The purpose of the current study is to apply the delay and probability discounting in the areas of parent training and probability of success of treatment. There was a total of 31 participants that completed one demographic questionnaire and two probability and delay discounting surveys either via computer or with paper and pencil. Participants had two options in the surveys: one was an immediate reward, and one with a probability delay. The first survey gave scenarios of hours of parent training, the second was a monetary probability discounting survey.

ABSTRACT Background: On behalf of the Orthopedic clinic, Västerås, a study has been conducted with focus on comparing the results after conservative and surgical treatment due to complete achillestendon rupture. Aim: To compare results when testing the active and passive range of motion, calf muscle endurance, estimation of pain related to the achillestendon and self-efficacy to be physically active for individuals who have undergone conservative or surgical treatment after complete achillestendon rupture. Method: 14 individuals afflicted by complete achillestendon rupture in 2010 were recruited as a purposive sample. Examination were conducted of: Ankle range of motion with a goniometer, calf muscle endurance through a toe-raise test, estimation of pain intensity related to the achillestendon by VAS and self-efficacy to be physically active through “Exercise self-efficacy scale”. P-value and the median were calculated. Result: The results of ankle range of motion and calf muscle endurance were based on the difference between the injured and the healthy side. When testing active plantarflexion the conservative group had a median of 4 ̊ and the surgical group had a median of 10 ̊. At the toe-raise test the conservative group had a median of 11 toe-raises and the surgical group a median of 7. Through estimation of “Exercise self-efficacy scale” the conservative group had a median of 115 point and the surgical group a median of 94. When testing active dorsiflexion, passive plantarflexion, passive dorsiflexion and estimation of pain related to the achillestendon the median value were 0 for both groups. Conclusion: There was no statistical significance between the groups.   Key words: Achilles tendon, operative, rupture, self efficacy, treatment outcome. / SAMMANFATTNING Bakgrund: På uppdrag av Ortoped kliniken Västerås, har en studie genomförts med fokus på att jämföra resultat efter konservativ respektive operativ behandling i samband med total hälseneruptur. Syfte: Att jämföra resultaten vid test av aktiv och passiv fotledsrörlighet, vadmuskeluthållighet, skattning av smärta relaterat till hälsenan samt self-efficacy för att vara fysiskt aktiv för individer som genomgått konservativ respektive operativ behandling efter total hälseneruptur. Metod: 14 individer som drabbats av total hälseneruptur under 2010 rekryterades enligt ett ändamålsenligt urval. Undersökningar gjordes av fotledsrörlighet med hjälp av goniometer, vadmuskeluthållighet via ett tåhävningstest, skattning av smärtintensitet relaterat till hälsenan via VAS och self-efficacy för att vara fysiskt aktiv via ”Exercise self-efficacy scale”. P-värde och median beräknades. Resultat: Resultaten för fotledsrörligheten och vadmuskeluthålligheten baserade sig på skillnaden mellan frisk och skadad sida. Vid test av aktiv plantarflexion hade den konservativa gruppen en median på 4° och den operativa gruppen en median på 10°. Vid tåhävningstestet hade den konservativa gruppen en median på 11 stycken tåhävningar och den operativa gruppen en median på 7. Vid skattning via ”Exercise self-efficacy scale” hade den konservativa gruppen en median på 115 poäng och den operativa gruppen en median på 94. Vid test av aktiv dorsalflexion, passiv plantarflexion, passiv dorsalflexion samt vid skattning av smärta blev medianvärdet 0 för båda grupperna. Slutsats: Det förelåg ingen statistisk signifikant skillnad mellan grupperna.   Nyckelord: Behandlingsresultat, egen förmåga, hälsena, operationer, ruptur.

Abstract This study aimed to investigate the role played by treatment supporters in promoting patients’ treatment outcomes in six TB clinics of Ekurhuleni Metropolitan Municipality, Gauteng. A descriptive research design was used to study TB patients who were registered in the clinics in April and May 2006. Interviews were conducted on 216 new adult patients six months after their registration at clinics, all 30 treatment supporters of those who had supporters and the staff responsible for TB at the six clinics at which the patients were registered. The patients were grouped into those who had supporters 53% (n=115) and those who did not 47% (n=101). Patients’ response rate was 97%. Treatment outcomes were compared between these two groups. Results showed that significantly more supported patients achieved successful outcomes than patients who did not have supporters. The results did not change when transfers and deaths were excluded from the measurement. Successful treatment outcomes were significantly associated with treatment supporters having fewer than 10 patients, patients living with someone, patients of age 40 or more years, male patients, those whose highest education levels were tertiary and secondary. Patients and clinic staff said that supporters were useful in checking on patients’ treatment, giving medicine, counselling and advising patients on medication and in practical help. Conclusion: Treatment supporters had a significant role in promoting patients’ treatment outcomes. It is recommended that TB treatment programme staff should consider using treatment supporters in their programmes.

Objectives: We aimed to assess the variation in patient body weight over time according to the treatment outcome among multidrug-resistant tuberculosis (MDR-TB) cases. Methods: This was a retrospective cohort study. The data of patients commencing MDR-TB therapy were analyzed. Data were collected from different public TB treatment facilities located in peri-urban areas to the south of Lima, Peru. The outcome was patient body weight (kilograms) from treatment commencement, measured monthly. A random effects model was fitted using robust standard errors to calculate 95% confidence intervals. Results: Of a total of 1242 TB cases, 243 (19.6%) were MDR-TB. Only 201 cases were included in the analysis; 127 (63.2%) were males and the mean patient age was 33.6 (standard deviation 16.2) years. Weight changes over time among the patients who were cured differed from changes in those who died during therapy (p < 0.001). Weight curve divergence was important at the end of the third, fourth, and fifth treatment months: on average, the weight difference was 2.18 kg (p < 0.001), 3.27 kg (p = 0.007), and 3.58 kg (p = 0.03), respectively, when cured patients were compared to those who died. Conclusions: Our results show that weight variation during treatment can be a useful surrogate for the treatment outcome, specifically death during therapy. MDR-TB patients with weight loss should be followed more closely, as they are at greater risk of death. / Revisión por pares

Objetivo: Avaliar em pacientes submetidos à cirurgia de correção de ptose palpebral e dermatocálase: a) o nível de associação de medidas propedêuticas pré-operatórias (função do músculo levantador da pálpebra superior (FMLPS), distância margem palpebral superior ao centro da pupila (DMR1) e altura do sulco palpebral (AS), com a magnitude de desinserção do tendão do músculo levantador da pálpebra superior (MLPS). b) A influência da idade, sexo, presença de ectrópio/entrópio e cirurgia ocular prévia na magnitude de desinserção do tendão do MLPS. c) Avaliar as diferenças das medidas propedêuticas palpebrais pré e pós-operatórias . d) Avaliar a presença de desinserção do MLPS na pálpebra não-ptótica de pacientes com ptose unilateral. e) Avaliar a presença de desinserção do MLPS em pálpebras com DMR1 normal. Metodologia: Desenho do estudo: Série de casos, não comparativo, prospectivo. Casuística: Quarenta e quatro pacientes com ptose palpebral e dermatocálase foram incluídos. Intervenção: Exploração do tendão do MLPS durante a blefaroplastia em pacientes com ptose e dermatocálase. Nos casos de desinserção, o tendão foi refixado ao tarso. Desfechos analisados: Avaliação do nível de associação das medidas propedêuticas pré-operatórias (além de sexo, idade, diabetes, cirurgia ocular prévia, presença de ectrópio/entrópio e queixa de ptose) na magnitude de desinserção do MLPS. Foram utilizados modelos uni e multivariados. A interação entre as variáveis foi testada no modelo multivariado e também foi realizada a avaliação da diferença entre as medidas de FMLPS, DMR1 e AS antes e depois da intervenção. A dependência entre os olhos foi corrigida por meio de equações de estimações generalizadas. Correlação de Pearson foi utilizada para quantificar a dependência entre os olhos para FMLPS, DMR1 e AS. Resultados: A média de desinserção do tendão do MLPS foi de 5,47 mm ± 3,02 para o olho direito e 5,99 mm ± 2,60 para o esquerdo. Com exceção da queixa de ptose e da FMLPS, todas as variáveis testadas foram estatisticamente associadas à magnitude de desinserção do tendão do MLPS. Quando todas elas entraram em um modelo multivariado, somente a DMR1 e a AS foram estatisticamente preditoras da magnitude de desinserção do tendão do MLPS. Houve diferença estatisticamente significante entre a FMLPS antes e depois da cirurgia, sendo a excursão do MLPS mais limitada após a cirurgia, diminuindo, em média, 1,1 mm (p < 0,001). As medidas pré e pós-operatórias de DMR1 e AS foram estatisticamente diferentes, com melhora no pós-operatório, sendo que DMR1 aumentou, em média, 1,6 mm e a AS diminuiu, em média, 3,97mm (p < 0,001). Encontrou-se correlação significante entre os olhos para todas as variáveis propedêuticas analisadas antes e depois da cirurgia. O mesmo foi encontrado para a correlação quanto ao grau de desinserção nos dois olhos (p > 0,01). Conclusões: a) Das medidas pré-operatórias, DMR1 e AS foram as que mais se associaram à magnitude de desinserção do tendão do MLPS, sendo que houve interação entre as duas medidas para esta associação no modelo multivariado de análise. b) Idade, sexo, cirurgia ocular prévia e presença de ectrópio/entrópio estiveram associados ao grau de desinserção, mas somente no modelo univariado de análise. c) Houve aumento significativo das medidas de DMR1 no pós-operatório, diminuição da AS e da FMLPS. d) Houve quatro pacientes com ptose unilateral. Dois deles apresentaram desinserção do MLPS no olho sem ptose. e) Foram encontrados oito pacientes com medidas de DMR1 normais em um ou ambos os olhos. Destes, somente um não apresentou qualquer desinserção do MLPS / Purpose: To evaluate on patients who underwent to ptosis and dermatochalasis correction: a) the association of pre-operatory propedeutic measures (upper eyelid levator muscle function (UELMF), margin reflex distance (MRD1), and eyelid crease height (ECH)) on the amount of upper eyelid levator muscle (UELM) disinsertion. b) The association of gender, age, previous surgery, and ectropion/entropion were analyzed as predictive factors for the amount of upper eyelid levator muscle disinsertion. c) To evaluate the differences of eyelid propedeutic measures before and after surgery. d) To evaluate the amount of UELM disinsertion in the normal eyelids of patients with unilateral ptosis. e) To evaluate the amount of UELM disinsertion in patients with normal MRD1. Methods: Design of the study: prospective non comparative case series study. Population: Forty four patients with blepharoptosis and dermatochalasis were enrolled. Intervention: Exploration of the levator tendon (LT) during blepharoplasty and ptosis correction and in case of its disinsertion, the tendon was reattached to the tarsus. Outcome Measured: Margin reflex distance (MRD1), upper eyelid levator muscle function (UELMF), eyelid crease height (ECH), gender, age, diabetes, previous surgery, ectropion/entropion, and ptosis complaint were analyzed as predictive factors for the amount of upper eyelid levator muscle disinsertion. Both the uni and multivariate approaches were tested and for the latter, interaction from variables was also evaluated. The differences between UELMF, MRD1, ECH before and after surgery were evaluated bilaterally. Dependency between both eyes was corrected by generalized estimating equations. Pearson correlation was used to evaluate the dependency of the two eyes regarding UELMF, MRD1 and ECH. Results: The mean levator tendon disinsertion was 5.47 mm ± 3.02 for the right eye and 5.99 mm ± 2.60 for the left. For univariate models, with the exception of the complaint of ptosis and eyelid function, all variables were statistically related to the amount of disinsertion of the upper eyelid levator tendon. For the multivariate model, when all variables were considered, only MRD1 and ECH were significantly associated with the amount of disinsertion. There was a statistical significant difference between the measures of UELMF before and after surgery with excursion decreasing a mean value of 1.1 mm after the procedure (p < 0,001). Measures of MRD1 showed an increase in a mean of 1.6 mm and ECH decreased in a mean of 3.97 mm (p < 0,001). We had found a significant correlation between both eyes for all eyelid propedeutic variables analyzed, both before and after surgery. Correlation of the propedeutic measures before surgery, between the two eyes, was stronger for the group without previous surgery. The same results for correlation was found for the amount of disinsertion (p < 0.001). Conclusions: a) From the pre-operatory measures, MRD1 and ECH were the most important variables regarding association with the amount of UELM tendon disinsertion. A very important interaction was found between these two variables on the multivariable analysis model. b) Gender, age, diabetes, previous surgery, and presence of ectropion/entropion were associated with the amount of disinsertion but only on the univariable model of analysis. c) There was an increase on the measures of MRD1, ECH and UELMF decreased. d) Four patients had unilateral ptosis. Two of those patients presented UELM disinsertion on the eye without ptosis. (e) Eight patients had normal values for MRD1 in one or both eyes, from those, only one had no disinsertion

The purpose of this project was to design an algorithm for the management of Dermatofibrosarcom Protuberans (DFSP.) The National Cancer Center Network guidelines suggest immediate reconstruction in most cases after DFSP resection. We believe this algorithm is inadequate. Due to the infiltrating nature of DFSP, tumor margins are often positive after resection. Immediate reconstruction in the context of residual tumor is problematic because of the risk for spreading microscopic disease and the potential to compromise reconstructive options. At our institution we examined the prevalence of positive margins on permanent pathology after immediate closure following surgical resection of DFSP. Forty-one patients were identified; 25 had received treatment with surgical excision and 16 with Mohs surgery. Of the 25 patients that were treated with surgical excision, 20 underwent immediate closure and 5 underwent delayed closure after tumor resection. Eight out of 19 (40%) of patients who underwent immediate closure were found to have positive margins on permanent pathology. Given these findings, we propose a treatment algorithm focused on more conservative surgical management of DFSP in which negative margins are established before closure. Mohs surgery, which allows for immediate identification of pathology, plays a central role.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 115-133).

Obsessive-compulsive disorder (OCD) contributes to significant distress and chronic individual and societal impairment (e.g., DuPont et al., 1995; Ruscio et al., 2010). Despite the effectiveness of existing exposure-based therapies, some clients do not achieve symptom reduction or remission (Öst et al., 2015). Thus, identification of the mechanisms of change in treatment and more focused interventions are warranted to improve intervention effectiveness (e.g., Zvolensky et al., 2006). Distress intolerance may be an important but understudied mechanism of change in treatment for OCD. The current study replicated and extended previous findings that were limited by a small sample size (Macatee & Cougle, 2015), lack of focus on OCD specifically (McHugh et al., 2014; Bornovalova et al., 2012; Williams et al., 2013), and the use of non-clinical participants (Cougle et al., 2011; Macatee & Cougle, 2015) by using a residential and intensive outpatient sample of patients diagnosed with OCD. The current study found that reductions in DI accounted for significant improvement in OCD severity beyond changes in biological sex, anxiety change, depression change. Further, reductions in DI significantly contributed to OCD treatment response. Limitations and future directions were discussed.