INTRODUÇÂO: A tireoidite crônica autoimune (TCA) é a principal causa de hipotireoidismo adquirido, o qual requer tratamento contínuo com levotiroxina (LT4). Até o momento, não há terapia capaz de regenerar o tecido tireóideo lesado e melhorar sua função. Como a terapia com Laser de baixa intensidade (LILT) foi eficaz em outras doenças autoimunes, bem como na regeneração de vários tecidos, o objetivo deste estudo foi avaliar a eficácia do Laser de baixa intensidade no tratamento de pacientes com hipotireoidismo decorrente de tireoidite crônica autoimune utilizando-se os seguintes parâmetros de resposta: a) o mapeamento dúplex-Doppler colorido da tireoide; b) a função tireóidea estimada pela dose de LT4 necessária para manter as concentrações séricas de T3 total, T4 total, T4 livre e TSH normais; c) as concentrações séricas de anticorpos antiperoxidase tireóidea (TPOAb) e antitireoglobulina (TgAb). MÉTODOS: Trata-se de ensaio clínico randomizado, placebo-controlado, conduzido no Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de março de 2006 a março de 2009, no qual foram incluídos 43 pacientes com hipotireoidismo causado por TCA. Todos eles apresentavam altas concentrações séricas de TPOAb e/ou TgAb e padrão ultrassonográfico compatível com TCA. Os pacientes foram randomizados em grupo L (submetido à LILT, n = 23) e P (submetido ao placebo, n = 20). Os limites da tireoide foram demarcados com o auxílio da ultrassonografia. Pacientes do grupo L submeteram-se à LILT (830 nm) e os do grupo P à função placebo do mesmo equipamento. Ambos os grupos foram submetidos, no total, à 10 sessões, duas vezes por semana, com a mesma técnica. Realizou-se pré e 30 dias pós-intervenção: o estudo ultrassonográfico (US) pelo modo-B, que incluiu o histograma computadorizado de escala de cinzas para estimar quantitativamente o índice de ecogenicidade; o US-Doppler colorido de amplitude atribuindo-se valores de 0 a 4 para os padrões de vascularização e o US-Doppler pulsado para estimar a velocidade de pico sistólico e o índice de resistividade das artérias tireóideas superiores e inferiores. Após o segundo US, os pacientes descontinuaram a LT4, a qual foi reintroduzida para os pacientes que apresentaram hipotireoidismo, em dose suficiente para obter normalização hormonal. Realizaram-se determinações séricas de T3 total, T4 total, T4 livre, TSH, TPOAb e TgAb pré-intervenção e no 1º, 2º, 3º, 6º e 9º meses pós-suspensão de LT4. RESULTADOS: No US modo-B pós-intervenção, verificou-se aumento estatisticamente significativo do índice de ecogenicidade no grupo L (1,24 ± 0,11) comparado ao P (0,98 ± 0,07; P < 0,001), assim como a proporção de pacientes com volume normal foi estatisticamente maior no grupo L (P = 0,005). O US-Doppler colorido de amplitude mostrou que o valor do padrão de vascularização foi estatisticamente maior no grupo P (2,3 ± 0,27) do que no L (1,87 ± 0,36; P = 0,033). Observou-se redução da dose de LT4 no grupo L (38,59 ± 20,22 g/dia) comparada à do P (106,88 ± 22,9 g/dia; p < 0,001). TPOAb foi menor no grupo L (681,91 ± 317,44 U/mL) do que no P (1176,40 ± 551,9 U/mL; p = 0,043). Não houve redução de TgAb e efeitos adversos. CONCLUSÕES: A LILT foi eficaz no tratamento da TCA, uma vez que no grupo L verificou-se: a) melhora da ecogenicidade, do volume e do padrão de vascularização da glândula tireoide no mapeamento dúplex-Doppler colorido; b) melhora da função da glândula tireoide, evidenciada pela redução da dose de LT4 necessária para tratar o hipotireoidismo c) modulação parcial da autoimunidade, demonstrada por meio da redução das concentrações séricas de TPOAb / INTRODUCTION: A chronic autoimmune thyroiditis (CAT) is the main cause of acquired hypothyroidism which requires continuous treatment with levothyroxine (LT4). So far there has been no such therapy which can make the damaged thyroid tissue regenerate, improving its function. As the low-intensity Laser therapy (LILT) was effective in other autoimmune diseases, as well as in regenerating several tissues, the objective of this study was to evaluate the efficacy of LILT in patients with hypothyroidism caused by CAT by utilizing the following response parameters: A) Color Doppler ultrasonography of thyroid; B) The thyroid function estimated by the dose of LT4 in order to keep the serum concentrations of normal T3, T4, free T4 (fT4) and TSH; C) The serum concentrations of thyroid peroxidase (TPOAb) and thyroglobulin antibodies (TgAb). METHODS: This is a placebo-controlled randomized clinical essay guided at the Institute of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo from March 2006 to March 2009, made up of 43 patients with hypothyroidism caused by CAT. All the patients showed high serum concentrations of TPOAb and/or TgAb and ultrasound pattern compatible with CAT. The patients were randomized in L group (submitted to LILT, n = 23) and P group (submitted to placebo, n = 20). The limits of thyroid were marked off with the help of ultrasonography. The patients in L group were submitted to LILT (830 nm) and the patients in P group were submitted to the placebo function of the same equipment. Both groups were submitted a total of 10 sessions, twice a week, using the same technique. Pre- and 30 days post-intervention were applied: ultrasonographic study (US) by B-mode, which included the grey scale computerized histogram to quantitatively estimate the index of echogenicity; the amplitude color Doppler US with values given from 0 to 4 for the vascularization patterns and the pulsed Doppler US to estimate the systolic peak velocity and the index of resistivity of superior and inferior thyroid arteries. After the second US the patients discontinued the LT4, which was later re-introduced in the patients having hypothyroidism in a certain amount so as to be sufficient to obtain hormonal normalization. Serum determinations of total T3, total T4, fT4, TSH, TPOAb and TgAb pre-intervention were accomplished and also in the 1st, 2nd, 3rd, 6th and 9th month post-suspension of LT4. RESULTS: In post-intervention B-mode US a significant increase in the index of echogenicity in L group (1.24 ± 0.11) was statistically observed compared with the P group (0.98 ± 0.07; P < 0.001), as well as the proportion of patients with normal volume was shown statistically higher in L group (P = 0.005). The amplitude color Doppler US showed the standard value of vascularization was statistically greater in P group (2.3 ± 0.27) than in L group (1.87 ± 0.36; P = 0.033). Pulsed Doppler US showed an increase in the systolic peak velocity of the inferior thyroid arteries in L group (34.47 ± 4.81 cm/s) in relation to P group (26.12 ± 4.29 cm/s; P = 0.016). A reduction in the dose of LT4 in L group (38.59 ± 20.22 g/day) was observed compared with the one in P group (106.88 ± 22.9 g/day; p < 0.001). TPOAb was smaller in L-group (681.91 ± 317.44 U/mL) than in P-group (1176.40 ± 551.9 U/mL; p = 0.043). There was no reduction of TgAb and adverse effects. CONCLUSIONS: LILT was effective in the treatment of CAT, once L group showed: A) amelioration of echogenicity, of volume and of vascularization of the thyroid gland in the color Doppler ultrasonography; B) improvement of thyroid function, featured through the reduction in the necessary dose of LT4 to treat the hypothyroidism; C) partial modulation of autoimmunity demonstrated by reduction of TPOAb serum concentrations

Although healthy relationship initiatives are becoming more common, relatively little is known about the processes and outcomes of these initiatives. This study uses a phenomenological qualitative approach to examine the experiences of Family and Consumer Science (FCS) extension agents in the implementation of couple and relationship education in the Utah Healthy Relationship Initiative. Data were collected through quarterly report forms submitted by extension agents describing successes and barriers to their work. Successes in the project related to collaborative partnerships, attendance/participation, and positive outcomes for participants. Collaborative partnerships were instrumental in reaching more participants and finding cultural resources. The challenges that agents reported included constraints for participants and agents' difficulties with resources. The findings underscore the benefits of creating flexible, low-intensity, and low-cost activities that attract participants and reduce some of the barriers to participation, as well as teaming up with community organizations to implement couple and relationship education programs.

A técnica de laserterapia é um método não invasivo utilizado por diversas áreas da saúde, e tem se mostrado eficaz no tratamento da diminuição da sensibilidade a dor. O presente estudo visa elucidar os efeitos desta terapia nas alterações moleculares induzida pela constrição crônica (CCI) do nervo isquiático de ratos. Esta técnica é aplicada em dias intercalados e tem a duração de 10 sessões. Ao finalizarmos o tratamento com laserterapia os animais foram eutanasiados e os gânglios das raízes posteriores (DRG L4L6) e o nervo isquiático foram retirados para posterior análise. Os DRGs foram processados para detecção da Substância P (SP) e do receptor de potencial transitório vanilóide tipo I (TRPV1). Ainda submetemos o nervo isquiático para a detecção do fator de crescimento neural (NGF) e proteína zero (P0). Nossos resultados demonstraram uma reversão da hipernocicepção dos animais tratados com LASER. Ainda, observamos um aumento da expressão de SP e TRPV1 nos animais com lesão e uma diminuição após o tratamento com LASER. Com relação aos ensaios referente ao nervo isquiático, podemos observar que houve um aumento da densidade óptica para o NGF e para a P0 após tratamento. Esses resultados podem ser observados de modo qualitativo por meio da técnica de imunohistoquímica de fluorescência. Nossos resultados em conjunto, demonstram a eficácia da laserterapia para reversão da hipernocicepção dos animais com lesão. Ainda, esta técnica é capaz de modular liberação de mediadores que participação do processo álgico, além de induzir a regeneração do nervo isquiático. / The laser therapy technique is a noninvasive method used by several health areas, and has been shown to be effective in treat pain sensitivity. The present study aims to elucidate the effects of this therapy on molecular changes induced by chronic constriction (CCI) in rats. This technique was applied every other day, during 10 sessions. At the end of treatment, the animals were euthanized and the posterior root ganglia (DRG L4-L6) and sciatic nerve were removed for further analysis. The DRG\'s were processed for the detection of Substance P (SP) and transient potential receptor type I (TRPV1). In addition, we submit the sciatic nerve for the detection of neural growth factor (NGF) and zero protein (P0). Our results demonstrated a reversal of hypernociception in animals treated with LASER. Furthermore, we observed an increase in SP and TRPV1 expression in animals with lesion and a decrease after LASER treatment. With respect to the tests referring to the sciatic nerve, we could observe that there was an increase in the optical density for NGF and P0 after treatment. These results can be observed qualitatively by fluorescence immunohistochemistry. Our results together demonstrate the efficacy of laser therapy for the reversal of hypernociception of animals with lesions. Furthermore, this technique is able to modulate the release of mediators that participate in the algic process; in addition, this technique is also able to induce regeneration of sciatic nerve in rats.

Problem Investigated. This dissertation is a study of the political effects of low-intensity warfare in Indonesia since 1945. In particular, it examines the interaction between general principles and contextual variables in guerrilla conflict, to determine whether such conflict causes the diffusion of political power. Analysis of insurgent movements indicates that power structures within a guerrilla group tend to be regionalised, diffuse and based on multiple centres of roughly equal authority. Conversely, studies of counter-insurgency (COIN) techniques indicate that successful COIN depends on effective political control over the local population. This tends to be exercised by regional or local military commanders rather than by central authority. Based on this, the author???s initial analysis indicated that one should expect to see a diffusion of political authority from central leaders (whether civilian or military) to regional military leaders, when a society is engaged in the conduct of either COIN or guerrilla warfare. The problem investigated in this dissertation can therefore be stated thus: To what extent, at which levels of analysis and subject to what influencing factors does low-intensity warfare in Indonesia between 1945 and 1999 demonstrate a political power-diffusion effect? Procedures Followed. The procedure followed was a diachronic, qualitative, fieldwork-based analysis of two principle case studies: the Darul Islam insurgency in West Java 1948-1962 and the campaign in East Timor 1974-1999. Principle research tools were: ??? Semi-structured, formal, informal and group interviews. ??? Analysis of official and private archives in Australia, Indonesia, the Netherlands and the UK. ??? Participant observation using anthropological fieldwork techniques. ??? Geographical analysis using transects, basemapping and overhead imagery. ??? Demographic analysis using historical data, cartographic records and surveys. Research was conducted in Australia, Indonesia (Jakarta and Bandung), the Netherlands (The Hague and Amsterdam) and the United Kingdom (London, Winchester, Salisbury and Warminster). Fieldwork was conducted over three periods in West Java (1994, 1995 and 1996) and one period in East Timor (1999-2000). General Results Obtained. The two principal case studies were the Darul Islam insurgency in West Java 1948-62 and the campaign in East Timor since 1974. The fieldwork data showed that low-intensity warfare in Indonesia between 1945 and 1999 did indeed demonstrate the political power-diffusion effect posited by the author. This effect was triggered by the outbreak of guerrilla warfare, which itself flowed from crises generated by processes of modernisation and change within Indonesian society from traditional hierarchies to modern forms of social organisation. These crises were also affected by events at the systemic and regional levels of analysis ??? the invasion of the Netherlands East Indies by Japan, the Cold War, the Asian financial crisis and increasing economic and media globalisation. They resulted in a breakdown or weakening of formal power structures, allowing informal power structures to dominate. This in turn allowed local elites with economic, social or religious influence and with coercive power over the population, to develop political and military power at the local level while being subject to little control from higher levels. This process, then, represented a power diffusion from central and civilian leadership levels to local leaders with coercive means ??? most often military or insurgent leaders. Having been triggered by guerrilla operations, however, the direction and process by which such power diffusion operated was heavily influenced by contextual variables, of which the most important were geographical factors, political culture, traditional authority structures and the interaction of external variables at different levels of analysis. Topographical isolation, poor infrastructure, severe terrain, scattered population groupings and strong influence by traditional hierarchies tend to accelerate and exacerbate the loss of central control. Conversely good infrastructure, large population centres, good communications and a high degree of influence by nation-state and systemic levels of analysis ??? particularly through economic and governmental institutionalisation ??? tend to slow such diffusion. Moreover, while power may be diffusing at one level of analysis (e.g. nation-state) it may be centralising at another (e.g. into the hands of military leaders at local level). Analysis of the Malayan Emergency indicates that, in a comparable non-Indonesian historical example, the same general tendency to political power diffusion was evident and that the same broad contextual variables mediated it. However, it would be premature to conclude that the process observed in Indonesia is generally applicable. The nature and relative importance of contextual factors is likely to vary between examples and hence additional research on non-Indonesian examples would be necessary before such a conclusion could be drawn. Further research on a current instance of guerrilla operations in Indonesia is also essential before the broader contemporary applicability of these findings can be reliably demonstrated. Major Conclusions Reached. Based on the above, the theses developed to answer the initial problem can be stated thus: The command and control (C2) structures inherent in traditional, dispersed rural guerrilla movements that lack access to mass media or electronic communications tend to lessen the degree of control by central (military or political) leaders over regional leaders. If COIN or Internal Security Operations are conducted, two factors will operate. First, there will be an increase in the degree of control over the civil population by local military leaders, at the expense of local or central political leaders. Second, where military command structures are pyramidal or segmentary, there will be an increase in control by local commanders at the expense of central military leaders. Where the central government is civilian or has interests divergent from the military???s, the first of these factors will dominate. Where the government is military or has interests largely identical to those of the military, the second factor will be dominant. The process of power diffusion can thus be summarised as follows: A crisis driven by processes of societal change or by external causes, leads to the outbreak of violence, one facet of which may include guerrilla operations. If guerrilla operations do occur, the C2 structures inherent in such operations give a high degree of autonomy and independence to local military leaders. The same (or a contemporaneous) crisis produces a breakdown of formal power structures, causing organisations to fall back upon informal power structures. The nature of these informal power structures is determined by geography, political culture, patterns of traditional authority within the society and the degree of interaction of systemic/regional factors with local events. Thus the guerrilla operations and the concomitant breakdown in formal power structures form the trigger for political power diffusion. The precise nature and progress of this diffusion is then determined by contextual variables.

Med fokus på Sveriges insats i Afghanistan som är en asymmetrisk konflikt där konventionella stridskrafter möter en motståndare som består av talibaner och kriminella med medel och metoder som skiljer sig från en reguljär motståndare. Problemet som kan uppstå är att motståndaren gömmer sig bland civila och förmågan till precisionsbekämpning av mål samt informationsinhämtning för att identifiera motståndare från civila blir viktigt. Syftet med uppsatsen är att se hur funktionen nyttjas i Sverige av erfarna truppförare och trupputbildare som har stor erfarenhet av prickskyttefunktionen för att sedan jämföra med insatsen i Afghanistan, FS19, och försöka se möjligheter till utveckling av funktionen vid internationell insats. Metoden kommer vara en jämförande fallstudie av prickskyttefunktionen i Sverige och Afghanistan. Med inriktning mot fyra ämnesområden (psykologisk effekt, risker, funktion och organisation) kommer en enkät att besvaras av chefer från FS19 och Arméns Jägarbataljon. Resultatet från studien är att prickskyttefunktionen nyttjades väldigt sällan på FS19. Den främsta orsaken till att den inte nyttjades var de ökade riskerna detta medförde samt att cheferna på FS19 föredrog att nyttja dem som skarpskyttar. Slutsatserna efter genomförd undersökning är att för att prickskytten skall nyttjas enligt definitionen måste befattning utvecklas i utlandsstyrkan och befattning måste övas, både för att öva prickskytten själv men också för att chef ska få förtroende för skytten och vilken effekt denne kan uppnå. Vidare måste förmågan till Personnel Recovery öka vilket ger cheferna större möjlighet att nyttja funktionen, förutsatt att befattning är övad och anses duglig. / The essay was written by Claes Christensson, during his sixth and final semester atKarlbergMilitaryAcademy. The essay is an exam in the final course at theNationalDefenceCollege basic officers program. Before entering the program, Christensson served fifteen months conscription in Arvidsjaur at the Army Ranger Battalion (ARB). Christensson was a sniper squad leader and is himself also a trained sniper. Today the Swedish Armed Forces (SAF) takes part in different conflicts around the world. This essay focuses on the SAF contribution to the asymmetric conflict currently taking place inAfghanistan. In today’s conflicts where insurgents cannot fight using conventional warfare, other means and methods are instead used. A problem for COIN forces is the fact that insurgents hide among the civilian populace. A sniper can however, with high precision, both destroy enemy personnel or locate and distinguish insurgents from civilians. The purpose of this essay is to determine how snipers are being used by highly experienced officers when training at the ARB. These experiences will then be compared to how snipers are being utilised in the Swedish contribution to ISAF (called FS19) at the Provincial Reconstruction Team (PRT) in Mazar-i-Sharif in northernAfghanistanbetween April and October 2010. The method of this essay will be a comparison between the ARB and FS19. Commanders will be subjected to a questionnaire and answer a number of questions, based upon four subjects. The subjects are psychological effect, risks, function and organisation linked to the sniper concept. The result of this essay shows that snipers were not nearly as often being used during FS19 than during exercises at ARB. The apparent reason for this was the increased risk and that commanders from FS19 preferably used them as sharpshooters. Soldiers with sniper rifles were being used to destroy enemy personnel with high precision and to determine civilians from enemy personnel. The conclusions are that if snipers are to be used in the proper fashion, the dedicated posting needs to be implemented in the SAF contribution to ISAF. Moreover, both snipers and commanders need to train applicably to get the full understanding of the effects a sniper can have and to gain confidence in the sniper as a concept. Furthermore, the Personnel Recovery ability needs to improve so that commanders can utilise the sniper concept in high risk operations.

Problem Investigated. This dissertation is a study of the political effects of low-intensity warfare in Indonesia since 1945. In particular, it examines the interaction between general principles and contextual variables in guerrilla conflict, to determine whether such conflict causes the diffusion of political power. Analysis of insurgent movements indicates that power structures within a guerrilla group tend to be regionalised, diffuse and based on multiple centres of roughly equal authority. Conversely, studies of counter-insurgency (COIN) techniques indicate that successful COIN depends on effective political control over the local population. This tends to be exercised by regional or local military commanders rather than by central authority. Based on this, the author???s initial analysis indicated that one should expect to see a diffusion of political authority from central leaders (whether civilian or military) to regional military leaders, when a society is engaged in the conduct of either COIN or guerrilla warfare. The problem investigated in this dissertation can therefore be stated thus: To what extent, at which levels of analysis and subject to what influencing factors does low-intensity warfare in Indonesia between 1945 and 1999 demonstrate a political power-diffusion effect? Procedures Followed. The procedure followed was a diachronic, qualitative, fieldwork-based analysis of two principle case studies: the Darul Islam insurgency in West Java 1948-1962 and the campaign in East Timor 1974-1999. Principle research tools were: ??? Semi-structured, formal, informal and group interviews. ??? Analysis of official and private archives in Australia, Indonesia, the Netherlands and the UK. ??? Participant observation using anthropological fieldwork techniques. ??? Geographical analysis using transects, basemapping and overhead imagery. ??? Demographic analysis using historical data, cartographic records and surveys. Research was conducted in Australia, Indonesia (Jakarta and Bandung), the Netherlands (The Hague and Amsterdam) and the United Kingdom (London, Winchester, Salisbury and Warminster). Fieldwork was conducted over three periods in West Java (1994, 1995 and 1996) and one period in East Timor (1999-2000). General Results Obtained. The two principal case studies were the Darul Islam insurgency in West Java 1948-62 and the campaign in East Timor since 1974. The fieldwork data showed that low-intensity warfare in Indonesia between 1945 and 1999 did indeed demonstrate the political power-diffusion effect posited by the author. This effect was triggered by the outbreak of guerrilla warfare, which itself flowed from crises generated by processes of modernisation and change within Indonesian society from traditional hierarchies to modern forms of social organisation. These crises were also affected by events at the systemic and regional levels of analysis ??? the invasion of the Netherlands East Indies by Japan, the Cold War, the Asian financial crisis and increasing economic and media globalisation. They resulted in a breakdown or weakening of formal power structures, allowing informal power structures to dominate. This in turn allowed local elites with economic, social or religious influence and with coercive power over the population, to develop political and military power at the local level while being subject to little control from higher levels. This process, then, represented a power diffusion from central and civilian leadership levels to local leaders with coercive means ??? most often military or insurgent leaders. Having been triggered by guerrilla operations, however, the direction and process by which such power diffusion operated was heavily influenced by contextual variables, of which the most important were geographical factors, political culture, traditional authority structures and the interaction of external variables at different levels of analysis. Topographical isolation, poor infrastructure, severe terrain, scattered population groupings and strong influence by traditional hierarchies tend to accelerate and exacerbate the loss of central control. Conversely good infrastructure, large population centres, good communications and a high degree of influence by nation-state and systemic levels of analysis ??? particularly through economic and governmental institutionalisation ??? tend to slow such diffusion. Moreover, while power may be diffusing at one level of analysis (e.g. nation-state) it may be centralising at another (e.g. into the hands of military leaders at local level). Analysis of the Malayan Emergency indicates that, in a comparable non-Indonesian historical example, the same general tendency to political power diffusion was evident and that the same broad contextual variables mediated it. However, it would be premature to conclude that the process observed in Indonesia is generally applicable. The nature and relative importance of contextual factors is likely to vary between examples and hence additional research on non-Indonesian examples would be necessary before such a conclusion could be drawn. Further research on a current instance of guerrilla operations in Indonesia is also essential before the broader contemporary applicability of these findings can be reliably demonstrated. Major Conclusions Reached. Based on the above, the theses developed to answer the initial problem can be stated thus: The command and control (C2) structures inherent in traditional, dispersed rural guerrilla movements that lack access to mass media or electronic communications tend to lessen the degree of control by central (military or political) leaders over regional leaders. If COIN or Internal Security Operations are conducted, two factors will operate. First, there will be an increase in the degree of control over the civil population by local military leaders, at the expense of local or central political leaders. Second, where military command structures are pyramidal or segmentary, there will be an increase in control by local commanders at the expense of central military leaders. Where the central government is civilian or has interests divergent from the military???s, the first of these factors will dominate. Where the government is military or has interests largely identical to those of the military, the second factor will be dominant. The process of power diffusion can thus be summarised as follows: A crisis driven by processes of societal change or by external causes, leads to the outbreak of violence, one facet of which may include guerrilla operations. If guerrilla operations do occur, the C2 structures inherent in such operations give a high degree of autonomy and independence to local military leaders. The same (or a contemporaneous) crisis produces a breakdown of formal power structures, causing organisations to fall back upon informal power structures. The nature of these informal power structures is determined by geography, political culture, patterns of traditional authority within the society and the degree of interaction of systemic/regional factors with local events. Thus the guerrilla operations and the concomitant breakdown in formal power structures form the trigger for political power diffusion. The precise nature and progress of this diffusion is then determined by contextual variables.

Made available in DSpace on 2016-08-03T16:31:10Z (GMT). No. of bitstreams: 1 Marines Vieira Sousa.pdf: 3305948 bytes, checksum: c21aab0050594481ff5a895b6e9e86a0 (MD5) Previous issue date: 2008-02-20 / This study investigated the effects of low-intensity laser on the rate of orthodontic movement of canines submitted to initial retraction. The sample was composed of 26 maxillary and mandibular canines, submitted to initial retraction with Niti coils with an force of 150g. One canine was irradiated with diode laser according to the following protocol: 780nm/20mW/5Jcm2/0.2J per point/Et=2J, at 0, 3 and 7 days after activation; the contralateral tooth was used as placebo. Retraction was performed for 4 months in the average, adding up to 9 laser applications. Dental casts obtained at each month were digitized on a 3D Scanner (3Shape) and the three-dimensional images were analyzed on the software Geomagic Studio 5 to measure the quantity of movement of retracted canines. Statistical analysis was performed by three-way Analysis of Variance, followed by the Tukey test (p<0.05). For evaluation of tissue integrity, initial and final periapical radiographs of retracted canines and molars were obtained, to evaluate a possible alveolar crest resorption by assessment of the distance from the alveolar bone crest to the cementoenamel junction, as well as the level of root resorption by the Levander and Malmgreen index, which was evaluated only on retracted canines. The non-parametric Wilcoxon test was applied for that purpose (p<0.05). The results indicated a statistically significant increase in the rate of movement of irradiated canines compared to the contralateral teeth, at all periods, as well as maintenance of tissue integrity. Thus, it was concluded that the diode laser may accelerate the orthodontic movement, contributing to reduce the treatment time.(AU) / Este estudo investigou os efeitos do laser de baixa intensidade na velocidade da movimentação ortodôntica de caninos submetidos à retração inicial. A amostra constou de 26 caninos superiores e inferiores, submetidos à retração inicial realizada com mola Niti, com força de 150g. Um dos caninos foi irradiado com laser de diodo, seguindo o protocolo de aplicação: 780nm/20mW/5Jcm2/0,2J por ponto/Et=2J, nos dias 0, 3 e 7 pós-ativação, sendo que o contralateral foi considerado placebo. A retração durou em média 4 meses, num total de 9 aplicações de laser. Os modelos de cada mês foram escaneados com scanner 3D (3Shape) e as imagens tridimensionais foram analisadas por meio do Software Geomagic Studio 5, para a mensuração da quantidade de movimentação dos caninos retraídos. Foi empregada a Análise de Variância a três critérios, seguida pelo teste de Tukey (p<0,05). Para verificação da integridade tecidual, foram efetuadas radiografias periapicais iniciais e finais dos caninos retraídos e dos molares, nas quais foram avaliados uma possível reabsorção na crista alveolar, por meio da distância da crista óssea alveolar até a junção cemento-esmalte e os níveis de reabsorção radicular, por meio do índice de Levander e Malmgreen, sendo este último avaliado somente nos caninos retraídos. Para isto, foi empregado o teste não paramétrico de Wilcoxon (p<0,05). Os resultados indicaram que houve um aumento estatisticamente significante na velocidade da movimentação dos caninos irradiados comparados ao seu contralateral, em todos os tempos avaliados, como também a preservação da integridade tecidual. Com isso, concluiu-se que o laser de diodo pode acelerar a movimentação ortodôntica, podendo contribuir para a diminuição do tempo de tratamento.(AU)

Orientador: Prof. Dr. Herculano da Silva Martinho / Tese (doutorado) - Universidade Federal do ABC, Programa de Pós-Graduação em Nanociências e Materiais Avançados, 2015. / Tratamentos clínicos utilizando irradiação com Laser de Baixa Intensidade em frequências de infravermelho e visível tem tido boa eficácia e aceitação pela comunidade médica. Tratamentos exitosos em crescimento de cabelo, desordens da pele e em gordura sob a pele têm incentivado o desenvolvimento de aparatos de irradiação para fins comerciais. Nosso objetivo é chamar a atenção para as diferenças entre a frente de onda com padrão de intensidade uniforme, em comparação com frentes de onda não uniformizadas, podendo isto ser levado em conta na fabricação destes aparatos no futuro. Desta forma, foram utilizados cinco diferentes aparatos ópticos, sendo que um deles provê a frente de onda uniformizada, ao mesmo tempo cobrindo todo o poço de cultura, enquanto os demais fornecem frentes de onda não uniformizadas e cuja luz pode não cobrir inteiramente o poço de cultura. Sendo assim, as células epiteliais Vero, que representam a camada mais superficial da pele, foram irradiadas utilizando as cinco variações da óptica. Já os fibroblastos, que representam a camada mais interna da pele, foram irradiados apenas com o aparato que uniformiza a frente de onda. Todas as células foram cultivadas em poços de 9,8 cm2 e foram irradiadas em quadruplicata com uma única dose inicial. Os dados de espectroscopia FTIR e contagem foram obtidos a cada 24 horas por 5 dias no caso das células Vero e em tempos de 6, 12, 24, 36 e 48h para os fibroblastos. Estes foram mantidos em regime de starvation, apenas em presença do meio DMEM enquanto as células Vero foram cultivadas em presença de soro fetal bovino, além do meio. O comprimento de onda do laser foi de 633 nm e a densidade de energia foi de 0,5 J/cm2 para todos os aparatos. Os dados foram estatisticamente analisados por teste-t (contagens) e Análise dos Componentes principais (espectros). Ao irradiar as células Vero com cinco diferentes aparatos, demonstramos que estas responderam de forma diferente a cada aparato, tanto nos resultados das contagens como dos espectros. O aparato com uniformização da frente de onda demonstrou ser o mais adequa+do à tratamentos que requerem bioestimulação, pois foi o único que induziu à bioestimulação e não induziu à bioinibição. Sugerimos que este aparato pode ser utilizado para tratamentos com uma frequência de irradiação diária, para que os efeitos ocorram ao longo de vários dias. O aparato S4 demonstrou ser adequado para tratamentos que requerem bioinibição, sendo sugerida a irradiação em frequência de três dias por um de descanso. A irradiação em fibroblastos com o aparato que uniformiza a frente de onda gerou mais bioestimulação do que nas células Vero, apesar de não ter sido alimentada com soro fetal bovino, e ocorreu 18h antes do que nas células Vero. / Clinical treatments with Low Level Laser Intensity in the infrared and visible frequencies have proven efficacy and acceptance in the medical community. Successful treatments as in hair growing, in skin disorders, and in fat layer have helped the development of electronic apparatus for irradiation for commercial use. Our goal is to draw attention for the differences between the wave front with equalized intensity pattern, in comparison with non equalized wave front, which can be taken into account in the manufacture of these devices in the future. Thus, five different optical apparatus were used, one of which provides the equalized wave front at the same time covering the entire culture well, while others do not provide equalized wave front and whose light can not fully cover the well culture. Thus, Vero epithelial cells, which represent the most superficial layer of the skin were irradiated using the five optical variations. On the other hand, fibroblasts, which represent the innermost layer of the skin were irradiated with only the apparatus that equalizes the wavefront. All cells were grown in wells of 9.8 cm 2 in quadruplicate and were irradiated with a single initial dose. FTIR spectroscopy data and count were measured every 24 hours for 5 days in the case of Vero cells and 6 times, 12, 24, 36 and fibroblasts for 48h. These were maintained under conditions of starvation only in presence of DMEM medium while Vero cells were cultured in the presence of fetal bovine serum, besides the middle. The laser wavelength was 633 nm and the fluence was 0.5 J/cm2 for all apparatus. Data were statistically analyzed by t-test (counts) and analysis of the main components (spectrum). By irradiating Vero cells with five different apparatus, we demonstrated that these responded differently to each apparatus, either as the results of the counts of the spectra. The apparatus with standardization of wavefront has proven to be the most appropriate for treatments requiring biostimulation because it was the one that led to the biostimulation and did not induce the bioinhibition. We suggest that this apparatus can be used for treatments with a frequency of daily irradiation so that the effects occur over several days. S4 apparatus has shown be suitable for treatments requiring bioinhibition. It is suggested its irradiation in a frequency three by one day. Irradiation of fibroblasts with apparatus which equalizes the wave front has generated more biostimulation than in Vero cells, despite not having been fed with fetal bovine serum, and 18 hours before it occurred in Vero cells.

O laser de baixa intensidade tem sido utilizado atualmente como terapia alternativa para alívio da dor em disfunções musculares e articulares por induzirem um efeito analgésico, antiinflamatório e biomodulador das funções fisiológicas celulares. O objetivo desse estudo foi avaliar o efeito do laser de GaAlAs (780nm) na dor à palpação dos músculos masseter e temporal anterior e articulação temporomandibular (ATM), amplitude dos movimentos mandibulares e atividade eletromiográfica dos músculos masseter e temporal anterior em pacientes com disfunção temporomandibular (DTM). As aplicações foram feitas no músculo temporal e masseter e na ATM 2 vezes/semana (durante 4 semanas). 48 pacientes com dor miofascial e artralgia distribuídos aleatoriamente entre tratamento real e placebo e entre doses energéticas de 25 J/cm² e 60 J/cm² foram avaliados utilizando-se uma Escala Analógica Visual (VAS) e um paquímetro digital antes, imediatamente após a última aplicação e 30 dias após o tratamento com laser. A eletromiografia de superfície foi realizada em máximo apertamento voluntário em rolos de algodão e máximo apertamento voluntário em posição intercuspidal antes e após a laserterapia. Os resultados mostraram que não houve diferença estatística significante na atividade eletromiográfica na comparação entre os grupos antes e após o tratamento com laser. Em relação à dor na palpação, houve diferença significante antes e após o tratamento em todos os grupos. A diminuição dos níveis de dor muscular foi mais acentuada nas pontas ativas, entretanto, não houve diferença estatística significante entre o grupo real e placebo. A dor articular mostrou melhora significante apenas na palpação do pólo lateral da ATM direita nos grupos ativos. A amplitude dos movimentos mostrou melhora no grupo ativo, principalmente, na dose de 60 J/cm². Em conclusão, o laser de baixa intensidade não promoveu mudanças na atividade eletromiográfica. Embora tenha sido encontrada uma superioridade da terapia laser em relação aos grupos placebos, não houve diferença estatística significante entre todos os grupos. / Low intensity laser have been used currently as an alternative pain-relief therapy for muscle and joint pain since it induces analgesic, anti-inflammatory and biomodulation effects of the physiological cell functions. The purpose of this study was to evaluate the effect of GaAlAs laser (780nm) on pain to palpation of the masseter and anterior temporalis muscles and the temporomandibular joint (TMJ), amplitude of the mandibular movements and electromyographic activity of the masseter and anterior temporalis muscles in patients with temporomandibular disorders (TMD). The laser was applied on the temporalis, masseter muscles and TMJ twice a week (during four weeks). Forty-eight patients with miofascial pain and arthralgia were randomly assigned between real and placebo treatment and between the energetic doses of 25 J/cm² and 60 J/cm², and were evaluated using Visual Analogue Scale (VAS) and digital paquimeter before, immediately after the final application, and 30 days after the laser treatment. Surface electromyography was performed with maximum voluntary clench on cotton rolls and maximum voluntary clench in intercuspal before and after laser therapy. The results show there were no significant statistical differences in the electromyographic activity between the groups before and after laser treatment. As to the pain at palpation, there was a significant difference before and after treatment in every group. There were sharper reductions in muscle pain level for the active probes; however, there was no significant statistical difference between the real and placebo groups. Joint pain showed significant improvement only in the palpation of the lateral pole of right TMJ in the active groups. The amplitude of the movements showed improvement in the active group, mainly, in the dose of 60 J/cm². As conclusion, low intensity laser did not promote any changes in the electromyographic activity. Although this study has found a superiority of laser therapy over placebo, there were no statistically significant differences between all groups.

Submitted by Aelson Maciera (aelsoncm@terra.com.br) on 2017-08-30T19:22:21Z No. of bitstreams: 1 TeseLHGS.pdf: 1716455 bytes, checksum: 7fe0843474a5a5278df1bfaa58e0f403 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-25T17:34:48Z (GMT) No. of bitstreams: 1 TeseLHGS.pdf: 1716455 bytes, checksum: 7fe0843474a5a5278df1bfaa58e0f403 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-25T17:34:55Z (GMT) No. of bitstreams: 1 TeseLHGS.pdf: 1716455 bytes, checksum: 7fe0843474a5a5278df1bfaa58e0f403 (MD5) / Made available in DSpace on 2018-01-29T17:09:50Z (GMT). No. of bitstreams: 1 TeseLHGS.pdf: 1716455 bytes, checksum: 7fe0843474a5a5278df1bfaa58e0f403 (MD5) Previous issue date: 2017-03-30 / Não recebi financiamento / The aim of the thesis was to present the effects of LLLT, physical exercise and their association on joint cartilage catabolism in the knees of rats submitted to an experimental model of osteoarthritis induced by anterior cruciate ligament (TLCA) transection. For this, a brief systematic review was initially performed where interventions in experimental and clinical studies with animals were considered. The search was performed in the Medline, PubMed, Scopus, Cochrane databases and by active search in a list of bibliographic references of the articles selected until October 2016. The research was carried out according to the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyzes). We searched the databases with the following terminologies for animal studies: laser therapy and exercise and knee osteoarthritis and animal model. The analyzes of the content of the selected clinical trials demonstrated that LLLT associated therapeutical exercises that can be used to improve pain and quality of life are: resistance exercises and resistance exercises associated with stretching. However, these are not methodologically sufficient to demonstrate improved functionality presenting moderate quality for animal studies and high quality for clinical studies. As the clinical studies included in this systematic review have a high methodological quality, it can be concluded that the therapeutic exercises used by the studies improved pain and functionality in knee OA. However, we suggest experimental studies with animals that may present higher methodological quality to explain the mechanisms of action of therapeutic resources. For this, the second study, investigated the effects of the protocol of resistance exercises and LLLT (associated or not) on the metabolism of cartilage in an experimental model of OA in the knee. Forty male Wistar rats were randomly divided into 4 groups: OA control (OAC); OA and LLLT (OAL); OA and Exercise (OAE); OA and Exercise and Laser (OAEL). The resisted exercise program started 2 weeks after the ACL injury, and were performed three times a week for 8 weeks, totaling 24 sessions consisting of climbing exercises with weights attached to their tails and laser irradiation (two- The results showed that all treated groups had the capacity to modulate some of the aspects related to the degenerative process due to ligament transection, but the association of resistance exercise with LLLT significantly decreased the density of chondrocytes (With or without LLLT) modulated the immunoexpression of IL-1β, caspase-3 and MMP-13. These results suggest that resisted exercises modulate the changes The present work evidences the great need of experimental studies that may explain the clinical mechanisms that favor the use of these resources. In the treatment of patients with OA in the knee. / O objetivo da tese foi apresentar os efeitos da LLLT, exercício físico e a associação dos mesmos sobre o catabolismo na cartilagem articular em joelhos de ratos submetidos a um modelo experimental de osteoartrite induzida através da transecção do ligamento cruzado anterior (TLCA). Para isto, inicialmente foi realizada uma breve revisão sistemática onde foram consideradas intervenções em estudos clínicos. A busca foi realizada nas bases de dados Medline, PubMed, Scopus, Cochrane e por busca ativa em lista de referências bibliográficas dos artigos selecionados de 1994 até outubro de 2016. A pesquisa foi realizada de acordo com as orientações do guia PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyses). Foi realizada a busca nos bancos de dados com as seguintes terminologias: laser therapy and exercise and knee osteoarthritis. As análises do conteúdo dos ensaios clínicos selecionados demonstraram que os exercícios terapêuticos associados à LLLT que podem ser utilizados para melhora da dor e qualidade de vida são: exercícios resistidos e exercícios resistidos associados à alongamentos. Porém, estes não são suficientes metodologicamente para demonstrar melhora da funcionalidade apresentando qualidade moderada para os estudos animais e alta qualidade para os estudos clínicos. Como os estudos clínicos incluídos nesta revisão sistemática têm uma alta qualidade metodológica, pode-se concluir que os exercícios terapêuticos utilizados pelos estudos melhoraram dor e funcionalidade na OA de joelho. Porém sugerem-se estudos experimentais com animais que possam apresentar maior qualidade metodológica para explicar os mecanismos de ação dos recursos terapêuticos. Para isso, o segundo estudo realizado, investigou os efeitos do protocolo de exercícios resistidos e LLLT (associados ou não) no metabolismo da cartilagem em um modelo experimental de OA no joelho. Quarenta ratos Wistar machos foram aleatoriamente divididos em 4 grupos: OA controle (OAC); OA e LLLT (OAL); OA e Exercício (OAE); OA e Exercício e Laser (OAEL). O programa de exercícios resistidos iniciado 2 semanas após a lesão do LCA, e foram realizados três vezes por semana por 8 semanas, totalizando 24 sessões que consistiam de exercícios de escalada, com pesos atados em suas caudas e a irradiação de laser (dois pontos-faces medial e lateral da articulação esquerda. Os resultados mostraram que todos os grupos tratados apresentaram a capacidade de modular alguns dos aspectos relacionados com o processo degenerativo devido à transecção ligamentar. Porém, a associação do exercício resistido com a LLLT diminuiu significativamente a densidade de condrócitos, e em animais OAE houve aumento de densidade. Além disso, os grupos com exercícios resistidos (com ou sem LLLT) modularam a imunoexpressão de IL-1β, caspase-3 e MMP-13. Estes resultados sugerem que os exercícios resistidos modularam as alterações morfológicas relacionadas à progressão da OA. Também, o programa de exercícios apresentou efeitos anti-inflamatórios nos joelhos dos ratos com OA. Com isso, o presente trabalho evidência a grande necessidade de estudos experimentais que possam explicar os mecanismos clínicos que favorecem o uso destes recursos no tratamento de pacientes com OA em joelho.