A maioria dos casos de pé torto congênito tratados pelo método de Ponseti requer a secção do tendão calcâneo para correção do equino residual. Evidências clínicas sugerem que há completa cicatrização entre os cotos tendíneos, mas este processo reparativo ainda não foi suficientemente estudado. Esta investigação teve como objetivo avaliar o processo de reparação que ocorre após a secção percutânea do tendão calcâneo para a correção do equino residual no pé torto congênito idiopático tratado pelo método de Ponseti. Por meio de estudo prospectivo, foram analisadas 37 tenotomias em 26 pacientes com pé torto congênito idiopático tratados pelo método de Ponseti, com seguimento mínimo de um ano após a secção. A tenotomia foi realizada percutaneamente com agulha biselada de grosso calibre, sob sedação e anestesia local. O exame ultrassonográfico foi feito logo após a secção tendínea para assegurar que ela tenha sido completa e mensurar o afastamento entre os cotos. A reparação foi estudada por meio da ultrassonografia realizada três semanas, seis meses e um ano após a tenotomia. A ultrassonografia, realizada imediatamente após o procedimento, mostrou que, em alguns casos, feixes tendíneos residuais persistiam entre os cotos, mas foram completamente seccionados, em seguida, sob controle ultrassonográfico. Houve afastamento médio de 5,65 mm ± 2,26 (2,3 a 11,0 mm) entre os cotos tendíneos logo após a secção. Em um caso ocorreu sangramento maior que o habitual, que foi controlado com pressão local e não provocou interferência no tratamento. Após três semanas, a ultrassonografia mostrou regeneração tendínea com preenchimento do espaçamento entre os cotos por tecido hipoecoico com ecotextura irregular e com restituição da continuidade entre os cotos demonstrada dinamicamente pela transmissão de movimentos do músculo tríceps sural para o calcanhar. Seis meses após a tenotomia, o exame ultrassonográfico evidenciou que o tecido de reparação apresentava ecotextura de aspecto fibrilar e, quando comparado ao tendão normal, havia leve ou moderada hipoecogenicidade e espessamento cicatricial. Um ano após a tenotomia, o exame ultrassonográfico mostrou estrutura fibrilar na região de reparação, com ecogenicidade semelhante ao tendão normal, mas ainda apresentando espessamento tendíneo cicatricial. Em termos gerais, ocorreu rápida cicatrização após a secção percutânea do tendão calcâneo, que restabeleceu a continuidade entre os cotos. Ao final do período de observação, o tecido de reparação tendínea apresentou aspecto ultrassonográfico semelhante ao lado normal, exceto por leve espessamento, o que sugere um mecanismo de reparação predominantemente intrínseco. / Most cases of congenital clubfoot treated by the Ponseti technique require percutaneous Achilles tenotomy in order to correct the residual equinus. Clinical evidences suggest that complete healing occurs between the cut tendon stumps, but there have not yet been any detailed studies investigating this reparative process. This study was performed to assess the Achilles tendon repair after percutaneous sectioning to correct the residual equinus of clubfoot treated by the Ponseti method. A prospective study analyzed 37 tenotomies in 26 patients with clubfoot treated by the Ponseti technique, with a minimum follow-up of one year after the section. The tenotomy was performed percutaneously with a large-bore needle bevel with patient sedation and local anesthesia. Ultrasonographic scanning was performed after section to ascertain that the tenotomy had been completed and to measure the stump separation. In the follow-up period, the reparative process was followed ultrasonographically at three weeks, six months and one year post-tenotomy. The ultrasonography performed immediately after the procedure showed that in some cases, residual strands between the tendon ends persisted, and these were completely sectioned under ultrasound control. A mean retraction of 5.65 mm ± 2.26 (range, 2.3 to 11.0 mm) between tendon stumps after section was observed. Unusual bleeding occurred in one case and was controlled by digital pressure, with no interference with the final treatment. After three weeks, ultrasonography showed tendon repair with the tendon gap filled with irregular hypoechoic tissue, and also with transmission of muscle motion to the heel. Six months after tenotomy, there was structural filling with a fibrillar aspect, mild or moderate hypoechogenicity, and tendon scar thickening when compared to a normal tendon. One year after tenotomy, ultrasound showed a fibrillar structure and the echogenicity at the repair site that was similar to a normal tendon, but with persistent mild tendon scarring thickness. It was observed that there was a fast reparative process after Achilles tendon percutaneous sectioning that reestablished continuity between stumps. The reparative tissue evolved to tendon tissue with a normal ultrasonographic appearance except for mild thickening, suggesting a predominantly intrinsic repair mechanism

Orientador: Manoel Barros Bertolo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T00:50:53Z (GMT). No. of bitstreams: 1 Bernardes_CynaraFerreira_M.pdf: 2007451 bytes, checksum: e391b0c846a262e5780f400dd970089f (MD5) Previous issue date: 2013 / Resumo: Objetivos: Avaliar a eficácia do uso das palmilhas em pacientes com Artrite Reumatóide (AR) na redução da dor, melhora da função e redução da média dos picos de pressão plantar. Material e Métodos: Vinte e sete pacientes com AR e dor nos pés foram avaliados em relação à dor, presença de deformidade e calosidades, incapacidade (Heath Assessment Questionnaire - HAQ-DI) e atividade de doença (Clinical Disease Activity Index - CDAI). Palmilhas foram prescritas de acordo com a necessidade de cada sujeito com objetivo de suporte articular e redução de dor. Os pacientes foram submetidos à avaliação pelo Foot Function Index (FFI) e podobarometria (Sistema F-SCAN) com a avaliação da média dos picos de pressão plantar em consulta inicial e após duas semanas de intervenção. Resultados: Houve redução do FFI após a intervenção em todas sub escalas. Os escores iniciais mais elevados do FFI total e suas subescalas de incapacidade (FFI-inc) e limitação da atividade (FFI-la) foram significativamente relacionados aos maiores escores do CDAI e HAQ-DI (p < 0.05). A melhora do FFI foi independente da idade dos sujeitos, tempo de doença, CDAI e HAQ-DI. Não houve redução significativa na média dos picos de pressão plantar após a intervenção, mesmo quando foram avaliados separadamente os pacientes com dor predominante em ante pé e retro pé. As palmilhas foram usadas em média 7,08 horas por dia. Efeitos adversos menores foram observados em sete pacientes, nenhum resultando em interrupção do tratamento. Conclusão: Foi observado redução de dor e incapacidade em indivíduos com AR após o uso de palmilhas, sem redução significativa das médias dos picos de pressão plantar. Os benefícios do uso das órteses em pés reumatóides podem ser multifatoriais, não somente relacionado à melhor distribuição da pressão plantar, mas à melhor acomodação do pé e aumento do estímulo proprioceptivo / Abstract: Objective: To evaluate the efficacy of insoles in Rheumatoid Arthritis (AR) patients reducing pain, improving function and reducing the mean peak plantar pressure. Methods: Twenty-seven rheumatoid patients with foot pain were evaluated regarding foot deformity, disability (Health Assessment Questionnaire - HAQ-DI) and disease activity (Clinical Disease Activity Index - CDAI). Foot orthosis were prescribed according to each patient's needs aiming to provide a better joint support and to reduce pain. The Foot Function Index (FFI) and the mean peak plantar pressure (FSCAN system) were evaluated at baseline and after two weeks of intervention. Results: FFI values decreased in all subscales after intervention. Higher initial disability and activity limitation FFI subscales and FFI total scores were significantly related to higher CDAI and to higher HAQ-DI scores (p < 0.05). FFI improvement was independent from age, disease duration, CDAI and HAQ-DI. No significant reduction in the mean peak plantar pressure was noted, even if evaluating separately the patients with pain mainly on the forefoot or on the hindfoot. Orthosis were worn 7.08 hours-day on average. Minor adverse effects were noted in seven patients, none of them resulting in treatment interruption. Conclusion: Foot orthosis reduces patient's referred foot pain and foot disability with no significant reduction in the mean peak plantar pressure. The benefits of foot orthosis in RA may be multifactorial, not only related to plantar pressure distribution, but also to a better foot accommodation and increased proprioceptive stimulus / Mestrado / Clinica Medica / Mestra em Clínica Médica

Orientador: Arnaldo Yoshiteru Kuaye / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos / Made available in DSpace on 2018-08-04T03:46:50Z (GMT). No. of bitstreams: 1 Walter_EduardoHenriqueMiranda_M.pdf: 405083 bytes, checksum: 97a1adce701599372e089ad7a9d73789 (MD5) Previous issue date: 2005 / Resumo: A composição química da água de coco, com altos teores de açúcares e sais minerais, pode propiciar condições favoráveis ao desenvolvimento microbiano, principalmente das bactérias. O processamento industrial da água de coco virtualmente elimina todos os microrganismos que possam causar algum tipo de doença humana. Entretanto, as características sensoriais da água de coco in natura ou envasada a fresco são consideradas superiores à da bebida pasteurizada ou comercialmente estéril. Além disso, a bebida fresca é mais barata que a industrializada. A segurança dos produtos frescos depende fundamentalmente da prevenção de sua contaminação, associada a uma refrigeração adequada durante o transporte e armazenamento. Os objetivos deste estudo foram os seguintes: i) avaliar a eficácia da imersão em água e a sanitização com hipoclorito de sódio, ácido peracético e vapor superaquecido, na descontaminação da superfície do coco verde, utilizando-se Listeria monocytogenes como microrganismo-teste; ii) desenvolver a flambagem como tratamento de descontaminação da superfície do coco verde; e iii) estudar o comportamento de L. monocytogenes inoculado experimentalmente em água de coco fresca mantida sob diferentes condições de temperatura. Os tratamentos químicos consistiram na imersão dos frutos em água destilada estéril, solução de hipoclorito de sódio (200 mg/L e pH 6,5) e solução de ácido peracético (80 mg/L) por 2 min. Todos os tratamentos químicos diferiram significativamente (a=0,05) entre si, ressaltando-se que a imersão em água, solução de hipoclorito de sódio e solução de ácido peracético reduziram a população inicial de L. monocytogenes em 1,55; 3,84; e 4,47 log UFC/superfície-teste do fruto, respectivamente. No tratamento com vapor superaquecido, a superfície-teste foi exposta ao vapor direto (117 oC) por 7 s, e no tratamento de flambagem à chama direta (1.150 oC), por 3 s. Ambos os tratamentos físicos reduziram mais de 5,69 log UFC de L. monocytogenes/superfície-teste do fruto. Os caldos de enriquecimento de amostras submetidas ao vapor superaquecido turvaram após 24 h de incubação a 35 oC. Nenhum microrganismo foi detectado dos caldos de enriquecimento provenientes das amostras submetidas à flambagem, e incubados por 48 h. Assim, a flambagem foi considerada o tratamento mais eficaz na descontaminação da superfície do coco verde. O desenvolvimento de L. monocytogenes em amostras de água de coco fresca (pH 4,9) submetida a diferentes temperaturas de incubação (4, 10 e 35 oC) também foi analisado. A população média de L. monocytogenes na água de coco experimentalmente inoculada foi de 2,95 log UFC/mL, e as populações máximas alcançadas na fase estacionária das amostras incubadas a 4, 10 e 35 oC foram de até 7,08; 7,72; e 8,32 log UFC/mL, respectivamente. As curvas de crescimento foram ajustadas utilizando-se a equação de Gompertz modificada. Em amostras de água de coco incubadas a 4, 10 e 35 oC, os menores tempos de latência (fase lag) foram de 12,7 dias, 4,2 dias e 3,8 h e os menores tempos de geração, de 2,7 dias, 10,7 h e 49,3 min, respectivamente. Assim, a água de coco é um substrato propício à sobrevivência e desenvolvimento de L. monocytogenes. A refrigeração pode prolongar o tempo de latência de L. monocytogenes em água de coco. Já o abuso de temperatura pode aumentar consideravelmente o nível desse perigo potencial. Os resultados deste trabalho poderão ser aplicados no estabelecimento de Boas Práticas de Fabricação ¿ BPF e de Análise de Perigos e Pontos Críticos de Controle ¿ APPCC tanto da água de coco fresca quanto da bebida processada / Abstract: The chemical composition of coconut water, with high levels of sugars and minerals, may offer favorable conditions for the microbial development, mainly of bacteria. The industrial processing of coconut water virtually eliminates all microorganisms that may cause human illness. However, the sensorial characteristics of in natura or fresh coconut water are considered superior than the pasteurized one or the commercially sterile drink. Moreover, the fresh drink is cheaper than the industrialized one. The fresh produce safety depends primarily on the prevention of its contamination, associated to a strict refrigeration control during transport and storage. The objectives of these study were the following: i) to evaluate the effectiveness of immersion in water and sanitation treatments with sodium hypochlorite, peroxyacetic acid and overheated steam for decontamination of tender coconut surface, using Listeria monocytogenes as a test microorganism; ii) to develop a procedure of fire flame as a decontamination treatment of tender coconut surface; iii) to study the behavior of L. monocytogenes experimentally inoculated in fresh coconut water incubated under different conditions. The chemical treatments consisted in the immersion of the fruits in sterile distilled water, solution of sodium hypochlorite (200 mg/L and pH 6.5) and solution of peroxyacetic acid (80 mg/L) for 2 min. The chemical treatments differed significantly (a=0,05) between itself, and the immersion in water, solution of sodium hypochlorite and solution of peroxyacetic acid caused a reduction of the initial population of L. monocytogenes of 1.55, 3.84, and 4.47 log CFU/test surface of the fruit, respectively. In the fire flame treatment the test surface was exposed to direct flame (1,150 oC) for 3 s and in the overheated steam treatment to direct steam (117 oC) for 7 s. The physical treatments caused a reduction of > 5.69 log CFU/test surface of the fruit. The enrichment broths with samples from overheated steam treatment became turbid after 24h of incubation at 35 oC. No microorganism was detected in the enrichment broths with samples from fire flame treatment, and incubated for 48 h. Thus, the fire flame treatment was considered the most efficient in the decontamination of tender coconut surface. The development of L. monocytogenes in samples of fresh coconut water (pH 4.9) incubated under / Mestrado / Tecnologia de Alimentos / Mestre em Tecnologia de Alimentos

Tissue biopsy and swab culture are the gold standards for diagnosing tissue infection; these tests require significant time, diagnostic costs, and resources. Towards earlier and specific diagnosis of infection, a non-destructive, rapid, and mobile detection device is described to distinguish bacterial species via light scatter spectra from the surface of an infected tissue, reagent-free. Porcine skin and human cadaveric skin models of wound infection were used with a 650 nm LED and an angular photodiode array to detect bacterial infections on the tissue surface, which can easily be translated to a typical CMOS array or smartphone. Tissue samples were inoculated with Escherichia coli, Salmonella Typhimurium, or Staphylococcus aureus and backscatter was collected from 100 degrees to 170 degrees in 10 degrees increments; each bacterial species resulted in unique Mie scatter spectra. Distinct Mie scatter spectra were obtained from epidermis (intact skin model) and dermis (wound model) samples, as well as from porcine and human cadaveric skin samples. Interactions between bacterial colonies and lipid particles within dermis samples generated a characteristic Mie scatter spectrum, while the lipid itself did not contribute to such characteristic spectrum as corroborated with body lotion experiments. The designed angular photodiode array is able to immediately and non-destructively detect tissue bacterial infection and identify the species of infection within three seconds, which could greatly improve point of care diagnostics and antibiotic treatments.

Doctor of Philosophy / Department of Psychology / Laura A. Brannon / Binge drinking is a serious health problem among American college students (Wechsler, Lee, Kuo, & Lee, 2000a). One technique that may reduce binge drinking is compliance. Cialdini (2001) defined compliance as taking an action because it has been requested and described sequential request tactics, including the commitment/consistency-based foot-in-the-door (FITD) tactic, and the reciprocity-based door-in-the-face (DITF) tactic. Cialdini claimed that these tactics yield automatic compliance. The present research investigated Cialdini’s automaticity assumption within the context of reducing binge drinking, by including a neutral or weak message along with the compliance request (consistent with Brannon & Brock, 2001). The main hypothesis was that compliance is not automatic, as demonstrated by differential compliance consistent with message strength. Parallel experiments investigated compliance with requests to reduce one’s drinking behavior (Experiment 1, N=129) or communicate about responsible drinking (Experiment 2, N=122). Participants were randomly assigned to one of six conditions in each experiment. Consistent with the purpose of each experiment, participants indicated whether they would comply with initial requests consistent with FITD and DITF methodology, or were not asked to comply with an initial request (control); read either a neutral or weak message about the importance of moderate alcohol consumption; then responded to the target request (dependent variable) by reporting the likelihood that they would not drink excessively for one week (Experiment 1) or would discuss responsible drinking with someone (Experiment 2). Participants in both experiments completed demographic and alcohol consumption information and a social desirability measure (Strahan & Gerbasi, 1972). Data were submitted to 2(Strength) × 3(Appeal) × 2(Gender) ANCOVAs (drinks per occasion and social desirability were covariates). Experiment 1 revealed a significant Strength × Appeal interaction, with the DITF and FITD appeals eliciting lower compliance rates than the control appeal when accompanied by a weak persuasive message, thereby refuting Cialdini’s automaticity assumption. A significant main effect for appeal in Experiment 2 (DITF yielded lower compliance than FITD or control appeal) did not support Cialdini’s (2001) claim. Correlates of drinking behavior among college students are discussed, as are implications of the present research for compliance theory and reducing binge drinking on American college campuses.

Doctor of Philosophy / Department of Agricultural Economics / Ted C. Schroeder / Concerns regarding management of animal disease and related perceptions about food safety have escalated substantially in recent years. Terrorist attacks of September 2001, discovery of bovine spongiform encephalopathy in a dairy cow in December 2003 in Washington state and subsequent discoveries of BSE infected animals in Texas in 2005 and Alabama in 2006, and recent worldwide outbreaks of highly contagious animal diseases (i.e., Foot-and-Mouth Disease and Avian Influenza A (H5N1)) have made apparent the need for animal traceability in U.S. livestock production and marketing. In addition, animal identification and trace-back systems are rapidly developing throughout the world increasing international trading standards. In recent years, increasing numbers of economic analyses of animal diseases have integrated epidemiological models into economic frameworks. However, there are only a few studies that have used this integrated framework to analyze the effects of animal traceability on highly contagious animal diseases. This study’s goal is to quantify and evaluate the economic impacts of different depths of animal identification/trace-back systems in the event of a hypothetical highly contagious foot-and-mouth disease outbreak that poses a threat to U.S. livestock competitiveness. Specifically, an epidemiological disease spread model is used to evaluate the impact of a foot-and-mouth disease outbreak in southwest Kansas. The information obtained from the disease spread model is then used in conjunction with an economic model to determine the changes in welfare of producers and consumers. Results obtained from the epidemiological model indicate that as the depth of animal identification in cattle is increased, the number of animals destroyed is reduced as are the associated costs. Also, the length of the outbreak is reduced by approximately two weeks. The economic results suggest that as surveillance is increased, decreases in producer and consumer welfare are smaller. Furthermore, as surveillance is increased, decreases in producer and consumer surplus measures can be reduced by approximately 60 percent.

Flatfoot is often asymptomatic but sometimes presents with symptoms, even in children. This thesis aimed to discover if there was a difference between children with and without symptoms, in the hope that this might aid treatment decisions. Firstly, an audit was performed to discover the prevalence and type of symptoms, as well as current treatment protocols. Secondly, 107 volunteers from the general population and 20 patients were assessed in more detail. The participants were divided into groups and ANOVA tests were used to find the significant differences. Pain and parental concern were frequently reported in the audit population. The majority of this population had moderate bilateral flexible flatfoot with an active Windlass mechanism and static heel valgus. Treatment was dependent on department. The symptomatic group displayed reduced passive ankle dorsiflexion indicating tightness of the tendo-Achilles, as well as increased frequency of severe knee hyperextension and knee valgus upon clinical examination. During static stance, three differences were found between symptomatic and asymptomatic groups, two differences between flat feet and neutral feet. During dynamic trials, the symptomatic group showed reduced stride length and percentage time spent in swing. The ground reaction profiles showed differences in early and late stance. Further investigation supported the idea that decreased late stance vertical ground reaction force peak was evidence of instability in the symptomatic group. Four kinematic parameters demonstrated significant differences at foot strike, five at midstance, and seven at foot off. In terms of kinetics, after controlling for relative stride length, four differences were found, but none between the asymptomatic and symptomatic flat feet. Plantar pressure was successfully used to estimate truncated foot length. The flat feet did not display increased peak midfoot pressure; it was actually lower in flat footed groups. Arch Index and Modified Arch Index were successfully used for instantaneous and continuous assessment of foot posture over stance. The differences found between symptomatic and asymptomatic flat feet (particularly at foot off) shed some light upon the potential causes of symptoms.

No description available.

Motivation is recognised as an important factor in the treatment of any patient.1,2 Motivation is also recognised as the cornerstone of occupational therapy.2,3 In recent history there has been an increase in the number of people diagnosed with diabetes and its complications, including diabetic foot complications.4-8 Motivation has been identified as a factor contributing to the treatment outcomes of a person with diabetic foot complications, and an assessment into the level of motivation is recommended.6,9-12 A review of the literature in the field revealed that this assessment of motivation has not been sufficiently investigated. The Model of Creative Ability provides a framework within which to assess motivation and principles with which to treat a client, based on the level of motivation.1-3 The purpose of this study was thus to investigate whether occupational therapy treatment, tailored to the level of motivation, for patients with diabetic foot complications, has more positive treatment outcomes than occupational therapy that is not tailored. An experimental pre-test-post-test-design with an experimental and a control group was used to conduct the research. Change in ulcer size and change in quality of life score were the two dependant variables that were measured both pre- and post-test. Subjects were assessed using the Reintegration to Normal Living Index to obtain a quality of life score. A wound tracing was done to determine the ulcer size, and the Creative Participation Assessment was used to establish the level of motivation and thus tailor the occupational therapy treatment that the subjects received. Subjects in the experimental group then underwent three months of tailored occupational therapy, whereas subjects in the control group continued to receive occupational therapy as usual for the same time period. At the end of the three month treatment period, the subjects were reassessed using the same assessments that were used pre-test. These results were then analysed statistically, to determine if a statistically significant difference occurred between the experimental and control groups with regards to the dependant variables. In spite of the small sample size, the results of the research indicate a positive trend towards occupational therapy treatment that is tailored to a client’s level of motivation. Copyright / Dissertation (MOccTher)--University of Pretoria, 2009. / Occupational Therapy / unrestricted

The Picornaviridae family contains a number of pathogens which are economically important including Poliovirus, Coxsakievirus, Hepatitis A Virus, and Foot-and-Mouth-Disease-Virus. Recently the emergence of novel picornaviruses associated with gastrointestinal, neurological and respiratory diseases in humans has been reported. Although effective vaccines for viruses such as FMDV, PV and HAV have been developed there are currently no antivirals available for the treatment of picornavirus infections. Picornaviruses proteins are classified as: the structural proteins VP1, VP2, VP3 and VP4 which form the subunits of the viral capsid and the replication proteins which function as proteases, RNA-polymerases, primers and membrane binding proteins. Although the host specificity and viral pathogenicity varies across members of the family, the icosahedral capsid is highly conserved. The capsid consists of 60 protomers, each containing a single copy of VP1, VP2 and VP3. A fourth capsid protein, VP4, resides on the internal side of the capsid. Capsid assembly is integral to life-cycle of picornaviruses; however the process is complex and not fully-understood. The overall aim of the study was to broaden the understanding of the evolution and function of the structural proteins across the Picornaviridae family. Firstly a comprehensive analysis of the phylogenetic relationships amongst the individual structural proteins was performed. The functions of the structural proteins were further investigated by an exhaustive motif analysis. A subsequent structural analysis of highly conserved motifs was performed with respect to representative enteroviruses, Foot-and-Mouth-Disease-Virus and Theiler’s Virus. This was supplemented by the in silico prediction of interacting residues within the crystal structures of these protomers. Findings in this study suggest that the capsid proteins may be evolving independently from the replication proteins through possible inter-typic recombination of functional protein regions. Moreover the study predicts that protomer assembly may be facilitated through a network of multiple subunit-subunit interactions. Multiple conserved motifs and principle residues predicted to facilitate capsid subunit-subunit interactions were identified. It was also concluded that motif conservation may support the theory of inter-typic recombination between closely related virus sub-types. As capsid assembly is critical to the viral life-cycle, the principle interacting motifs may serve as novel drug targets for the antiviral treatment of picornavirus infections. Thus the findings in the study may be fundamental to the development of treatments which are more economically feasible or clinically effective than current vaccinations.