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A comparison of medical and physical therapies in the management of facial arthromyalgia (temporomandibular joint dysfunction).

This thesis reports on a randomised controlled trial of medical and physical therapy in the management of chronic temporomandibular joint pain and dysfunction. The literature review first explores the meaning and measurement of chronic pain. The anatomy and dynamic function of the temporomandibular joint and associated musculature is then introduced before describing the pain and dysfunction which affects this specific region. The development of terminology, classification and epidemiology is addressed to provide a basis for understanding the condition. A discussion of the presumed multifactorial aetiology and current management follows, with focus on the two areas of specific interest in this study the physical and medical therapies The study methods, results and discussion are presented in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. A referral cohort of 1,038 subjects were screened and assessed. 250 subjects met inclusion criteria and agreed to participate with informed consent. Subjects were randomised into four groups: medical therapy, placebo, occlusal bite guard, medical therapy and occlusal bite guard. A three month treatment phase and a six month follow-up phase were then conducted. The first section of the results examines the referral cohort. Demographic, clinical diagnostic, and psychosocial profile are reported with treatment uptake for the trial. The second section examines the three month trial phase, treatment efficacy and outcome. The analysis of subgroups is explored, including the characteristics of responders and non-responders to therapy in addition to outcome measures in subjects with initially high pain scores and high levels of depression. The final section analyses reasons for patient withdrawal and non compliance before examining the follow up phase post therapy for maintenance of improvement. Both primary and secondary outcome measures revealed significant improvement in pain amongst all four groups which was maintained during the follow-up phase

PPP: a risk approach in the water sector

Objective: This thesis provides a theoretical and managerial contribution on how PPP can address risk in the water sector in developing countries. Three thesis objectives support the results. The first identifies literature contributions, the second is related to the perception of risk management by different stakeholders, and the third concerns the risk approach in PPP water contracts in developing countries. Design: A hybrid method combining systematic, semantic network, and narrative analysis review of previous research supported the first objective. To answer the second thesis’ objective, a semi-structured interview using quantitative and qualitative analysis identified the perception of risk management in PPP water projects. To support the third objective, a case study provided interesting insights regarding the risk approach in PPP contracts Findings: From a total of 122 studies, the first objective, identified five main PPP research domains: risk management, contracts, infrastructure, governance, and financing and tariffs. Twenty-five risk factors with high impact were established as a result of the semiinterviews. The top-five critical risk factors are related to political interference, no baselines for performance measurement, unfavourable global private investment climate, non-payment of bills and water asset condition uncertainty. The case study showed how PPP contracts can fail for not having risk management concerns and we have underestimated risks as conflicts between partners. The traditional risk management approach in PPP contracts showed that there is space to improve. The key risk indicators approach was proposed. Originality: Research outputs showed that PPP laws and sector legislation should be permanently adapted to the local needs. The traditional risk management framework fails to provide a solution. The key risk indicators introduce a paradigm shift, which provides useful guidelines for future studies.Objectivo: Esta tese tem como objetivo ser uma contribuição teórica para a abordagem de como os contratos de Parcerias Públicas Privadas (PPP) abordam a gestão de risco no sector da água em países em vias de desenvolvimento. Os três objetivos da tese suportam os resultados apresentados. O primeiro identifica as contribuições da literatura, o segundo recai sobre a perceção de especialistas sobre a abordagem do risco e o terceiro capta a abordagem do risco dos contratos do tipo PPP em países em vias de desenvolvimento. Metodologia: Com o objetivo de responder ao primeiro objetivo da tese, foi aplicada uma metodologia híbrida através da combinação de uma revisão bibliográfica sistemática, semântica e análise narrativa. Os contributos do segundo objetivo da tese, suportaram-se em entrevistas semiestruturadas através do recurso à estatística descritiva e análise de conteúdo. O terceiro e último objetivo teve como base um estudo de caso. Resultados: A revisão da literatura identificou um total de 122 estudos e a existência de cinco campos relevantes nos contratos do tipo PPP: gestão de risco, contratos, infraestruturas, governança, aspetos financeiros e tarifas. O resultado do segundo estudo identificou vinte e cinco fatores de risco. Os cinco fatores que apresentaram uma maior frequência foram: interferência política, ausência de bases de medição do desempenho, um contexto de investimento desfavorável, o não pagamento das faturas e o desconhecimento do estado de preservação das infraestruturas. Os resultados do terceiro estudo mostraram que o sucesso de um contrato do tipo PPP pode ser comprometido na ausência de uma gestão de risco adequada, onde as gestões de conflitos entre parceiros sejam subestimadas em termos contratuais. A temática gestão de risco nos contratos do tipo PPP tem oportunidades de melhoria. Assim, propõe-se a introdução de indicadores chave de desempenho do risco. Originalidade: As leis com impacto nos contratos do tipo PPP devem ser continuamente atualizadas e adaptadas às distintas realidades. É proposta uma alteração de paradigma através da introdução dos indicadores chave de desempenho do risco, fornecendo possíveis linhas orientadoras para pesquisa futura

User's manual for the BROOM decision support system.

Abstract Not Provide

African Studies Abstracts Online: number 31, 2010

ASA Online provides a quarterly overview of journal articles and edited works on Africa in the field of the social sciences and the humanities available in the ASC library. Issue 31 (2010). African Studies Centre, Leiden.ASC – Publicaties niet-programma gebonde

Conceptual Trends and Implications for Risk Research. Report of the Task Force Meeting: Risk and Policy Analysis Under Conditions of Uncertainty, November 25-27,1985

The Task Force focused on the uncertainties in decision systems for choosing or modifying technologies intended to improve human well-being. The challenge was to delineate an international research agenda to assist communities to venture into the future with greater confidence in technological innovation. The Task Force recommended research in three interrelated areas: (1) Protocols -- Development of procedural advice for the integrated assessment of the contribution of technologies to environmental and economic achievements, and the associated uncertainties. (2) Case Studies -- Integrated assessments involving local or regional clusters of technologies and decision-making bodies, and investigation of ecosystem effects, economic effects, and effects on human well-being, as well as the structure and performance of institutions. (3) Educational Materials -- Development of educational materials to support integrated assessments