<p>Disabling hearing loss is a problem around the world, with the World Health Organization estimating that 466 million people worldwide have disabling loss, and that this number is expected to increase to over 900 million people by 2050. There are different types of hearing loss, but sensorineural hearing loss (SNHL) is the most common and results from damage to the inner ear. The audiogram is the most common test used to diagnose hearing loss, but it is limited in that it can only identify a shift in hearing sensitivity (thresholds), i.e., it cannot identify the cochlear location causing SNHL. The electrocochleogram (ECochG) is an evoked response consisting of several summed responses of electrical potentials from within the inner ear. Several components represent activity from different places in the inner ear: the compound action potential (CAP) is the summed onset response of auditory nerve fibers, the cochlear microphonic (CM) is the AC response of the hair cells (primarily outer hair cells), and the summating potential (SP) is the DC hair cell response (primarily inner hair cells). Most ECochG responses in humans are collected non-invasively (e.g., from the ear canal or ear drum), whereas most ECochG responses in animal models are collected invasively (e.g., from the cochlear round window). <br></p><p></p><p>In this project, we aimed to bridge this gap by recording non-invasive ECochG responses from awake chinchillas. We first started by calculating standard ECochG metrics from existing data across different forms of SNHL. Next, we tested the feasibility of recording non-invasive ECochG responses from the ear canals of awake chinchillas. Finally, we defined and calculated additional metrics from ECochG responses to further help in identifying location(s) of SNHL. The ability demonstrated here to record non-invasive ECochG responses from awake animals increases the translational applicability of pre-clinical SNHL animal models by permitting detailed cochlear assessments at multiple time points post exposure. Detailed ECochG measures can advance hearing science and audiology by helping to identify the location of damage causing the hearing loss, which can ultimately allow for more individualized treatment. </p><br>

Driving while sleepy, drowsy or fatigued are leading contributors to road crashes. Sleepiness, drowsiness and fatigue usually occur at the end of a prolonged period of time during which an individual has been awake. Although these factors have been heavily researched, it is not clear how one of their primary causes, a prolonged total awake time (TAT), might affect driving skills such as hazard anticipation, hazard mitigation and attention maintenance, three skills that are crucial for safe driving. The first experiment investigated how these three driving skills are affected by prolonged TAT, and if so to what extent. Forty-eight participants completed two separate driving simulator sessions, one a pre-test and one a post-test. Based on the online questionnaire, participants were assigned to two different groups, namely Short-hours and Long-hours. A total of two hours elapsed between the pre-test and post-test for the Short-hours group. A total of twelve hours elapsed between the pre-test and post-test for the Long-hours group. The pre-test session was administered at 9:00 a.m. or 10:00 a.m. for both Short-hours and Long-hours groups. The post-test session was administered at 11:00 a.m. or 12:00 p.m. for the Short-hours group and at 9:00 p.m. or 10:00 p.m. for the Long-hours group. It was expected that Long-hours group would perform on average more poorly in the post-test due to a longer total awake time. In each session, participants were asked to navigate a simulated world that included twelve scenarios: four examined drivers' hazard anticipation skills, four examined hazard mitigation skills and four examined attention maintenance skills. While driving, all participants' eye behaviors were measured. The results showed that the Long-hours group drivers' hazard anticipation, hazard mitigation and attention maintenance skills were compromised. The above findings led to the development of a PC-Based Sleepiness and Fatigued Driving Evaluation and Training Program (SAFE-T) that was used to train drivers in each of the three driving skills mentioned above. The SAFE-T Program was configured to run on a standard PC so that the training could be undertaken without the need for advanced simulation by any drivers whose jobs required that they be awake and driving at the end of a long shift. The second experiment investigated if the SAFE-T Program would effectively train drivers who were awake for a prolonged period of time to maintain their driving performance in each of the three driving skills, namely hazard anticipation, hazard mitigation, and attention maintenance. Based on the online questionnaire, participants were assigned to two different groups, namely Trained (SAFE-T) and Placebo. Thirty-six participants completed a pre-test, the SAFE-T or placebo training, and a post-test. All participants were in the Long-hours condition in this experiment, which is a total of twelve hours (the time that elapsed between the pre-test and the post-test). The pre-test was administered at 9:00 a.m. or 10:30 a.m., the training was administered right after the pre-test, and the post-test was administered at 9:00 p.m. or 10:30 p.m. The results showed that participants who were given SAFE-T training performed better during the post-test than during the pre-test in all the three skills. In contrast, the participants who were given Placebo training performed worse during the post-test than during the pre-test in all the three skills.

Notre étude est dédiée au développement d’un protocole d’évaluation du langage à visée clinique. Nous examinons les spécificités du traitement du langage oral à travers le filtre des fonctions langagières actualisées par la prosodie. Système composite par excellence, largement négligé tant dans l’étude du traitement du langage que dans les évaluations orthophoniques, la prosodie est cependant en étroite relation avec les composantes du langage et réalise par ce biais l’ensemble des fonctions structurantes du langage. Deux fonctions linguistiques de la prosodie sont ici testées en compréhension : une fonction syntaxique, sous-tendue par le marquage accentuel des frontières de syntagmes réalisé par un accent final et un accent initial, et une fonction pragmatique impliquant la fonction de focalisation initiée par un accent emphatique. Après avoir procédé à la normalisation de notre protocole auprès d’un groupe de sujets contrôles, notre évaluation a été intégrée à la prise en charge longitudinale de deux patients atteints de gliomes de grade II. Dans ce cadre spécifique, nous avons adapté nos épreuves au contexte de la chirurgie éveillée. Les capacités langagières des patients ont été testées en condition pré-opératoire afin d’observer l’impact cognitif de la tumeur et en condition post-opératoire afin d’évaluer les conséquences de l’exérèse. Les résultats soulèvent des questionnements concernant la spécialisation hémisphérique de la prosodie. Ils ont aussi permis de mesurer la sensibilité de notre protocole. L’étude exploratoire réalisée en condition peri-opératoire nous a permis de soulever les contraintes inhérentes à la méthode de stimulation électrique directe. / This study is dedicated to the development of an exploratory clinical protocol for language evaluation, where prosody is seen as the core system for assessing spoken language processing in a more comprehensive way than is usually the case in clinical studies. Indeed, prosody is usually largely neglected in studies on language processing, as well as in speech therapy and neuropsychological evaluations. However, prosody is tightly linked to the different components of language, and plays a central role in linguistic structuring. Two linguistic functions of prosody are tested here in language comprehension: 1) the syntactic function of prosody, where both final and initial accenting help delimit syntagmatic grouping ; 2) the pragmatic function of prosody, where prosodic focus brings salience to a specific part of discourse. The protocol was first normalized on a control group of healthy participants. We then ran the evaluation in a peri-surgical context on two patients suffering from grade II glioma. The protocol had to be adapted to the context of awake surgery. The language capacities of the patients were tested first in pre-surgical context in order to assess the cognitive consequences of the brain tumor, then in post-surgical context to evaluate the consequences of the tumor removal. Results raise questions regarding the hemispheric specialization of prosody, and more globally regarding the localization of language processing. The other interesting outcome of this research is to propose improvements for the evaluation of language capacities in a surgical context using direct brain electric stimulation.

Titel: Patienters upplevelser av att vara vaken i regional anestesi - En systematisk litteraturstudie med kvalitativ innehållsanalys  Bakgrund: Regional anestesi används idag i allt större utsträckning. Genom att blockera nervsignaler kan smärtsignaler blockeras och möjliggöra operationer på bedövad kroppsdel. Detta medför att patienten kan vara vaken under operationen och därmed ges möjlighet att interagera med vårdpersonalen i operationsrummet.  Syfte: Studiens syfte var att genom en systematisk litteraturstudie undersöka patienters upplevelser av att vara vaken i regional anestesi.   Metod: Litteraturstudien har genomförts genom en kvalitativ innehållsanalys. Resultatet från tio vetenskapliga artiklar har sammanställts och analyserats enligt Bettany-Saltikov och McSherry (2016).  Resultat: Upplevelsen av att vara vaken under operation är individuell och varierar mellan nyfikenhet och djup oro. I litteraturstudien framkommer behovet av att patienten erhåller information som är anpassad efter deras behov samt att de finns en vårdrelation med vårdpersonal och då framförallt med anestesisjuksköterskan. Genom en god vårdrelation kan upplevelsen av operationen förbättras.  Slutsats: Vikten av kommunikation mellan patient och anestesisjuksköterska har framkommit ha en stor betydelse för hur operationen och anestesin upplevs. Genom en god vårdrelation minskar behovet av läkemedel och leder till ett snabbare tillfrisknande och hemgång. / Title: Patients experiences of being awake in regional anesthesia – A systematic litterature review with a qualitative content analysis.  Background: The use of regional anesthesia in surgery is increasing. By blocking nerve signals this enables different kind of surgeries on the anesthetized body. This means that the patient can be awake during the surgery and is able to interact with caregivers in the operating room.  Aim: The aim was to illuminate patients’ experiences of being awake in regional anesthesia.  Method: The litterature review has been conducted using a content analysis. The result from ten qualitative articles has been compiled and analyzed according to Bettany-Saltikov and McSherry (2016).  Results: The experience of being awake during surgery is individual and varies between curiosity and deep anxiety. The result of this study revealed the need of patient to get customized information according to their needs and the significance of the relationship with caregivers and especially the nurse anesthetist. Through a good relationship with caregivers the experience of the surgery can improve.  Conclusions: The importance of communication between the patient and the anaesthesia nurse has emerged to have a significant impact on how the surgery and anaesthesia are experienced. Through a good care relationship reduces the need for drugs and leads to a faster recovery.

Stroke is the leading cause of long-term disability in the developed world and can have devastating effects on the health and everyday functioning of individuals. In most cases stroke is ischemic and is caused by the obstruction of blood flow due to a clot in the brain blood vessels. This initiates a cascade of events that result in tissue death and loss of behavioural function associated with the damaged region. The peri-infarct cortex is a region surrounding the infarct core that survives the ischemic event and is most susceptible to pharmacological treatments and rehabilitation. α4ß2 nicotinic acetylcholine receptor (nAChR) signalling has been implicated as a mechanism that affects cell survival and cell death in the acute response after stroke. Nicotinic receptor signalling is also involved in modulating brain excitability, which can affect neural plasticity and restoration of cortical circuits and lead to recovery of lost function after stroke. In order to elucidate the role of α4ß2 nAChRs on acute and chronic recovery after stroke, we tested two hypotheses: (1) blocking α4ß2 nAChRs triggers acute neuroprotection and (2) α4ß2 nAChRs play a role in regulating plasticity and long-term functional recovery. In the first set of experiments a new model of targeted photothrombotic stroke was induced in a distal branch of the middle cerebral artery (MCA) in awake and anaesthetized mice. Mice treated with the α4ß2 nAChR antagonist dihydro-ß-erythroidine (DHßE) showed smaller lesion sizes relative to vehicle controls and this effect was greater in mice that were awake during stroke induction. To determine the mechanism of α4ß2 nAChRmediated neuroprotection, changes in collateral flow were measured using Evans bluestained surface angiograms and laser Doppler flowmetry. Contrary to what was expected, DHßE did not appear to induce neuroprotection by altering collateral flow. In the second set of experiments, we first used confocal imaging to quantify and characterize the expression of α4ß2 nAChRs after stroke. Next, mice were induced with a targeted photothrombotic stroke in the forelimb somatosensory cortex. Mice were then chronically treated with DHßE to determine if α4ß2 nAChR antagonism could improve recovery of function. Behavioural tests showed that blocking α4ß2 nAChRs chronically had no effect on forelimb function after stroke. Voltage-sensitive dye imaging was used to measure forelimb-evoked responses in the somatosensory cortex and revealed no differences in cortical responsiveness between treated and non-treated groups. Altogether, these results show that changes in α4ß2 nAChR signalling that occur after stroke mediate ischemic cell death but do not have an effect on long-term recovery and plasticity. Moreover, they present a novel pathway for investigating stroke pathophysiology and the development of acute neuroprotective treatments. / Graduate / 0317 / aseto@uvic.ca

Submitted by Bruna Rodrigues (bruna92rodrigues@yahoo.com.br) on 2016-09-21T12:17:25Z No. of bitstreams: 1 DissMCV.pdf: 1396676 bytes, checksum: d3fa0ce7f0f0504dfe6926528b1e7366 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-21T18:23:20Z (GMT) No. of bitstreams: 1 DissMCV.pdf: 1396676 bytes, checksum: d3fa0ce7f0f0504dfe6926528b1e7366 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-21T18:23:27Z (GMT) No. of bitstreams: 1 DissMCV.pdf: 1396676 bytes, checksum: d3fa0ce7f0f0504dfe6926528b1e7366 (MD5) / Made available in DSpace on 2016-09-21T18:23:33Z (GMT). No. of bitstreams: 1 DissMCV.pdf: 1396676 bytes, checksum: d3fa0ce7f0f0504dfe6926528b1e7366 (MD5) Previous issue date: 2015-10-16 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / The orexins are hypothalamic neuropeptides involved in an array of functions such as regulation of sleep/wake states and chemoreception to CO2/pH. The Locus coeruleus (LC) is a chemosensitive site and expresses an extensive population of orexin receptor 1 (OX1R). Here we tested the hypothesis that OX1Rs located in the LC participate in the ventilatory response to hypercapnia in a vigilance state and diurnal cycle-dependent manner. To this end, we performed unilateral injections of SB-334867 (OX1R antagonist, 5 mM) into the LC of male Wistar rats and evaluated the ventilatory response to 7% CO2 during wakefulness and sleep in the dark and light phase of the diurnal cycle. Hypercapnia induced an increase in ventilation in all groups compared to normocapnic values. However, the injection of (SB-334867) promoted an attenuation of the hypercapnic chemorreflex during wakefulness, due to changes in VT. In addition, microinjection of SB-334867 decreases the wakefulness time during dark phase. We suggest that projections of orexin-containing neurons to the LC contribute, via OX1Rs, to the hypercapnic chemoreflex during wakefulness in the dark phase. / As orexinas são neuropeptídeos hipotalâmicos envolvidos em uma variedade de funções, tais como, na regulação do ciclo sono-vigília e na quimiorecepção ao CO2 / pH. O locus coeruleus (LC) é um núcleo quimiossensível e expressa uma extensa população de receptor de orexina 1 (OX1R). Portanto, nós testamos a hipótese de que OX1Rs localizados no LC participam da resposta ventilatória à hipercapnia no estado de vigília de maneira dependente do ciclo claro e escuro. A participação da neurotransmissão orexinérgica do LC na resposta ventilatória à hipercapnia foi avaliada por meio da microinjeção do antagonista de receptor-1 OXR- 1 (SB-334867, 5 mM) no LC de ratos Wistar não anestesiados durante o sono e a vigília nas fases clara e escura. Nossos resultados demonstraram que a hipercapnia induz um aumento significativo da ventilação em todos os grupos comparado aos valores de ventilação na normocapnia. No entanto, na fase escura, a microinjeção do SB-334867 promoveu uma atenuação do quimiorreflexo hipercápnico durante a vigília, mas não durante o sono devido à diminuição do volume corrente VT. Adicionalmente, a microinjeção do SB-334867 diminui o tempo que os animais passam acordados em normocapnia na fase escura. Portanto, nossos dados sugerem que as projeções orexinérgicas para o LC atuando em OXR-1 exercem uma modulação excitatória na resposta ventilatória ao CO2 durante a vigília na fase escura. / 2014/00330-3

Bakgrund: WHO:s checklista är avsedd för operationskliniker världen över som vill reducera komplikationer i samband med operativa ingrepp. Studier har visat att checklistan inte bara förbättrade patientsäkerheten utan också bidrog till bättre teamarbete och kommunikation mellan personal. Få studier finns om hur patienter som är vakna under operation påverkas av att man använder checklista. Syfte: Syftet med denna pilotstudie var att belysa hur ett antal operationssjuksköterskor upplevde att använda checklistan inför vaken patient. Metod: En pilotstudie med kvalitativ ansats där datainsamlingen genomfördes i form av halvstrukturerade intervjuer med tre operationssjuksköterskor. Det samlade intervjumaterialet analyserades med hjälp av kvalitativ innehållsanalys. Resultatet: Resultatet presenterades utifrån sex kategorier som beskrev hur operationssjuksköterskorna upplevde att använda checklistan inför vaken patient; Anpassning, Information, Kommunikation, Obehag, Oro och Säkerhet. Slutsats: Operationssjuksköterskorna upplevde säkerheten i arbetet kring patienten som den viktigaste aspekten med att använda checklista. Samtidigt var man dock tveksam till att använda den inför vaken patient. Detta beskrevs i form av oro för patienten och en egen obehags-känsla. Operationssjuksköterskorna funderade kring möjligheter med förändringar i en sådan situation, exempelvis genom information om checklistan preoperativt, att tala tyst eller vid sidan om patienten. Inga tydliga förslag gavs om hur checklistan skulle anpassas till vaken patient. / Background: The WHO checklist is intended for operating clinics around the world to reduce the number of complications combined with surgery. Studies have shown that the checklist not only does improve patient safety but also contributes to better teamwork and communication between staff. Little is known how the checklist affects non sedated patients undergoing surgery. Aim: The aim of this study was to illustrate how a couple of theatre nurses experience the use of checklist in presents of non sedated patient. Method: The study hade a qualitative approach and semistructured interviews were made involving three theatre nurses. The collected material was analyzed by content analysis. Result: The result was presented six categories describing how the theatre nurses experienced using the checklist in presents of non sedated patient; adjustment, information, communication, anxiety, discomfort, safety. Conclusions: The theatre nurses experienced safety as the most important issue in using the checklist. At the same time they were doubtful to use it in presents of non sedated patients. They described it as a feeling of discomfort and an unpleasant feeling that they felt. The theatre nurses suggested that more preoperative information conserning the checklist and other adjustments could make it easier to use the checklist in front of non sedated patients. However, they gave no specific suggestions how to adjust the checklist to non sedated patients.

Bakgrund: Tidigare forskning visar på en förändring inom intensivvården och att fler patienter vårdas lättsederade i mekanisk ventilation. Sederingsnivån ska vara tillräcklig för att patienter ska tolerera endotrakealtuben och fortsatt behandling trots obehaget det ger. Detta leder till att patienter blir mer delaktiga i sin egen vård men ställer även högre krav på intensivvårdssjuksköterskor som ska vårda dessa patienter. Syfte: Att belysa patienters upplevelse av att vara lättsederad och vårdas vaken med mekanisk ventilation. Metod: För att besvara examensarbetets syfte användes en allmän litteraturöversikt. Tjugo vetenskapliga artiklar som bestod av både kvalitativ, kvantitativ och mixed method design användes. Analysen skedde genom att identifiera likheter och skillnader i syfte, metod och resultat. Resultat: I resultatet framkom det både fördelar och nackdelar med att vårdas lättsederad i mekanisk ventilation. Tre teman framkom i analysarbetet: upplevelser av sitt tillstånd, upplevelsen av att bli sedd och hörd samt upplevelsen av samspel och delaktighet. Slutsats: Patientupplevelsen visade på både psykiskt och fysisk påfrestning. Patienter uttrycker hinder gällande kommunikation, existentiella faktorer och relationer med anhöriga och sjuksköterskor. Trots detta uttrycks önskemål om att få vårdas lättsederade i mekanisk ventilation under ett vårdtillfälle på intensivvårdsavdelningen.

Dagens sjukvård förändras och utvecklas i snabb takt. Vårdtiderna kortas och allt fler ingrepp, mer och mer avancerade, övergår till att utföras under lokalanestesi med vakna patienter. En vaken patient får en upplevelse kring omvårdnaden under ett ingrepp. I vården är tid en bristvara, det kan finnas risk för att mötet mellan patient och sjuksköterska går väldigt fort. För patienten är det av stor betydelse att omhändertagandet blir bra för att upplevelsen under hela ingreppet ska bli så bra som möjligt. Omvårdnad är sjuksköterskans specifika kompetens. En viktig uppgift är att kontinuerligt arbeta med utvärdering och utveckling av olika arbetsmetoder. Att beforska patienters upplevelser inom vården är viktigt, det kan ge en indikation på om det finns behov av förbättring. Alla förändringar bör följas upp och utvärderas. Syftet med studien är att undersöka hur vakna patienter under en kardiologisk intervention upplever omvårdnaden. Metoden som användes var en kvantitativ enkätstudie. Instrumentet som användes var Kvalitet ur Patientens Perspektiv (KUPP). Resultatet visar på att respondenterna överlag upplever de faktiska förhållandena som mycket bra. Drygt 70% av respondenterna svarade på frågan om vad de var särskilt nöjda med och det handlade till största del om positivt bemötande. I enkäten påvisades ingen brist som kräver åtgärd men i förbättringsförslag framkom önskemål om varma filtar vilket åtgärdats. Slutsatsen är att vakna patienter som genomgår en kardiologisk intervention är nöjda med omvårdnaden och omhändertagande under hela ingreppet. Studiens resultat är begränsat till den utvalda patientgruppen av polikliniska stabila svensktalande kardiologiska patienter. För att kunna dra mer generella slutsatser krävs ett större underlag med studier av andra patientgrupper. / The health care of today is rapidly changing and developing. An increasing number of interventions, more and more advanced, are performed during local, instead of general anaesthesia, whereby inpatient times are reduced. The patients are awake and aware of the surrounding activities, including nursing. With time in short supply, the meeting between patient and nurse may go very quickly, which might be hazardous. In order to maintain a good patient experience during the procedure, it is important that the nursing care is not set aside. Nursing is the specific competence of the registered nurses, who must work continuously with development and evaluation of the quality of different working methods. Investigating patient experiences in health care is important, in order to high-light needs for improvement. Any changes should be followed-up and evaluated. The purpose of this study was to investigate the experience of nursing during a cardiological intervention in awake patients. The method used was a quantitative survey study. The instrument was Quality from the Patient's Perspective, (KUPP). The results show that patients generally experience the investigated conditions as very good. The free-text question asking for particularly positive experiences was answered by 70% of the patients, mainly high-lighting good care-giving conduct. The questionnaire did not reveal any significant shortcomings requiring to be acted upon, although a free-text answer proposing warm blankets has been addressed. The conclusion of the study is that awake patients undergoing a cardiological intervention are satisfied with the nursing and the care throughout the procedure. This result is limited to the current study group comprising of cardiologically relatively stable Swedish-speaking out-patients. An expanded survey group including other patient categories is necessary in order to draw more general conclusions.

Bakgrund: Regional anestesi är en metod som blivit allt vanligare inom sjukvården. Metoden innebär att alla sinnesintryck temporärt elimineras från den valda kroppsdelen där kirurgin ska genomföras, detta görs genom att anlägga en nervblockad. Metoden möjliggör att patienten kan vara vaken under ett kirurgiskt ingrepp. Den högteknologiska operationsmiljön beskrivs många gånger som opersonlig, distanserad och kall, vilket kan medföra att patienterna upplever osäkerhet och sårbarhet. Således är det av vikt att undersöka patienters upplevelser för att anestesisjuksköterskan bättre ska kunna bemöta, vårda och stödja dem genom kirurgin. Syfte: Studiens syfte var att beskriva patienters upplevelser av att vara vaken under ett kirurgiskt ingrepp i regional anestesi. Metod: En strukturerad litteraturstudie med kvalitativ design, baserad på 13 vetenskapliga artiklar. De vetenskapliga artiklarna har analyserades med hjälp av Bettany-Saltikov och McSherrys dataextraktion. Resultat: I resultatet framkom tre huvudkategorier: Miljöns och kirurgins påverkan, Upplevelser av att överlämna sin kropp och Vårdpersonalens betydelse. Upplevelsen av att vara vaken under ett kirurgiskt ingrepp i regional anestesi kan upplevas både positivt och negativt. Vissa patienter upplevde delaktighet och kontroll medan andra upplevde motsatsen. Vidare kunde de uppleva smärta, rädsla, oro och obehag i samband med det kirurgiska ingreppet, trots detta var de generellt nöjda genom interaktionen de hade med vårdpersonalen. Slutsats: Anestesisjuksköterskan har en avgörande roll för patientens upplevelse av att vara vaken under kirurgi. Stöd, tröst och omtanke från anestesisjuksköterskan hjälpte patienten att överkomma sin oro och rädsla. En god kommunikation, information och närhet från vårdpersonalen kan stärka patientens välbefinnande och delaktighet.