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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

The effectiveness of rocker sole shoes in chronic low back pain

MacRae, Catharine Sian January 2013 (has links)
Shoes with a rocker sole are marketed as reducing low back pain. There is minimal evidence to support these claims. This investigation compared rocker sole shoes to flat sole shoes in people with chronic low back pain (CLBP). The thesis reports findings of a randomised clinical trial and a series of biomechanical experiments. Following preparatory pilot and reliability studies, 115 people with CLBP were randomised to wear rocker sole shoes or flat sole shoes; all participants attended an exercise and education programme. Participants were assessed without knowledge of group allocation pre-randomisation, at six weeks, six months, and one year (main outcome point). Primary outcome was the Roland Morris Disability Questionnaire (RMDQ). Analysis was by intention-to-treat. Biomechanical experiments recruited 20 participants from the main study and investigated effects of wearing rocker sole and flat sole shoes on standing balance and gait, immediately and after 6 months of shoe wear, using centre of pressure and motion-analysis derived kinetic, kinematic and spatio-temporal measures. Balance and gait in people with and age-and gender-matched controls without CLBP were compared. Rocker sole shoes were no more beneficial than flat sole shoes for CLBP patients; flat sole shoes were more beneficial in a sub-group of CLBP aggravated by standing or walking. Biomechanical studies found rocker sole shoes introduced immediately greater postural instability than flat sole shoes but neither shoe had long-term training effects on postural control. Furthermore, although both shoes resulted in small immediate changes in kinetic, kinematic and spatio-temporal parameters of shod gait, neither shoe had long-term training effects on these parameters in barefoot gait. Finally, in contrast to some previous research, postural control during standing, and kinetics, kinematic, and spatio-temporal parameters during gait were similar between people with and without CLBP.
2

The development of a new rating scale for the perceptual assessment of tracheoesophageal voice quality outcome following total laryngectomy

Hurren, Anne January 2014 (has links)
Perceptual assessment of voice in people with surgical voice restoration (SVR) is essential to evaluate surgical and other interventions aimed at delivering optimal voice quality. Currently there are no tools to measure this that do not have issues of validity and reliability. This work describes the development and trialling of investigatory versions of three scales to address this situation: a) the Sunderland Tracheoesophageal Perceptual Scale (SToPS) for professional raters, b) the Naïve Rater Scale for non-specialist raters and c) the Patient and Carer Scale. In the final testing of the pilot version 55 speakers using tracheoesophageal voice were evaluated by twelve Speech and Language Therapists (SLT’s) and ten Ear, Nose and Throat (ENT) surgeons, divided into experienced or not at assessing voice. Ten naïve raters assessed the voice stimuli within a test-retest design. Forty tracheoesophageal speakers and thirty-seven carers attended an interview to rate their own or their relative’s voice. Inter rater agreement was then calculated between SLT, ENT, naïve, patient and carer groups with weighted kappa co-efficients Strength of agreement values (Landis and Koch 1977) were compared to profession and expertise. Expert SLT’s achieved “good” agreement for nine of fourteen parameters. Naïve judges attained “good” levels of inter and intra-rater agreement for the parameters Overall Grade and Social Acceptability. The greatest inter group consensus was for patients and carers, with “good” agreement for Intelligibility, Volume and Wetness. The only other “good” agreement was between naïve/ENT and naïve/ SLT groups for Overall Grade. The scales are ready for clinical use with the proviso that future work will determine whether it is possible to enhance agreement so less experienced judges can achieve “good” levels of agreement for more parameters and examine which perceptual parameters might be more prominent or vital for outcomes for different groups.
3

Signalling interactions between Streptococcus gordonii and Candida albicans

Jack, Alison Alexandra January 2014 (has links)
Streptococcus gordonii is an early bacterial coloniser of the oral cavity and influences development of plaque biofilms. Interactions of Candida albicans, an opportunistic fungal pathogen, with S. gordonii are hypothesised to promote fungal carriage and persistence. Evidence suggests that signalling molecules produced by streptococci, including competence stimulating peptide (eSP) and autoinducer 2 (AI -2L affect C. albicans growth. However, less is understood about the molecular basis of these interactions.
4

Genotoxic effects of orthopaedic wear debris on the bladder

Maclean, Angus D. January 2015 (has links)
Concern over the biological effects of metal wear debris released from metal-on-metal bearing hips is high. Previous studies have suggested high 1evels of meta-I are found in patients' urine and there is an increase in bladder cancer after 10 years. This study investigates whether there is evidence of genotoxicity in patients' bladders after hip resurfacing. -Methods A cohort of 71 patients with metal-on-metal hip resurfacing two years post implant, were compared with a control group of 23 patients with no implant. Levels of cobalt, -chromium, molyb-clenum an-cl nickel were tested in blood and urine. A validated chromosomal test for the detection of bladder cancer (UroVysion) was used to detect chromosomal aneuploidy in patients' urine and buccal mucosa. Genetic mutation in bladder cancer genes p53 and FGFR3 were also screened for. Patients' urothelial cells were screened for appearances-suspicioI:Js -ofcancer. Atris-k -patient-s -wer-e -r-eferr-ed to the urology -se-rvic-es for cystoscopy. Nanoparticle tracking analysis was used to screen for nanoparticles in patients blood and urine. Results levels of cobalt and chromium were significantly raised in hip resurfacing patients' blood and urine, compared to controls. Levels of chromosomal aneuploidy were significantly raised in hip resurfaCing patients' urinary cells and -in their buccal mucosa. Fifteen h-ip resurfacing patients had -c~l/s neemed atypic-al or suspicious of bladder cancer when reviewed by a cytologist. Six of these patients had repeated atypical cytology, and one had a grade 1 transitional cell carcinoma diagnosed on cystoscopy. An additional population of nanoparticles was identified in post-operative urine. Discussion This study raises the concern of a metal induced carcinogenesis that may be occurring in the bladders of patients who have received meta1-on-metal hip resurfacing. The proposed mechanism is thattheur-othelium -is exposed to high levels -of -cobalt and chromium, which induce chromosomal aneuploidy in urothelial cells.
5

Failure of the femoral component of metal-on-metal hip resurfacing arthroplasty

Baker, Richard Paul January 2015 (has links)
Historically, hip resurfacing failed from polyethylene wear and osteolysis. Modern hip resurfacing has seen a recent resurgence in its use with a different metal on metal bearing but higher failure rates than conventional total hip arthroplasty. This MD thesis explores the causes of femoral failure over nine experiments. Vascular foramina of the femoral neck are unlikely to be damaged by preparation of the femoral head for resurfacing. Increased porosity of the cancellous bone of the prepared femoral head is noted when radiographic cysts are present and in larger femoral heads. Cement penetration in the femoral head was independent of its surface porosity. The swirl cementing technique is superior to traditional bolus techniques, but neither is perfect. Temperatures reached during mechanical preparation of the femoral head are sufficient to cause osteonecrosis in one third of cases. Temperatures can be reduced with ice cold saline to safe threshold levels. The pedestal sign is a progressive phenomenon, associated with decreasing function and failure. Pedestal sign classification systems have moderate inter and intra-observer agreement, modification has improved its accuracy. Femoral necks thin over the first five years and then stabilise. Failure from fracture was associated with surgical error - notching and varus stem position and patient related factors (increased BMI). Late failure was associated with obesity. The outcome from revision of resurfacing is similar to revision of a conventional THA. Better patient selection, careful femoral head preparation, reduction of thermal injury and improved cementing technique should improve the outcome of hip resurfacing. Pedestal sign formation predicts failure and its progression is associated with decreased functional outcome.
6

Geneties and the etiology of cleft lip and palate in man

Bear, J. C. January 1972 (has links)
No description available.
7

Determination of femoral head centre during total hip arthroplasty

Diamond, Owen John January 2014 (has links)
Total hip arthroplasty (THA) is a successful operation with predictable results in patients with end-stage hip arthritis. Poor component placement, orientation or sizing on either the acetabular or femoral side increases the risk of a poor outcome. In particular on the femoral side, not restoring offset or introducing a leg length discrepancy are issues that can be avoided with good surgical technique and planning. A Calliper has been used since 1992 in Musgrave Park Hospital, Belfast as a method of intraoperative simple hip navigation to help determine the position of femoral head centre and aid femoral side reconstruction. The Calliper system has certain limitations and so a new system, the Femoral Head Navigation System (FHNS) is being developed. The aim of this thesis was to compare the FHNS to the current Calliper system in terms of the ability to determine the position of femoral head centre during THA. The further subject of this thesis was to research alternative methods and to validate the underlying assumptions made by the proposed method of the FHNS. These included, that femoral head diameter can be measured accurately, that the Head Centre Location Device (HCLD) part of the FHNS is accurate, that the femoral head is grossly spherical, that the posterior femoral head surface is less affected than the superior or anterior surface by osteoarthritis and fmally that the Trochanteric Fossa is a reliable entry point for the proximal femoral axis. The results showed that the mean accuracy in determining the position of femoral head centre for the FHNS (1. 1 mrn, range 0.0 to 3.3 mm) was statistically more accurate than the original Calliper system (4.0mm, range 0.5 to 11.0mm) (p=O.003). These findings along with the results of the validation experiments suggest that the FHNS has a potential role in THA in improving the surgical technique for determining the position of femoral head centre and inserting the femoral component.
8

Assessment of functional improvement in the hemiparetic arm following focal rehabilitation intervention

Ashford, Stephen January 2012 (has links)
The complex nature of upper limb function presents a challenge for rehabilitation following neurological injury. Some patients, with relatively mild injury, have potential to recover useful function such as the ability to use the hand to hold and manipulate objects (active function). Others with more severe injury will continue to have a non-functional upper limb, and may require assistance from another person (or their own non-affected arm) to care for the affected limb (passive function). The aim of this thesis was to develop and evaluate a self-report upper limb measure of active and passive function – the Arm Activity measure (ArmA) for use in focal spasticity management. A systematic review demonstrated that no suitable measure was available, but provided possible items for inclusion in the ArmA. Patient-selected items were also included from goal setting for spasticity intervention. A modified Delphi consultation was undertaken to reduce the number of items, followed by item confirmation with a larger group of clinicians and pilot testing with patients and carers. The resulting twenty-item measure has two sub-scales of ‘active’ and ‘passive’ function. Two inter-linked studies were undertaken, firstly to evaluate the psychometric properties of the ArmA, and secondly to undertake a hypothesis-generating cohort investigation of the course of functional changes following spasticity intervention. Internal consistency evaluated by Cronbach’s alpha was >0.85 for both sub-scales. Kappa coefficients for test-retest reliability were >0.90. Mokken analysis demonstrated unidimensionality for both subscales (Item H >0.5 for all items). Expected convergent and divergent relationships were seen with comparison measures (rho 0.5-0.63). The passive function sub-scale was responsive to change following spasticity intervention. In the cohort study, spasticity initially reduced following intervention and then increased again. Passive function improved and was maintained despite the increase in spasticity. Adequate psychometric properties were demonstrated for the passive function sub-scale although further evaluation is indicated, particularly for the active function sub-scale.
9

Improving the dietary management of orofacial granulomatosis

Campbell, Helen January 2012 (has links)
Orofacial granulomatosis (OFG) is a rare disfiguring inflammatory disease of the lips, face and oral cavity. The cause is unknown but perhaps involves an allergic component. Management includes immunosuppressant medications or a cinnamon and benzoate free diet which has proven benefit in 72% of patients. The diet is challenging, not all patients respond and symptom recurrence is common. Patients identify chocolate as a problem but are often resistant to long term avoidance. Phenolic acids are among the chemical constituents of cinnamon and benzoates and while the cinnamon and benzoate free diet avoids the highest sources, some dietary exposure remains. Atopy rates are high in patients with OFG and a recent study identified a high rate of pollen sensitisation to pollens associated with oral allergy syndrome (OAS). OAS is an allergic disorder manifesting immediate lip swelling readily resolved by dietary avoidance of raw plant foods containing homologous proteins that cross react with these pollens. The aim of this thesis was to improve the dietary management of patients with OFG. A medical notes review (n=207) outlined the clinical presentation and provided insight into differing phenotypes for patients with OFG. A subsequent study developed and implemented a novel diet low in phenolic acids improving symptoms in 5/10 patients; 4/6 had prior treatment with a cinnamon and benzoate free diet. The next project focused on OAS, examining dietary response to avoidance of cross reactive plant foods in patients with associated pollen sensitisation. Only 2/14 patients responded satisfactorily but a high rate of silver birch sensitisation raises questions about the role this might play in OFG. A final study investigated the reintroduction of chocolate in patients with OFG and found that it can be included cautiously in the diet of some patients with white chocolate being less prone to cause reactions than milk and dark chocolate. This thesis has provided further insight into dietary management that can be translated directly into clinical practice for patients with OFG.
10

The influence of facial parameters on orthognathic patient, layperson and clinician perceived attractiveness

Baghaie-Naini, Farhad January 2013 (has links)
Purpose: To undertake an objective and quantitative evaluation of how the variation of facial parameters influences perceived attractiveness. Methods: Part 1 (chapter 3): The craniofacial height of an idealized image was altered from 1/6 to 1/10 of standing height, creating 10 images shown in random order to 89 observers (74 laypeople; 15 clinicians), who ranked the images from most to least attractive. Part 2 (chapters 4-8): Assessing the influence of lower facial parameters on perceived attractiveness. Idealized facial images were created. Specific parameters were incrementally altered, creating a range of images, rated on a Likert scale by 185 observers: pre-treatment orthognathic patients (n=75), laypeople (n=75) and clinicians (n=35). Part 3 (chapter 9): A longitudinal study assessing the effects of orthognathic surgery on perceptions of attractiveness. The images from chapter 8 were rated by 50 orthognathic patients at T1 (pre-treatment) and T2 (6-months following debond). Results: Part 1: A proportion of 1/7.5 was perceived as the most attractive (range: 1/7 to 1/8.5). Images perceived as most unattractive had a proportion of 1/6 and 1/10. Part 2: Chin height: The classical lower facial canon may be used as an ‘ideal’ proportional ratio. Variations within a given range were largely unnoticed, i.e. between 30% chin to lower anterior face height (LAFH) (male and female), up to 40% (males) and 50% (females). Surgery was desired with greater variations in chin height: >50% and <20-23% of LAFH (males), >58% and <20-22% of LAFH (females). Clinician and patient ratings were similar and more critical than laypeople. Mandibular and chin point asymmetry: 10-mm is perceived as significant; at 5-mm and below, it is largely unnoticed. The greater the degree of asymmetry above 10-mm, the greater the desire for correction. Clinician and patient ratings were similar and more critical than laypeople. Lower face convexity: A straight profile is perceived as most attractive and greater degrees of convexity or concavity deemed progressively less attractive. A range of 10° to 12° may be acceptable; beyond these values surgical correction is desired. Patients are most critical, and clinicians are more critical than laypeople. Chin prominence: An ‘ideal’ sagittal position with soft tissue pogonion on or just behind a true vertical line through subnasale may be used. Retrusion or protrusion up to 4-mm is unnoticeable. Surgery is desired for protrusions greater than 6-mm and retrusions greater than 10-mm. The overall direction of aesthetic opinion appears to be the same for all observer groups. Mandibular prominence: Retrusion up to −4 mm or protrusion up to 2-mm was unnoticeable. Surgery was desired from protrusions of greater than 3 mm (patients and laypeople) and 5-mm (clinicians) and retrusions greater than −8 mm. The overall direction of aesthetic opinion was the same for all the observer groups, but patients were more critical than laypeople. Part 3: There was little change in perception between T1 and T2. The process of orthognathic treatment does not appear to have any significant effect on patients’ perceptions of facial profile attractiveness or the limits of mandibular sagittal deviation at which they would desire surgery.

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