The WHO member countries undertook to eliminate poliomyelitis globally by the year 2000. Acute flaccid paralysis (AFP) surveillance finds paralytic cases of polio so that swift action can be taken and shows that wild poliovirus has been eliminated when polio cases no longer occur. Mpumalanga Province, a rural province in the north-east of South Africa, developed a rapid reporting system where infection control nurses at the public and private sector hospitals report weekly to the AFP surveillance Officer, including zero reporting, on 9 infectious disease syndromes that require rapid action on clinical presentation alone. This system was implemented in 1998 and included AFP. The non-polio AFP reporting rate increased from 0.37 in 1997 to 0.55 during 1998 with more than 80% of the units reporting weekly. The binomial exact confidence intervals however include 1. A hospital record review of all paediatric admissions revealed that only 2 AFP cases were missed by the system. The AFP reporting rate remains below the international standard of 1 per 100 000 children under 15 years of age despite an adequate reporting system. The role of chance variation, particularly in small geographical areas, has not been discussed in official polio-eradication guidelines but it is . imperative that population size be taken into account when judging the rate of AFP case detection. With the low international reference rate and play of chance variation it is possible that regions with relatively small populations, low non-polio AFP detection rates and no cases of polio detected for an extended period may have adequate surveillance systems supporting polio free certification. In these areas additional criteria for determining the adequacy of the surveillance system should also be considered. / Dissertation (MMed)--University of Pretoria, 2006. / School of Health Systems and Public Health (SHSPH) / Unrestricted

INTRODUCTION: Injury to the facial nerve can lead to functional and aesthetic sequelae in patients. Though surgical interventions are available to restore lost motor and sensory function, outcomes are often suboptimal due to inadequate or disorganized axonal regeneration. While engineering improvements to the standard of care are underway, gaps remain in our molecular understanding of peripheral nerve injury to translate these efforts clinically. Over the last few decades, advancements in intravital imaging such as the development of fluorescent reporter mice and use of multiphoton excitation techniques have allowed for markedly enhanced characterization of biological phenomena at higher resolutions, at greater depths, and for longer timescales. Challenges in reliably and serially imaging in vivo within murine models have been overcome through the development of chronic imaging windows in various settings of the body. However, there are very few techniques available presently for imaging the peripheral nerve microenvironment and no prior work detailing use in the facial nerve setting. OBJECTIVE: Longitudinal studies employing intravital imaging techniques carry potential to improve understanding of peripheral nerve regeneration and function. Using multiphoton microscopy and fluorescent reporter mice, we propose a prototype, surgical protocol of implantation, and initial safety and efficacy testing of a facial nerve window to enable chronic imaging for enhanced characterization of the peripheral nerve microenvironment. METHODS: A stainless-steel implant with an affixed glass coverslip and aluminum external fixation component was developed for implantation in a transgenic reporter mouse model to enable chronic intravital imaging of the facial nerve buccal and marginal mandibular branches. A qualitative observational study and clinical assessment scoring study was performed post-surgical implantation to monitor behavior, physical appearance, weight loss, and reactivity to animal handling over the typical time-course of nerve regeneration. Segments of facial nerve branches were harvested from control and window-implanted mice and imaged using widefield epifluorescence microscopy for axon quantification to determine any adverse effects from window compression onto axonal fibers. Two-photon microscopy (2PM) and Simulated Raman Scattering (SRS) were also performed through the window to visualize axon tracts, myelin sheaths, and surrounding collagen matrix in wild-type and transgenic mice models. RESULTS: Qualitative serial observational studies and assessment scoring indicated no obvious functional deficits over the time-course of typical nerve regeneration and normal scores for weight, behavior, physical appearance, and reactivity. Neural histomorphometric analysis indicated no significant difference in mean myelinated axon count of buccal (mean ± SD; control buccal, 947.6 ± 129.9; window-implanted buccal, 799.3 ± 128.6; p = .136) and marginal mandibular branches (control marginal mandibular, 801.3 ± 145.1; window-implanted marginal mandibular, 738.0 ± 197.2; p = .599) between control and window-implanted mice, suggesting that neuropathy was not induced from the window itself. High-resolution images of nerve morphology in healthy and injured transgenic and wild-type mice were obtained using 2PM and SRS. CONCLUSION: Herein, we describe a novel and replicable platform for longitudinal intravital imaging of murine facial nerve. Future studies will evaluate viability of this model for imaging the facial nerve microenvironment, particularly Schwann cell-axon interactions, in the setting of severe nerve injury over a period of several weeks to months. Improved understanding gained through such studies of the structural peripheral nerve microenvironment may allow for advancements in viral vector therapeutics, nerve graft scaffold design, as well as advanced injury diagnostics and tracking. / 2022-06-02T00:00:00Z

No description available.

Functional Neuromuscular Stimulation (FNS) is a method by which paralyzed muscles are stimulated electrically in order to produce a useful movement. The design and testing of a laboratory system for the modulated control of the lower extremities during FNS-induced cycling on an exercising device (Paracycle) is described. The system hardware, which is designed around a standard IBM compatible Personal Computer, features six independent stimulation channels. Waveform characteristics such as pulse frequency, width and amplitude are defined as a function of the crank position of the Paracycle for each channel. An extensive software package allows programmability of the waveform parameters and supports the user in the definition of stimulation sequences. The effective performance of the complete FNS-controller/ Paracycle system has been demonstrated during a controlled case study with two paraplegic subjects.

The bidirectional link between insufficient sleep and the distress related to a parasomnia known as isolated sleep paralysis (ISP) might lead to chronic health effects. The impact of fear-ridden hallucinations related to this REM sleep disorder can be both distressful and embarrassing for individuals often resulting in a reticence to seek help. This quantitative study was guided by a biopsychosocial approach with an integrated theoretical framework. One aim of the study was to determine if fear parameters of ISP (low and high) differ when considering psychosocial factors and sleep quality, based on the Dysfunctional Beliefs and Attitudes About Sleep Scale, the Social Phobia Inventory, the Locus of Control (LOC) subscales, and the Pittsburg Sleep Quality Inventory. Predictive associations between psychosocial factors and subjective sleep quality (SSQ) were also investigated. Retrospective online data from a sample of 159 participants ages 18 and over were analyzed via MANOVA, multiple regression, and independent samples t-tests. Findings from the MANOVA were significant and showed that participants who experience ISP with more fear scored higher on two measures, external other LOC and social phobia. The MANOVA regarding differences in SSQ in relation to psychosocial variables were not significant, and independent sample t-tests did not differentiate fear parameters for DBAS and SSQ (poor sleep was found for both parameters). Providers of therapeutic treatments should take factors of social phobia and external other LOC into account with regards to poor sleep quality for those distressed by ISP. Sleep quality assessments might benefit those who are afraid to disclose about ISP sleep distress, as long term poor sleep can place some at risk for negative health outcomes.

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No description available.

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A promising approach to treat patients with vocal fold paralysis using electrical stimulation is investigated throughout this research work. Functional Electrical Stimulation works by stimulating the atrophied muscle or group of muscles directly by current when the transmission lines between the central nervous system are disrupted. This technique helps maintain muscle mass and promote blood flow in the absence of a functioning nervous system. The goal of this work is two-fold: develop control techniques for muscle contraction to optimize muscle stimulation and develop a small-scale electromagnetic system to provide stimulation to the laryngeal muscles for patients with vocal fold paralysis. These studies; therefore, focus on assessing a linear Proportional-Integral (PI) controller and two nonlinear controllers: Model Reference Adaptive Controller (MRAC) and an Adaptive Augmented PI (ADP-PI) system to identify the most appropriate controller providing effective stimulation of the muscle. Direct stimulation is applied to mouse skeletal muscle in vitro to test the controllers along with numerical simulations for validation of these experimental tests. The experiments included muscle contractions following four distinct trajectories: a step, sine, ramp, and square wave. Overall, the closed-loop controllers followed the stimulation trajectories set for all the simulated and tested muscles. When comparing the experimental outcomes of each controller, we concluded that the ADP-PI algorithm provided the best closed-loop performance for speed of convergence and disturbance rejection. Next, the focus of the research work was on the implementation of an electromagnetic system to generate appropriate currents of stimulation using the aforementioned controllers. For this study, Nickel-Titanium shape memory alloys were used to assess activation (contraction) through a two-coil system guided by the controllers. The application of the two-coil system demonstrated the effectiveness of the approach and a main effect was observed between the PI, MRAC, and ADP-PI controllers when following the trajectories. Lastly, a small scale two-coil system is developed for animal testing in the muscle-mass-spring setup. Experiments were successful in generating the appropriate stimulation controlled by the output-based algorithms for muscle contraction. Trials conducted for this study were compared to the muscle contractions observed in the first study. The controllers were able to provide appropriate stimulation to the muscle system to follow the set trajectories: a step, ramp, and sinusoidal input. More trials are required to draw statistical conclusions about the performance of each controller. Regardless, the small-scale two-coil system along with the applied controllers can be reconfigured to be an implantable system and tested for appropriate stimulation of the laryngeal muscles. / Ph. D.

The purpose of this study is to present quantitative findings of the Bender-Gestalt Visual Motor Test which will indicate the effectiveness of this media as an instrument of differential diagnosis when applied to General Paresis and Mixed Schizophrenia.