Thesis (Ed. D.)--West Virginia University, 2007. / Title from document title page. Document formatted into pages; contains xi, 418 p. Includes abstract. Includes bibliographical references (p. 146-158).

Osteoarthritis (OA) is a common joint disease found mostly in the elderly that progressively leads to the loss of articular cartilage, along with subchondral bone changes (sclerosis) and joint space narrowing, eventually resulting in joint failure. Osteoporosis (OP), another bone disorder mostly of the elderly, is the gradual loss of bone tissue mass (bone mineral density (BMD)) resulting in reduction in bone strength and an increased risk of fracture. Bone geometry also plays a role in developing a fracture or not. OA causes increase in bone volume, but fracture is still prevalent in OA patients. The aim of this study was to investigate association of upper femur geometry and texture features to hip OA and hip fracture using radiography. Supine anteroposterior radiographs of hip and BMD from 125 postmenopausal women were used for this research. Hip geometry parameters and texture related parameters were obtained from the radiographs. Participants’ weight, height, and body mass index (BMI) were also used in this research. OA was found in women with higher weight, BMI, femur neck BMD, neck diameter (ND), and neck cortex thickness, and shorter joint space width (JSW). OA women also had higher homogeneity index of Laplacian images of femur neck and lower entropy of Laplacian images of femur neck. Fractures were more common among women with lower neck BMD, and higher femoral neck axis length, JSW, hip axis length (HAL) and acetabular width (w). For cervical fractures, JSW and w were higher. Women with trochanteric fractures had lower neck BMD and head diameter, and higher ND and HAL. Upper femur geometry may play a role in the initiation and progression of OA and OP, and trabecular microarchitectural changes in OA are relatively distinct. Higher weight, BMI and neck BMD are predisposing factors for OA. Lower neck BMD is a predisposing factor for trochanteric fracture.

Tutkimuksen päätavoitteena oli selvittää, mitkä fyysisen aktiivisuuden mittausmenetelmät soveltuvat käytettävyydeltään parhaiten ikääntyneille. Tavoitteena oli saada käyttäjäkokemuksia ikääntyneiltä tutkimuksessa käytettävistä fyysisen aktiivisuuden mittausmenetelmistä. Tutkimukseen osallistui seitsemän yli 65-vuotiasta testihenkilöä. He osallistuivat kolmen päivän tutkimusjaksolle, jonka aikana he käyttivät oman arkensa keskellä Polar Loop -aktiivisuusmittaria, Accupedo-älypuhelinsovellusta ja Omron walking style 3 -askelmittaria. Lisäksi tutkimuksen kohdejoukko täytti päiväkirjaa ja vastasi alku- ja loppukyselyyn. Kyselyn avulla selvitettiin fyysisen aktiivisuuden mittausmenetelmien käytettävyyttä ja testihenkilöiden käyttäjäkokemuksia mittausmenetelmistä. Kohdejoukon keski-ikä oli 74,9 vuotta (SD 4,9). Naisten osuus oli 57 %. Aktiivisuusmittarin, älypuhelinsovelluksen ja askelmittarin välillä oli huomattavia eroja mitattujen askelmäärien välillä. Aktiivisuusmittari antoi suurimman askelmäärän 81 % kaikista tutkimusjakson päivistä. Tutkimukseen osallistujat arvostivat käytettävyydeltään ja luotettavuudeltaan eniten Polar Loop -aktiivisuusmittaria. Aktiivisuusmittari oli ominaisuuksiltaan ja käytettävyydeltään ikääntyneille sopivin fyysisen aktiivisuuden mittausmenetelmä. Askelmittari ja älypuhelinsovellus olivat ikääntyneille haastavia käyttää ja niitä pidettiin yleisesti epäluotettavina. / The main object of this study was to find out which activity measurement methods have the best usability among elderly. The aim was to collect user experience data from elderly on the selected activity measurement methods used in this study. Seven participants aged over 65 years participated this study. All of them attended a three-day trial period, during which they used the following measurement methods to follow their normal daily life activity: Polar Loop activity meter, Accupedo smartphone application and Omron walking style 3 pedometer. In addition, the participants filled out a diary and answered a questionnaire on usability and personal experiences of the measurement methods. Average age of the participants was 74,9 (SD 4,9) years and 57% were woman. There were significant differences in the number of steps measured by activity meter, smartphone application and pedometer. The activity meter gave the biggest number of steps in 81% of the cases. The participants appreciated most the usability and reliability of the Polar Loop activity meter. The activity meter was found to be the most suitable physical activity measurement method for elderly by its properties and usability. Pedometer and smartphone application were experienced challenging to use and unreliable.

Tutkimuksen tarkoituksena oli selvittää valmisteilla olleen laajan väestötasoisen liikuntatutkimuksen toteutettavuutta pilottitutkimuksen avulla. Tavoitteena oli määritellä mittausproseduurin resurssitarvetta erilaisilla mittauskokoonpanoilla sekä arvioida seuranta-palautejärjestelmän toimivuutta ja käyttökelpoisuutta kuuden kuukauden liikuntaintervention aikana. Lisäksi tavoitteena oli tutkia eri monitorointilaitteiden (syke-, askel- ja aktiivisuusmittari), seuranta-palautejärjestelmän eri vastaustapojen (sähköposti tai matkapuhelimen tekstiviesti) ja eri raportoimisaikojen (1 viikko tai 3 viikkoa) sekä käyttäjän saaman palautteen vaikutusta liikunta-aktiivisuuteen ja kehon antropometrisiin muuttujiin. Tutkimukseen osallistui 60 vapaaehtoista testihenkilöä. Heidät jaettiin satunnaisesti ryhmiin raportoimisajan, monitorointilaitteen, vastaustavan sekä palaute/ei palautetta mukaisesti. Testihenkilöille suoritettiin tutkimuksen alussa ja lopussa mittaukset (aerobinen kestävyyskunto, paino, vyötärön ympärys, lantion ympärys, verenpaine, puristusvoima) sekä pyydettiin arvio omasta kunnosta ja terveydentilasta. Lisäksi tutkittavat saivat kuntoarviotaan vastaavan liikuntaohjeen, päiväkirjataulukon sekä laiteopastuksen monitorointilaitteeseensa. Testihenkilöt saivat monitorointilaitteen käyttöönsä tutkimuksen (6kk) ajaksi. Seuranta-palautejärjestelmän henkilökohtaisen sivun avulla testihenkilöt pystyivät tarkastelemaan liikuntasuorituksiaan ja vertaamaan suorituksiaan toisiin ryhmätasolla. Järjestelmän seurantajakson pituus oli kolme viikkoa. Seuranta-palautejärjestelmä lähetti palautteen viikossa kertyneiden liikuntasuoritusten lukumäärä perusteella. Tutkimuksessa saatiin lupaavia tuloksia vähän liikkuvien osalta. Fyysinen aktiivisuus (MET-min/vko) kasvoi LOWACT-ryhmällä 180 % ja MODACT-ryhmällä 30 %. HIGHACT-ryhmällä fyysinen aktiivisuus laski 29 %. Aerobinen kunto (VO₂max) kasvoi 6 % LOWFIT-ryhmässä ja laski 4 % HIGHFIT-ryhmässä. Tutkimuksen perusteella vaikuttaa, että monitorointilaitteiden sekä seuranta- ja palautejärjestelmän muodostama konsepti on toimiva ja sillä voi olla kansanterveydellistä merkitystä väestötason liikunta-aktiivisuuden lisäämiseksi. / The purpose of this pilot study was to investigate the feasibility of a larger population based physical activity intervention study. The aims were to define the resources needed for measurement procedure in different measurement settings and to assess functionality and usability of the questionnaire and feedback system during a 6-month health-promoting exercise training program. Also aim was to study how the different monitoring devices (heart rate monitor, pedometer, activity meter), reporting methods (e-mail or text message), reporting intervals (1 week or 3 weeks) and feedback influenced on the level of physical activity and antropometric variables. The study population consisted of 60 voluntary healthy subjects. The subjects were randomized to subgroups based on reporting interval, monitoring device, reporting method and feedback. Measurements of aerobic fitness, weight, waist circumference, hip circumference, blood pressure and hand grip force were performed to study subject in the beginning and in the end of the study. Also self-reported physical fitness level and health status were gathered. The subject were given exercise training program corresponding to their reported fitness level, diary in which to mark their physical activity and were taught how to use their monitoring device. The monitoring device was given to study subjects for the duration of the study (6 months). The study subjects were able to observe their own physical activity and compare their activity with that of others in the study population with the aid of the feedback systems personal web page. The length of the feedback systems follow up period was three weeks. The feedback system sent feedback to the study subjects based on the number of physical activity events accumulated during one week. The study gave promising results in the low physical activity subgroup. Physical activity (MET-min/week) increased by 180 % in the LOWACT group compared to 30% in the MODACT group. In the HIGHACT group physical activity decreased by 29%. The subjects in the LOWFIT group increased their aerobic fitness (VO₂max) by 6%, whereas aerobic fitness decreased 4% in the HIGHFIT group. Based on the study, it appears that the concept consisting of a combination of monitoring devices and feedback system is feasible and may have significance to public health in promoting physical activity in the general population.

Thesis (Masters Diploma (Medical Technology)) -- Cape Technikon, Cape Town, 1991 / Scalp ringworm, a potentially disfiguring and emotionally traumatic disease of childhood, appears to have attained an unacceptably high incidence in the southern and Western Cape. This study examined aspects of tinea capitis and was undertaken in four distinct sections, each evolving from the prior study. Attempts were made to establish the local incidence, the clinical presentation and the causative dermatophytes; to ascertain the effects of geographical influences on this spectrum of organisms; to determine the number of fungal carriers within certain communities and to examine both in-vivo and in-vitro effects of easy-to-use, topical preparations on this group. On examining the incidence, it was shown that approximately 3% of children seen at the Red Cross Children's Hospital in Rondebosch attend specifically for scalp ringworm but many more, particularly of low socio-economic backgrounds remain untreated (Neil, 1987). Random visits to primary schools along the West Coast and to childcare institutions in the Cape Peninsula revealed an infection rate as high as 53% and 29% respectively. Following examination of the varied clinical presentations evoked by infection with T.violaceum, the predominant manifestation of disease was shown to be various degrees of scalp scaling. The findings highlighted the often subtle and easily overlooked clinical presentations which presumably contributed to the high prevalence of this disease amongst the community. Laboratory investigation revealed the major aetiological agent to be the anthropophilic fungus, T.violaceum (92%). This was followed by M.canis and M.audouinii constituting only 2,8% and 1,7% of isolates respectively. Small numbers of seven other dermatophytes, including T.verrucosum, T.yaoundei, T.mentagrophytes, T.schoenleinii, T.tonsurans, M.gypseum and E.floccosum, were also isolated. Examination of geographical influences showed that none of the associated factors, with particular reference to altitude and climate, appeared to exert any discernible effect on the prevailing dermatophyte species in any particular region.

Thesis (Masters Diploma Technology (Medical Technology)) -- Cape Technikon, Cape Town, 1991 / Adenovirus type 7 (Ad?) is the sub-species of adenovirus most frequently associated with serious illness. In Cape Town, the strain predominantly responsible for infantile pneumonia due to adenovirus is adenovirus type 7c (Ad7c), and it has been the cause of several outbreaks of nosocomial infection in the respiratory unit at the Red Cross War Memorial Hospital for Children.. This study explored two strategies which could possibly assist in the prevention of the spread of adenovirus infection in the hospital environment. The guanosine analog, 9-(1,3-dihydroxy-2-propoxymethyl) guanine (DHPG) is a highly effective antiviral agent against herpesviruses. It has also been reported that this drug could have therapeutic potential with regard to adenovirus infections. Based on this postulate, it was decided to perform in vitro studies to evaluate the antiviral activity of DHPG against Ad7c. DHPG was tested for it's inhibitory potential against the replication of Ad7c in cell culture. The virus was propagated in the presence of drug concentrations ranging from 2 pM to 150 pM and the manifestation of cytopathic effect was monitored. Ad7c replication in cell culture was not inhibited by the drug at those concentrations that were tested, although growth ~f herpes simplex virus, used as a control, was significantly impaired. The value of passive immunization in the prevention or amelioration of disease has been well recognized. Commercial preparations of immunoglobulin are not routinely monitored for the presence of antibodies to Ad7c. In this study, 17 batches of intramuscular and intravenous globulin were tested for the presence of neutralizing antibodies specific for Ad7c. The batches, which were randomly selected, were all found to contain high levels of neutralizing antibodies to Ad7c. The conclusions reached were that DHPG will not be an efficacious antiviral agent for treatment of Ad7c infections, but that the implementation of passive immunization to children who are infected or exposed to Ad7c in a hospital ward, may be of help to control the spread of nosocomial infections.

The measurement of ankle joint dorsiflexion is an important component of the clinical examination of the foot and is also an outcome measure often employed in research. Diagnosis of ankle equinus or limited ankle dorsiflexion is based solely on this measurement. Although a great majority of research papers in this field utilise normal clinical goniometers for obtaining the maximum ankle dorsiflexion angle (MADA) and important clinical decisions are based on these findings, there is overwhelming evidence that this method is highly unreliable. Thus this thesis aimed to investigate alternative methods of measuring ankle dorsiflexion and various issues that affect the MADA in order to obtain a clear picture of foot segment movement from which an Ankle Goniometer could be consequently designed and validated. Ten different techniques were identified that included various apparatuses designed specifically for measuring ankle dorsiflexion. However, during validation, their methodological quality would have benefitted from the use of an actual patient population and comparison with a reference standard, which caused papers to score poorly on methodological quality assessment. It was concluded that issues affecting this measurement and that needed to be researched further include: foot posture, the amount of moment applied and the stretching characteristics of the calf muscle tendon unit. Experiments within this study indicated that in adults, the mean maximum pronated angles were always higher than in other postures, with 8.27o difference between the pronated and supinated postures (p=0.032) and 5.78o between pronated and neutral (p=0.000). However, the reported difference between neutral and supinated (mean angle of 2.49o) is of little clinical significance. It was observed that the forefoot always travels through a greater angle than the hindfoot in all 3 foot postures, while the hindfoot to forefoot angle increases during the application of a moment, indicating that the ‘midtarsal joint locking mechanism’ cannot be applied to passive dorsiflexion of the foot. In adolescents, there are no significant differences in the mean MADA between the 3 postures, implying that this measurement technique may be performed in any of these postures. It was also concluded that there is no need to control moment applied during this measurement procedure to produce consistent results between raters and that the calf muscle tendon unit does not stretch significantly following brief repetitive passive stretching. ii An ankle goniometer that measured purely hindfoot movement by eliminating forefoot influence and that increased reliability by holding the foot in the chosen posture, was consequently designed. This was validated by synchronizing with an electrogoniometer and an optoelectronic motion capture system. Reliability testing, with the foot held in a supinated posture as opposed to the traditional Rootian method of placing the foot at subtalar joint neutral position, spanned a number of different trials, including intra-tester and inter-tester reliability studies utilising both controlled and uncontrolled conditions, in convenience samples of healthy participants and a random sample of patients. Reliability testing between 4 raters with little experience on the utilization of this device was finally conducted. It has been shown that the Ankle Goniometer is a valid and reliable device for measuring ankle joint complex dorsiflexion both in healthy adults and in a patient population.

For several years, microwave engineers have dreamed of using non-ionising electromagnetic waves in medical imaging applications. The rate of evolution of microwave techniques for medical application has been immense and shows no signs of relenting. Since the limitations of X-ray mammography are well reported, alternative techniques using microwaves for breast cancer detection are developed. Some of these techniques have progressed to the point where positive clinical experience has emerged.

The natural response to the intrusive bodily sensation of discomfort is positional change. The purpose of this study was to explore how children and young people with profound physical, learning and communication difficulties, largely dependent on others to gauge their need for positional change, have their comfort needs met when using postural management equipment. Thirteen qualitative case studies were undertaken. Nine of the participants attended a special needs education primary or secondary school, two were in transition to school and two attended day services. All participants had a neurodevelopmental disability, with each being the focus of one case study. Parents, teachers, therapists and key support staff were interviewed, and the school or day centre routines of the children and young people were observed, with selective video recording. Single case and cross case analyses were undertaken. The findings showed threats to comfort include the restrictive nature of various accessories, hastiness of care tasks producing positioning errors and the procedural stretching of tissues prior to application. Opportunities for lessening discomfort included scheduled daily routines and time out of postural management equipment. Equipment use for the children and young people in this study was intrinsically coupled with care giving. Attentive caregivers read the behavioural expressions of the children and young people and reassuringly responded, safeguarding them from discomforting experiences. This maximised each individual‘s adaptive functioning, without compromising the benefits of postural support. This study highlights that the same item of equipment can be both comfortable and uncomfortable. Given the social and interactional world in which the children and young people live and learn, and the complex nature of their difficulties, it is others who must accept responsibility for ensuring their optimal level of comfort.

<p>Vevs-karakterisering med høyoppløsning MAS MR spektroskopi</p><p>Høyoppløsning MAS er en MR spektroskopisk metode som gir høyt oppløste spekter av faste materialer. I dette doktorgradsarbeidet har høyoppløsning MAS blitt anvendt på forskjellige typer humant vev. Det primære målet var å etablere en metode for å studere biokjemiske egenskaper i vevsprøver, med hovedvekt på vev fra brystkreftpasienter.</p><p>Prøvepreparering før MAS analyser er enkelt sammenlignet med ekstraksjon. Vi har funnet at oppløsningen i spektrene, og dermed den oppnåelige biokjemiske informasjonen, er tilsvarende som i spekter fra ekstrakter av vevsprøver. En viktig fordel i forhold til ekstraksjons-metoder er at vevsprøven som studeres kan bevares slik at den kan vurderes ved andre metoder etterpå. Organer er gjerne satt sammen av forskjellige typer celler og vev og en slik heterogenitet vil ha betydning for den biokjemiske profilen, siden celler av forskjellig type kan ha forskjellig metabolisme. En del av prosjektet gikk ut på å optimalisere MR eksperimentene med hensyn på biokjemisk informasjon samtidig som at vevsprøven ble bevart for en patologisk undersøkelse. Lav temperatur under analysene ble funnet å være viktig for en slik bevaring av vevet. Vi oppnådde høyt oppløste spekter og har langt på vei kartlagt den kjemiske sammensetningen av intakte vevsprøver. Den metabolske profilen i brystkreftprøver viste en sammenheng med vevs-sammensetning bestemt ved patologi.</p><p>MR spekter av biologisk materiale kan inneholde hundrevis av topper, og flere av disse kan henge sammen med sykdomsprosesser i vevet. Ved sammenligning av enkelt-topper mot kliniske funn kan man miste viktig informasjon i spektrene som er ikke er synlig for det blotte øyet. Multivariate analyser gjør det mulig å undersøke hele spektrene mot kliniske kjennetegn. I denne avhandlingen har prisipalkomponent-analyse blitt brukt til å korrelere MAS spektrene med pasientenes diagnoser og andre kliniske funn.</p><p>En studie av livmorhalskreft omfattet vevsprøver fra åtte pasienter med livmorhalskreft og åtte kontroller. Prinsipalkomponent-analyse av MAS spektrene ga to klare grupperinger av de ulike spektrene i samsvar med prøvetype. Den kjemiske profilen bestemt med MAS har en sammenheng med de makroskopiske forandringene i kreftvev fra livmorhals.</p><p>Hjerneautopsier fra pasienter med en sjelden neurodegenerativ sykdom som rammer barn (neuronal ceroid lipofuscinosis) ble undersøk på samme måte mot autopsier fra personer uten kjent sykdom i nervesystemet. To former av sykdommen var inkludert i studien som omfattet totalt 24 biopsier, og den formen som bryter ut tidligst lot seg skille fra de to andre gruppene. Vevsprøver fra denne gruppen inneholdt svært lite eller ikke påviselige mengder NAA, som syntetiseres og lagres i nevroner. Dette korrelerer med tap av nevroner som er observert hos slike pasienter.</p><p>Den største studien inkluderte vevsprøver fra svulst og ikke-infiltrert vev (n=18) fra 85 brystkreftpasienter. MAS spekter fra disse prøvene ble undersøkt med hensyn på absolutt konsentrasjon av bestemte metabolitter og ved PCA med hensyn på sammenheng med flere kliniske parametere, som pasientens diagnose, svulstens størrelse og lymfeknutestatus hos pasienten. Det ble funnet flere trender til sammenhenger mellom MAS spekter og kliniske parametere. Det mest lovende resultatet med hensyn på fremtidig klinisk verdi var en mulig korrelasjon med lymfeknutestatus hos pasientgruppen med den vanligste formene for brystkreft.</p> / Paper III is a preprint of an article published in NMR in Biomedicine. http://www.interscience.wiley.com