Functional MRI was used to detect brain activations in the primary somatosensory cortex (SI) in response to a vibrotactile stimulus applied to the thumb (D1) and little finger (D5) of the right (R) and left (L) hands. Four studies were carried out with healthy subjects in order to determine the scanning and stimulation protocols that resulted in consistent and robust SI activity. It was found that a strong stimulus, compared to a weak stimulus, led to the SI activity being detected more frequently and at a more statistically significant level. Also, extending the scanning duration per digit further increased the T-scores. The SI activations for each digit showed multiple foci and were distributed throughout the SI area. However, a clustering occurred in separate centres for stimulation to RD1 and RD5 near the Brodmann area 1/Brodmann area 3 boundary. The Euclidean separations of the cortical digit representations for LD1-D5 and RD1-D5 were calculated on the basis of the `centre of mass' of the multiple activations. Observed separations ranged between 1.2 mm to 22.8 mm. A further vibrotactile fMRI study was carried out involving patients with complex regional pain syndrome (CRPS). It has been suggested an altered central processing mechanism is involved in the disease, possibly due to cortical reorganisation in the sensory/motor cortices. The most efficient experimental protocols from the healthy subject studies were used to determine if these cortical differences were present in four patients. Data were acquired over two scanning sessions, approximately four months apart. The study revealed multiple SI foci and overlapping between the digits in both the healthy and CRPS hands, similar to those observed in the first studies. Larger SI activations were detected in one patient, smaller SI activations were detected in another patient and two patients demonstrated cluster sizes in the normal range. The cluster sizes and the changes in size between the two scans suggest a correlation with the amount of pain experienced by the patients. A general lack of consistency in the results from all the studies may be attributed to the difficulty of reliably detecting SI activity at a field strength of 1.5 T.

In dieser Arbeit werden CRPS Typ I und Patienten verglichen, die eine Fraktur oder Trauma erlitten, bzw. sich einer Operation unterziehen musste. Der Vergleich untersucht sensorische und psychologische Faktoren beider Populationen. This doctoral thesis compares psychological und QST-Data of CRPS Type I Patients and Patients who suffered under Trauma, Fracture or had to undergo surgery. / We compared the sensory profiles and psychological factors of CRPS Type I patients and patients that had a fracture, surgery or other traumas without developing a CRPS. The main focus was to detect a difference in QST ("quantitative sensory testing") profiles.

Currently, there is a dearth of knowledge regarding pediatric Complex Regional pain syndrome (CRPS), whether it is in regards to its pathophysiological mechanisms, pediatric-specific diagnostic criteria, validated diagnostic tests, conclusive treatment regimens, or validation of invasive and noninvasive treatment protocols in the pediatric CRPS population. It is imperative to first explore and establish a pediatric CRPS diagnostic criteria in order to optimize diagnostic accuracy for clinical and research purposes. This study first examined the efficacy of the Budapest criteria, a validated diagnostic instrument for adult CRPS, in the pediatric population. The test was administered to 221 pediatric patients at the Pediatric Pain Rehabilitation Center (PPRC), an intensive day treatment program at Boston Children’s Hospital for youth with chronic pain, and included both CRPS and non-CRPS chronic pain patients. Utilizing the Budapest criteria, secondary analyses were performed to determine whether the pediatric CRPS patients had an alleviation of their diagnosis from admission to discharge from the program. The Budapest clinical decision rule (to satisfy at least 2 signs categories and 3 symptoms categories) was utilized in examining the data. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the Budapest criteria in the pediatric sample were 0.56, 0.95, 10.39, and 0.47, respectively. The low sensitivity and high specificity was in contrast to the adult findings, and suggests that the Budapest criteria would be appropriate when the primary purpose is to identify stringent research samples as opposed to maximizing clinical diagnoses of CRPS. The likelihood ratios indicated that while satisfying the Budapest clinical decision rule may conclusively increase the probability of the pediatric patient actually having CRPS, a negative test does not significantly decrease the probability of the patient having CRPS. Therefore, modifications that appropriately increase the sensitivity while maintaining the high specificity of the Budapest Criteria are recommended. Repeated measures ANOVA resulted in a significant decrease of the Budapest signs and symptoms score in the 94 pediatric CRPS patients in the sample, both in the Clinician + Budapest (satisfied the Budapest clinical decision rule) and Clinician Diagnosed (did not satisfy the Budapest clinical decision rule) CRPS cohorts (p < 0.001). This further authenticated the use of a multidisciplinary treatment approach in managing pediatric CRPS, as the program was successful in alleviating the patients’ signs and symptoms. Further research must be conducted to explore the improvements that can be made to the Budapest Criteria for its use in pediatric CRPS so as to maximize its diagnostic accuracy. Overall, this study corroborated the use of interdisciplinary treatment regimens for pediatric CRPS, but further rigorous investigation is necessary to elucidate the mechanisms behind pediatric CRPS and the rehabilitation programs’ success in managing CRPS.

Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic pain condition associated with significant alterations in the somatosensory and motor cortex brain regions. Cognitive-affective alterations have recently been recognized in patients suffering with CRPS, however, relatively little neuroimaging research has been done to examine these dimensions. Moreover, many children and adolescents suffer from CRPS, but very little is known about the impact of this condition on brain states in the pediatric population. The aim of this paper is to assess the structural brain differences between children with CRPS and healthy controls and to examine to what degree fear level influences such differences. This study is part of a larger investigation that integrates functional and structural brain differences to evaluate fear-related brain circuitry in patients with CRPS. Thirty-seven patients with CRPS were age and gender matched with 35 healthy controls. The two groups underwent structural magnetic resonance imaging (MRI) scans as well as completed the Fear of Pain Questionnaire, child report (FOPQ). To examine gray matter differences, voxel-based morphometry (VBM) and cortical thickness (CT) analysis was completed. Patients with CRPS in this study had an average age of 13.2 (SD=2.7) and were predominantly female (73%). Of the 35 patients who completed FOPQ, 49% reported clinically significant pain-related fear. Compared with healthy controls, CRPS patients had significantly less in gray matter (GM) volume in pain- and fear-related brain regions, including the dorsolateral prefrontal gyrus, motor and somatosensory cortex, anterior and posterior cingulate cortex, nucleus accumbens, putamen, amygdala, and hippocampus. Furthermore, gray matter decreases in regions such as anterior midcingulate cortex, nucleus accumbens, and putamen were associated with elevated pain-related fear in patients. Differences in gray matter volume in fear-circuitry areas could potentially be one mechanism by which abnormal fear learning and extinction develops in youth suffering with CRPS. Further research examining brain changes post-treatment is needed to determine if treatments that target improving pain and fear levels are associated with concomitant normalization of brain structures.

No description available.

Notre principal objectif est d'améliorer la qualité des prévisions de production d'énergie photovoltaïque (PV). Ces prévisions sont imparfaites à cause des incertitudes météorologiques et de l'imprécision des modèles statistiques convertissant les prévisions météorologiques en prévisions de production d'énergie. Grâce à une ou plusieurs prévisions météorologiques, nous générons de multiples prévisions de production PV et nous construisons une combinaison linéaire de ces prévisions de production. La minimisation du Continuous Ranked Probability Score (CRPS) permet de calibrer statistiquement la combinaison de ces prévisions, et délivre une prévision probabiliste sous la forme d'une fonction de répartition empirique pondérée.Dans ce contexte, nous proposons une étude du biais du CRPS et une étude des propriétés des scores propres pouvant se décomposer en somme de scores pondérés par seuil ou en somme de scores pondérés par quantile. Des techniques d'apprentissage séquentiel sont mises en oeuvre pour réaliser cette minimisation. Ces techniques fournissent des garanties théoriques de robustesse en termes de qualité de prévision, sous des hypothèses minimes. Ces méthodes sont appliquées à la prévision d'ensoleillement et à la prévision de production PV, fondée sur des prévisions météorologiques à haute résolution et sur des ensembles de prévisions classiques. / Our main objective is to improve the quality of photovoltaic power forecasts deriving from weather forecasts. Such forecasts are imperfect due to meteorological uncertainties and statistical modeling inaccuracies in the conversion of weather forecasts to power forecasts. First we gather several weather forecasts, secondly we generate multiple photovoltaic power forecasts, and finally we build linear combinations of the power forecasts. The minimization of the Continuous Ranked Probability Score (CRPS) allows to statistically calibrate the combination of these forecasts, and provides probabilistic forecasts under the form of a weighted empirical distribution function. We investigate the CRPS bias in this context and several properties of scoring rules which can be seen as a sum of quantile-weighted losses or a sum of threshold-weighted losses. The minimization procedure is achieved with online learning techniques. Such techniques come with theoretical guarantees of robustness on the predictive power of the combination of the forecasts. Essentially no assumptions are needed for the theoretical guarantees to hold. The proposed methods are applied to the forecast of solar radiation using satellite data, and the forecast of photovoltaic power based on high-resolution weather forecasts and standard ensembles of forecasts.

Nos travaux de thèse se situent à l’interface entre la recherche fondamentale en neuroscience et ses applications cliniques dans le domaine de la chirurgie réparatrice des membres. Nous nous sommes intéressés au Syndrome Douloureux Régional Complexe de type I caractérisé par l’occurrence d’un état douloureux chronique et d’une perte sévère de mobilité segmentaire. Cette affection, dont l’incidence clinique est élevée, reste à ce jour largement incomprise dans ses mécanismes physiopathologiques et les moyens de traitement disponibles sont d’une efficacité limitée. Dans ce cadre, nous avons d’abord développé une méthodologie de traitement non médicamenteux des deux principaux symptômes de l’algodystrophie que sont la douleur chronique et la mobilité articulaire et validé leur efficacité thérapeutique sur une population de patients.La méthode s’appuie sur les propriétés physiologiques des vibrations mécaniques transcutanées et des vibrations tendineuses qui sont de puissants activateurs des mécanorécepteurs cutanés et proprioceptifs musculaires. L’activation isolée ou conjointe de ces deux canaux sensoriels permet tout à la fois de générer une antalgie puissante et durable et d’améliorer de façon significative la mobilité articulaire. Nous avons ensuite recherché les mécanismes responsables de ces effets. L’utilisation d’un modèle de douleur expérimentale nous a alors permis de montrer que la réduction importante et durable de la douleur générée par les vibrations a une origine à la fois tactile et proprioceptive musculaire, et que ses mécanismes d’action affectent à la fois la transmission médullaire des informations nociceptives et leur traitement central. D’un point de vue théorique nos résultats suggèrent que les afférences proprioceptives cutanées et musculaires contribuent au contrôle des phénomènes douloureux et que les flux afférents proprio-tactile contribuent à la préservation des propriétés fonctionnelles des réseaux centraux responsables de la représentation et de la commande du mouvement. / This thesis tends to deal with both the aspects of neuroscience fundamental research and its possible clinical applications in limbs’ reconstructive surgery. We focused our attention on Complex Regional Pain Syndrome Type I characterized by a chronic pain syndrome associated with a severe loss of segmental mobility. This particular disorder, with a high incidence has been to this day ratherly impenetrable regarding its physiological mechanisms, furthermore available treatments have a limited efficiency.For the matter, we first developed a non-drug therapeutic approach targeting toward algodystrophy two mains symptoms, which are chronic pain and articular mobility loss and monitored its efficiency on a patients’ population.The method is based on the physiological properties of both the tendons vibrations and trancutaneous mechanical vibrations, which are powerful activators of skin’s mechanoreceptors and muscular proprioceptive mechanoreceptors. Isolated or concomitant activation of both those sensorial chanels enables a powerful and lasting analgesic effect along with a significant improvement of the articular mobility.Afterwards, we searched for possible mechanisms behind those outcomes. Using an experimental pain model we were able to show that the significant and lasting reduction of pain endured due to the vibrations comes from afferent messages of tactile and muscular proprioceptive origin, acting both on medullar transmission of the nociceptive inputs and their central processing.From a theoretical perspective, our results suggest that cutaneous and muscular proprioceptive afferences are part of the control process of pain phenomenon and, that afferent proprio-tactile flux contribute to maintaining functional properties of central networks in charge of movement representation and command.

FRP laminates and fabrics, used as an externally bonded reinforcement (EBR) to strengthen or repair concrete members, have proven to be an economical retrofitting method. However, when used to strengthen long-span members or members with limited access, the labor and equipment demands may negate the benefits of using continuous EBR FRP. Recently, CFRP rod panels (CRPs) have been developed and deployed to overcome the aforementioned limitations. Each CRP is made of several small diameter CFRP rods placed at discrete spacing. To fulfill the strengthening length, CRP’s are spliced together and made continuous by means of overlaps (or finger joints). In this doctoral dissertation, the effectiveness of spliced CRPs as flexural strengthening reinforcement for RC members was investigated by experimental, analytical and numerical methods. The experimental research includes laboratory tests on (1) RC beams under four-point bending and (2) double-lap shear concrete specimens. The first set of tests examines the behavior of concrete members strengthened with spliced CRPs. Several beams were fabricated and tested, including: (a) unstrengthened, (b) strengthened with spliced CRPs, (c) strengthened with full-length CRPs, and (d) strengthened with full-length and spliced CFRP laminates. The double-lap shear tests serve to characterize the development length and bond strength of two commonly used CRPs. Several small-scale CRPs, with variable bond lengths, were tested to arrive to an accurate estimation of development length and bond strength. Several other specimens were additionally tested to preliminarily examine the effects of bond width and rod spacing. A 3D nonlinear finite element simulation was utilized to further study the response of CRP strengthened RC beams, by extracting essential data, that couldn’t be measured in the experimental tests. Additionally, analytical tools were added to investigate the behavior of tested bond and beam specimens. The first tool complements the double-lap shear tests, and provides mathematical terms for important characteristics of the CRP/concrete bond interface. The second tool investigates concrete cover separation failure, which was observed in the beam testing, for RC beams strengthened with full-length and spliced CRPs.

Le syndrome douloureux régional complexe (SDRC) est un trouble neurologique qui se caractérise par des douleurs intenses, des troubles vasomoteurs, sudomoteurs, moteurs et trophiques, accompagnés d’un œdème au niveau du membre affecté. Malgré la présence de peu de données en faveur, à cause de l’absence d’un traitement clé du SDRC, le blocage sympathique a été utilisé depuis de nombreuses années pour traiter ce syndrome. Objectif Le but principal de ce projet est d’étudier l’effet antalgique de la néostigmine utilisée comme adjuvant à la bupivacaïne lors d’un bloc stellaire dans le traitement du syndrome douloureux régional complexe du membre supérieur. Méthodes Il s’agit d’une étude pilote, randomisée en double insu. L’intensité de la douleur a été évaluée en utilisant l’échelle numérique. La force de préhension aux deux mains a été estimée par dynamométrie de Jamar. La dextérité fine des doigts a été mesurée par le « Purdue Pegboard Test ». L’œdème au niveau de la main a été déterminé par la volumétrie. Le questionnaire « SF-36 » a été utilisé afin de déterminer l’homogénéité des échantillons. Résultats Notre étude a eu des difficultés à établir l’efficacité de la thérapie par bloc stellaire dans le traitement du syndrome douloureux régional complexe. Conclusion Notre recherche n’a pu prouver l’hypothèse que le traitement de la douleur dans le SDRC du membre supérieur par un bloc stellaire est plus efficace quand l’action de l’anesthésique local est potentialisée par l’ajout de la néostigmine. / Complex regional pain syndrome (CRPS) is a neurological disorder characterized by severe pain, vasomotor, sudomotor, motor and trophic changes, accompanied by a swelling in the affected limb. Despite the limited data on his efficiency, in the absence of a definite curative treatment of the CRPS, sympathetic blocks have been used for years to treat the syndrome. Objective The main purpose of this project was to investigate the analgesic effect of neostigmine used as an adjuvant to the local anaesthetic bupivacaine in stellate ganglion blockade, in treating CRPS of the upper limb. Methods This was a pilot, randomized, double-blind study. The intensity of the pain was evaluated using a numeric scale. Grip strength in both hands was estimated by Jamar dynamometry. Fine finger dexterity was measured by the "Purdue Pegboard Test." The swelling in the hand was determined by volumetry. The questionnaire "SF-36" was used to determine the homogeneity of the samples in terms of quality of life assessment. Results Our study had difficulties in establishing the efficiency of stellate ganglion blockade in the treatment of complex regional pain syndrome. Conclusion This research project has not been able to prove that the pain treatment in upper limb CRPS by means of stellate ganglion blockade is more effective when the action of the local anesthetic is potentiated by the addition of neostigmine.

Made available in DSpace on 2016-04-26T20:25:58Z (GMT). No. of bitstreams: 1 Augusto Grieco.pdf: 807036 bytes, checksum: f5a5f167db0673f493e2cbc84d16a5d8 (MD5) Previous issue date: 2007-10-22 / The present masters degree dissertation has as an objective to establish the real position of the statements of The Council of Social Welfare Recourses ( in Portuguese Conselho de Recursos da Previdência Social CRPS) in the Brazilian law. This essay is justified by the evolution of the access to the courts by the commons users of the Social Security what brings the revival of the administrative process as an instrument of social protection. The focus of this work is the birth of the jurisprudence in social welfare by the processual exercise of the Public Administration. It emphasizes the unicity of the political power and its indivisibility, and the importance of the exercise of the administrative activity, in its jurisprudential guide lines as a basilar element for the State secures its purposes for the social order, such as the welfare and the social justice. This study recognizes the administrative process as a branch of the processual gender as so, one of the fundamental guarantee to the citizen. The core of this study will be the analysis of the instrument of jurisprudential uniformization at service of the Plenary Court of the Council of Social Welfare Recourses (CRPS). This work broaches the subject of the species of jurisprudential uniformization expected by the Internal Rules of the Council of Social Welfare Recourses (CRPS). At last, this essay arises essential conclusions developed during the study, which evidence of rule character of the statements of the Council of Social Welfare Recourses, which get in the Brazilian Law as rules of general and abstract character, as an element that binds all the administrative structure of the social welfare, mainly the Social Security National Institute / A presente dissertação de mestrado tem por finalidade situar os enunciados do Conselho de Recursos da Previdência Social no ordenamento jurídico brasileiro. Justifica-se o presente estudo diante da evolução do acesso à justiça por parte dos beneficiários que impõe um renascimento do processo administrativo como instrumento de proteção social. O trabalho focaliza a formação jurisprudencial administrativa previdenciária pelo exercício da processualidade no âmbito da Administração Pública. Destaca o poder político como uno e indivisível e o exercício da atividade administrativa pela sua linha jurisdicional como elemento fundamental para que o Estado alcance os objetivos traçados para a ordem social, quais sejam, o bem-estar e a justiça sociais. Reconhece o processo administrativo como uma espécie do gênero processo e como garantia fundamental do cidadão. O núcleo do estudo será, por sua vez, a análise do instrumento de uniformização jurisprudencial colocado à disposição do Conselho Pleno do CRPS. Por derradeiro, aborda as espécies de uniformização de jurisprudência previstas no Regimento Interno do CRPS. Ao final, apresentam-se as conclusões essenciais desenvolvidas durante o estudo, que evidenciam o caráter de norma aos enunciados do CRPS, os quais ingressam no ordenamento jurídico na qualidade de norma com caráter geral e abstrato, vinculando toda a estrutura administrativa previdenciária, em especial o Instituto Nacional do Seguro Social