The role of thoracoscopy in the management of patients with chest injuries is constantly being redefined as more reports on its use continue to emerge in the literature. As of today ...video-thoracoscopy has been used mainly as a diagnostic tool for certain occult injuries, such as of the diaphragm, as well as a minimally invasive management option in specific therapeutic situations including early evacuation of retained thoracic collections. It has the potential to replace open surgery in the management of more than 50% of civilian and military thoracic injuries previously considered candidates for open surgical management with all the benefits of minimally invasive surgery. In addition, it is a promising tool for earlier detection of missed injuries in patients otherwise managed nonoperatively. The procedure-related complication rate is low and there are only few contraindications for thoracoscopy, mainly haemodynamic instability and obliterated pleural space caused by previous infections or surgical interventions. However, the scientific evaluation of the global impact of thoracoscopy in the management of thoracic injuries is currently limited to descriptive series, some of them using historical controls, and a few non-randomized prospective studies. Until more well-designed, prospective, randomized studies emerge which compare thoracoscopy to standard management protocols in defined patient populations with thoracic injuries using relevant end points, the potential benefit of thoracoscopy in chest trauma remains unvalidated and its value is limited to isolated patients depending on individual surgeon’s preferences and skills.
From the Editors of World Journal of Surgery Doherty, Gerard M.; Garden, O. James; Leppäniemi, Ari ...
World journal of surgery,
November 2006, 2006-11-00, 20061101, Letnik:
30, Številka:
11
Journal Article
The aim of the presented green ICT project is primarily to start new and advance existing innovation development in SME networks, secondly to accelerate innovation diffusion in B2B networks and ...thirdly to improve the operational environment of enterprises through green ICT solutions that support sustainable development. Various technology development projects - and also ideas for further projects - have arisen as a result of this project. In order to answer our research question - how to improve innovation diffusion in SME networks in collaboration with academia -in this article we introduce an academia-driven innovation management model and green ICT pilot case. In the conceptual part of this paper we discuss the process of innovation diffusion and the mediator's role in value creation for SME networks.
The ubiquity of text messaging (SMS) based mobile communication creates new opportunities for marketers. However, the factors that induce consumers to accept mobile devices as an advertising medium ...are not yet fully understood. This paper examines the drivers of consumer acceptance of SMS-based mobile advertising. A conceptual model and hypotheses are tested with a sample of 4,062 Finnish mobile phone users. Structural equation modeling is used to test five drivers of mobile advertising acceptance: (1) utility, (2) context, (3) control, (4) sacrifice, and (5) trust. The results show that utility and context are the strongest positive drivers, while sacrifice is negatively related to the acceptance of mobile advertising. Despite the concerns about privacy, our results indicate that control and trust are not that important to consumers in mobile advertising.
Bombing attacks against civilians have become the primary weapon of terror groups worldwide, and they are likely to remain the primary instrument of terrorism because bombs are easily and ...inexpensively manufactured, are simple to activate, and require no more than a motivated and determined perpetrator. The explosive can be of military, commercial, or homemade origin. Metal particles of various shapes are often added to the explosive to increase its wounding potential; steel balls, nails, nuts, and the like are the most commonly used. The explosive is detonated by an electrical charge activated remotely or through a switch operated by a suicide bomber.1 Especially, the new bomb compositions containing metal objects and the use of suicide bombers have characterized the terror attacks in Israel.2
Objective: To identify risk factors associated with delayed diagnosis of pancreatic injuries.
Design: Retrospective study.
Setting: University hospital, Finland.
Patients: 31 patients treated for ...pancreatic injuries from January 1986 to April 1998.
Interventions: Clinical, laboratory, and radiological assessment. Initial management operative (n = 22) and non-operative (n = 9).
Main outcome measures: Timely or delayed (>12 hours after injury) recognition of pancreatic trauma.
Results: Blunt trauma (7/17 timely and 12/14 delayed diagnosis, p = 0.03), intoxication on admission (4/10 compared with 5/5 patients studied, p < 0.05), low New Injury Severity Score (median, interquartile 34, 11.5-41 compared with 14.5, 10-25, p = 0.02), low Abdominal Trauma Index (38, 20-54 compared with 16.5 15-24, p = 0.01), absence of associated abdominal organ injuries (1/17 compared with 8/14, p = 0.004), and initial nonoperative management (2/17 compared with 7/14, p = 0.04) were significant risk factors of delayed diagnosis of pancreatic trauma. The main reasons for the delay in diagnosis were missed pancreatic injury at initial operation (n = 4, 2 penetrating), failure to exclude blunt pancreatic injury before non-operative management (n = 4), delay in presentation (n = 3), underestimation of the severity of pancreatic injury on initial computed tomogram (n = 2), and missed diagnosis of blunt duodenal rupture with mild pancreatic injury (n = 1).
Conclusions: In patients with blunt abdominal trauma and altered consciousness with few clinical signs, and no or mild associated abdominal injuries, we recommend additional diagnostic studies to exclude pancreatic rupture before starting non-operative management. Exposure and evaluation of the pancreas during laparotomy for trauma is essential.
Peruskoululaisten matematiikan osaamisen taso on heikentynyt Suomessa, mikä ei voi olla vaikuttamatta tulevaisuudessa yhteiskuntaan. On aloja, joilla matematiikan osaaminen on välttämätöntä, mutta ...tulevaisuudessa matematiikan osaajia ei välttämättä riitä kaikkiin korkeakoulujen koulutusohjelmiin. Heikko osaamistaso voi vaikuttaa jo alakoulun oppisisältöihin siten, että vaatimuksia alennetaan ja opetetaan helpompia asioita, jotta suurin osa oppilaista pysyisi opetuksessa mukana. Tärkeää olisi antaa huomiota myös niille oppilaille, jotka ovat matemaattisesti lahjakkaita. Matemaattisesti lahjakkaan oppilaan kannustaminen ja motivointi sekä mahdollisuus opiskella omalla tasollaan antaa hänelle paremman mahdollisuuden olla tulevaisuudessa matematiikan huippuosaaja. Tässä pro gradu -tutkielmassa tutkittiin matemaattista lahjakkuutta ja matemaattisesti lahjakkaiden oppilaiden opetuksen eriyttämiseen liittyviä työtapoja.
Teoriaosan aluksi käsitellään lahjakkuutta ja lahjakkuusteorioita. Tarkemmin perehdytään matemaattiseen lahjakkuuteen ja matemaattisesti lahjakkaan oppilaan tunnistamiseen. Teoriaosan toinen pääluku käsittelee opetuksen eriyttämistä. Yksityiskohtaisemmin käydään läpi opetuksen nopeuttamista, ryhmittelyä ja opetuksen rikastamista sekä matemaattisesti lahjakkaan oppilaan opetuksen eriyttämistä.
Tutkimuksen kohteena ovat 3.-6. -luokkien luokanopettajien käsitykset matemaattisesta lahjakkuudesta ja matemaattisesti lahjakkaan oppilaan opetuksen eriyttämisestä. Tutkimusaineiston keräämiseksi rakennettiin mittari ja tutkimusaineiston kerääminen toteutettiin kuusisivuisella paperisella kyselylomakkeella kevään ja syksyn 2012 aikana. Kyselylomakkeita lähetettiin satunnaisesti valituille alakouluille ympäri Suomea yhteensä 394. Vastauksia saatiin 88, jolloin vastausprosentti on 22,3 %. Kyselylomakkeessa oli sekä Likert-asteikollisia monivalintakysymyksiä että avoimia kysymyksiä. Tutkimus on otteeltaan kvantitatiivinen survey-tutkimus, jossa tutkimustulosten perusteella pyritään kuvailemaan, vertailemaan ja selittämään tutkimusongelmia ja niihin liittyviä ilmiöitä.
Aineiston analysointi suoritettiin IBM SPSS Statistics 19 tilastonkäsittelyohjelmalla. Analysointimenetelminä käytettiin pääkomponenttianalyysiä, t-testiä ja sen non-parametrista vastinetta U-testiä sekä yksisuuntaista varianssianalyysiä ja sen non-parametrista vastinetta Kruskal-Wallisin testiä. Aineiston kuvailuun käytettiin aritmeettista keskiarvoa, keskihajontaa, mediaania, moodia ja frekvenssiä. Monivalintakysymysten muuttujista muodostettiin pääkomponentteja ja tutkittiin, miten vastaajien taustatekijät vaikuttivat annettuihin vastauksiin.
Saatujen vastausten perusteella 3.-6. -luokkien luokanopettajien mielestä matemaattisesti lahjakkaalla oppilaalla on hyvä hahmotuskyky, ja hän on loogisesti ajatteleva sekä ongelmanratkaisukykyinen. Vähiten häneen yhdistettiin ominaisuudet "lahjakas vain matematiikassa" ja "käytökseltään haasteellinen". Matemaattisesti lahjakkaan oppilaan opetuksen eriyttämisessä käytetyimpiä työtapoja olivat oppikirjan lisätehtävät ja päässälaskutehtävät. Harvimmin käytettiin matematiikkakerhoa ja erityisopettajan antamaa opetusta. Tehokkaimpia työtapoja matemaattisesti lahjakkaan oppilaan oppimisen kannalta olivat oppilaan omien mielenkiinnon kohteiden hyödyntäminen, pelit sekä matematiikkakerho. Erityisen mielenkiintoinen tutkimustulos on se, että käytetyimmät työtavat eivät ole niitä, jotka ovat vastaajien mielestä tehokkaimpia. Tutkimustulosten perusteella olisi syytä perustaa kouluihin matematiikkakerhoja lahjakkaille oppilaille.
Tässä tutkimuksessa oli luotettavuuden kannalta katsottuna paljon hyviä asioita, mutta myös luotettavuutta heikentäviä seikkoja. Tutkimus oli pääosiltaan validi. Yhden kysymyksen kohdalla oli tulkinnan varaa, joten vastauksia ei saatu siihen asiaan, jota oli tarkoitus kysyä. Tutkimuksen reliabiliteetti oli hyvä. Tutkimuksen luotettavuutta alentaa hieman se, että populaatiosta otettu satunnaisotos ei edustanut populaatiota kuin korkeintaan kohtuullisesti. Toinen luotettavuutta alentava tekijä oli alhainen vastausprosentti.
Abstract
This dissertation aims to examine the theoretical and empirical foundations of the mobile marketing phenomenon. While numerous studies have yielded important insights into this topic, the ...existing mobile marketing literature appears to be inconsistent and somewhat fragmented. With the help of two action research projects, interviews of mobile marketing practitioners, and an online survey, this study aims to contribute to our understanding of the nature of mobile marketing communications in consumer markets.
This thesis consists of an introductory section and five papers. The first paper evaluates the current state of mobile marketing research based on a review and an analysis of extant literature that focuses on mobile (or wireless) applications aimed at marketing or advertising. Various definitions of mobile marketing are evaluated and a more technologically-agnostic definition is provided. The second paper presents a framework of the mobile marketing communications environment that delineates how mobile marketing should be integrated into a company's integrated marketing communications strategy. A comprehensive overview of divergent mobile marketing activities is provided, along with representative examples derived from popular press. In addition, a detailed description of mobile marketing campaign planning and its implementation process is provided. The third paper provides a conceptual model of the relationships between interactive integrated marketing communications and database management in a mobile context. The results from empirical research suggest that consumers are willing to participate in Short Message Service (SMS) marketing in a retailing context.
The fourth and fifth papers utilize data collected by means of an online survey (n = 4,062) and examine the factors associated with consumers' intention to receive mobile advertising messages and responses to SMS direct-response campaigns. The results suggest that consumers' intention to receive mobile advertising messages is related to the relevance of the message, permission to receive mobile advertising messages, the benefits of receiving the message and the privacy of personal data. In addition, the results suggest that women and men differ significantly in their responses to SMS call-to-action campaigns, consumers aged 36-45 years are most likely to respond to SMS call-to-action in a TV program and participate in SMS sweepstakes and other competitions, and that employment status has a substantial impact on consumers' SMS campaign activity.
Overall, this thesis provides a conceptual and theoretical foundation intended to guide research efforts focused on mobile media and to aid practitioners in their quest to achieve mobile marketing success.
This study aims to examine the service “egna medel” provided by Swedish social services. A client using this service provides a mandate to the social services to manage their income and pay necessary ...outgoings in their place. This study aims to explore the underlying needs which makes the client require the service, what the service signifies in the client’s life and whether the clients using this service feel that “egna medel” provides them a possibility to live an independent life. The empirical data was collected by means of seven qualitative interviews with clients in Stockholm county. The results were analysed with a theoretical framework circuiting around the notions of independence and normalization. The results show that the service provides the clients with a sense of security and keeps them from falling back into mental illness or drug abuse. In addition the results show that the clients perceive themselves as independent despite having conceded the control over their economy to the social services. The results also show that the clients are constrained from living like others due to their low income, not due to the service “egna medel”.
As the malpractice and financial environment has changed, injured patients evaluated by the trauma team and discharged from the emergency department (ED) are now commonplace. The evaluation, care, ...and disposition of this population has become a significant workload component but is not reported to accrediting organizations and is relatively invisible to hospital administrators. Our objective was to quantify and begin to qualify the evolving picture of the trauma ED discharge population as a work component of trauma service function in an urban, Level I trauma center with an aeromedical program.
Trauma registry (contacts, mechanism, transport, injuries, and disposition) and hospital databases (ED closure, occupancy rates) were queried for a 5-year period (1999-2003). Trend analysis provided statistical comparisons for questions of interest.
During the 5-year study period, the total number of trauma contacts rose by 18.1% (2,220 in 1999 vs. 2,622 in 2003; trend p < 0.05). This increase in total contacts was not a manifestation of an increase in admissions (1,672 in 1999 vs. 1,544 in 2003) but rather a reflection of a marked increase in patients seen primarily by the trauma team and discharged from the ED (473 in 1999 vs. 1,000 in 2003; trend p < 0.05). These ED discharge patients were increasingly transported by helicopter (12.3% in 1999 vs. 29.2% in 2003; trend p < 0.05) and less frequently from urban areas (57.1% in 1999 vs. 48.1% in 2003; trend p < 0.05) over the course of the study period. Average injury severity of this group increased over the study period (Injury Severity Score of 2.7 +/- 0.1 in 1999 vs. 3.3 +/- 0.1 in 2003; trend p < 0.05). ED length of stay for this group increased 19.8% over the study period (trend p < 0.05), averaging nearly 5 hours in 2003.
The total number, relative percentage, and injury severity of patients evaluated by the trauma team and discharged from the ED has significantly increased over the last 5 years, representing nearly 5,000 patient care hours in 2003. Systems to care for these patients in a cost- and resource-efficient fashion should be put in place. The impact of this growing population of patients on the workload of the trauma center should be recognized by accrediting agencies, hospital administration, and Emergency Medical Services.
