Most cases of lung cancer have a commonly-understood behavioral etiology. Thus, individuals with lung cancer are often blamed for their illness by others and may therefore seek to avoid this blame by concealing their diagnosis from others. This study sought to determine the prevalence of diagnosis concealment, examine potential predictors of concealment, and test parts of a cognitive-affective-behavioral model of the effects of concealing a concealable stigma among individuals receiving treatment for lung cancer. With regard to predictors of concealment, it was hypothesized that concealment would be positively associated with male gender, introversion, and trait social anxiety and would be negatively associated with social support and the use of seeking guidance and support as a coping strategy. Hypothesized correlates of concealment included poorer self-esteem as well as greater anxiety, cancer-specific distress, and social avoidance. A sample of 117 participants receiving chemotherapy or radiation for stage I-IV non-small cell lung cancer and limited to extensive stage small cell lung cancer was recruited during routine outpatient visits. A medical chart review was conducted to assess clinical factors and participants completed a standard demographic questionnaire as well as measures of coping strategies, introversion, trait social anxiety, social avoidance, social support, anxiety, depression, cancer-specific distress, self-esteem, perceived stigma, public self-consciousness, and private self-consciousness. Results indicated that 31% of participants concealed their diagnosis from others since their diagnosis and 26% concealed their diagnosis in the month preceding their participation in the study. Hypotheses regarding predictors and correlates of concealment were not supported. However, exploratory analyses identified use of alcohol, recency of a recurrence of lung cancer, use of positive reappraisal as a coping strategy, and social support as predictors of concealment as well as internalized shame as a correlate of concealment. These findings serve to extend existing literature on concealing a concealable stigma and support parts of an existing model on the effects of concealment. Future research should aim to test the impacts of concealment in the context of certain social situations to examine longitudinal relationships between predictors and consequences of concealment.

Thoraxkirurgiska ingrepp har väldokumenterade ökade risker för svåra smärtor postoperativt och tidigare forskning visar om den postoperativa smärtlindringen underbehandlas ökar risken att utveckla en kronisk smärta (CPSP) som drabbar 30-50% av alla som genomgår thoraxkirurgi. Detta leder till högre vårdkostnader för samhället, en kraftig försämring av patientens livskvalitet och ett vårdlidande för patienten. Sjukvården borde fokusera på att möta patienternas lidande och ge redskap och möjlighet för vårdarna att lindra lidandet och stärka patientens förmåga till egenvård av smärta i hemmet. Syftet med denna litteraturstudie var att belysa sjuksköterskans upplevelse av vad som behövs för att ge en bra smärtbehandling till patienter som genomgått större kirurgi exempelvis thoraxkirurgi och vilka hinder som måste överstigas för att lyckas. Examensarbetet genomfördes som en systematisk litteraturstudie där innehållet från elva artiklar analyserades och sammanställdes. I analysen av resultatet framkom två teman; Upplevda hinder och sjuksköterskans strategier. De beskriver hur sjuksköterskan på olika sätt arbetar med smärtskattning och vilka hinder som kan uppstå. Resultatet visar på stora problem i smärtbehandling, både vad gäller att smärtskatta som att lindra lidandet och berodde bland annat på bristande kunskap hos både patient och sjuksköterska. Slutsatsen är att sjukvården borde satsa på mer individualiserad patientinformation både preoperativt och innan hemgång, så patienten förstår varför smärtlindring är viktigt. Om detta görs kan man förhindra postoperativa komplikationer och kronisk smärta, som leder till lägre vårdkostnader och minst lika viktigt att bibehålla en patient med god livskvalitet.

No description available.

Mitigating injury in side impact has been an important topic of research for decades. In the mid 1980’s the American government began a program intended to improve the crashworthiness of vehicles in side impact. This program ultimately led to the introduction of a dynamic side impact test (Federal Motor Vehicle Safety Standard (FMVSS) 214), which new vehicles must pass, along with a very similar test aimed at consumer awareness (New Car Assessment Program (NCAP) side impact test). The work presented in this thesis involved the study and simulation of these tests to evaluate occupant response in side impact, with a focus on the thoracic response. In the first portion of the work presented here, an in-depth study of the National Highway Traffic Safety Administration (NHTSA) crash test database was performed. In this study the results of the side impact crash tests of 72 vehicles were examined to understand the general trends seen in this type of testing with regards to vehicle velocity, side intrusion, and occupant injury prediction. A series of average velocity profile curves was created from accelerometer data at 18 measurement points on each vehicle crash tested. Additionally the injury criterion measured by the front seat occupant was plotted against several vehicle variables (such as mass and occupant arm to door distance) to study the effect these variable had on the injury predicted by the occupant. No single variable was shown to have a strong correlation to injury, although increasing door intrusion distance, peak lateral velocity, the Head Injury Criterion (HIC), and pelvic acceleration were found to positively correlate to thoracic injury. In addition, increasing vehicle model year, vehicle mass, and arm to door (AD) distance showed negative correlations with thoracic injury. Following the survey of the NHTSA database, a finite element model of the NHTSA side impact test was developed. This model included a full scale Ford Taurus model, a NHTSA barrier model and three side impact anthropometric test device (ATD) occupant models, each representing a different 50th percentile male dummy. Validation of this model was carried out by comparing the simulated vehicle component velocity results to the corridors developed in the NHSTA crash test database study as well as comparing these velocities, the vehicle deformation profile, and the occupant velocity, acceleration and rib deflection to several Ford Taurus crash tests from a similar vintage to the finite element model. As this model was intended as a ‘baseline’ case to study side impact and occupant kinematics in side impact, side airbags were not included in this model. A lack of experimental data and a lack of consensuses within the automotive crash community on the proper method of modeling these devices and their effectiveness in real world impacts also led to their exclusion. Following model validation, a parametric study was carried out to assess the importance of the initial position of the occupant on the vehicle door velocity profile and the predicted occupant injury response. Additionally the effect of the door trim material properties, arm rest properties and the effect of seat belt use were studied. It was found that the lateral position of the occupant had an effect on the door velocity profile, while the vertical and longitudinal position did not. The use of seatbelts was shown to have no significant effect in these simulations, due to minimal interaction between the restraint system and occupant during side impact. Furthermore, there was a general decreasing trend in the injury predicted as the initial position of the occupant was moved further inboard, down and forward in the vehicle. Stiffer interior trim was found to improve the injury prediction of the occupant, while changing the material of the foam door inserts had no effect. It was found that in general the occupant remained in position, due to the inertia of the occupant, while the seat began moving towards the centerline of the vehicle. Future considerations could include more advanced restraint systems to couple the occupant more effectively to the seat, or to develop side interior trim that engages the occupant earlier to reduce the relative velocity between the occupant and intruding door. Overall, the model correlated well with experimental data and provided insight into several areas which could lead to improved occupant protection in side impact. Future work should include integrating side airbags into the model, widening the focus of the areas of injury to include other body regions and integrating more detailed human body models.

Background: Clinical ergonomic advice for sitting posture has been inferred from anthropometry theory and physiology studies. Qualitative observation of posture has been used to argue that postures are too flexed, too extended, too static, too mobile, require insufficient muscle activity or require too much. In other fields of healthcare, evidence is progressed from basic science to clinical trials before an intervention is prescribed, but postural advice has been prescribed from basic science without quantitative studies of postural behaviour. Spinal neuromuscular control can predict development of low back pain, it is affected by spinal pain, and can be trained, but studies examining these variables rarely measure the spinal position of their test subjects. There is a need for more detail of how spinal positions affect regional muscle activity. Study Objectives: The overall aims of this thesis were to quantify sagittal spinal postures in sitting for comparison within and between subjects and tasks, and to detail paraspinal and abdominal muscle activity associated with sitting postures. The studies quantified regional spinal curves in - Study I: typical posture behaviour during a computer task in comparison with standing, - Study II: postures that are achievable in sitting, - Study III: the regional muscle activity associated with sitting postures that have been clinically advocated as ‘ideal’, - Study IV: cohorts with and without a history of low back pain for comparison of regional muscle activity. Results and Conclusions: For clinical trials quantifying postural behaviour, the postural variation within subjects and task conditions in Study I demonstrated the importance of measurement over a prolonged period and subjects performing relevant tasks (as opposed to brief measures such as radiography that have been the standard for posture assessment). The use of surface tracking to quantify regional spinal curves and sagittal balance establish a foundation to investigate the effect of interventions on posture behaviour (eg. chair geometry, posture training, task variables and subject cohorts). Study I also showed that typical sitting posture for a computer task was more flexed at the thoracolumbar spinal region than when subjects deliberately ‘corrected’ their sitting posture, and both sitting postures were flexed at the lumbar region relative to standing. Study II showed that most subjects were unable to sit with spinal curves like those adopted in standing unless facilitation and feedback were provided, although these curves have been clinically advocated as ‘ideal’ posture. If clinical theories about ‘ideal’ sitting posture are correct, then teaching individuals the awareness of spinal position or skill to adopt these postures could be as important for workplace health and safety as other variables such as design and adjustment of office furniture. Study III showed three upright sitting postures that have been clinically advocated as ‘ideal’ were distinguished by incremental changes in activity of the lumbar multifidus muscles. In Study IV, individuals with a history of low back pain showed more incremental activity at the longissimus thoracis muscle to achieve the same sitting postures. If particular postures are shown to be ‘ideal’ in clinical trials, then training for these postures may need to focus on muscular strategies as well as spinal position. The distinct differences in regional muscle activity observed with spinal curves and subject cohorts (Studies III and IV) imply that studies of spinal neuromuscular control should measure or control spinal curves during testing. If spinal posture were controlled, the flat posture (flat surface from ~T5 to sacrum) would have the advantages of being achievable, commonly used in sitting and easily assessed. The flat posture also demonstrated the lowest muscle activity of the upright sitting postures examined, which may improve accuracy of determining muscle activity onset/offset used as an outcome measure for interventions, distinguishing cohorts or as a predictor for low back pain occurrence.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Thesis (M.Sc.). / Written for the Medical Physics Unit. Title from title page of PDF (viewed ). Includes bibliographical references.

L'objectif scientifique de la thèse est de contribuer à améliorer la compréhension des mécanismes lésionnels découlant de l’impact non pénétrant d’un projectile en région thoracique latérale. Concrètement, l’application concerne l’amélioration de l’évaluation du potentiel lésionnel et l’optimisation de projectiles dits « à létalité réduite ». Cette étude a été menée dans le cadre du projet PARCHOC, associant la Délégation Générale pour l’Armement-Techniques Terrestres, le laboratoire PRISME de l’université d’Orléans, les sociétés Nexter munitions, ITC élastomère et ATCOM télémétrie. Il s’agit notamment de mettre en évidence les paramètres des projectiles qui doivent être maîtrisés pour limiter le risque lésionnel. Nous avons d’abord réalisé une étude pour caractériser des projectiles d'essais constitués d'un culot rigide et d'une ogive en mousse d'élastomère. Les propriétés dynamiques des élastomères ont été caractérisées par le système des barres de Hopkinson. Ce travail a permis la mise au point d'un modèle numérique de comportement des élastomères. Des essais ainsi que des simulations d’impacts sur cibles rigides ont ensuite été réalisés afin d'étudier l'influence du couple masse-vitesse et des caractéristiques mécaniques des élastomères sur le chargement généré. Dans la seconde partie de l'étude, des essais sur cibles biologiques instrumentées ont été menés à l’aide des projectiles d'études précédemment caractérisés. Les résultats expérimentaux et numériques montrent que la dangerosité des projectiles est liée à l’action qu’ils exercent sur la structure osseuse thoracique après sa fragilisation et que le mécanisme lésionnel est fortement dépendant de l’impulsion transmise par le projectile lors de l’impact. / The scientific objective of the thesis was to make a contribution in the understanding of the injury mechanisms following the blunt impact of a projectile on the lateral thoracic region. Practically, the application concerns safety certification and optimization of less-lethal projectile. This research was supported by the project PARCHOC partners: the Délégation Générale pour l’Armement-techniques terrestres, the PRISME laboratory (Orléans university),the companies Nexter munitions, ITC élastomère and ATCOM télémétrie. In particular, we have sought the principal projectile parameters which must be controlled to limit injury risk. Firstly, we have performed a study based on specialized test projectiles, made with a rear rigid part and soft foam (elastomeric) nose. The foams’ chemical formulations were made so that the dynamical properties (measured with the Hopkinson bar apparatus) were those expected. Experiments and simulations of the impacts on rigid wall target have been made to investigate how the mass-velocity couple and the foam material properties influence the impact force. Secondly, an experimental campaign was made using pig anatomical parts and the projectiles previously studied. Experimental and numerical results obtained during the thesis demonstrate that the dangerous nature of the projectiles used is essentially linked to the action on the thoracic bone structure after it has been weakened by the impact. Furthermore, injuries are strongly dependent upon the impulse transmitted during the impact.

As afecções pulmonares são muito comuns na rotina clinica de pequenos animais. No entanto, por apresentarem sintomas inespecíficos, muitas vezes o diagnóstico dessas doenças torna-se limitado. Recursos de imagem como a radiografia e a ultrassonografia torácica são válidos como exames de triagem, mas somente a biopsia pulmonar garante um diagnóstico especifico da doença. Desse modo a toracoscopia fornece um meio minimamente invasivo de diagnóstico para as doenças torácicas e oferece os benefícios de melhor iluminação e ampliação da imagem, quando comparado com a toracotomia. Nesta pesquisa foram avaliadas as técnicas de biópsia pulmonar através da agulha cortante guilhotinada e da pinça de biopsia, guiadas por toracoscopia pelo acesso transdiafragmático em cães que apresentavam imagem sugestiva de nódulo pulmonar em exame radiográfico prévio. Foram utilizados 14 cães da rotina de atendimento do Hospital de Clinicas Veterinárias (HCV) da Faculdade de Veterinária (FAVET) da UFRGS, independente de raça, sexo, idade e peso corporal. Somente animais com nódulos visíveis na radiografia torácica e que apresentaram exames pré-cirúrgicos sem alterações que impediam de serem anestesiados foram incluídos no estudo. Os animais foram posicionados em decúbito dorsal e foram feitos dois acessos à cavidade torácica, um primeiro portal intercostal, para introdução dos dispositivos de biopsia, e outro portal paraxifoide transdiafragmático para introdução do endoscópio. Com cada instrumento de biopsia foram coletadas três amostras do mesmo nódulo ou de nódulos macroscopicamente semelhantes e próximos quando o tamanho destes era inferior a um centímetro. As amostras foram encaminhadas para exame histopatológico no laboratório de Patologia Veterinária da FAVET/UFRGS. A frequência cardíaca (FC), frequência respiratória (FR), saturação de oxigênio (SpO2) e pressão arterial média (PAM) foram aferidas em seis momentos diferentes do procedimento: após a indução da anestesia (T1), Após o estabelecimento do pneumotórax (T2), após a introdução do primeiro trocarte (T3), após a introdução do segundo trocarte (T4), após a coleta dos fragmentos da biopsia (T5) e após reestabelecer a pressão negativa no tórax (T6). O tempo cirúrgico foi cronometrado da incisão ao fechamento da ferida, e foram registradas quaisquer complicações cirúrgicas. No pós-operatório os animais foram avaliados quanto à presença de enfisema subcutâneo, hematoma, seroma, infecção local e deiscência de pontos. Não foi necessário converter os procedimentos toracoscópicos para cirurgia convencional em nenhum dos animais. Concluiu-se tratar de uma técnica segura, rápida sem complicações trans e pós-operatórias. Ambos dispositivos permitiram aquisição de material suficiente para analise histopatológica das alterações pulmonares, no entanto a agulha cortante guilhotinada apresentou maior eficácia principalmente em nódulos pulmonares de maior diâmetro. O acesso transdiafragmático mostrou-se eficiente para exploração de ambos os hemotóraces. / Lung diseases are common in the small animals clinical routine. However, diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides precise diagnosis. Thus, thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared to thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy through the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of UFRGS were assessed. Inclusion criteria was presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of the FAVET / UFRGS. Heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2) and mean arterial pressure (MAP) were measured in six time points during the procedure: after induction of anesthesia (T1); after the establishment of pneumothorax (T2); after introduction of the first trocar (T3); after insertion of the second trocar (T4); after biopsy sampling (T5); and after reestablishment of the thoracic negative pressure (T6). The animals were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedures in any patient. Thoracoscopic-assisted biopsy using both guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications. Both devices provided good quality samples for histopathological analysis of lung abnormalities. However, the cutting guillotine needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic access provided optimal approach for both hemithoraces.

Made available in DSpace on 2015-12-06T23:47:21Z (GMT). No. of bitstreams: 0 / Objetivo: Analisar as diferenças histopatológicas entre os lobos pulmonares submetidos a biópsia cirúrgica de pacientes com fibrose pulmonar idiopática. Métodos: Foram incluídos 16 pacientes com resultados de biópsias concordantes de dois sítios pulmonares, o lobo médio ou o segmento lingular. Técnicas semiquantitativas foram utilizadas na avaliação histológica pulmonar, aplicando-se um escore com base nas alterações encontradas no padrão histológico de pneumonia intersticial usual (PIU). Resultados: Encontrou-se maior incidência de foco fibroblástico em lobo inferior esquerdo e maior volume médio dos fragmentos pulmonares originários do lobo médio. Nenhuma diferença significante, que viesse a mudar o estadiamento da doença, e independentemente do local de origem da biópsia, foi encontrada. Conclusão: Não há dados que fundamentem a rejeição ao uso dos lobos médios e segmentos lingulares na investigação histológica de doenças intersticiais, em especial a fibrose pulmonar idiopática.. / Objective: To analyze the histopathology differences between the pulmonary lobes submitted to surgical biopsy in patients with idiopathic pulmonary fibrosis. Methods: Sixteen patients with usual interstitial pneumonia and concordant biopsies of two distinct lobes (the middle lobe or the lingula) were included in this study. Semiquantitative techniques were used in the histological evaluation of fragments of different lobes of the lung. A score was applied for the evaluation of usual interstitial pneumonia. Results: A greater incidence of fibroblastic foci was found in the left inferior lobe, and a greater mean volume of pulmonary fragments was obtained from the middle lobe. No significant difference was found in variables related to disease staging, no matter what was the pulmonary lobe. Conclusion: There is no reason to despise the middle lobe and the lingula in the histopathological investigation of interstitial diseases of the lung, especially the idiopathic pulmonary fibrosis. / BV UNIFESP: Teses e dissertações