It is generally recognized that a serious illness with concurrent hospitalization in an ICU will have an impact on family members. Few researchers, however, have described the ways in which spouses are affected when their mates are hospitalized in an ICU. Therefore, this study aimed to describe and explain the spouses' experiences of having a mate in an ICU following coronary artery bypass graft surgery. Kleinman's conceptual framework guided the development of the research question and provided the focus for data collection and analysis. Kleinman proposes that an understanding of the client's perspective is necessary for the provision of effective health care. A qualitative research method based on the theoretical perspective of phenomenology was used to answer the research question. The spouses' viewpoints were elicited through unstructured interviews. The sample consisted of seven spouses, four women and three men. The spouses were interviewed on two occasions, once while their mate was still in the ICU and once shortly following their mate's discharge from the ICU. A total of 13 in-depth interviews were conducted over a 3 month period. Data were analyzed simultaneously with and following data collection. Responses that were similar were grouped together into categories. After the data were examined and sorted into categories, the researcher defined the theme that dominated each category. The themes that emerged from the data were clarified, validated, and/or rejected by the participants during subsequent interviews. As relationships between the categories were identified, the important aspects of the spouses' experiences became apparent. The findings revealed that the spouses located the ICU experience within the context of their experience with their mate's coronary artery bypass graft surgery. The spouses understood and made sense of the ICU experience by attaching meaning to specific events that related to the entire surgical experience. They perceived the surgical experience as consisting of three distinct but interrelated phases: pre-surgery; waiting during surgery; and post-surgery. During each phase, the spouses described and explained how they reacted to and coped with each new situation. These two themes, "reaction to the situation" and "coping with the situation," appeared as threads throughout the entire surgical experience. By organizing the data in relation to phases and themes, the researcher was able to meaningfully understand and communicate the spouses' entire surgical experience. In view of the study findings, implications for nursing practice, education and research are delineated. / Applied Science, Faculty of / Nursing, School of / Graduate

ABSTRACTBackground: Thoracic surgery includes surgical diseases in the thorax and is dominated by coronary artery surgery. Pain after heart surgery is often most intense three to four days after the surgery. The pain treatment has improved over the last 20-30 years. Despite this, 30-50% report unbearable postoperative pain. Pain can in many cases be relieved by non- pharmacological methods such as Transcutaneous Electric Nerve Stimulation (TENS). TENS activates the body's own pain-relieving mechanisms by stimulating peripheral nerves. Aim: The aim of this study was to explore whether TENS has an effect on postoperative pain after thoracic surgery and to describe obstacles and opportunities for TENS as a pain management method. Method: The study has a descriptive design. The method of the study is a quantitative literature review that included 11 articles. The database PubMed was used to find articles. Result: TENS had a positive effect on self-estimated pain and reduced the consumption of analgesics after thoracic surgery. The few articles that included obstacles and opportunities showed that nurses perceived using TENS moderately difficult. Furthermore, they did not show any side effects. Conclusion: TENS as a pain management method after thoracic surgery relieves pain and reduces the consumption of analgesics, which could lead to less suffering for the individual, reduced burden on healthcare and a lower social cost.

No description available.

Background: Emerging evidence suggests that cervical and thoracic joint manipulations may be advocated in treating patients with shoulder pain. Objectives: To determine the acute effects of cervical, cervicothoracic, and thoracic joint manipulations on outcomes of self-reported pain and pain pressure threshold in experimentally induced shoulder pain. Design: Repeated measures. Methods: Twenty (20) healthy volunteers were tested on two sessions. Session 1 consisted on baseline assessment of pain pressure threshold testing over the infraspinatus bilaterally and self-reported shoulder pain using the shoulder pain and disability index (SPADI) pain scale. An isokinetic exercise protocol was used to induce delayed onset muscle soreness. In session 2 (24-48 h later), all variables were reassessed before and immediately after a combination of cervical, cervicothoracic and thoracic manipulations. Results: SPADI pain scale scores were significantly different between time points (p < 0.001): the exercise protocol significantly increased reported pain [mean increase 14.1, p < 0.001] while the manipulation significantly decreased reported pain (mean decrease 5.60, p < 0.001)) although pain remained higher than baseline levels. Pain pressure threshold differences were also found between time points (p = 0.001): manipulation significantly increased pain threshold bilaterally (p < 0.001) similar to baseline levels. Conclusions: Cervical, cervicothoracic, and thoracic joint manipulations acutely increased pain pressure threshold and decreased self-reported shoulder pain in participants with experimentally induced shoulder pain. Physiotherapists may consider the combination of such techniques to achieve short-term hypoalgesic effects and facilitate the application of more active interventions.

Objective: To evaluate the age-related changes in active pumping in thoracic duct (TD) from 24-month-old Fisher-344 rats comparing with TD pumping in 9-month rats. Methods: Lymphatic diameters, contraction amplitude and frequency, ejection fraction, and fractional pump flow were determined in isolated TD preparations. Western blot analyses were performed to evaluate relative levels of eNOS and iNOS in 9- and 24-month-old TD. Results: Stretch-dependent regulation was altered in aged TD especially at higher levels of pressure: the negative inotropy, negative chronotropy and diminished minute pumping (2- to 3-fold decrease) were observed. Physiological NO/imposed-flow-dependent inhibition was completely abolished in aged TD, yet NO-synthase blockade by l-NAME (10-4 M) increased pumping in a flow-independent manner. Western blot analyses indicated that the relative levels of eNOS were decreased ∼ 7-fold in the 24-month-old TD when compared with 9-month-old TD; whereas iNOS levels were increased ∼ 10-fold in 24-month-old TD. Conclusions: These data provide the first evidence that stretch- and imposed-flow-dependent regulatory mechanisms are greatly altered in aged TD. These alterations of active pumping mechanisms in TD appear to be related with age-related disturbances in NO-dependent regulatory pathways, and may reflect diminished lymphatic muscle contractility as well as altered lymphatic endothelium function.

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The objective of this study was to evaluate the effects of sex, loading rate, and age on the compressive and tensile material properties of human costal cartilage over a wide range of subject ages and sexes. Cylindrical compression samples and dog-bone shaped tension samples were tested to failure on a material testing system using target strain rates of 0.005 strain/s and 0.5 strain/s. Compression data were obtained from forty (n = 40) subjects (M = 26, F = 14) ranging in age from 11 – 69 years (Avg. = 39.1 ± 18.2 yrs.), and matched loading rate data were obtained for thirty-four (n = 34) samples. Tension data were obtained from forty-one (n = 41) subjects (M = 30, F = 11) ranging in age from 10 – 59 years (Avg. = 32.9 ± 14.9 yrs.), and matched loading rate data were obtained for seventeen (n = 17) samples. For both compression and tension, load and sample deflection data were collected and used to calculate stress and strain. For the compression data, the toe region was fit using a second-order polynomial, and the toe transition stress, toe transition strain, second-order polynomial coefficient A, and second-order polynomial coefficient B were calculated. In addition, the elastic modulus, ultimate stress, ultimate strain, and strain energy density (SED) were also calculated for each test. For the tension data, only the elastic modulus, ultimate stress, ultimate strain, and SED were calculated for each test. There were no effects of sex on the material properties for either method of loading or strain rate. Therefore, male and female data were combined for the age and loading rate analyses. For compression, toe transition stress, toe transition strain, A, elastic modulus, ultimate stress, and SED were all found to be significantly higher at 0.5 strain/s compared to 0.005 strain/s. For tension, no material properties were found to differ with respect to loading rate. Regarding the effects of age, toe transition stress, toe transition strain, A, B, ultimate stress, ultimate strain and SED were found to significantly decrease with advancing age for the 0.005 strain/s compression data. At 0.5 strain/s, toe transition stress, toe transition strain, elastic modulus, ultimate stress, ultimate strain, and SED all significantly decreased with advancing age. For tension, ultimate stress, ultimate strain, and SED were found to significantly decrease with advancing age at 0.005 strain/s and 0.5 strain/s. Comparing the two loading modes, the ultimate stress, elastic modulus, and SED were significantly higher in compression than in tension. For the compression samples, sample density and percent calcification were also obtained for each sample using physical measurements and micro-CT scans, respectively. However, since there were only a few samples with large calcifications, no meaningful trends were found. This is the first study of its kind to analyze the effects of sex, loading rate, and age on both the compressive and tensile material properties on human costal cartilage from such a wide range of subject ages. The results from this study can be used to develop more accurate finite element models of the human body, which will allow researchers to better evaluate human occupant response and injury risk in motor vehicle collisions for both young and old individuals. / Master of Science / Serious thorax injuries are often observed in motor vehicle collisions. Although a considerable amount of research has investigated the material and structural properties of rib cortical bone and whole rib sections, only a limited number of studies have focused on characterizing the material properties of costal cartilage, which comprises a substantial portion of the anterior region of the thorax. The studies that do exist include small subject pools and/or are limited to sub-failure indentation tests. Indentation tests are limited to low deflections and focal loading and are unable to obtain the failure material properties of costal cartilage. Therefore, the purpose of this study was to quantify the compressive and tensile material properties of human costal cartilage at two loading rates for a wide range of subject demographics. These properties were then evaluated with respect to sex, loading rate, and age. Cylindrical compression samples and dog-bone shaped tension samples were tested to failure on a material testing system at target strain rates of 0.005 strain/s and 0.5 strain/s. Compression data were obtained from forty (n = 40) subjects ranging in age from 11 – 69 years, and tension data were obtained from twenty-eight (n = 28) subjects ranging in age from 10 – 59 years. For both compression and tension, load and sample deflection data were collected and used to calculate stress and strain. For the compression data, the magnitude and shape of the initial loading region (i.e., the toe region), elastic modulus, ultimate stress, ultimate strain, and strain energy density (SED) were quantified for each test. For the tension data, the elastic modulus, ultimate stress, ultimate strain, and SED were calculated for each test. There were no significant effects of sex on the material properties for either method of loading or strain rate. Therefore, male and female data were combined for the age and loading rate analyses. For compression, the toe region transition point (i.e., stress and strain), toe region shape coefficient A, elastic modulus, ultimate stress, and SED were all found to be significantly higher at 0.5 strain/s compared to 0.005 strain/s. For tension, no material properties were found to differ with respect to loading rate. Regarding the effects of age, toe region transition point (i.e., stress and strain), toe region shape coefficients A and B, ultimate stress, ultimate strain, and SED were found to significantly decrease with advancing age for the 0.005 strain/s compression data. For the 0.5 strain/s compression data, toe transition stress, toe transition strain, elastic modulus, ultimate stress, ultimate strain, and SED all significantly decreased with age. For tension, ultimate stress, ultimate strain, and SED were found to significantly decrease with advancing age at 0.005 strain/s and 0.5 strain/s. The ultimate stress, elastic modulus, and SED were higher in compression than in tension. Overall, this is the first study to evaluate the effects of sex, loading rate and age on the compressive and tensile material properties of human costal cartilage from a wide range of ages. These data can be used to assess differences in the response and tolerance of the human rib cage for occupants of various age in motor vehicle collisions.

Methods of non-invasive vascular imaging of thoracic vessels are briefly introducted in the first part of the thesis. Benefits and limitations of CT angiography and MR angiography of the thoracic aorta, pulmonary vessels, great thoracic veins and cardiac vessels are discussed. The main part of the thesis is concerning to pulmonary veins imaging in cohort of patients with atrial fibrilation, who underwent radiofrequency ablation of the pulmonary veins. Aim of the study was to confirm the CT angiography as suitable method of pulmonary veins imaging, to find out frequency of atypical pulmonary veins anatomic arrangement and to measure pulmonary veins diameter in our cohort, including comparison between both sexes. The main purpose of the study was to compare the diameter of pumonary veins before and after the radiofrequency ablation and discover frequency and severity of iatrogenic pulmonary vein stenoses after the procedure. The group of patients planned for biventricular stimulation implantation is presented finally. CT angiography of coronary sinus and his branches was performed before the procedure. Aim of this work was to evaluate whether the CT angiography is proper method for cardiac venous system visualisation and wheather is it possible to choose patients suitable for implantation of left ventricle...

Frontal motor vehicle collisions (MVCs) account for the majority of injuries and fatalities in MVCs according to the Fatality Analysis Reporting Systems (FARS). One of the most commonly injured regions of the body during MVCs is the thorax. While there are fewer adult passengers riding in the rear seat compared to the front seat, the number of adults in the rear seat may increase dramatically in the near future with the rise of ridesharing services and highly automated vehicles (HAVs). With the increase in exposure for adults riding in the rear seat, the safety of these passengers needs to be evaluated. Previous research has shown that occupant protection in the rear seat is disproportionately lower than that of the front seat in modern vehicles due to the focus on front seat occupants in both regulatory and market-driven crash tests. This has resulted in many of the occupant safety systems, e.g., pretensioners (PT), load limiters (LL), and airbags, being widely available in the front seat, but sparsely available in the rear seat. Anthropomorphic test devices (ATDs) have been developed to investigate occupant safety during frontal MVCs and can be utilized in the investigation of rear seat occupant injuries. However, the biofidelity and injury risk criteria used for these ATDs has only been validated when seated in the front seat. To validate the response and injury risk predictions of existing frontal ATDs in the rear seat it is necessary to generate new biomechanical data in the rear seat of modern vehicles. The purpose of this work is to quantify the biomechanical responses of two frontal ATDs, i.e., the Hybrid III and THOR-50M 50th percentile male ATDs, and 50th percentile male post mortem human surrogates (PMHS) seated in the rear seat of modern vehicles, which have various seat geometries and restraint types, during frontal MVCs. Emphasis is placed on comparisons between the thoracic responses of the three human surrogates e.g., thoracic deflection time histories, and thoracic injury risks, i.e., ATD injury risk prediction versus instances of PMHS injuries. A series of twenty-four frontal sled tests were first conducted with the HIII and THOR-50M ATDs seated in the rear seats of seven vehicle test bucks with varying seat geometries and two different restraint types. Three vehicles had advanced restraints while four had conventional restraints. Three different crash pulses were used derived from vehicle specific US New Car Assessment Program frontal crash data: Scaled (32kph), Generic (32kph), and NCAP85 (56kph). Thoracic injury metrics were not exceeded in the lower severity pulses for either ATD but were exceeded during some of the high severity tests. A matched comparison analysis between a front and rear seated Hybrid III 50th percentile male ATD is presented second that highlights the disparities between front and rear seat iii occupant safety of modern vehicles during frontal MVCs. The Hybrid III ATD data were used for this comparison. Thoracic injury risk was found to be higher for the rear seated HIII across all vehicles, while thoracic acceleration was lower in the rear than the front for some vehicles. PMHS thoracic responses and injury risk equations were then evaluated in four of the vehicles used for the ATD tests using the high severity sled pulse, i.e., NCAP85 (56kph). Thoracic acceleration and normalized deflection values were higher in vehicles with conventional restraints, and the location of maximum deflection was always inboard of the sternum. The resulting thoracic injuries ranged from AIS 3 to AIS 5. Additionally, there were a larger average number of rib fractures in vehicles with conventional restraints versus advanced restraints. A multi-point deflection injury risk equation predicted injury the best. However the less censored rib fracture data that were obtained suggest that all three of the injury equations evaluated could be improved. Lastly, the PMHS data were used to assess the similarities in thoracic response between the ATDs and PMHS. An objective rating metric was used for the response comparison. The HIII had a slightly better average score than the THOR-50M; however, the THOR-50M had a more biofidelic kinematic response during the tests. This analysis furthers the understanding of the effect of different occupant protection systems on thoracic injury risk in a rear seat environment and the biofidelity of frontal 50th percentile male ATDs in the rear seat. / Doctor of Philosophy / Frontal motor vehicle collisions (MVCs) account for the majority of injuries and fatalities in MVCs according to the Fatality Analysis Reporting Systems (FARS), a nationwide census of fatal injuries suffered during crashes. One of the most commonly injured regions of the body during MVCs is the thorax i.e. the chest. While there are fewer adult passengers riding in the rear seat compared to the front seat, the number of adults in the rear seat may increase dramatically in the near future with the rise of ridesharing services and in the future, the rise of highly automated vehicles (HAVs commonly called "driverless cars"). The safety of adult rear seat passengers needs to be evaluated due to the potential increase in occupancy rates. Previous research has shown that occupant protection in the rear seat is disproportionately lower than that of the front seat in modern vehicles. This is likely due to the focus on front seat occupants in both regulatory tests and market-driven crash tests such as the New Car Assessment Program and IIHS frontal overlap tests. This has resulted in many of the advanced occupant protection systems being widely available in the front seat, but sparsely available in the rear seat. Anthropomorphic test devices (ATDs), i.e., crash test dummies, have been developed to investigate occupant safety during frontal MVCs and can be utilized in the investigation of rear seat occupant injuries. However, the biofidelity (similarity of ATD response to a human surrogate) and injury risk criteria used for these ATDs has only been validated when seated in the front seat. To validate the thoracic response and injury risk predictions of the existing frontal ATDs when seated in the rear seat it is necessary to generate new biomechanical data in the rear seat of modern vehicles. The purpose of this work is to quantify the thoracic response of two current 50th percentile male frontal impact ATDs, i.e., the Hybrid III and THOR-50M, and similarly sized male post mortem human surrogates (PMHS) seated in the rear seat during a frontal MVC. Several vehicles were used and chosen to represent various seat geometries and restraint types. There are two restraint types in the rear seat within this body of work, conventional and advanced. A conventional restraint consists of a three point seat belt, while an advanced restraint consists of a three point seat belt with additional safety features installed. Emphasis is placed on the injury risk prediction from the ATD versus actual instances of injuries from the PMHS. A series of frontal sled tests were first performed with the Hybrid III and THOR-50M ATDs. Three different crash pulses derived from vehicle specific US New Car Assessment Program frontal crash data were used: Scaled (32kph), Generic (32kph), and NCAP85 (56kph). v These tests showed that the established injury metrics for the two ATDs were exceeded in some of the high severity tests. A matched comparison analysis between a front and rear seated Hybrid III 50th percentile male ATD is presented and highlights the disparities between front and rear seat occupant safety of modern vehicles during frontal MVCs. The thoracic injury risk was found to be higher in the rear compared to the front for all vehicles. A series of frontal sled tests were then performed with the mid-sized male PMHS using the high severity sled pulse (NCAP85) and four of the vehicles from the ATD tests. The thoracic deflections for the PMHS were normalized by the surrogate chest depth in order to compare them between different sized surrogates, and were found to be higher in vehicles with conventional restraints. All PMHS had severity thoracic injuries. Additionally, there were a larger average number of rib fractures in vehicles with conventional restraints versus advanced restraints. Finally, the thoracic response of each ATD was compared to the PMHS to further the understanding of the effect of different occupant protection systems on thoracic injury risk in a rear seat environment and investigate rear seat biofidelity of each ATD. The THOR-50M had a more biofidelic kinematic response, while the Hybrid III matched the PMHS thoracic deflections and accelerations more accurately when compared with an objective rating metric. The comparison between surrogate responses furthers the understanding of 50th percentile male ATD biofidelity, the ATD injury risk prediction capabilities, and effects of different occupant protection systems on thoracic injuries in the rear seat.

No description available.