistas de vinte e duas sub-paisagens, revelou serem as mesmas múltiplas com alcance semi-limitado,e determinou três fatores na percepção das paisagem, como o fator panorâmico que inclui a água e fundo cênico, o fator antrópico, constituído pelas atuações humanas e a cor e o fator vegetação. O Centro de Visitantes da FLONA registrou a presença de visitantes, na maioria alunos e professores, oriundos do estado do Rio Grande do Sul. A estrutura da FLONA apontou deficiências quanto ao quadro técnico, na sua infraestrutura e no Centro de Visitantes. A Trilha do Veado localizada no interior da FLONA, apresentou um número inferior de atrativos em relação à proposta inicial, bem como, indicou deficiência na sinalização dos mesmos. Quanto à qualidade visual dos elementos presentes na Trilha do Veado, foram percebidas linhas parcialmente definidas, formas orgânicas, grau de textura média e de ordenamento aleatório, com cores de pouca variação e com pouca variação nas tonalidades de verde. Baseado nos dados climáticos foi proposta uma capacidade de carga para a Trilha variável com as estações do ano e no número de integrantes dos grupos. A análise dos atrativos da Trilha do Veado determinou a possibilidade de uso em Ecoturismo e sua aplicação em temas inerentes a Educação Ambiental.

Made available in DSpace on 2014-10-09T12:51:59Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:57:00Z (GMT). No. of bitstreams: 0 / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

La marge sud péruvienne est située au niveau d’une zone majeure de subduction océan continent depuis au moins le Paleozoique inférieur. C’est dans ce cadre que s’est formé l’un des plus importants orogènes du monde : les Andes Centrales. En effet, l’épaisseur crustale y est >60 km et ce sur une importante surface. Cependant, on considère actuellement que ce surrépaississement a été acquis incrémentalement seulement depuis ~30 Ma. Dans le but de comprendre comment et quand ce surrépaississement est apparu, la majeure partie des études précédentes s’est focalisée sur l’évolution de l’arc magmatique et sur l’histoire de la déformation, du soulèvement et de l’érosion de la zone d’arrière arc. Cependant, l’évolution tectonique et thermique de l’avant arc reste mal connue bien que cette zone soit susceptible de bien enregistrer les changements liés à la dynamique de subduction.Cette thèse à pour objectif de mieux contraindre l’évolution thermique et les couplages entre les processus magmatiques, tectoniques et sédimentaires depuis 200 Ma dans l’avant-arcactuel du sud du Pérou. De nouvelles données géo-thermochronologiques couplées à une nouvelle carte tecto-stratigraphique éclaircissent l’évolution de la marge péruvienne depuis le Jurassique. Trois périodes clefs sont analysées dans ce mémoire : le début de l’épaississement crustal, les déformations de l’avant-arc associées à la formation de l’Orocline bolivien et l’épaississement crustal de l’orogène des Andes Centrales pendant le Néogène.Nous montrons que l’épaississement crustal a probablement commencé entre 90 et 50Ma après plus de 200 Ma d’amincissement, et ce a la faveur d’une évolution en trois étapes :croissance initiale (90-74 Ma), « flare-up » (74-62 Ma) et effondrement extensionnel (62-50Ma). L’extension a ensuite prédominé dans l’avant-arc tout en diminuant progressivement jusqu’à ~30 Ma. Par ailleurs, nous mettons en évidence d’importantes zones de faillesnormales orientées perpendiculairement à la marge sud-péruvienne et qui délimitent de grands blocs basculés vers le nord-ouest. Ces déformations révèlent une extension parallèle à l’orogène dans l’avant arc pendant le Paléogène, probablement due à la formation de l’Orocline bolivien par rotation antihoraire de blocs rigides. Enfin, les traits géomorphiques visibles dans la zone cotiere du sud du Pérou permettent de définir deux périodes de soulèvement de la surface (entre 23 et 10 Ma et depuis ~4.5 Ma), séparées par une période de subsidence (entre ~10 et ~4.5 Ma). La même chronologie ayant été décrite sur le versant Amazonien de l’orogène, nous proposons que cette évolution soit due à des variations à grande échelle de l’épaisseur crustale ; le soulèvement de la surface étant provoqué par addition à la croûte de magma d’origine mantellique et la subsidence par un flux de matériel crustal ductile depuis les zones précédemment sur-épaissies. / The southern Peruvian margin has been located above a major ocean-continentsubduction zone since at least the Early Paleozoic, resulting in the formation of one of thelargest orogens in the world: the Central Andes, where crustal thickness is >60 km over a largearea. This overthickening is currently thought to have occurred incrementally only during thelast 30 Ma. To understand how and when crustal overthickening was acquired, most of theprevious studies have focused on the magmatic arc evolution and on deformation, uplift anderosion history of the backarc. The tectono-thermal Cenozoic evolution of the forearc remainspoorly known, whereas it is a zone prone to recording changes in subduction dynamics.The objective of this dissertation is to address the thermal evolution and the couplingbetween magmatic, tectonic and sedimentary processes over the past 200 Ma in the presentdayforearc of southern Peru where the crust thickens from ~30 km along the coastline tomore than 60 km under the present-day volcanic arc. New geo- and thermochronological datacoupled to a novel geological map illuminate the evolution of the south Peruvian margin sincethe Jurassic. Three key periods of the margin evolution are addressed in this dissertation: theonset of crustal thickening, the deformations associated in the forearc with the formation ofthe Bolivian Orocline and the Neogene crustal thickening of the Central Andean orogen.We show that crustal thickening likely began between 90 and ~50 Ma after more than200 My of lithospheric thinning during a three step evolution of the magmatic arc as follows:growth (90-74 Ma), flare-up (74-62 Ma), extensional collapse (62-50 Ma). Extension prevailedin the forearc since then and waned until ~30 Ma. In addition, we evidence important normalfault zones striking perpendicular to the southern Peruvian margin that delineate largenorthwestward tilted blocks. This deformation reveals orogen parallel extension in the forearcduring the Paleogene likely due to the formation of the Bolivian Orocline by counterclockwiserotation of rigid blocks. Finally, geomorphic features in the coastal area of southern Perureveal two periods of surface uplift (~23 to 10 Ma and since ~4.5 Ma), separated by a period ofsurface subsidence (from ~10 to ~4.5 Ma). The same chronology has been described on theAmazonian side of the Central Andean orogen. We thus propose that this evolution is due tolarge-scale crustal thickness variations; surface uplift being triggered by addition of mantlederivedmagmas to the crust and subsidence by ductile flow away from the previouslyoverthickened crust.

Physiotherapy student practice education, the focus of this thesis, is a highly valued, yet scarcely researched component of pre-registration physiotherapy education. Moreover, the student voice is largely absent from existing research. In this study, 14 physiotherapy students’ perspectives of practice education were gained through email communications (n=13) and face-to-face interviews (n=12). To provide an in-depth and provocative view, physiotherapy student practice education was analysed as a type of activity system, employing concepts borrowed from cultural-historical activity theory (CHAT). Interacting activity systems, objects, players, rules, norms, divisions of labour, mediating artefacts, intra- and inter-systemic contradictions were explored and identified. The findings show that assessment skewed students’ object motives. Practice educators were positioned as powerful gatekeeper/assessor gift-holders. Physiotherapy students enacted ‘learning practice’ norms, such as extensive reading, and adopted the position of practice educator-pleaser. Students sometimes refrained from speaking when they wanted to, for example, to challenge unprofessional staff behaviour. Students were reluctant to show themselves as learners, feeling instead that they needed to present themselves as knowledgeable, able practitioners. However, students did not easily recognise themselves as able contributors to practice. For students, knowledge for practice was focussed on patient assessment and treatment, but the level, depth and volume of knowledge required was perceived differently across distinctive practice areas. Intra- and inter-systemic contradictions, such as the skewing of student object motives towards assessment, and away from whole-patient-centred care, are highlighted. The study findings therefore have implications for patient care as well as for the object of physiotherapy student practice education, student learning and assessment and workplace learning. A cross-profession review of the object of physiotherapy student practice education, to include the voice of service users, students, practice educators, HEIs and service providers, is recommended. A review of physiotherapy student practice-placement assessment, which seemed to be at the core of PSPE dynamics and conditions, is recommended, to take account of the extent to which assessment can influence students’ PSPE object motives, PE/student dynamics and student/patient interactions. Developmental Work Research is proposed as a way forward for future research in this area.

Cette thèse explore des pistes d'amélioration du système de trafic aérien dans l'espace océanique de l'Atlantique Nord (NAT). D'abord, on considère le système actuel, où les avions suivent les rails prédefinis. On favorise les re-routages entre rails, diminuant la congestion dans l'espace continental. On applique des méthodes stochastiques d'optimisation pour trouver une configuration de vols sans conflits avec la séparation reduite entre aéronefs. Ensuite, on simule la planification des trajectoires avec le Wind Networking (WN). La source prinicipale des erreurs dans la prédiction de trajectoires étant l'incertitude dans la prévision du vent, le WN permet aux avions d'échanger leurs vents mesurés afin d'ajuster leurs prédictions. Enfin, on introduit le concept de free-flight dans NAT. Etant donné des trajectoires vent-optimales, on applique une méthode stochastique d'optimisation pour réduire le nombre de conflits au niveau stratégique, tout en conservant les trajectoires proches de leur optimum. Nos résultats numériques mettent en évidence plusieurs pistes pour améliorer le système de trafic aérien dans NAT, en considérant de nouvelles technologies et de nouveaux concepts. / This thesis investigates the ways to improve the air traffic system in the highly congested North Atlantic oceanic airspace (NAT). First, we consider the current system, where aircraft follow predefined NAT tracks. We favor the re-routings between tracks, decreasing congestion in pre-oceanic airspace, and apply stochastic methods of optimization to find a conflict-free flight configuration with reduced separation between aircraft. Second, we simulate trajectory prediction by Wind Networking (WN). While the main source of time prediction errors is the uncertainty in wind forecast, WN permits aircraft to exchange measured winds and adjust their predictions using this recent and accurate information. Third, we study the impact of introducing the free flight concept in NAT. We apply a stochastic method of optimization on data provided by NASA consisting of NAT flights with wind optimal trajectories. The aim is to reduce the number of conflicts on the strategic level, while keeping the trajectories close to the optimal routes. Our computational experiments show that the air traffic situation in NAT can be improved in several different ways, considering new technologies and new trajectory planning concepts.

The diploma thesis, which deals with the usage of tractors with tracked chassis in the agricultural primary production, presents in a literature overview the design of the chassis of wheeled tractors, which is supplemented with front axle suspension systems. Main theoretical part of the overview describes the construction of the tracked chassis. There are mentioned and described all units of significant producers of tracked tractors. Further, the work describes the design of suspension of tracked tractors and the possibility of control of the tracked chassis. The theoretical part ends with a chapter focusing on semi-tracked tractors. Practical part shows the methodology and results of the measuring by use of the tracked tractors in the agricultural company annual production, focused on the utilization of each Tractor-set. Thesis is completed by characteristic of the general agriculture company with the analysis of the investments and costs.

Made available in DSpace on 2014-06-11T19:32:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-10-10Bitstream added on 2014-06-13T21:04:03Z : No. of bitstreams: 1 ribeiro_mcs_dr_rcla.pdf: 2488984 bytes, checksum: 03d50e477260abf1ff5efba31498aa81 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Neste trabalho são apresentados os resultados obtidos por meio de análises geomorfológicas (Mapa de Níveis de Paleosuperfícies) e termocronológicos (traços de fissão em apatitas e U-Th/He em apatitas) ao longo da Serra do Mar nos setores (1), (2), (3) e (4). As correlações entre as analises geomorfológicas e termocronológicas evidenciaram uma geológica e geomorfológica compreendida entre o Cretáceo Superior e Paleoceno, demonstrando que a evolução das morfologias que compõem a área de estudo estiveram associadas a eventos tectônicos e sucedidos por uma intensa atividade erosiva. De acordo com as datações realizadas utilizando termocronômetros com temperatura de fechamento distintas, estes indicaram que as configurações dos relevos que compõem a Serra do Mar não podem ser associadas apenas aos efeitos das atividades erosivas (recuo de escarpa) e isostáticas, para poderem explicar a homogeneidade entre as idades de traços de fissão e (U-Th)/He em apatitas, sem a presença da atuação tectônica soerguendo e desnivelando parte destes relevos. / In this paper the results obtained geomorphological analysis (Map of levels of Palaeosurfaces) and thermochronogical analysis (apatite fission-track and UTh/ He). The correlation between the geomorphologica and the thermochronological analysis evidenced a geological and geomorphological evolution from the Upper Cretaceous to the Palaeocene, showing that the evolution of the morpholoies composing the study area were associated to tectonics events and preceded by intense erosive activity. According to the datings done using thermocronometers with distinct closing temperatures the configuration of the relieves that compose the Serra do Mar can not be associated only to the effects of the erosive (escarpment retreate) and isostatic activities but also to the tectonic motion uplifting and unlevelling part such morphologies, in order to explain the homogeneity between the ages of the fission-track and U-Th/He of apatites.