Introdução: A técnica cirúrgica ideal para o manejo de pacientes com sequência de Robin (SR) não está estabelecida. Uma das cirurgias mais comumente utilizadas, a distração osteogênica de mandíbula (DOM), ainda é controversa devido aos seus potenciais riscos e à falta de evidências claras de sua eficácia nesta população. Objetivos: Comparar a variação da permeabilidade da via aérea (VA), dos sintomas clínicos e dos parâmetros polissonográficos em crianças com SR submetidas a DOM. Métodos: Neste estudo de antes e depois prospectivo, 38 pacientes com SR foram avaliados pré e pós-DOM. A gravidade dos sintomas foi classificada conforme uma escala de manifestações clínicas da SR. Os pacientes foram submetidos a nasofibrolaringoscopia (NFL), e as imagens foram classificadas de acordo com duas escalas validadas de obstrução de VA por um pesquisador cegado. Os pacientes que não necessitavam de suporte ventilatório foram submetidos à polissonografia. Resultados: A média de idade dos pacientes é de 45 dias. Destes, 15 pacientes (39,5%) com SR isolada, 10 pacientes (26,3%) com SR plus e 13 pacientes (34,2%) com SR sindrômicos. Os sintomas dos pacientes melhoraram significativamente após a DOM, como evidenciado pela diminuição no escore da escala de manifestações clínicas de SR (escore pré-operatório de 2,20 versus escore pós-operatório de 0,81; P < 0,001). As duas escalas endoscópicas também apresentaram uma melhora pós-operatória estatisticamente significativa na obstrução de VA (escala de Yellon: escore pré-operatório de 1,56 versus escore pós-operatório de 0,92; escala de Sousa: escore pré-operatório de 2,19 versus escore pós-operatório de 1,16; P < 0,001 para ambas). Além disso, houve uma variação estatisticamente significativa nos seguintes parâmetros polissonográficos avaliados no pré e pós-operatório: índice de apneia-hipopneia, tempo de sono total, nadir de dessaturação e índice de dessaturação (P < 0,05). Conclusões: A DOM parece ser uma opção cirúrgica eficaz para crianças com SR, como evidenciado pela melhora pós-operatória dos sintomas clínicos, escalas endoscópicas e índices polissonográficos. / Introduction: The optimal surgical technique for the management of patients with Robin Sequence (RS) has not been established. One of the most commonly used surgical techniques, mandibular distraction osteogenesis (MDO), is still controversial because of its potential risks and the lack of clear evidence of its efficacy. Objectives: To assess variations in airway patency, clinical symptoms, and polysomnographic parameters in children with RS who underwent MDO. Methods: In this prospective study, 38 patients with RS were evaluated before and after MDO. Symptom severity was classified using a grading scale for RS clinical manifestations. Patients underwent flexible fiberoptic laryngoscopy, and the images were classified by a blinded examiner using two validated grading scales for airway obstruction. Patients not requiring ventilatory support underwent a polysomnography. Results: Patients’ symptoms significantly improved after MDO, as shown by a decreased score in the grading scale for RS clinical manifestations (preoperative score of 2.20 vs. postoperative score of 0.81; P < 0.001). The two endoscopic grading scales also showed a statistically significant postoperative improvement in airway obstruction (first scale: preoperative score of 1.56 vs. postoperative score of 0.92; second scale: preoperative score of 2.19 vs. postoperative score of 1.16; P < 0.001 for both). Moreover, there was a statistically significant variation in the following polysomnographic parameters evaluated pre- and postoperatively: apnea-hypopnea index, total sleep time, oxygen desaturation nadir, and oxygen desaturation index (P < 0.05). Conclusions: MDO seems to be an effective surgical option for children, as shown by postoperative improvements in clinical symptoms, endoscopic grading scales, and polysomnographic parameters.

abstract: Driver distraction research has a long history spanning nearly 50 years, intensifying in the last decade. The focus has always been on identifying the distractive tasks and measuring the respective harm level. As in-vehicle technology advances, the list of distractive activities grows along with crash risk. Additionally, the distractive activities become more common and complicated, especially with regard to In-Car Interactive System. This work's main focus is on driver distraction caused by the in-car interactive System. There have been many User Interaction Designs (Buttons, Speech, Visual) for Human-Car communication, in the past and currently present. And, all related studies suggest that driver distraction level is still high and there is a need for a better design. Multimodal Interaction is a design approach, which relies on using multiple modes for humans to interact with the car & hence reducing driver distraction by allowing the driver to choose the most suitable mode with minimum distraction. Additionally, combining multiple modes simultaneously provides more natural interaction, which could lead to less distraction. The main goal of MMI is to enable the driver to be more attentive to driving tasks and spend less time fiddling with distractive tasks. Engineering based method is used to measure driver distraction. This method uses metrics like Reaction time, Acceleration, Lane Departure obtained from test cases. / Dissertation/Thesis / presentation / REACTION TIMES / DRIVING DATA RESULTS / Masters Thesis Computer Science 2015

Introdução: A técnica cirúrgica ideal para o manejo de pacientes com sequência de Robin (SR) não está estabelecida. Uma das cirurgias mais comumente utilizadas, a distração osteogênica de mandíbula (DOM), ainda é controversa devido aos seus potenciais riscos e à falta de evidências claras de sua eficácia nesta população. Objetivos: Comparar a variação da permeabilidade da via aérea (VA), dos sintomas clínicos e dos parâmetros polissonográficos em crianças com SR submetidas a DOM. Métodos: Neste estudo de antes e depois prospectivo, 38 pacientes com SR foram avaliados pré e pós-DOM. A gravidade dos sintomas foi classificada conforme uma escala de manifestações clínicas da SR. Os pacientes foram submetidos a nasofibrolaringoscopia (NFL), e as imagens foram classificadas de acordo com duas escalas validadas de obstrução de VA por um pesquisador cegado. Os pacientes que não necessitavam de suporte ventilatório foram submetidos à polissonografia. Resultados: A média de idade dos pacientes é de 45 dias. Destes, 15 pacientes (39,5%) com SR isolada, 10 pacientes (26,3%) com SR plus e 13 pacientes (34,2%) com SR sindrômicos. Os sintomas dos pacientes melhoraram significativamente após a DOM, como evidenciado pela diminuição no escore da escala de manifestações clínicas de SR (escore pré-operatório de 2,20 versus escore pós-operatório de 0,81; P < 0,001). As duas escalas endoscópicas também apresentaram uma melhora pós-operatória estatisticamente significativa na obstrução de VA (escala de Yellon: escore pré-operatório de 1,56 versus escore pós-operatório de 0,92; escala de Sousa: escore pré-operatório de 2,19 versus escore pós-operatório de 1,16; P < 0,001 para ambas). Além disso, houve uma variação estatisticamente significativa nos seguintes parâmetros polissonográficos avaliados no pré e pós-operatório: índice de apneia-hipopneia, tempo de sono total, nadir de dessaturação e índice de dessaturação (P < 0,05). Conclusões: A DOM parece ser uma opção cirúrgica eficaz para crianças com SR, como evidenciado pela melhora pós-operatória dos sintomas clínicos, escalas endoscópicas e índices polissonográficos. / Introduction: The optimal surgical technique for the management of patients with Robin Sequence (RS) has not been established. One of the most commonly used surgical techniques, mandibular distraction osteogenesis (MDO), is still controversial because of its potential risks and the lack of clear evidence of its efficacy. Objectives: To assess variations in airway patency, clinical symptoms, and polysomnographic parameters in children with RS who underwent MDO. Methods: In this prospective study, 38 patients with RS were evaluated before and after MDO. Symptom severity was classified using a grading scale for RS clinical manifestations. Patients underwent flexible fiberoptic laryngoscopy, and the images were classified by a blinded examiner using two validated grading scales for airway obstruction. Patients not requiring ventilatory support underwent a polysomnography. Results: Patients’ symptoms significantly improved after MDO, as shown by a decreased score in the grading scale for RS clinical manifestations (preoperative score of 2.20 vs. postoperative score of 0.81; P < 0.001). The two endoscopic grading scales also showed a statistically significant postoperative improvement in airway obstruction (first scale: preoperative score of 1.56 vs. postoperative score of 0.92; second scale: preoperative score of 2.19 vs. postoperative score of 1.16; P < 0.001 for both). Moreover, there was a statistically significant variation in the following polysomnographic parameters evaluated pre- and postoperatively: apnea-hypopnea index, total sleep time, oxygen desaturation nadir, and oxygen desaturation index (P < 0.05). Conclusions: MDO seems to be an effective surgical option for children, as shown by postoperative improvements in clinical symptoms, endoscopic grading scales, and polysomnographic parameters.

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.

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.

Orientador: Jose Ricardo de Albergaria Barbosa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-03T23:42:34Z (GMT). No. of bitstreams: 1 FreireFilho_FranciscoWagnerVasconcelos_D.pdf: 1185958 bytes, checksum: d471fe34fa012fb2c3725a04c776609d (MD5) Previous issue date: 2004 / Resumo: O objetivo deste trabalho foi comparar dois sistemas de distratores osteogênicos alveolares justa-ósseos de 9mm de abertura máxima de fabricação nacional. Foram analisadas duas marcas comerciais (Grupo I e Grupo II), através das avaliações dimensionais dos distratores e parafusos, da resistência à tração dos distratores e da resistência à flexão e à torção dos parafusos. Na avaliação dimensional foram utilizados dez distratores de cada fabricante e quarenta parafusos, sendo dez de cada tamanho oferecido, 1,3 x 5mm e 1,3 x 7mm do grupo I e 1,5 x 5mm e 1,5 x 7mm do grupo II. Os dados foram submetidos ao teste dos postos assinalados de Wilcoxon para os distratores e o teste de Friedman para os parafusos. No teste de resistência à tração foram utilizados dez distratores de cada marca comercial e os resultados submetidos ao teste t Student. No teste de resistência à flexão foram utilizados quarenta parafusos e aplicados os testes F e de Tukey, ao nível de significância de 5%. No teste de resistência à torção, foram utilizados dez parafusos de cada fabricante, sendo do tipo 1,3 x 5mm do grupo I e 1,5 x 5mm do grupo II e os resultados submetidos ao teste t Student. Os distratores do grupo II apresentaram menor variação das mensurações realizadas, porém não houve diferença estatística entre os parafusos de ambas as marcas. Os distratores do grupo II foram estatisticamente mais resistentes à tração. Os parafusos de 1,5x5mm do grupo II foram os mais resistentes à flexão e à torção / Abstract: The aim of this study was to perform a comparative analysis between two different alveolar distractions devices, of 9mm length, built by manufactured in Brazil. These two different devices were provided by companies (group I and group II). The analysis consisted of a macroscopic assessment from the distraction devices and its screws, followed by a traction resistance of the devices and torsion and bending resistance of the screws. Were used, for macroscopic assessment, ten distraction devices and forty screws, which included ten screws of every length offered by each company. Data was submitted to the Wilcoxon test for devices and Friedman test for screws. Ten distraction devices from each company were used for the traction resistance, and its results were submitted to the Student t test. Forty screws were used for the bending resistance. Values were compared trough F and Tukey test, with 5% significance. For the torsion resistance, ten screws from each company were used. The 1.3 X 5mm screws from group I and the 1.5 X 5mm from group II were chose to realize this test, and its results were submitted to the Student t test. Devices from group II presented less variation of its measurements, but there were not any statistical difference between the screws. Group II devices were tatistically more resistant to traction. Screws 1.5x5mm, produced by group II, were more resistant to bending and to torsion / Doutorado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Doutor em Clínica Odontológica

Bakgrund: Cancer leder till mycket lidande för barnen och de behöver hjälp med att lindra lidandet med hjälp av icke-farmakologiska metoder. Av alla dessa drabbade barn och ungdomar har många besvär av smärta och ångest och det blir psykiskt påfrestande under sjukdomstiden. Syfte: Syftet med studien var att beskriva hur icke-farmakologiska metoder används, för att avleda smärta och ångest hos barn och ungdomar som genomgår cancerrelaterade undersökningar och behandlingar. Metod: Litteraturstudie. Artikelsökning gjordes i databasen PubMed, Cinahl och manuellt. Totalt valdes tio vetenskapliga artiklar. Resultat: Resultatet visade att icke-farmakologiska metoder såsom beröring, hypnos och distraktion i form av lek eller såpbubblor samt musik, minskar smärta och ångest hos barn och ungdomar med cancerdiagnos, som genomgår smärtsamma undersökningar, till exempel benmärgsaspiration, blodprover och andra behandlingar. Slutsats: De icke-farmakologiska metoderna är ett komplement till de farmakologiska medicinerna för att minska smärta och ångest. Det är viktigt att åldersanpassa de icke-farmakologiska metoderna. Omvårdnadspersonalen kan bli mer lyhörd för att använda icke-farmakologiska metoder, gällande smärt- och ångestlindring hos barn med cancerdiagnos. De bör få möjlighet att utveckla sin kunskap och kompetens inom detta område. I sin tur kan det leda till mer trygga barn och ungdomar, och även trygga föräldrar. / Background: Cancer leads to a lot of suffering for the children and they need help to alleviate suffering by means of non-pharmacological methods. Of all these affected children and adolescents, there are many complaints of pain and anxiety and it becomes psychologically stressful during the illness. Purpose: The purpose of the study was to describe how non-pharmacological methods are used to derive pain and anxiety in children and adolescents undergoing cancer-related studies and treatments Method: Literature study. Article search was made in the PubMed, Cinahl database and manually. A total of ten scientific articles were selected. Results: The results showed that non-pharmacological methods such as massage, hypnosis, play or soap bubbles and music distraction reduce pain and anxiety in children with cancer diagnosis undergoing painful investigations, such as bone marrow aspiration, blood samples and other treatments.Conclusion: The non-pharmacological methods complementary to the pharmacological drugs to reduce pain and anxiety. It is important to age-match the non-pharmacological methods. Nursing staff can be more responsive to using non-pharmacological methods, regarding pain and anxiety relief in children with cancer diagnosis. They should be given the opportunity to develop their knowledge and skills in this field. In turn, it can lead to more safe children and young people, and also to safeguard parents.

The 85th percentile off-road glances while performing three tasks on an in-vehicle system while driving in a simulator was investigated. The tasks were a radio task, a telephone task and a sound settings task which were performed at three occasions each. The distribution of 85th percentile off-road glance durations for each subject and task showed that durations differed between individuals rather than between tasks. It also turned out that durations longer than 2.00 seconds were not rare and 2 of 16 subjects had durations longer than 2.00 seconds in the radio task. Even though the distribution showed small differences between tasks on an individual level, differences on a group level were found between the tasks. A tendency of a learning effect was found, which implied a decrease in 85th percentile off-road glance durations as the tasks were performed at several occasions. A tendency of a floor effect in 85th percentile off-road glance durations, when the subjects are familiarized with tasks, was also found. Performance on a computerized trail-making test, measuring ability of visual search, motor speed and mental flexibility, was found not to be related with 85th percentile off-road glance durations.

The main focus for this thesis was cross-modal attention capture by sudden and unexpected sounds and vibrations, known as deviants, presented in a stream the same to-be-ignored stimulus. More specifically, the thesis takes a multisensory perspective and examines the possible similarities and differences in how deviant vibrations and sounds affect visual task performance (Study I), and whether the deviant and standard stimuli have to be presented within the same modality to capture attention away from visual tasks (Study II). Furthermore, by presenting spatial deviants (changing the source of the stimuli from one side of the body to the other) in audiotactile (bimodal), tactile, and auditory to-be-ignored, it explores whether bimodal stimuli are more salient compared to unimodal (Study III). In addition, Study III tested the claims that short-term memory is domain-specific. In line with previous research, Study I found that both auditory and tactile deviants captured attention away from the visual task. However, the temporal dynamics between the two modalities seem to differ. That is, it seems like practice causes the effect of vibratory deviants to reduce, whereas this is not the case for auditory deviants. This suggests that there are central mechanisms (detection of the change) and sensory-specific mechanisms. Study II found that the deviant and standard stimuli must be presented within the same modality. If attention capture by deviants is produced by a mismatch within a neural model predicting upcoming stimuli, the neural model is likely built on stimuli within each modality separately. The results of Study III revealed that spatial and verbal short-term memory are negatively affected by a spatial change in to-be-ignored sequences, but only when the change is within a bimodal sequence. These results can be taken as evidence for a unitary account of short-term memory (verbal and spatial information stored in the same storage) and that bimodal stimuli may be integrated into a unitary percept that make any change in the stream more salient.

Introdução: A técnica cirúrgica ideal para o manejo de pacientes com sequência de Robin (SR) não está estabelecida. Uma das cirurgias mais comumente utilizadas, a distração osteogênica de mandíbula (DOM), ainda é controversa devido aos seus potenciais riscos e à falta de evidências claras de sua eficácia nesta população. Objetivos: Comparar a variação da permeabilidade da via aérea (VA), dos sintomas clínicos e dos parâmetros polissonográficos em crianças com SR submetidas a DOM. Métodos: Neste estudo de antes e depois prospectivo, 38 pacientes com SR foram avaliados pré e pós-DOM. A gravidade dos sintomas foi classificada conforme uma escala de manifestações clínicas da SR. Os pacientes foram submetidos a nasofibrolaringoscopia (NFL), e as imagens foram classificadas de acordo com duas escalas validadas de obstrução de VA por um pesquisador cegado. Os pacientes que não necessitavam de suporte ventilatório foram submetidos à polissonografia. Resultados: A média de idade dos pacientes é de 45 dias. Destes, 15 pacientes (39,5%) com SR isolada, 10 pacientes (26,3%) com SR plus e 13 pacientes (34,2%) com SR sindrômicos. Os sintomas dos pacientes melhoraram significativamente após a DOM, como evidenciado pela diminuição no escore da escala de manifestações clínicas de SR (escore pré-operatório de 2,20 versus escore pós-operatório de 0,81; P < 0,001). As duas escalas endoscópicas também apresentaram uma melhora pós-operatória estatisticamente significativa na obstrução de VA (escala de Yellon: escore pré-operatório de 1,56 versus escore pós-operatório de 0,92; escala de Sousa: escore pré-operatório de 2,19 versus escore pós-operatório de 1,16; P < 0,001 para ambas). Além disso, houve uma variação estatisticamente significativa nos seguintes parâmetros polissonográficos avaliados no pré e pós-operatório: índice de apneia-hipopneia, tempo de sono total, nadir de dessaturação e índice de dessaturação (P < 0,05). Conclusões: A DOM parece ser uma opção cirúrgica eficaz para crianças com SR, como evidenciado pela melhora pós-operatória dos sintomas clínicos, escalas endoscópicas e índices polissonográficos. / Introduction: The optimal surgical technique for the management of patients with Robin Sequence (RS) has not been established. One of the most commonly used surgical techniques, mandibular distraction osteogenesis (MDO), is still controversial because of its potential risks and the lack of clear evidence of its efficacy. Objectives: To assess variations in airway patency, clinical symptoms, and polysomnographic parameters in children with RS who underwent MDO. Methods: In this prospective study, 38 patients with RS were evaluated before and after MDO. Symptom severity was classified using a grading scale for RS clinical manifestations. Patients underwent flexible fiberoptic laryngoscopy, and the images were classified by a blinded examiner using two validated grading scales for airway obstruction. Patients not requiring ventilatory support underwent a polysomnography. Results: Patients’ symptoms significantly improved after MDO, as shown by a decreased score in the grading scale for RS clinical manifestations (preoperative score of 2.20 vs. postoperative score of 0.81; P < 0.001). The two endoscopic grading scales also showed a statistically significant postoperative improvement in airway obstruction (first scale: preoperative score of 1.56 vs. postoperative score of 0.92; second scale: preoperative score of 2.19 vs. postoperative score of 1.16; P < 0.001 for both). Moreover, there was a statistically significant variation in the following polysomnographic parameters evaluated pre- and postoperatively: apnea-hypopnea index, total sleep time, oxygen desaturation nadir, and oxygen desaturation index (P < 0.05). Conclusions: MDO seems to be an effective surgical option for children, as shown by postoperative improvements in clinical symptoms, endoscopic grading scales, and polysomnographic parameters.