12 research outputs found
Case study of physiotherapy treatment of a patient with Bell's palsy
No full textThesis title: Physiotherapy treatment of a patient with Bell's palsy Author: Dominic Kalafatis Work placement: Ustředni Vojenská Nemocnice in Prague Summary In this bachelor thesis, which was written and composed by myself, it is divided in two parts, the general part and the special part. The general part mainly is the theoretical part in which it is included the whole anatomy of the face, the facial and neck muscles. The cranial nerves and specifically the facial nerve, the seventh cranial nerve. Kinesiology of the facial muscles for any facial expression. All these components will be described in this part. Secondly, the special part which is the most important part of the whole bachelor thesis, is the part of the case of my patient with Bell's palsy/ Facial paresis. There will be the whole anamnesis, the initial kinesiologic examinations, therapy sessions, the final kinesiologic examinations in which there are also the improvements of my patient and finally the evaluation of the therapies. The last part of my bachelor thesis it is composed from my bibliography which contains the literature which I used to write the general part of my bachelor thesis. The list of figures and tables from the whole thesis. The abbreviations and finally the last thing is the ethics committee. Key words: Facial..
Incidence and outcome of ventilatorassociated pneumonia in Inkosi Albert Luthuli and King Edward VIII Hospital surgical intensive care units
No full textBackground. Ventilator-associated pneumonia (VAP) is one of the most common causes of hospital morbidity and mortality, but has been poorly studied in the South African context. Objective. To evaluate the incidence and outcome of VAP in the intensive care units (ICUs) of two major centres in the Durban metropolitan area.Methods. The study was conducted over a period of 6 months with all intubated and mechanically ventilated patients who were screened on admission to ICU. A questionnaire was prepared to note patients’ age, gender, date and time of intubation or reintubation. Patients were monitored from date of admission to the date of discharge from ICU or death. A diagnosis of VAP was made on a clinical pulmonary infection score (CPIS) of ≥6.Results. Of 32 patients evaluated, eight patients (25%) were diagnosed with VAP. Median duration of ventilation in the VAP group was 249 hours v. 65.5 hours in the non-VAP group (p=0.0002). We found no statistically significant association between age or gender with the development of VAP (p=0.28 and p=0.59, respectively). The most common organism isolated was Acinetobacter baumannii, followed by Pseudomonas aeruginosa. Three of the eight (37.5%) patients diagnosed with VAP died in the ICU. Conclusion. VAP is common in critically ill patients, possibly associated with poor outcome. These results highlight the need for strict adherence to evidence-based preventive measures
Sensitization of Recombinant Human Tumor Necrosis Factor-related Apoptosis-inducing Ligand-resistant Malignant Melanomas by Quercetin
No full textMalignant melanoma is the most commonly diagnosed skin cancer associated with a high rate of metastasis. Low-stage melanoma is easily treated, but metastatic malignant melanoma is an extremely treatment-resistant malignancy with low survival rates. The application of recombinant human tumor necrosis factor-related apoptosis-inducing ligand (rhTRAIL) for the treatment of metastatic malignant melanoma holds considerable promise because of its selective proapoptotic activity towards cancer cells and not nontransformed cells. Unfortunately, the clinical utilization of rhTRAIL has been terminated due to the resistance of many cancer cells to undergo apoptosis in response to rhTRAIL. However, rhTRAIL-resistance can be abrogated through the cotreatment with compounds derived from Mother Nature\u27 such as quercetin that can modulate cellular components responsible for rhTRAIL-resistance. Here, we show that rhTRAIL-resistant malignant melanomas are sensitized by quercetin. Quercetin action is manifested by the upregulation of rhTRAIL-binding receptors DR4 and DR5 on the surface of cancer cells and by increased rate of the proteasome-mediated degradation of the antiapoptotic protein FLIP. Our data provide for a new efficient and nontoxic treatment of malignant melanoma. Copyright (c) 2018 The Author( s)
Wiener modelling and model predictive control for wastewater applications
No full textThe research presented in this paper aims to demonstrate the application of predictive control to an integrated wastewater system with the use of the wiener modeling approach. This allows the controlled process, dissolved oxygen, to be considered to be composed of two parts: the linear dynamics, and a static nonlinearity, thus allowing control other than common approaches such as gain-scheduling, or switching, for series of linear controllers. The paper discusses various approaches to the modelling required for control purposes, and the use of wiener modelling for the specific application of integrated waste water control. This paper demonstrates this application and compares with that of another nonlinear approach, fuzzy gain-scheduled control
POSITIONING STRATEGIES DEVELOPMENT
No full textThe positioning strategy has suffered serious changes in the last few decades, being influenced by the rapid development of competition and the growing focus on specific traits belonging to the market, to the consumer or to the product. The purpose of this paper is to present the developments of theoretical positioning strategies and the orientation from more simple, product oriented strategies, to ones more oriented towards the client and with a briefer period of time. The world is moving in a much faster pace than in the past, thanks to communication development so companies are obliged to adopt more specific strategies in order for them to be effective. This essay represents a literary review presenting a documentary research within the scientific articles and strategy and positioning books. The paper begins with the analysis of company strategies and the marketing strategies in general. The first author to group the product positioning strategies is Porter with his three generic strategies. Following the development of brands and because of the lack of competitiveness in the simple generic positioning strategies, this paper has also presented the newer positioning strategies proposed by Kotler, Treacy & Wiersema, and also more complex ones such as Bowman's Strategy Clock and Blankson and Kalafatis positioning strategy based on the type of the consumer. The fast expansion of local brands in all categories has led to mistakes in positioning strategies, categories also presented in the current essay. The results of this study show that new positioning strategies are more and more based on the consumer and market segments and on the product specification - which have also evolved in the last decades. Adaptability to fast changes in the competitive market will represent the future positioning strategies
Mild cognitive impairment: the Manchester consensus
No full text\ua9 The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society.Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology in mild cognitive impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5-15% of people developing dementia per year. However, ~50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that these may also help guide prognosis. Diagnostic criteria allow for a diagnosis of Alzheimer\u27s disease to be made where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single disease marker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI
Outcomes 30 days after ICU admission: The 30DOS study
No full textBackground: The spectrum of illness and long-term outcome of critically ill patients admitted to intensive care units (ICUs) in South Africa remains largely unknown. Objectives: This study was designed to provide data on ICU outcomes and disease burden in public sector ICUs in KwaZulu- Natal. The primary objective was to describe 30-day mortality of all patients admitted to participating sites. Secondary objectives included clinical demographics and spectrum of illness amongst these patients, and testing a template to demonstrate feasibility of such data collection. Methods: 30DOS was a multicentre, prospective, observational cohort study conducted over 30 days. An a priori decision was made to report study results separately for adults and paediatric patients. This article reports the results for adult patients. The complete 30-DOS study included 11 ICUs in six hospitals. All adult patients admitted to study ICUs were included. Patients were followed up telephonically by a research assistant. Data on patient demographics, preadmission functional scoring, injury severity scoring, co-morbidities, admission diagnosis/es, organ support, and outcome were collected. Results: A total of 228 adults were included. The majority of admissions (73.7%) occurred on an emergency basis, with 68.4% occurring in the postoperative period. Approximately half were for non-communicable disease (49.6%), followed by trauma (29.0%) and infectious disease (21.5%). There were a total of 59 (25.9%) deaths within the first 30 days after admission. In-ICU mortality was 19.7%. There were 12 (5.3%) in-hospital deaths following discharge and two (0.9%) out-of-hospital deaths. Thirtyday survival was known for 174 (76.3%) admissions with a 33.9% mortality rate. Conclusion: Overall in-ICU mortality was 19.7% with a large trauma burden in a young population. Thirty-day mortality was 33.9%. Information pertaining to patient demographics and spectrum of illness provided novel information to further the understanding of the demand placed on critical care resources within South Africa
Key account management in an Arab context
No full textThis study sought to contribute to the literature on key account management (KAM) relationships. In doing so, it aimed to address a number of gaps in the existing literature, particularly a noticeable lack of research into key account management in developing economies, as opposed to developed economies. More specifically, the study sought to examine the dynamics of key account management relationships in an emerging economy in the Arab World. The main research question to address was: How is KAM relationship management applied in an Arab context?
The research utilised 50 cross-sectional semi-structured in-depth interviews to achieve the study’s aim. More specifically, the study was based upon a sample of recipients involved with key accounts from supplier organisations which operated in different sectors and had different ownership – local and foreign. Primary data was gathered through in-depth semi-structured interviews primarily with key account managers, and with company directors, marketing and sales managers, and selling/support teams.
In general, the findings revealed that there are informal and formal aspects of KAM relationships in an Arab context that complement each other. These have some similarities and differences with the Western context. In particular, similarities appeared mainly along the formal aspects such as, roles and duties of key account managers (KAMgrs), identification and selection criteria of key accounts, special treatment and activities carried out with key customers; the actors involved including senior managers and support teams; and the resources utilised. However, differences existed in the selection and the recruitment criteria and some competencies that were Arab specific, the degree of involvement of senior managers differ significantly from what is noted in the KAM literature. As for the informal aspect, that is manifested in Wasta and family connections, trust, and personal involvement, which makes the KAM relationship management approach in an Arab context uniquely different and plays a major role in how customers are acquired and retained and the overall management of key customers. Furthermore, evidence shows that there is a tendency to transfer Western KAM practices to the Arab world, with some adaptation to take into consideration the country-specific and contextual factors.
Overall, it is argued, that the study’s findings contribute to existing knowledge in a number of ways. First, they extend our knowledge into key account management in an Arab context and confirm the importance of both the formal and informal aspects in managing KAM relationships. They also add weight to the view that in Arab cultures personal and affective/emotional dimensions of the relational factors are given more importance, compared to the impersonal and calculative aspects that are more emphasised in the West. The findings contribute to existing knowledge regarding KAM segmentation and the importance of the personal profile in an Arab context vis a vis the business profile, and they validate the view that a process of crossvergence of management practices is occurring across borders. The findings, however, challenge the view that KAM can be rolled out unchanged into any international context. They also discover the competencies required for Arab KAMgrs. Finally the findings contribute to existing knowledge by discovering the benefits of Wasta for key account managers
Prospective observational cohort study on grading the severity of postoperative complications in global surgery research
No full textNestle Health Sciences
Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries The International Surgical Outcomes Study group
No full textFunded by Nestle Health Sciences through an unrestricted research grant, by a
National Institute for Health Research Professorship held by
R.P., and sponsored by Queen Mary University of London
