30 research outputs found
The role of imaging and biopsy in the management and staging of large non-pedunculated rectal polyps
No full textIntroduction: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are often used for benign and Sm1 large non-pedunculated rectal polyps (LNPRPs), although other surgical techniques including transanal endoscopic microsurgery (TEMS) and transanal minimal invasive surgery remain available. This review covers the role of pre-excisional imaging and selective biopsy of LNPRPs. Areas covered: Polyps between 2 and 3 cm with favorable features (Paris 1, Kudo III/IV pit patterns, and non-lateral spreading type [LST]) may have a one-stage EMR without biopsy and imaging, provided adequate expertise is available with other technologies such as magnifying chromoendoscopy. Higher-risk polyps (moderate/severe dysplasia, 0–IIa+c morphology, nongranular LST, Kudo pit pattern V or submucosal carcinoma, or those >3 cm) should have pre-EMR/ESD imaging with magnetic resonance imaging (MRI) and/or endorectal ultrasound (ERUS) ± biopsies and photographs prior to multidisciplinary team discussion. Expert commentary: In some centers, EMR and ESD are considered the primary modality of treatment, with TEMS as a back-up, while elsewhere, TEMS is the main modality for excision of significant polyps and early colorectal cancer lesions. Likewise, the exact roles of ERUS and MRI will depend on availability of local expertise, although it is suggested that the techniques are complementary.</p
SCIENTIFIC REALISM IN THE AGE OF STRING THEORY
No full textString theory currently is the only viable candidate for a unified description of all known natural forces. This article tries to demonstrate that the fundamental structural and methodological differences that set string theory apart from other physical theories have important philosophical consequences. Focussing on implications for the realism debate in philosophy of science, it is argued that both poles of that debate face new problems in the context of string theory. On the one hand, the claim of underdetermination of scientific theory by the available empirical data, which is a pivotal element of empiricism, loses much of its plausibility. On the other hand, the dissolution of any meaningful notion of an external ontological object destroys the basis for conventional versions of scientific realism. String theory seems to suggest an intermediate position akin to Structural Realism that is based on a newly emerging principle, to be called the principle of theoretical uniqueness
The dynamic study – a randomised controlled feasibility trial of a novel polyvinylideneflouride mesh (Dynamesh-HIATUS) cruroplasty versus suture only repair of large hiatus hernia
No full textRenal colic in a dialysis patient: a case of renal stone disease
No full textRenal colic in a dialysis patient: a case of renal stone diseas
Role extension in advanced ultrasound practice: a framework approach and case study
No full textIntroduction:
Role extension into novel areas of ultrasound practice can be challenging for health care professionals. Expansion into existing areas of advanced practice typically occurs using established processes and accredited training; however, in areas where there is no formal training, there can be a lack of support for how to develop new and progressive clinical roles.
Topic Description:
This article presents how the use of a framework approach for establishing areas of advanced practice can support individuals and departments with safely and successfully developing new roles in ultrasound. The authors illustrate this via the example of a gastrointestinal ultrasound role, developed in an NHS department.
Discussion:
The framework approach comprises three elements, each interdependent upon and inform each other: (A) Scope of practice, (B) Education and competency and (C) Governance. (A) Defines (and communicates) the role extension and area(s) of subsequent ultrasound imaging, interpretation and reporting. By identifying the why, how and what is required this informs (B) the education and assessment of competency for those taking on new roles or areas of expertise. (C) Is informed by (A) and is an ongoing process of quality assurance to safeguard high standards in clinical care. In supporting role extension, this approach can facilitate new workforce configurations, skill expansion and enable increasing service demands to be met.
Summary:
By defining and aligning the components of scope of practice, education/competency and governance, role development in ultrasound can be initiated and sustained. Role extension utilising this approach brings benefits for patients, clinicians and departments
THE CYCLIC WHOLENESS OF BING, TAO AND LAW IN SUN TZU’S THE ART OF WAR
No full textThe Art of War by Sun Tzu (Pingyin: Sunzi Bing Fa)is well-known as one of the oldest writings in Chinesehistory attributed to an individual author. It is the mostfamous treatise of the Military School (Bingjia), of TheHundred Schools of Thought of the Pre-Qin and Han period.However, the text is often misunderstood in the based uponthe misunderstanding of its terms. Readers and scholarsoften interpret the text in a pragmatic or utilitarian way,ignoring its philosophical Taoist subtexts. In the text, theterm translated as war – Bing – is related to two complicatedphilosophical terms and concepts: Tao (Dao) and Law (Fa).Therefore, for fully understanding Sun Tzu’s philosophicaltreatise on Bing, this paper will investigate, how changesof Tao (Dao) and Law (Fa) in relation to Bing occur in aholistic cycle. Bing, Tao and Law must be coordinated,otherwise any operation whether military or political willnot be in conformity with the Grand Tao, and will not beable to achieve its aims
Eleiko 360°
No full textThis report will present athesis on behalf of Eleiko Sports AB and carried out by two students at the InnovationEngineering (University of Halmstad). In this report the project participants willdescribe the project background along with the current product issues andneeds. A clear structure for participants, stakeholders and information flowbetween these parts will be included in this report so that you can clearly seethe areas of responsibility. The report includes a timetable which the grouphas worked along and also methods used. In the development process you will beable to read about how the students in an interdisciplinary way have used themethods and come up with an entirely new product. The new product is a socalled collar and it is an axial locking device used in competitive andtraining context in the exercise of weightlifting. Production costs andproduction process will be included in the report and you will also be able to(in short) see how the market, sales approach and the future of the product will look like
From physical improvement to holistic renewal:the Danish experience
No full textUrban and neighbourhood renewal in Denmark first became of publicinterest and the subject of legislation in the early twentieth century.Concern was based on health, fire and sanitation issues with the focuson the condition of individual dwellings. It was not until the early1940s that the first urban quarter in Copenhagen was renewed throughdemolition and rebuilding. Based on legislation from 1939, withrevisions in 1959 and 1969, the slum clearance approach was stronglycriticised for disrupting local life and destroying cultural assets. It wasnot until 1983 that more sensitive policies were adopted, when newlegislation opened the way for urban and housing renewal programmeswhich established the rights of residents and provided subsidies forimprovement work. At the same time, large non-profit social housingestates, built in the 1960s and 1970s, came under scrutiny. Initially,these modernist-style estates were labelled ‘neighbourhoods withconstruction problems’ which needed attention to their flat roofsand crumbling concrete but it was not long before the housingmanagement and life opportunities of residents were also beingquestioned. A neighbourhood renewal approach was then developedwhich combined a focus on the social integration of immigrants andtheir children with local involvement, resident participation and thephysical improvement of housing and its environment.During the first decade of the twenty-first century, local and areabasedinitiatives became the established approach to creating ‘inclusiveneighbourhoods’ and changing the social mix. The open stigmatisationof deprived neighbourhoods as ‘ghettos’ by the government andpolitical leaders worked against the combined efforts of municipalities,residents and housing organisations to create positive solutions. At the same time, housing renewal programmes began to include ruralas well as urban areas and now almost the entire housing and buildingstock in Denmark is considered a potential target for refurbishmentand energy efficiency measures.The challenge for housing renewal is to achieve a balance betweenthe preservation of the built heritage, sustainability, innovation, jobcreation and demolition. Since 2007, the financial and economiccrisis and the accompanying reduction in private investment haveimpeded progress. Population loss and the economic recessionprevalent in western and southern Denmark have reduced regionalhousing demand. These situations have become major concerns for themunicipalities affected, and proposals for demolishing empty housesin villages and rural areas are under active consideration. Both largerand smaller social housing estates in areas losing population are difficultto let, and the housing organisations that own them would like to beable to demolish housing or change its use without having to bear thecost of outstanding loans.This chapter considers how a market consisting of regulated privaterented housing, non-profit social housing with regulated cost rents,a free market owner-occupied housing sector, and private rentedhousing built since 1991 can be renewed. A case study of Bispehavenin the western part of the city of Aarhus illustrates the challenges facedin renewing large scale social housing estates over the past 30 years
Análisis de los procesos operativos y distribución de planta en la Empresa Cimetcorp S.A.
No full textEste documento contiene archivo en PDF.Analiza los procesos productivos y diseña una distribución de planta para el área de producción de la empresa Cimetcorp S.A. Para el desarrollo del trabajo se aplican los métodos de Richard Muther y el de Guerchet, para poder evaluar las dimensiones de cada uno de los espacios físicos que ocupan las máquinas y equipos de trabajo, así mismo define la relación que existe entre cada actividad, referente a los procesos para poder gestionar una mejor propuesta en base a los resultados que se obtengan. El impacto económico que afecta a la empresa, se debe a la baja productividad, causada por la mala distribución de planta. La propuesta está valorada en 1.521,40 lo que permitirá tener un flujo continuo en el desarrollo de las actividades y así poder incrementarla productividad de la entidad, contando con procesos estandarizados y una distribución de planta idónea.Analyze the production processes and designsa suitable plant distribution for theproduction area of ́Cimetcorp S.A. ́company for the development of the work, Richard Muther and Guerchet ́s methods are applied, in order to evaluate the dimensions of each of the physical spaces that the machines and work equipment occupy. It also defines the relationship between each activity, in reference to the processes in order to manage a better proposal based on the results obtained. The economic impact affects the company is due to the low productivity caused by the poor distribution of the plant. The proposal is valued 1,521.40 which will allow a continuous flow in the developmentof the activities and thus beable to increase the productivity of the entity, counting on standardized processes and a suitable plant distribution
Power and Propulsion Systems on Board Unmanned Naval Vessels: Study Into the Impact and Feasibility of Removing Maintenance Tasks on Board Naval Vessels
No full textWith the growing shortage of seafaring personnel, onboard systems need to be more reliable to beable to sail without. Multiple efforts are done to be able to sail with unmanned systems (systems thatdon’t need maintenance while sailing), but for large unmanned surface vehicles, the P&P system isone of the systems that is not reliable enough. The goal of this thesis research was to study the possibilities of adjusting an existing P&P system to make it reliable enough for unmanned sailing. Theresearch resulted in creating a reliability model that gives insight in the direct impact maintenance hason reliability to study the possibilities of removing maintenance personnel from board. Therefore, themain research question of this thesis is:What adjustments to the power and propulsion system of a Navy vessel are necessary to be able tooperate for a given period of time, consisting of several missions, without any onboard maintenancepersonnel?To answer this research question, a study regarding the current system was done first with an functionaland physical decomposition. This gave insight in what functions the P&P system needs to fulfill to provide the ship with power and propulsion, what systems the P&P system contains and what preventivemaintenance actions are currently done to prevent failure. With the data and knowledge acquired bystudying the system, performing a failure mode and effect analysis (FMEA) showed that data currentlyavailable is not able to show the impact of maintenance and thus it is unclear how reliable an unmannedsystem would be.To be able to do so, a fault tree analysis (FTA) model was created to calculate the reliability and showthe direct impact of maintenance for the P&P system on board a Holland class ocean going patrolvessel of the Royal Netherlands Navy. The model made use of an exponential distribution that was implemented with a timedependent Weibull failure rate function while only using the mean time betweenfailure (MTBF) and the maintenance frequency for preventive maintenance actions.As a result, it has been found that either making the 20 weakest components of the P&P system redundant, or changing the maintenance strategy from condition based to predictive and making the 5weakest components redundant, the reliability of a P&P system that receives no maintenance during50day missions can be as reliable as a manned P&P system. Furthermore, several sensory equipment is added to replace inspections currently done by maintenance personnel on board.However, even though the reliability of a 50day unmanned system can be as reliable as a mannedsystem mathematically, the model does not take into account corrective maintenance. An expansionto this model including corrective maintenance should be researched to show the opportunities of anunmanned hybrid propulsion system. Other recommendations for further research include identifyingfailure mechanisms to adjust the failure rate progression and implementing repair times and cost tostudy the feasibility of adjusting the current P&P system and maintenance strategy for unmanned sailing.Marine Technolog
