Cognitive performance in elderly patients undergoing carotid endarterectomy or carotid artery stenting: A twelve-month follow-up study

Background: It is still a matter of debate if and to what extent carotid endarterectomy (CEA) and carotid artery stenting (CAS) impair cognitive functioning in the elderly. Methods: We conducted a nonrandomized clinical trial on subjects with asymptomatic carotid artery stenosis comparing CEA (n = 28; 24 males and 4 females; 72.6 ± 5.8 years old) with CAS (n = 29; 17 males and 12 females; 75.1 ± 5.7 years old). Cognition, mood and functional status were evaluated by a broad spectrum of tests performed on the day prior to carotid reopening as well as 3 and 12 months after. Results: No significant differences in scores on cognitive tests including the Babcock story recall test and Rey's auditory verbal learning test (memory), category naming test (verbal fluency), trail-making test parts A and B (attention and executive function) and controlled oral word association test (executive functioning) were observed 3 and 12 months after carotid reopening independent of the technique used. Only scores on the copy drawing test (visuospatial and constructional abilities) slightly but significantly (p < 0.05) worsened in the CAS group 12 months after the intervention. No significant differences between the CEA and CAS groups were detected regarding mood and functional status after 3 and 12 months. Conclusions: CEA and CAS seem to be safe procedures in elderly patients in terms of cognitive, mood and functional status in the short and long term. CAS might be preferred for the shorter hospital stay, but further studies with a larger number of old and oldest old subjects with a longer follow-up are needed to better understand the cost-effectiveness of both treatments

Railway Transport Planning and Management

Railway engineering is facing different and complex challenges due to the growing demand for travel, new technologies, and new mobility paradigms. All these issues require a clear understanding of the existing technologies, and it is crucial to identify the real opportunities that the current technological revolution may pose. As railway transportation planning processes change and pursue a multi-objective vision, diagnostic and maintenance issues are becoming even more crucial for overall system performances and alternative fuel solutions

Mechanisms of Security: Locks, keys, and ordered life in Iron Age Norway (c. 0–1050 AD)

This thesis examines the technological and social parameters for, and the social impact of, the introduction and implementation of locking into Norway in the Iron Age, based on analyses of locks and keys. The functional properties of locking devices and their practical applications as security mechanisms constitute the focal point of the study, and the basis for discussing how locking contributed to the ordering and organisation of life and society in the course of the first millennium AD. The main aims are to establish an empirical foundation for the study of locking devices and to understand locks and keys as a technological and social phenomenon which was affected by and had effects on the societies that created and used them. The archaeological material is approached from a conceptual framework centred on perspectives of entanglement and social boundaries, in which locking is considered a social practice. As material agents locks and keys are seen as involved in the physical protection of things and spaces, regulation of access, and manifestation of ownership rights, as well as the creation and negotiation of values and norms as part of social order. The analytical material is comprised by more than eight hundred locks and keys dated from the Roman Period to the Viking Age, deriving from burials, depositions, and settlements, as well as single finds. The finds are used in the construction of renewed classifications for Scandinavian locks and keys, which is based on their functional designs and their correlation to lockable containers, doors, and fetters. Through temporal, spatial, and contextual analyses of types the thesis outlines a complex picture of production, innovation, distribution, and application of locking devices. The results illustrate that locks and keys were introduced and developed in stages in Norway, and that their use expanded and diversified practically as well as socially. The analytical patterns are further discussed in terms of security, ownership, and order, arguing that locking from its introduction became gradually embedded into society during the Iron Age. This is suggested to result from the success of locks and keys in achieving order, and their close relationship with processes of hierarchisation, social differentiation, and social complexity. The thesis provides new insights into the practical functions and applications of diverse locking mechanisms, technological development, craft specialisation, exchange and contact networks, and the social impact of locking in terms of physical and social order. It also contributes to current debates concerning social organisation and transformations within Norway and wider Scandinavia and Northern Europe in the first millennium AD.Doktorgradsavhandlin

Maritime Logistik im Zeitalter der Nordischen Kreuzzügen

The Limes Saxoniae remained a stable cultural frontier zone until the year 1147, when Danish and German princes managed to subdue the Slavic lands east of the Elbe lastingly in a joint maritime-terrestrial campaign. It was the first papally authorised crusading campaign “contra Sclavos ceterosque paganos habitantes versus Aquilonem” – the last pagans of northern Europe. This expeditio was a precedent, followed by many more campaigns against the Slavs, Prussians, Lithuanians, Livs, Estonians and other pagan nations of the Baltic Rim; a time frame spanning over four centuries, colloquially captured by the umbrella term ‘Northern Crusades’. Most of these campaigns required seaborne transport, which is studied here with an interdisciplinary historical-archaeological approach. The diachronic theme is examined by a number of case studies, which involve different angles: On the one hand, questions of navigation and orientation are addressed, as exemplified by a re-evaluation of a 13th-century Danish itinerary to Estonia. On the other hand, the capabilities and use of ships are assessed, which supplied the Catholic enclaves in the pagan East with crusaders, settlers and goods. Numerous shipwrecks are re-visited to verify the claims of contemporary chroniclers, with discussions on technical aspects of ship-construction, but also with a focus on early trade links. Another major focus lies on timber trade across the Baltic Sea, shedding light on an often overlooked aspect: The Teutonic Order as economic rather than solely militaristic power. This study is concluded by assessing the local maritime transport geography of a Teutonic Order castle and a nearby appertaining shipwreck from a period of political instability and the imminent collapse of the Livonian Confederation.Für Jahrhunderte bildete der Limes Saxoniae eine feste Kulturgrenze, bis ins Jahr 1147, als dänische und deutsche Fürsten die slawischen Länder östlich der Elbe in koordinierten see- und landseitigen Angriffen unter ihre Kontrolle brachten. Es war der erste päpstlich angeordnete Kreuzzug “contra Sclavos ceterosque paganos habitantes versus Aquilonem” – gegen die letzten Heiden Nordeuropas. Dieser Kreuzzug war der Ausgangpunkt für zahlreiche weitere Feldzüge gegen Slawen, Pruzzen, Litauer, Liven, Esten und anderen heidnischen Nationen des Ostseeraumes und charakterisierte eine über vier Jahrhunderte umspannende Epoche, die unter dem Begriff 'Nordische Kreuzzüge' verstanden wird. Für die meisten dieser Feldzüge war die Schifffahrt eine Grundvoraussetzung, die hier durch einen interdisziplinär historisch-archäologischen Ansatz erforscht wird. Die diachronische Thematik wird durch eine Reihe von Fallstudien untergliedert, die unterschiedliche Ansatzpunkte haben: Auf der einen Seite wird der Frage nachgegangen, wie man sich im Mittelalter orientierte und welche Navigationstechniken zum Einsatz kamen, exemplarisch anhand eines dänischen Itinerars nach Estland aus dem 13. Jahrhundert veranschaulicht. Auf der anderen Seite werden die Einsatzmöglichkeiten und Einsatzgebiete von Schiffen untersucht, welche die katholischen Enklaven im heidnischen Osten mit Kreuzfahrern, aber auch Kolonisten und Gütern versorgten. Eine Reihe an mittelalterlichen Schiffwracks werden unter dieser Fragestellung evaluiert, um die Aussagen von zeitgenössischen Chronisten, Diskussionen zu schiffbaulichen Eigenheiten, aber auch frühen Handelsverbindungen zu vergleichen. Ein weiteres Augenmerk liegt auf dem baltischen Holzhandel, der einen oft übersehenen Aspekt aufgreift: Der Deutsche Orden als Handelsmacht. Diese Arbeit schließt mit einer Fallstudie zur maritimen Transportgeografie einer Deutschordensburg und eines zugehörigen Schiffwracks ab, die in eine Zeit der politischen Instabilität und des bevorstehenden Zusammenbruchs der Livländischen Konföderation im Jahre 1561 datieren

A performance reporting tool for electricity service delivery for selected local South African municipalities

Thesis (PhD (Industrial Systems))--University of Pretoria, 2021.Basic services such as sanitation, waste removal, water, and electricity supplies are necessary for life, well-being, and human dignity. In South Africa, municipalities are the sphere of government constitutionally designated to provide these services. With months of rolling blackouts and volatile operating performance, Electricity Service Delivery (ESD) deserves some attention and improvement because it is setting the country on a pathway to national emergency, weakening investors’ confidence and stagnating the country’s already problematic economic growth prospects. Since improvement does not materialise spontaneously, deliberate and purposeful actions are required to understand the current state of ESD, extract stakeholders’ intentions for an improved ESD (diagnosis), and then devise means to operationalise the intentions. This study focuses on performance assessment with initial reporting capabilities to provide adequate information and insight for diagnosis of ESD within South African local municipalities. It starts by exploring a systematic literature review of available tools for diagnostic service performance assessment. Then, it extracts and validates, through a focus group session, the criteria which such tools must satisfy to be considered useful in the South African context. The study is based on a Design Science Research (DSR) methodology and follows an inquisitive process of multi-stakeholder engagement to extract evidence about existing functional and constructional ESD areas of concern/requirements. The study inductively develops an artefact, the ESD Performance Reporting Tool (ESD-PRT) to guide improvement in electricity service delivery in South African local municipalities. The ESD-PRT continuously extracts performance metrics from Power System Resources (PSR), citizens, and organisational competencies of the municipalities, with provisions for emerging areas of concern and requirements within design domains and sub-domains. It was evaluated for practicality and usefulness based on the DSR iterative approach and compared to the closest available similar solution. This entry point solution to an optimised local municipality ESD would guide the redesign of ESD and potentially save South Africa billions of Rands currently lost to energy losses, downtime in economic activities and social discontent occasioned by power outages and rolling blackouts. The study was demonstrated in three local municipalities geo-located in two different provinces. The researcher believes that the study outcome would apply to most local municipalities in South Africa. However, its applicability to metropolitan municipalities still needs to be tested.Industrial and Systems EngineeringPhD (Industrial Systems)Unrestricte

A transformation grammar-based methodology for housing rehabilitation: meeting contemporary functional and ICT requirements

This research starts from the premise that the future of the real estate market in Portugal will require the rehabilitation of existing residential areas in order to respond to new life-styles and dwelling requirements that have emerged in an era in which information plays a structuring role in society. The goal of this research is the definition of design guidelines and a rehabilitation methodology to support architects involved in the process of adapting existing dwellings, allowing them to balance sustainability requirements and economic feasibility with new dwelling trends such as the incorporation and updating of Information Communication and Automation Technologies and the need to solve emerging conflicts affecting the use of space prompted by the introduction of new functions associated with such technologies. In addition to defining a general methodology applicable to all the building types, the study focuses on a specific type, called “rabo-de-bacalhau” (“cod-tail”), built in Lisbon between 1945 and 1965 for which a specifc methodology has been generated. Both shape grammar and space syntax were used as part of the rehabilitation methodology as tools to identify and encode the principles and rules behind the adaptation of existing houses to new requirements.FCT PhD Gran

Rethinking Death and Donation: Mediating Death at the End of Life in the Wake of Brain Death\u27s Failings

Since its inception in 1968, death by whole-brain criteria, or simply brain death, has enjoyed the status of one of the relatively well settled issues in bioethics. Indeed, its almost universal acceptance in law and medical practice seems to confirm this depiction. However, over the last fifteen years or so, a growing number of experts in medicine, philosophy, and religion regard brain death as an untenable criterion for human death. Given that the debate about brain death has occupied a relatively small group of professionals, few are aware that brain death fails to correspond to any coherent biological or philosophical conception of death. This is significant, for if the brain-dead are not dead, then the removal of their unpaired vital organs for transplantation is the direct cause of their deaths. The aim of this dissertation is to examine and evaluate the social, legal, medical, and philosophical problems inherent in the current social policy allowing for organ donation under the brain death criterion of human death. The position I maintain is that brain death is fraught with numerous difficulties that render it ethically untenable in current practice and should be abandoned as a criterion for determining death. The chapters are devoted to disclosing these specific problems, which include the vexing historical ties between brain death and organ donation, the incoherence of its philosophical, biological, and clinical conceptions, the confusion of the general public, medical community, and law makers regarding its meaning and use, and the problems of alternatives to the current standard such as consciousness based definitions of death, eliminating the dead donor rule, and the enactment of conscience clauses. The dissertation concludes by suggesting possible avenues to expand discussion in terms of how we might proceed in efforts to further organ transplantation in light of the major problems that call into question the ethical sustainability of brain death as a means for organ procurement

Development of an environmental health risk and socio-economic perception framework to critically assess the management of TWW reuse practice and options in Kuwait

This thesis introduces a new methodological approach to provide a framework for environmental health and socioeconomic perception that critically assesses the management of treated wastewater (TWW) reuse practice and options. The methodology combines Multi-Criteria decision Making (MCDM) and Rapid Impact Assessment Matrix (RIAM). The approach uses expert opinion to assess TWW reuse options and converts the qualitative subjective evaluation of experts into quantitative objective and numeric output. The methodology includes the use of a Driver Force, Pressure, State, Impact and Response (DPSIR) framework to analyse the current situation in a specific case study (Kuwait). The research identified the best available TWW reuse options for Kuwait and determined the essential environmental health and socioeconomic criteria affected by the practice of selected TWW reuse options. The latter include recreational and agricultural irrigation, firefighting and industrial and ruses, oil depressurization and groundwater recharge. Options where the public had direct contact with TWW, such as showering, cooking and drinking were rejected. Environmental health criteria were found to be the most significant criteria associated with TWW reuse practice and options, but given current heavy subsidies of wastewater treatment, distribution and transportation, the economic burden was also significant. Further research in this area is recommended to enable a reduction of pressures on freshwater resources through TWW reuse practice and this should be included within a wider context of integrated water management (IWM)