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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.

Réalisé au sein de l'IRCAM, en cotutelle avec Philippe Leroux. La version intégrale de cette thèse est disponible uniquement pour consultation individuelle à la Bibliothèque de musique de l’Université de Montréal. / « Vers une musique autogérée », est un regard sur mes œuvres des trois dernières années : un quatuor à cordes, un quatuor pour flûte basse, saxophone baryton, percussion et piano, une pièce pour voix de femme et douze musiciens et une pièce pour silent piano et dispositif électronique, qui sera le chapitre le plus exhaustif. Tout au long de cette étude, on examinera les notions qui m’inspirent, les points de départ de chaque pièce ainsi que les moyens employés pour arriver au bout de chaque idée. On parlera du tandem « intuition – processus » et comment il s’exprime chaque fois de façon différente, des réseaux qui se créent dans la musique, on abordera le concept omniprésent de l’incompatibilité et les relations que cela autorise, et on suivra l’évolution progressive de l’écriture vers une musique qui se veut « autogérée », en examinant comment ce terme se manifeste, selon les différents contextes. / « Towards an autoregulated music » is a look on my works of the past three years: a string quartet, a quartet for bass flute, baritone saxophone, percussion and piano, a work for female voice and twelve musicians and a piece for silent piano and real time electronics, the most thorough chapter. Throughout this study, we’ll examine the notions that inspire me, every piece’s starting points and the means applied to take every idea to its full potential. We’ll talk about the tandem « intuition – process » and how it’s expressed every time in a different way, the networks that exist in the music, we’ll approach the ever-present concept of incompatibility and the relations it allows, and we’ll follow the gradual evolution of the writing towards a music that calls itself « autoregulated », considering how this term is expressed, in different contexts.

Several surgically corrective procedures are considered to treat Adult Acquired Flatfoot Deformity (AAFD) patients, relieve pain, and restore function. Procedure selection is based on best practices and surgeon preference. Recent research created patient specific models of Adult Acquired Flatfoot Deformity (AAFD) to explore their predictive capabilities and examine effectiveness of the surgical procedure used to treat the deformity. The models’ behavior was governed solely by patient bodyweight, soft tissue constraints, and joint contact without the assumption of idealized joints. The current work expanded those models to determine if an alternate procedure would be more effective for the individual. These procedures included one hindfoot procedure, the Medializing Calcaneal Osteotomy (MCO), and one of three lateral column procedures: Evans osteotomy, Calcaneocuboid Distraction Arthrodesis (CCDA), Z osteotomy and the combination procedures MCO & Evans osteotomy, MCO & CCDA, and MCO & Z osteotomy all used in combination with a tendon transfer. The combination MCO & Evans and MCO & Z procedures were shown to provide the greatest amount of correction for both forefoot abduction and hindfoot valgus. However, these two procedures significantly increased the joint contact force, specifically at the calcaneocuboid joint, and ground reaction force along the lateral column. With exception to the lateral bands of the plantar fascia and middle spring ligament, the strain present in the plantar fascia, spring, and deltoid ligaments decreased after all procedures. The use of patient specific computational models provided the ability to investigate effects of alternate surgical corrections on restoring biomechanical function in flatfoot patients.

Elevens grundläggande rätt till studiero är lagligt förankrad i Skolverkets regelverk. Den ställer krav på såväl design av infrastruktur i form av ljuddämpande lokaler, som på skolans personal i det dagliga arbetet.  Rektorer, pedagoger och elever bär det betydelsefulla ansvaret att gemensamt skapa en trygg och ostörd studiemiljö. Denna undersökning undersöker klassrumsbuller och dess inverkan på elevens inlärningsförmåga. Syftet med föreliggande examensarbete är att undersöka högstadieelevers prestation under studiero jämfört med prestation under distraktion i form av simulerat ljudbuller. Det ska även studeras om det förekommer signifikanta skillnader mellan pojkar och flickor under de olika ljudförhållandena. Ett ytterligare syfte är att utreda samband mellan elevernas arbetsminneskapacitet och resistens mot distraktion. Resultaten visar att eleverna presterade signifikant sämre under distraktion än under studiero. Det förelåg däremot inga relevanta skillnader mellan pojk- och flickgruppen i prestation. Vidare kunde en positiv korrelation mellan elevernas kognitiva förmåga och resistens mot distraktion fastställas. Elever med högre arbetsminneskapacitet presterade signifikant bättre än elever med låg arbetsminneskapacitet under distraktion i form av klassrumsbuller. / Students´ basic right to a healthy study environment is legally embedded in the regulations of the Swedish National Agency for Education. A peaceful study environment requires both the design of sound-deadening infrastructure as the effort of the school staff in their daily work. Principals, teachers and students share the responsibility to jointly create a safe and uninterrupted study environment. This study investigates classroom noise and its impact on students' learning ability. The aim of this thesis is to examine middle school pupils´ performance in an undisturbed study environment compared to performance during distraction by way of simulated audio noise. A second aim is o study if there are significant differences between boys and girls under the distinct sound conditions. A further aim is to investigate the relationship between students' working memory capacity and their resistance to distraction. The results show that students performed significantly lower under distraction than under undisturbed study conditions. There was, however, no relevant differences in performance between boys and girls. Furthermore, a positive correlation between students' cognitive ability and resistance to distraction was determined. Students with higher working memory capacity performed significantly better compared to students associated with low working memory capacity when distracted by classroom noise.

O presente estudo teve por objetivo avaliar a eficácia de uma intervenção não-farmacológica de distração no alívio de dor aguda em crianças hospitalizadas submetidas a procedimentos dolorosos por demanda clínica, controlando variáveis de estresse e catastrofização de dor. O delineamento do estudo foi um ensaio clínico randomizado cruzado (cross-over). A amostra do estudo foi composta por 40 crianças na fase escolar (6 a 11 anos), que estavam internadas na Enfermaria de Pediatria do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP e que foram submetidas a procedimento de punção venosa ou arterial prescrito por demanda clínica. Os participantes foram randomizados em dois grupos, sendo que todas as crianças receberam a intervenção e foram controles de si mesmas, mas em dois períodos distintos. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do hospital. Inicialmente, avaliações do estresse e catastrofização de dor foram processadas, utilizando-se, respectivamente, a Escala de Estresse Infantil (ESI) e a Escala de Catastrofização de Dor para Crianças (PCS-C), a fim de controlar essas variáveis. Para avaliação da intensidade de dor foram utilizados os seguintes instrumentos: Escala Visual Analógica (VAS) e Escala de Faces Revisada (FPS-R). Na coleta de dados, o Grupo 1 recebeu a intervenção de distração audiovisual antes e durante um procedimento de punção realizado pela enfermeira e, em outro dia um segundo procedimento de punção foi realizado sem intervenção. No Grupo 2, por sua vez, o procedimento ocorreu de forma inversa, sendo primeiramente sem intervenção e posteriormente com intervenção. A intervenção constituiu-se na distração audiovisual com o direcionamento da atenção da criança antes e durante o procedimento doloroso para filmes de curta metragem com temáticas infantis. Após a conclusão dos procedimentos de punção eram aplicadas as duas escalas de dor para avaliar a percepção da intensidade de dor pelas crianças. A análise de variância ANOVA 2 X 2 com comparação entre- e intra-grupos foi processada com a finalidade de atender ao objetivo do estudo. O nível de significância adotado em todas as análises realizadas no presente estudo foi de 5%. Os resultados mostraram que os dois grupos foram semelhantes nas medidas basais de estresse e catastrofização de dor; não houve diferenças estatisticamente significativas nessas variáveis. Verificou-se que houve diferença estatisticamente significativa entre os grupos nos períodos com e sem intervenção da distração; os escores em ambas as escalas FPS-R e VAS mostraram-se menores no período com distração em comparação ao período sem intervenção. Além disso, a sequência de exposição da distração nos grupos e o período em que foi realizada a distração também interferiram significativamente no efeito da intervenção de distração. A análise do efeito carry-over mostrou que aproximadamente 30% dos efeitos estimados no alívio de dor foram atribuídos exclusivamente à intervenção de distração. Em conclusão, a intervenção de distração audiovisual foi eficaz na redução da percepção da intensidade de dor durante o procedimento doloroso agudo em crianças hospitalizadas. A técnica de distração pode ser recomendada como uma estratégia não-farmacológica simples e eficaz para alívio da dor aguda, podendo ser implementada na prática clínica em ambientes de cuidados pediátricos. / The present study was aimed to evaluate the efficacy of a non-pharmacological intervention of distraction for acute pain relief in hospitalized children undergoing painful procedures by clinical demand, controlling variables of stress and pain catastrophizing. The study design was a crossover randomized controlled trial. The sample was composed of 40 children at school age (6-11 years), who was admitted in the pediatric ward of the Hospital of Clinics of Ribeirão Preto Medical School-USP and who underwent venipuncture or arterial puncture prescribed by clinical demand. Participants were randomized into two groups and all children that received the intervention were themselves controls, in two different periods. The study was approved by the Committee of Ethics on Research of the Hospital. Initially, the stress and pain catastrophizing assessments were performed using The Child Stress Scale (CSS) and Pain Catastrophizing Scale for Children (PCS-C), respectively, aiming to control these variables. The instuments used for pain assessment were the following: The Visual Analog Scale (VAS) and The Faces Pain Scale Revised (FPS-R). In the data collection, the Group 1 received the audiovisual distraction intervention before and during the puncture performed by the nurse and in another day a second puncture was performed without intervention. Contrarily, in Group 2 the procedure was first without intervention and subsequently with intervention in another day. The intervention consisted in audiovisual distraction by focusing the child\'s attention before and during the painful procedure to short films about infant thematics. The two pain scales were applied after the puncture procedures to assess the childrens perception of pain intensity. An ANOVA 2 X 2 analyses of variance was performed including between- and within-groups comparisons. The level of significance adopted in all analyzes of the present study was 5%. The results showed that the two groups were similar in the baseline of stress and pain catastrophizing outcomes; there were no significant differences between the groups in these variables. There was a statistically significant difference between groups in the periods with and without distraction intervention; the scores in both scales FPS-R and VAS were lower during distraction compared with the no intervention period. Furthermore, the sequence of exposure of the distraction in the groups and the period that distraction was performed also significantly interfered in the effect of distraction intervention. The analysis of the carry-over effect showed that around 30% of the estimated effects on pain reliefing were attributed to the distraction intervention. In conclusion, the intervention of audiovisual distraction was efficacy in reducing the perception of pain intensity during routine acute painful procedure in hospitalized children. The findings of the present study endorse that distraction is a simple and efficacious non-pharmacological management for acute pain relief, which could be implemented in clinical practice of pediatric care settings.

A expansão craniana com o uso de molas tem demonstrado eficácia no tratamento das anormalidades craniofaciais, tais como as craniossinostoses. A ação expansora exercida pelas molas tem sido observada tanto quando colocadas entre as margens parietais dos ossos do crânio, como quando lateralmente à sutura sagital, principalmente nas escafocefalias. No presente estudo foi criado um modelo experimental com coelhos, e feita uma avaliação descritiva do comportamento da calota craniana e das suturas sob ação de molas. Foram utilizados 13 coelhos Nova Zelândia com quatro semanas de vida, divididos em quatro grupos: grupo I, foram implantados no crânio marcadores de amálgama para controle; no grupo II, marcadores de amálgama e osteotomia da sutura sagital; no grupo III, marcadores de amálgama, osteotomia da sutura sagital e colocação de uma mola expansora na região interparietal e, no grupo IV, marcadores de amálgama, craniotomia parassagital linear com colocação da mola. Os animais foram sacrificados com duas, quatro, oito e doze semanas. Foi realizado controle radiológico com avaliação do afastamento dos marcadores de amálgama, da variação dos ângulos cefalométricos e das medidas da base do crânio, bem como um estudo histopatológico da região de colocação das molas. Nos grupos com o uso de molas a separação dos bordos da craniotomia foi maior do que naqueles sem a utilização de mola. Houve ossificação em todos os grupos, com maior rapidez no grupo II. O crescimento ósseo deu-se a partir dos bordos e da profundidade. Não foram observadas diferenças significativas no padrão histopatológico da regeneração óssea entre os grupos com colocação de mola na região interparietal e parassagital. O modelo experimental com coelhos se mostrou adequado às análises propostas pelo estudo. Concluiu-se que houve osteogênese por distração nos grupos III e IV e que apresentaram uma expansão craniana semelhantes. / Spring-mediated skull expansion has proven to be effective in the treatment of craniofacial abnormalities, such as craniosynostosis. The use of springs in cranial expansion has been studied both in the sagittal and in parasagittal regions, especially in scaphocephaly. A rabbit model was used in the present study to analyze the effects of springs on the cranial vault and sutures. Thirteen 4-week-old New Zealand rabbits were used and divided into 4 groups: group I, amalgam markers were used as control; in group II, amalgam markers and osteotomy of the sagittal suture; in group III, amalgam markers and osteotomy of the sagittal suture with implant of an expansible spring in the interparietal region and in group IV, amalgam markers and linear parasagittal craniectomy with springs. Animals were sacrificed after 2, 4 and 12 weeks. Radiological control with assessment of the amalgam markers, variation of cephalometric angles and cranial base measurements, as well as the histopathological analysis of the spring implant area were carried out. In the groups using springs distraction of the craniectomy borders was greater than in those that did not use springs. Ossification was observed in all of the groups and was faster in group II. Bone growth started from the borders and depth. There were no significant differences in the histopathological pattern of bone regeneration between the groups with spring implant in the interparietal and parasagittal region. The rabbit model proved to be adequate for the analysis proposed by the study. It was concluded that there was osteogenesis caused by distraction in groups III and IV, with similar skull expansion rates.

O presente estudo teve por objetivo avaliar a eficácia de uma intervenção não-farmacológica de distração no alívio de dor aguda em crianças hospitalizadas submetidas a procedimentos dolorosos por demanda clínica, controlando variáveis de estresse e catastrofização de dor. O delineamento do estudo foi um ensaio clínico randomizado cruzado (cross-over). A amostra do estudo foi composta por 40 crianças na fase escolar (6 a 11 anos), que estavam internadas na Enfermaria de Pediatria do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP e que foram submetidas a procedimento de punção venosa ou arterial prescrito por demanda clínica. Os participantes foram randomizados em dois grupos, sendo que todas as crianças receberam a intervenção e foram controles de si mesmas, mas em dois períodos distintos. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do hospital. Inicialmente, avaliações do estresse e catastrofização de dor foram processadas, utilizando-se, respectivamente, a Escala de Estresse Infantil (ESI) e a Escala de Catastrofização de Dor para Crianças (PCS-C), a fim de controlar essas variáveis. Para avaliação da intensidade de dor foram utilizados os seguintes instrumentos: Escala Visual Analógica (VAS) e Escala de Faces Revisada (FPS-R). Na coleta de dados, o Grupo 1 recebeu a intervenção de distração audiovisual antes e durante um procedimento de punção realizado pela enfermeira e, em outro dia um segundo procedimento de punção foi realizado sem intervenção. No Grupo 2, por sua vez, o procedimento ocorreu de forma inversa, sendo primeiramente sem intervenção e posteriormente com intervenção. A intervenção constituiu-se na distração audiovisual com o direcionamento da atenção da criança antes e durante o procedimento doloroso para filmes de curta metragem com temáticas infantis. Após a conclusão dos procedimentos de punção eram aplicadas as duas escalas de dor para avaliar a percepção da intensidade de dor pelas crianças. A análise de variância ANOVA 2 X 2 com comparação entre- e intra-grupos foi processada com a finalidade de atender ao objetivo do estudo. O nível de significância adotado em todas as análises realizadas no presente estudo foi de 5%. Os resultados mostraram que os dois grupos foram semelhantes nas medidas basais de estresse e catastrofização de dor; não houve diferenças estatisticamente significativas nessas variáveis. Verificou-se que houve diferença estatisticamente significativa entre os grupos nos períodos com e sem intervenção da distração; os escores em ambas as escalas FPS-R e VAS mostraram-se menores no período com distração em comparação ao período sem intervenção. Além disso, a sequência de exposição da distração nos grupos e o período em que foi realizada a distração também interferiram significativamente no efeito da intervenção de distração. A análise do efeito carry-over mostrou que aproximadamente 30% dos efeitos estimados no alívio de dor foram atribuídos exclusivamente à intervenção de distração. Em conclusão, a intervenção de distração audiovisual foi eficaz na redução da percepção da intensidade de dor durante o procedimento doloroso agudo em crianças hospitalizadas. A técnica de distração pode ser recomendada como uma estratégia não-farmacológica simples e eficaz para alívio da dor aguda, podendo ser implementada na prática clínica em ambientes de cuidados pediátricos. / The present study was aimed to evaluate the efficacy of a non-pharmacological intervention of distraction for acute pain relief in hospitalized children undergoing painful procedures by clinical demand, controlling variables of stress and pain catastrophizing. The study design was a crossover randomized controlled trial. The sample was composed of 40 children at school age (6-11 years), who was admitted in the pediatric ward of the Hospital of Clinics of Ribeirão Preto Medical School-USP and who underwent venipuncture or arterial puncture prescribed by clinical demand. Participants were randomized into two groups and all children that received the intervention were themselves controls, in two different periods. The study was approved by the Committee of Ethics on Research of the Hospital. Initially, the stress and pain catastrophizing assessments were performed using The Child Stress Scale (CSS) and Pain Catastrophizing Scale for Children (PCS-C), respectively, aiming to control these variables. The instuments used for pain assessment were the following: The Visual Analog Scale (VAS) and The Faces Pain Scale Revised (FPS-R). In the data collection, the Group 1 received the audiovisual distraction intervention before and during the puncture performed by the nurse and in another day a second puncture was performed without intervention. Contrarily, in Group 2 the procedure was first without intervention and subsequently with intervention in another day. The intervention consisted in audiovisual distraction by focusing the child\'s attention before and during the painful procedure to short films about infant thematics. The two pain scales were applied after the puncture procedures to assess the childrens perception of pain intensity. An ANOVA 2 X 2 analyses of variance was performed including between- and within-groups comparisons. The level of significance adopted in all analyzes of the present study was 5%. The results showed that the two groups were similar in the baseline of stress and pain catastrophizing outcomes; there were no significant differences between the groups in these variables. There was a statistically significant difference between groups in the periods with and without distraction intervention; the scores in both scales FPS-R and VAS were lower during distraction compared with the no intervention period. Furthermore, the sequence of exposure of the distraction in the groups and the period that distraction was performed also significantly interfered in the effect of distraction intervention. The analysis of the carry-over effect showed that around 30% of the estimated effects on pain reliefing were attributed to the distraction intervention. In conclusion, the intervention of audiovisual distraction was efficacy in reducing the perception of pain intensity during routine acute painful procedure in hospitalized children. The findings of the present study endorse that distraction is a simple and efficacious non-pharmacological management for acute pain relief, which could be implemented in clinical practice of pediatric care settings.

Relatively few studies have investigated the relationship between early childhood attentional control and later cognitive outcomes, especially language development. The current study is an investigation of the relationship between the executive functioning (EF) component of attentional control and language ability in the second year of life. More specifically, the predictive nature of two aspects of attentional control, attentional focus and resistance to distraction, was be the primary focus of the proposed study. Although it was expected that children both high in attentional focus and resistance to distraction would have significantly superior language development than infants with lower attentional capacities, analyses indicated associations between the postural deviation component of resistance to distraction and language. Attentional focus was also related to infant language ability. Avenues for future research regarding early childhood attentional control, resistance to distraction, and language ability are discussed.

<p>Statistics showing that in-vehicle driver distraction is a major contributing cause in road accidents is presented. Driver distraction is defined building on the driving theory by Gibson and Crooks. The idea to use driver distraction countermeasures as a way of mitigating the effects of the driver distraction problem is then introduced. A requirement list is formulated with ten requirements that distraction countermeasures should meet. A simplification of regarding distraction as a gaze direction problem makes way for designing an experiment to evaluate two driver distraction countermeasures in which new eye- tracking technology plays a key role. The experiment also makes use of a simulator, a surrogate in-vehicle information system as a distractor, and thirty subjects. The most important dependent measures were in-vehicle glance time and a steering wheel reaction time measure. The evaluated countermeasures – a blue flash at middle of the road position and a kinesthetic brake pulse – could, however, not be shown to meet the most important of the requirements formulated. The lack of effect of the countermeasures in the experiment may either depend on their actual inefficiency or on methodological shortcomings of the experiment. These alternatives are discussed. It is speculated that the biggest problems with the possible lack of actual efficiency have to do with that the theoretical basis for using a flash did not transfer to the driving setting, and that the brake pulse used was too weak. The methodological problems have to do with the non-validated dependent measures used, missing data, nuisance warnings, insufficient distractors, non-precise hypotheses, and difficulties with separating the effect of the countermeasures from the psychological force to look on the road.</p>