Σκοπός της παρούσας μελέτης είναι η εκτίμηση και αξιολόγηση της αποτελεσματικότητας της αντικατάστασης της εξωτερικής οστεοσύνθεσης με ενδομυελικό ήλο, κατά την φάση ωρίμανσης του πώρου μετά από οστική επιμήκυνση. Σε πειραματικό επίπεδο διενεργήθηκε, σε 12 σκελετικά ώριμα θηλυκά πρόβατα τα οποία χωρίσθηκαν σε δύο όμοιες ομάδες (ομάδα Α και ομάδα Β), οστεοτομία κνήμης και σταδιακή επιμήκυνση 2cm με τη χρήση συσκευής Ilizarov και ρυθμό 0,5mm/12ώρο. Στην ομάδα Α, αμέσως μετά το τέλος της επιμήκυνσης, γινόταν αφαίρεση της συσκευής Ilizarov και τοποθέτηση, υπό ακτινοσκοπικό έλεγχο στατικού ενδομυελικού ήλου, χωρίς γλυφανισμό. Στην ομάδα Β (ομάδα ελέγχου), η συσκευή Ilizarov παρέμεινε (κατά την συνήθη τεχνική) έως το τέλος της φάσης ωρίμανσης του πώρου. Η πορεία της ωρίμανσης του πώρου, μελετήθηκε και στις δύο ομάδες, σε συγκεκριμένες χρονικές στιγμές, με ακτινολογικούς ελέγχους, υπερηχογραφήματα, triplex, και ψηφιακή αγγειογραφία. Όλα τα πειραματόζωα θυσιάστηκαν την 70η ημέρα μετά την οστεοτομία και τα οστικά παρασκευάσματα μελετήθηκαν με υπολογιστική αξονική τομογραφία και ιστοπαθολογική ανάλυση . Όλα τα πειραματόζωα της ομάδας Α, ανέχθηκαν επιτυχώς την ενδομυελική ήλωση, και διατήρησαν τον άξονα του σκέλους, ενώ βελτιώθηκε η κινητικότητα και η ποιότητα διαβίωσή τους μετά την αφαίρεση της συσκευής. Σε όλα είχε αναπτυχθεί ώριμος πώρος στο τέλος της φάσης σταθεροποίησης, με έντονη παρουσία στοιχείων οστικής ανακατασκευής (remodeling). Στην ομάδα Β, στο ίδιο χρονικό διάστημα, 5 στα 6 ανέπτυξαν σκληρό δευτερογενή ώριμο πώρο, 3 είχαν διαταραχή στον άξονα του σκέλους, 3 παρουσίασαν επιπολής λοίμωξη στις εισόδους των βελονών ενώ 1 ανέπτυξε εν τω βάθη λοίμωξη. Σε κλινικό επίπεδο, σε 30 ασθενείς (33 περιπτώσεις), η συσκευή εξωτερικής επιμήκυνσης (Ilizarov ή μονόπλευρη) αντικαταστάθηκε σε κάποια χρονική στιγμή κατά την διάρκεια της φάσης σταθεροποίησης μετά το τέλος της οστικής επιμήκυνσης από στατική ενδομυελική ήλωση. Τα κύρια αίτια που οδήγησαν σ’ αυτή την αντικατάσταση ήταν: α) καθυστέρηση πώρωσης στο σημείο οστικής συμπλησίασης (17 ασθενείς), β) γωνιακή παραμόρφωση του πώρου ή κάταγμα (8 ασθενείς), γ) δυσανεξία της συσκευής (5 ασθενείς), σε συνδυασμό ή όχι με καθυστέρηση ωρίμανσης του πώρου επιμήκυνσης. Ο μέσος χρόνος παρακολούθησης των ασθενών ήταν 4 χρόνια (2-13 χρόνια). H συσκευή επιμήκυνσης παρέμεινε κατά μέσο όρο 340 ημέρες (148-630 ημέρες) ή κατά αναλογία με το μέγεθος του οστικού ελλείμματος 38 ημέρες/cm ελλείμματος. Σε έναν ασθενή (3,03%) συνέβη ενδομυελική λοίμωξη μετά την τοποθέτηση του ήλου ενώ σε 5 περιπτώσεις (15,2%) μικρή απώλεια του μήκους του πώρου. Σε μία περίπτωση (3,03%) υπήρξε αποτυχία πώρωσης στο σημείο της οστικής συμπλησίασης. Στους υπόλοιπους ασθενείς επήλθε ολοκλήρωση της ωρίμανσης του πώρου είτε στην περιοχή της επιμήκυνσης είτε στην περιοχή της τελικής συμπλησίασης σε μέσο χρονικό διάστημα 5,9 μηνών. Η δευτερογενής ενδομυελική ήλωση μετά από διατατική οστεογένεση μειώνει τη διάρκεια εφαρμογής της εξωτερικής οστεοσύνθεσης, επιλύει προβλήματα δυσανεξίας στη συσκευή της εξωτερικής οστεοσύνθεσης, ενώ προάγει τη διαδικασία πώρωσης στην περιοχή της τελικής συμπλησίασης και στην περιοχή του επιμηκυνθέντος πώρου επιταχύνοντας την λειτουργική αποκατάσταση του σκέλους. / The purpose of the study is to evaluate the effectiveness of external fixation exchange by intramedullary nailing during consolidation phase following callus distraction phase in distraction osteogenesis. In 12 skeletally mature sheep, divided in two groups (group A and group B), tibial shaft osteotomy and 2cm gradual callus distraction using Ilizarov external fixator was performed. In group A, Ilizarov fixator was removed immediately after lengthening completion and static unreamed intramedullary nail was inserted. In group B (control group), Ilizarov device remained during consolidation phase (according to the usual technique). Formatted callus was studied by radiographs, ultrasonograms, triplex and digital angiograms. All animals were sacrificed 70 days after osteotomy and bone specimens, were evaluated by computed tomograms and histopathologic examination. In group A, all animals successfully tolerated intramedullary nailing attaining limb alignment and formatted mature callus (which had started the remodeling phase), before being sacrificed. In group B, 5/6 formatted mature callus, 3 had serious axis disorder, 3 persistent superficial pin-track infections and 1 deep infection. The method decreases the total duration of external fixation, limits joint stiffness, pin-track infections and axial deformities, and provides protection against re-fracture. We also evaluated the outcome in 30 patients (33 segments) with secondary intramedullary nailing during the consolidation phase after callus distraction using an external device. Docking site nonunion (17 patients), angular deformity or fracture of the lengthened area (8 patients), or intolerance to the external device (5 patients), in combination or not with a delayed distracted callus maturation, were the main reasons for nailing. The average follow-up time was 4 (2-12 years). Intramedullary infection after nailing occurred in 1 case, and slight callus length loss in 5 cases. Failure of union at the docking site with nail breakage occurred in 1 case. In the other patients, consolidation in the lengthened callus area as well as union at the docking site was achieved average 6 months after nailing. Secondary intramedullary nailing during the consolidation phase of distraction osteogenesis is a treatment option for intolerance of the external fixator, delayed callus maturation or docking site nonunion, reducing the prolonged use of the external fixator.

A critical part of traffic safety is a driver’s ability to detect and respond to emergency roadway hazards. This thesis uses eye movements and motor responses to divide driver perception-response time in three stages: perception, inspection, and movement time. The effects of cognitive distraction and repeated exposure on each stage were investigated for three distinct hazards (left-turning vehicle, pedestrian, right-incursion vehicle). In general, there were varying effects of cognitive distraction observed depending on the hazard being responded to. Cognitive distraction resulted in a significant increase in perception times for the pedestrian and right-incursion vehicle hazards, whereas cognitive distraction resulted in significantly longer inspection times for the left-turning vehicle hazard. When considering the effect of repeated scenario exposure, perception times were the most greatly affected. Perception times were significantly shorter during the second exposure to the left-turning vehicle hazard in the baseline condition, and for all hazards in the distraction condition.

A critical part of traffic safety is a driver’s ability to detect and respond to emergency roadway hazards. This thesis uses eye movements and motor responses to divide driver perception-response time in three stages: perception, inspection, and movement time. The effects of cognitive distraction and repeated exposure on each stage were investigated for three distinct hazards (left-turning vehicle, pedestrian, right-incursion vehicle). In general, there were varying effects of cognitive distraction observed depending on the hazard being responded to. Cognitive distraction resulted in a significant increase in perception times for the pedestrian and right-incursion vehicle hazards, whereas cognitive distraction resulted in significantly longer inspection times for the left-turning vehicle hazard. When considering the effect of repeated scenario exposure, perception times were the most greatly affected. Perception times were significantly shorter during the second exposure to the left-turning vehicle hazard in the baseline condition, and for all hazards in the distraction condition.

The objective of this thesis was to determine whether evaluative body image, affective body image, and behavioural body image were predictive of women’s sexual desire, arousal and orgasm. Results are based on self-report and body composition data from 88 women (a subset of a larger data set including men) in heterosexual romantic relationships at the time of data collection. Hierarchical multiple regression indicated that poor evaluative, affective and behavioural body image were detrimental to women’s sexual functioning. Specifically, dissatisfaction with one’s body predicted decrements in desire (β = -.31, p <.05) and arousal (β = -.35, p <.01). Similarly, feeling that others evaluate one’s body negatively, predicted decrements in desire (β = .22, p <.05) and arousal (β = .35, p <.01). Feeling negatively about one’s appearance predicted decrements in arousal (β = .26, p <.05). Negative thoughts and feelings about one’s body that influence sexual behaviours (body image self-consciousness) predicted decrements in arousal (β = -.37, p <.01) and orgasm (β = -.25, p <.05). Implications for public health messages, treatment programs, sexual problem assessments and directions for future research are discussed. / Social Sciences and Humanities Research Council

Distraction osteogenesis (DO) is a surgical procedure in which applied strain stimulates new bone growth; however, the underlying mechanisms by which bone cells respond to load are still uncertain. An organ culture model of DO was developed and validated by using linear distraction on the femoral shafts of 5 day old Wistar rats. Two loading regimes were utilized: distracting the bones for 2 hrs on day 1 (GRP I); distracting the bones for 2 hrs on days 1, 3, and 5 (GRP II). After 1 week in culture, the bones were compared to unloaded contralateral controls and assessed for changes. Structural, dimensional, massing, micro-CT, areal, and viability properties were obtained from testing. Relative to paired controls, distracted bones demonstrated an increase in failure load (9.15% GRP I, 18.85% GRP II), increase in stiffness (31.28% GRP I, 53.21% GRP II), increases in areal and polar moments of inertia, and viability (6.21% GRP I, 13.02% GRP II). Our results suggest that DO can be modeled successfully with an organ culture, and continued use of this system will help to gain insight into the mechanisms and pathways by which distraction osteogenesis occurs.

Bakgrund. Miljön på intensivvårdsavdelningen är fylld av olika stimuli i form av ljud och ljus. Sjuksköterskorna arbetar bedside och täta omvårdnadsåtgärder är nödvändiga för dessa kritiskt sjuka patienter. Denna miljö lämnar en liten möjlighet för sömn och vila. För att patienterna ska få möjlighet till vila under dagtid har vissa intensivvårdsavdelningar lagt in en period med mindre aktivitet, tysta timmen, också kallat patientvila. Målet med patientvilan är att erbjuda patienterna en timme med ostörd vila under dagtid. Syfte. Att undersöka patienternas möjlighet till vila under dagtid genom att observera antal utförda omvårdnadsåtgärder enligt VIPS sökordsmodell. Metod. En icke-deltagande strukturerad observationsstudie utfördes. Observationsprotokoll utformades med VIPS-sökordsmodell. Studien utfördes på två intensivvårdsavdelningar i Mellansverige, IVA 1 och IVA 2. Observationerna utfördes under åtta dagar. Observatörerna registrerade allt som skedde runt patienterna mellan klockan 12.00 – 13.00, då patientvilan ägde rum. Resultat. Totalt observerades 19 patientplatser på IVA 1 och IVA 2. Under de åtta tillfällen som observerades registrerades totalt 158 störningar, 101 av dessa störningar skedde på IVA 2 och 57 störningar skedde på IVA 1. Antalet störningsmoment per patient under patientvilan varierade från en till 18 stycken. På IVA 1 var de vanligaste störningsmomenten läkemedelshantering samt speciell omvårdnad. Miljö fick mest punktmarkeringar på IVA 2. Den enda åtgärden som inte förekom var träning. Totalt 152 störningsmoment utfördes av vårdpersonal. Slutsats. Patienterna blir störda under patientvilan med en mängd olika omvårdnadsåtgärder. Vissa åtgärder är nödvändiga och svåra att undvika, andra åtgärder hade kunnat prioriteras annorlunda. Klinisk betydelse. Att öka medvetenheten hos personalen angående betydelsen av sömn och vila för patienterna på intensivvårdsavdelning. / Background. The environment at the ICU (Intensive Care Unit) is filled with different stimuli of sound and light. Nurses work bedside for the critically ill patients, and frequent nursing interventions are required. This environment gives little possibility for sleep and rest. It is important to make sure that the patients will have the possibility to get sufficient amount of rest during the day. Some ICUs have addressed this by applying less activities during one hour per day, patient resting or quiet time. Purpose. To investigate patients' ability to rest during the day, by observing the number of performed nursing interventions according to the VIPS-model. Method. A non-participating structured observational study was performed. The observation protocol was designed with the VIPS-model. The study was conducted in two ICUs in central Sweden, ICU 1 and ICU 2. The observations were carried out during eight days. Observers registered everything that happened around the patients between the hour of 12:00 to 13:00, when the quiet time took place. Results. A total of 19 patients were observed on ICU 1 and ICU 2. A total of 158 interruptions were observed, 101 of these interruptions occurred in the ICU 2 and 57 interruptions occurred in the ICU 1. The number of interruptions during the quiet time varied from one to 18 distractions. The most common interruptions, for the ICU 1, were medication and special care. The environment was the most common distraction at the ICU 2. The only intervention that didn´t occur was training. A total of 152 distractions were performed by health professionals. Conclusions. The patients are disturbed during quiet time, with a variation of nursing interventions. Some interventions could have been prioritized differently, but other interventions were necessary and difficult to avoid. Relevance to clinical practice. To increase awareness among staff regarding the importance of sleep and rest for patients in ICU.

Inledning: För barn kan sjukhusvistelser och allt vad de innebär av undersökningar och behandlingar ofta uppfattas som hotfulla och obehagliga. Insättning av perifer venkateter och venös provtagning tillhör de ingrepp som barn uppfattar som mest stressfulla och smärtsamma. Det finns i dagsläget gott om evidensbaserade metoder för att lindra barns oro och smärta i samband dessa ingrepp men det är oklart i hur stor utsträckning dessa metoder tillämpas. Syfte: Syftet är att undersöka sjuksköterskans tillvägagångssätt vid venös provtagning och insättning av perifer venkateter. Utgångspunkten för studien är undersöka sjuksköterskans förberedelser av barnet, hur sjuksköterskan arbetar för att främja barnets självbestämmande, användning av distraktioner, farmakologisk smärtlindring samt hur barn och föräldrar bemöts av sjuksköterskan inför och under provtagning eller insättning av perifer venkateter. Metod: Venös provtagning och insättning av perifer venkateter observerades och registrerades efter ett egenutformat observationsschema. Observationerna gjordes på avdelningar och mottagningar på ett barnsjukhus. Resultat: 18 sjuksköterskor observerades i 25 situationer. Observationerna genomfördes på både avdelningar och mottagningar på ett större barnsjukhus. Alla sjuksköterskorna använde sig av distraktioner och hade ett individuellt anpassat bemötande. Alla barn fick någon form av farmakologisk smärtlindring. I 17 av situationerna förberedde sjuksköterskan barnet genom att gå igenom hur proceduren gick till och i 22 situationer fick barnet vara med och bestämma. Slutsats: Slutsatsen är att sjuksköterskor på det barnsjukhus där studien genomfördes arbetar evidensbaserat i sitt tillvägagångssätt vid venös provtagning och insättning av en perifer venkateter. Vidare forskning skulle behövas för att undersöka hur sjuksköterskor på andra vårdinstanser som exempelvis barnspeciallistmottagningar arbetar. / Introduction: For children, hospitalization and all the means of examinations and treatments are often perceived as threatening and unpleasant. Venepunctures and peripheral catheterization belong to the procedures considered the most stressful and painful. There are plenty of evidence-based methods to alleviate children's distress and pain during these procedures, but it is unclear to what extent these methods are applied. Purpose: The purpose of this study is to examine the nurse´s approach to venepuncture and peripheral catheterization. The starting point of this study is to examine the nurse´s preparation of the child, how the nurse encourages the child´s autonomy, using of distractions and pharmacological analgesia and also how the child and its parents are cared for during the procedure. Method: Venepunctures and peripheral catheterization were observed and registered in a observational chart made for this study. The observations were performed at wards and clinics at achildren´s hospital. Results: 25 observations were performed on 18 different nurses. The observations were performed at both wards and clinics at a children´s hospital. All of the nurses used distractions and treated the children individually. All of the children received some form of pharmacological pain relief. In 17 of the situations the nurse explained the procedure to the child beforehand.In 22 of the situations the child was given the opportunity to participate and decide how the procedure was to be executed. Conclusion: The conclusion of this study is that nurses at the Hospitalare working with an evidence-based approach to venepuncture and peripheral catheterization. Further research is required to determine if nurses inother health facilitiesare working evidence-based or not.

In today's fast-paced, hyper-mediated society, the ability to balance accuracy and efficiency is essential. Media literacy educational programs have arisen to meet this need and proliferated in recent years. Although the practice of media literacy is thriving, its underlying mechanisms are poorly understood and evidence of effectiveness is mixed (e.g., Bergsma & Carney, 2008). A social psychological perspective has the potential to illuminate previously overlooked variables and inform research and practice in this growing field. In particular, whereas media literacy efforts typically emphasize thorough processing of media messages, dual-process theories of persuasion (e.g., Eagly & Chaiken, 1993; Petty & Cacioppo, 1986) suggest this is not always realistic. When motivation or ability is compromised, individuals default to a low-effort processing mode, relying on peripheral cues or heuristics rather than carefully evaluating message arguments. In this mode, media messages can persuade unconsciously. Using a dual-process approach, the present research investigated how specific barriers to motivation (perceptions of personal invulnerability) and processing ability (emotion-based advertising, environmental distractions) influence the processes of media literacy. Participants (N = 882) were randomly assigned to 16 conditions in a 2 [vulnerability: demonstrated, control] x 2 [distractions: present, absent] x 2(2) [ad type: informational, emotional; two replicates of each type] between-subjects nested design. The vulnerability manipulation increased distrust in the target ads and reduced their persuasiveness, not through the hypothesized mechanism of heightened perceptions of vulnerability, but mediated by increased counterarguing. Relative to informational ads, emotional ads were judged more persuasive, attractive, similar to personal experience, and elicited greater identification. However, they were also rated less trustworthy than informational ads, suggesting emotional advertising largely bypasses logical decision-making processes. Distraction reduced counterarguing only among those who found the ad relatively unpersuasive. The results of this research highlight the central role of trust in media literacy processes. Although individuals recognize and distrust emotional forms of advertising, they are nonetheless persuaded by such appeals. Given the sophistication of contemporary advertising techniques and the ubiquity of distractions, the present research suggests new approaches to media literacy are needed, specifically tailored to decision-making under these more realistic media-use conditions.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Flexion distraction chiropractic technique (FDCT) is a commonly used manual therapy technique which is purported to address various clinical pain syndromes. However, it lacks the credibility of appropriate evidence-based guidelines. An analysis of the literature would be able to inform the development of guidelines. Objectives: The aim of this systematic review was to determine the evidence to support the use of FDCT in clinical practice. Data sources: A systematic review of PubMed and Summons was conducted, using the following search terms: chiropractic, flexion distraction, protocol and / or technique. Study selection: All electronic or paper, English articles, which possessed the required key indexing terms and represented randomised and non-randomised controlled study designs were included. Data extraction: Blinded review of the articles was conducted by three independent reviewers utilising the PEDro (for randomised controlled trials) and NOS for (non-randomised controlled trials). This allowed the methodological rigour of the article to be ranked. This ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence for FDCT. Data synthesis: 18 review outcomes were aggregated around four clinical categories; two articles each on neck pain, chronic pelvic pain, and physiological outcomes and the remaining twelve on low back pain. There was agreement that the evidence for pelvic pain and physiological function was limited to no evidence and limited respectively. Conflicting evidence existed for neck and low back pain (single and multimodal treatment) with limited and moderate evidence respectively. Conclusion: FDCT is clinically advocated for many conditions. The evidence provided in this review indicates that practitioners should be guarded in their use of FDCT, as the evidence to its widespread use is limited to only those conditions noted in this review. Therefore, further high quality and rigorous studies are required to develop appropriate treatment guidelines for use by practitioners to adequately provide evidence based care in clinical practice.

Bakgrund: Upplevelser från barndomen gällande nålrelaterade procedurer kunde lämna spår efter sig långt upp i vuxen ålder, ja kanske hela livet. Med insikt om detta fenomen borde alla involverade försöka att undvika att negativa minnen dröjde sig kvar efter utfört nålstick. Syfte: Syftet var att beskriva faktorer som påverkade barns reaktioner vid nålrelaterade procedurer. Metod: En litteraturöversikt med kvalitativ ansats grundat på vetenskapliga artiklar gjordes. Resultatet byggde på 10 artiklar som analyserats induktivt med Fribergs fem-stegs modell. Resultat: Barnets reaktion på nålrelaterade procedurer påverkades både av det som sjuk-sköterskan och föräldrarna gjorde. Föräldrarna och sjuksköterskan anpassade sig efter barnets behov när det kom till distraktioner och information. Genom analys av de granskade artik-larna uppstod tre huvudkategorier: barnets handlingar, föräldrarnas påverkan och sjuk-sköterskans påverkan. Slutsats: Distraktionsmetoder var inte alltid något som sjuksköterskan tillämpade, trots att det kunde ha en viss analgetisk funktion. Effekten av distraktionsmetoderna på barnet var vari-erande från gång till gång. Genom att individanpassa information samt ha ett förhållningssätt som var anpassat efter barnet kunde sjuksköterskan och föräldrarna påverka hur barnet kom att hantera situationen. / Background: Experiences from childhood in terms of needle-related procedures could leave traces far into adulthood, perhaps for life. By recognizing this phenomenon should all involved try to avoid negative memories to remain after completed pinprick. Aim: The aim was to describe the factors that influence children's reactions to needle-related procedures. Method: A literature review with qualitative approach based on scientific articles has been made. The result was based on 10 articles that were analyzed inductively by using Fribergs five-stage model. Result: The child's reaction to needle-related procedures was affected by what both the nurse and the parents did. The parents and the nurse adapted to the child's needs when it came to distractions and information. Through analysis of the reviewed articles emerged three main categories: the child's actions, parental influence and the nurse's influence. Conclusion: Distraction methods were not always something that the nurse applied although it may have some analgesic function. The child´s reaction to distraction methods varied. By personalizing information and having an approach adapted to the child, the nurse and the parents could affect how the child would handle the situation.