Este estudo avaliou pacientes portadores de cromoblastomicose, sendo feita uma categorização clínica em dois grupos, de acordo com a forma clínica da lesão dermatológica: o primeiro composto por indivíduos com lesões elevadas e o segundo formado por casos com lesões planas, com biópsias realizadas antes e depois dos tratamentos. Através de critérios semiquantitativos, os elementos anatomopatológicos foram analisados, constatando-se a presença do padrão granulomatoso chamado granuloma micótico misto organizado, com baixa intensidade em lesões planas e alta em elevadas. Evidenciou-se que pacientes com lesões planas evoluíram bem clinicamente, com exames micológicos negativos e sem recidivas (bons respondedores), porém aqueles com lesões elevadas apresentaram evolução clínica desfavorável, com exames micológicos positivos e doença recidivante ou recalcitrante, apesar dos tratamentos recebidos (maus respondedores). E, entre os componentes histopatológicos reacionais à invasão fúngica, verificou-se associação significativa para fibrose, podendo levar a um pior prognóstico. Estes achados clínicos e histopatológicos conferem a esta patologia uma idéia de polaridade, à guisa dos fenômenos das formas polares da hanseníase, da fagocitose, e dos agentes de baixa virulência. Os autores propõem uma classificação morfológica dos granulomas da CBM em dois tipos polares: granuloma micótico misto organizado (GMMO) polar com alta intensidade dos elementos celulares (que corresponderia ao polar não tuberculóide) e GMMO polar com baixa intensidade (que corresponderia ao polar tuberculóide). / Patients with chromoblastomycosis were studied and dichotomized into two groups according to the clinical lesions: flat and elevated ones which were biopsied before and after treatments. Histopathological structures underwent through semiquantitatively analisys evidencing the mixed organized mycotic granuloma with low intensity of histopathological elements in flat lesions and high in elevated ones. Flat lesions have improved clinically with negative micological studies (good responders) while elevated lesions’ patients did not (bad responders). It was found significant association between evidence of fungus and fibrosis with a poor prognosis. Clinical and histopathological findings suggest a polarity concept to this disease based on the fenomenal polar forms of hanseniasis, fagocitosis and the low virulence agents. The authors proposed a morphological classification of the chromoblastomycosis’ granulomas into two polar types: polar mixed organized mycotic granuloma (MOMG) with high intensity of the cellular elements (like the polar non tuberculoid type) and the polar MOMG with low intensity (like the polar tuberculoid type).

<p>Pravilna ishrana preživara je važna za održanje zdravstvenog stanja životinja, a takođe je i ključna za efikasnu i ekonomičnu proizvodnju mleka i mesa. Kod visokoproizvodnih preživara, kao &scaron;to su tovna junad i mlečne krave, energetske potrebe su velike kako bi se ostvario brz prirast telesne mase i visok prinos mleka. Termički tretmani se koriste za pobolj&scaron;anje hranljivih, higijenskih, fizičkih i hemijskih karakteristika hrane za životinje. Osnovni cilj istraživanja u okviru ove disertacije je analiza uticaja različitih termičkih tretmana na promene skrobne komponente i svarljivost kukuruza kod preživara. U tu svrhu primenjeni su tretmani peletiranja, parnog flekičenja, mikronizacije i ekstrudiranja na uzorcima kukuruza i potpune sme&scaron;e za krave muzare. Promene u strukturi skrobnih granula su praćene pomoću skening elektronske mikroskopije i diferencijalne skenirajuće kalorimetrije, dok su promene u hidrataciji i bubrenju uzoraka određene analizom kriva pastiranja, indeksa apsorpcije vode (WAI) i indeksa rastvorljivosti u vodi (WSI). In situ tehnikom je praćena promena brzine svarljivosti skroba i suve materije u buragu preživara i uticaj različitih termičkih tretmana na mesto varenja skroba kukuruza. Promene u svarljivosti organske materije (SOM) kroz ceo digestivni trakt preživara su određene in vitro multi-enzimskom metodom.<br />Na osnovu rezultata DSC analize uzoraka kukuruza i sme&scaron;a utvrđeno je da su parno flekičenje, mikronizacija i peletiranje blagi tretmani, dok je ekstrudiranje o&scaron;triji tretman koji dovodi do potpunije želatinizacije skroba. U uzorku parno flekičanog kukuruza do&scaron;lo je do interakcije degradiranih komponenti (skroba, proteina i lipida) na molekularnom nivou i nastanak jedinjenja sa većom molekulskom masom i smanjenom rastvorljivo&scaron;ću. U dva uzorka ekstrudiranog kukuruza zbog većih sila smicanja i dužeg vremena zadržavanja materijala u ekstruderu do&scaron;lo je do delimične želatinizacije koja je bila praćena dekstrinizacijom skroba. In situ metodom su za uzorak netretirane sme&scaron;e određene najniže vrednosti nestajanja SM i skroba u buragu, dok su svi primenjeni termički tretmani doveli do značajnog povećanja razgradnje SM i skroba. Najmanje povećanje razgradnje skroba u poređenju sa netretiranom sme&scaron;om je zabeleženo kod sme&scaron;e koja je sadržala parno flekičan kukuruz, dok je u svim uzorcima ekstrudiranih sme&scaron;a do&scaron;lo do razgradnje velike količine skroba već tokom prva 3h inkubacije. U poređenju sa netretiranom sme&scaron;om, svi primenjeni termički tretmani su doveli do povećanja brzine razgradnje skroba u manjoj ili većoj meri a u zavisnosti od vrste i intenziteta tretmana. Značajne razlike u karakteristikama razgradnje skroba su zabeležene nakon variranja procesnih parametara ekstrudiranja, dok su uočene razlike između sme&scaron;a koje su sadržale mikronizirani kukuruz bile mnogo manje izražene. Mobile bag metodom određena je svarljivost skroba u crevima koja je u netretiranoj i svim termički tretiranih sme&scaron;ama iznosila 100%. Statističkom obradom rezultata nije utvrđeno značajno povećanje SOM kukuruza i sme&scaron;e nakon primenjenih termičkih tretmana u poređenju sa netretiranim uzorcima.</p> / <p>Proper ruminant nutrition is important for maintaining the health of animals, and it is also crucial for the efficient and economical production of milk and meat. In high-yielding ruminants, such as fattening cattle and dairy cows, energy needs are high in order to achieve rapid weight gain and high milk yield. Thermal treatments are used to improve nutritional, hygienic, physical and chemical characteristics of animal feed. The main objective of this research is the analysis of the influence of various thermal treatments on changes in the starch component and the digestibility of corn in ruminants. For this purpose pelleting, steam flashing, micronization and extrusion of maize samples and complete mixture for dairy cows were applied. Changes in the structure of starch granules were monitored by scanning electron microscopy and differential scanning calorimetry (DSC), while changes in the hydration and swelling of samples were determined by analyzing pasting properties, water absorption index (WAI) and water solubility index (WSI) of samples. In situ technique was used to determine the changes in the rate of digestibility of starch and dry matter in rumen and the influence of various thermal treatments on the site of digestion of corn starch. Changes in the organic matter digestibility (OMD) through the entire digestive tract of the ruminants are determined by the in vitro multi-enzymatic method.<br />Based on the results of DSC analysis of corn and complete feed samples, it has been found that steam flaking, micronization and pelleting are mild treatments, while the extrusion is more severe treatment that leads to a more complete starch gelatinization. In steam flaked corn interaction of degraded components (starch, proteins and lipids) at the molecular level resulted in the formation of compounds with higher molecular weight and reduced solubility. In two samples of extruded corn, due to the higher shear rate and longer retention time of the material in the extruder, there was partial gelatinization followed by dextrinisation of starch. In untreated complete feed, the lowest values of DM and starch disappearance in rumen were determined using in situ method, while all the applied thermal treatments led to a significant increase in the degradation of DM and starch. The smallest increase in degradation of starch in comparison to untreated mixture was observed in a mixture containing steam flaked corn, while in all extruded mixtures large amount of starch was degraded during the first 3 hours of incubation. Compared to the untreated mixture, all applied thermal treatments resulted in an increase in the degradation rate of starch to a lesser or greater extent depending on the type and intensity of the treatment. Significant differences in the degradation characteristics of the starch were observed after variation of the extrusion processing parameters, while the observed differences between the mixtures containing micronized corn were much less pronounced. Digestibility of starch in the intestine was determined with mobile bag method, which was 100% in untreated and all thermally treated mixtures. Statistical analysis of the results did not show a significant increase in OMD of maize and mixtures after the applied thermal treatments compared to the untreated samples.</p>

No description available.

Clinical guidelines developed from randomized controlled trials (RCT) recommend standard treatments for physicians to treat their patients. However, RCT are usually conducted among younger or healthier populations. Patients who did not participate in clinical trials, such as the elderly or patients with comorbidities, might not be suitable for the standard treatments; instead non-standard treatments can be an alternative treatment option to provide clinical benefits. Physicians are key stakeholders in determining the use of non-standard treatments in clinical practice. While a number of studies have reported on the use of non-standard treatments, little is known about factors associated with a physician’s decision to use non-standard treatments and which information sources are associated with their use. The objectives of this study were to identify factors associated with a physician’s decision to use non-standard treatments and to investigate which information sources were associated with their use. This study applied Rogers’ theory of diffusion of innovation to posit that a physician’s decisions to use non-standard treatments are a function of 1) the perceived advantages of non-standard treatments (effectiveness and toxicity), 2) the sources of information (scientific sources, professional contacts, patient demands, and commercial sources), 3) physician characteristics (years of practice, specialty, innovativeness, and practice experience), and 4) practice settings (practice location, academic affiliation, types of facility, and practice size). This study implemented a convergent parallel mixed-method approach consisting of interviews and surveys to address the objectives. For this study, a convenience sample of 10 medical oncologists was interviewed in January and February 2017. Interviews were transcribed and coded using a coding system based on the theoretical model of this study. Case reports were created to summarize each interview. The content analysis and multi-case analysis were both conducted to describe variable-level factors and contrast and compare factors within and across groups. Surveys were distributed to 1,500 medical oncologists and hematologists who currently practice in eight states across the Midwest. Dillman’s tailored design method was used to guide survey development and administration. The survey examined oncologists’ use of non-standard treatments in elderly patients with diffuse large B-cell lymphoma (DLBCL). Factorial survey design was applied to construct six hypothetical patient vignettes representing a variety of patient age and comorbidity. The dependent variable was whether a physician recommended a non-standard treatment to each vignette. Independent variables were selected from the theoretical model. The descriptive and frequency statistics were conducted for each survey item. The reliability tests were used to evaluate internal consistency of multi-item measures. Generalized Estimating Equations (GEE) were used to test the influence of factors on a physician’s decisions to use non-standard treatments. Among ten interview participants, three were open and five were intermediate open toward using non-standard treatments. Approximately 41.5% of survey participants recommended non-standard treatments for two or more vignettes. Both interviews and surveys showed that sources of information were key factors affecting oncologists’ use of non-standard treatments. In particular, interviewed oncologists used various information sources to justify their use of non-standard treatments such as early phase clinical trials or colleagues’ suggestions. Survey data showed that oncologists who placed higher importance on scientific sources were less likely to use non-standard treatments although scientific or medical journals were the top sources where they learned about rituximab with non-anthracyclines. In vignettes involving patients with rheumatoid arthritis with chronic neutropenia, those who placed a higher importance of professional sources were more likely to use non-standard treatments. Additionally, interview data showed that oncologists who have a sub-specialty, practice in academic settings, have high patient volume, have positive past experience with non-standard treatment and were aware of colleagues’ use non-standard treatments were relatively more open toward using non-standard treatments. Survey data showed that oncologists who agreed that rituximab with non-anthracyclines has a safer toxicity profile than rituximab with anthracyclines, those who commonly encounter younger patients, and those who had more years since graduating from medical school were more likely to use non-standard treatments. In addition to patient characteristics such as comorbidity, physicians’ characteristics and their sources of information are influential to the decision of using non-standard treatments.

No description available.

[pt] O presente trabalho apresenta um estudo da influência dos tratamentos térmicos de têmpera e revenido sôbre a resistência à fratura do aço estrutural R4, adotado na fabricação de elos para sistemas de ancoragem de unidade offshore e soldados pelo processo de centelhamento. Corpos de prova do tipo CT foram retirados da região da solda dos elos, usinados com orientação L-R e submetidos a diferentes tratamentos térmicos de têmpera (temperaturas de austenitização de 810, 840, 870 e 900ºC) e revenido (640 e 680ºC), num total de quatro condições microestruturais. Após pré-trincamento em fadiga, os corpos de prova foram submetidos a carregamento monotônico em tração, com o objetivo de se determinar a resistência à fratura do material com base no parâmetro CTOD (Crack Tip Opening Displacement). Os resultados do ensaio de CTOD demonstraram que houve uma redução da resistência à fratura do aço estrutural R4 com o aumento da temperatura de austenitização (810, 840 e 870°C) e temperatura de revenido de 640°C. Entretanto, para maiores temperaturas de austenitização (900°C) e revenido (680°C), houve um aumento do parâmetro CTOD. Modificações microestruturais no material causadas pelos tratamentos térmicos foram associadas com as variações da tenacidade. / [en] This study has been made concerning the influence of quenching and tempering heat treatments on the fracture resistance of a grade R4 structural steel, largely used for fabricating offshore mooring chains by flash welding. CT specimens were taken from the welded joints region in L-R and machined following orientation and subjected to different quenching (austenizing temperatures of 810, 840, 870 and 900ºC) and tempering (640 ºC and 680ºC) treatments, in a total of four microstructural conditions. After fatigue precracking, the specimens were monotonically loaded in tension in order to determine the fracture resistance of the material on the basis of the CTOD (Crack Tip Opening Displacement) parameter. The results of the CTOD tests showed that the fracture resistance of the grade R4 structural steel has decreased when increasing the austenitizing temperature (810, 840 and 870°C) and tempering at 640ºC. However, when adopting higher austenitizing (900°C) and tempering (680° C) temperatures, the parameter CTOD has increased. The microstructural modifications caused by the heat treatments were associated with the toughness modifications.

As the population tends to urbanize, the potential consumer market of fresh produce becomes distant from the producing farm. This distance brings to growers and handlers the problems of how to keep their fresh products unspoiled after harvest and during transit period of shipping, and how they can be delivered to the specified destination without substantial deterioration. It is the common interest of fruit growers, shippers, wholesalers, and retailers that the shelf-life of fresh fruit be prolonged to increase sales. Sweet cherries are one of the important fruit crops in Utah. Being highly perishable, fresh sweet cherries have relatively short storage life after harvest . It is known that the approximate limit for the successful commercial storage of fresh sweet cherries is about 10 days to 2 weeks only. A practicable measure for extending this storage limit has to be established so that the market may have fresh sweet cherries over a longer season and also be able to balance the time of plenty and the time of scarcity. Furthermore, the Utah grown cherries may find new outlets in the distant market. Thus the benefit will be shared by the grower, the seller, and the consumer. Metabolic breakdown and fungal deterioration are the two important factors which cause the spoilage of fruits. Studies have shown that with many perishable produces, precooling -- the prompt application of refrigeration prior 2 to normal storage or transportation is the key to successful storage. Hydro -cooling treatment is considered to be advantageous especially in Utah, where high temperature and low relative humidity predominate during the harvest season of sweet cherries. Post-harvest chemical and packaging treatments of sweet cherries are possible approaches on ext ending the keeping quality of the fruits concerned. With some of the antifungal agents available today, the fungi which cause fruit decay might be successfully controlled. As a matter of fact, new fungicides, antifungal antibiotics, and packaging films are continuously developed by the industries in the United States. Appropriate combination of these newly developed materials with hydro-cooling followed by refrigerated storage, coupled with in vitro study of the effects of chemicals on fruit decay organisms, might lead to an improvement in the storage life of sweet cherries. It was with this idea in mind that experiments were conducted to study the effects of hydro-cooling, chemicals, and packaging treatments on preserving fresh sweet cherries and also in vitro effects of chemicals on certain fungi responsible for fruit deterioration.

Les recommandations pour la prise en charge des accès fébriles ne sont pas particulières au Cabinda ni à l’Angola. L’emploi des tests de diagnostic rapides (TDR) et/ou de la microscopie est la règle et permet de porter le diagnostic d’accès palustre. Nos observations dans des structures de santé montrent que ces examens sont très peu pris en compte. Lorsqu’un TDR est négatif, un examen de goutte épaisse sanguine est souvent demandé. Cette goutte épaisse peut dans un quart des cas être déclarée positive avec une très faible parasitémie et le diagnostic d’accès palustre retenu. Les examens microscopiques sont perçus comme plus fiables que les TDR. La plupart des enfants et des adultes fébriles reçoivent un traitement antipaludique quels que soient les résultats des examens. Ce traitement est le plus souvent une association thérapeutique à base d’artémisinine. Le choix d’utiliser la voie parentérale en traitant par la quinine ou les dérivés injectables de l’artémisinine n’est pas réservé aux cas les plus graves.Ces antipaludiques sont disponibles dans les pharmacies privées ainsi que dans le secteur informel en dehors de toute prescription. Des dérivés d’Artemesia en monothérapie y sont également accessibles.L’amélioration de la formation du personnel de santé ainsi que de leurs conditions de travail apparaissent être les mesures les plus pertinentes pour modifier la situation. Le développement d’un centre de référence, en permettant une connaissance actualisée du paludisme, est également nécessaire. Par ailleurs, la prévention de la transmission par l’usage des moustiquaires imprégnées d’insecticides de longue durée doit être développée. / The recommendations for the management of febrile attacks are similar in Angola as in other neighboring countries. The use of rapid diagnostic tests (RDTs) and / or microscopy is the rule and allows the diagnosis of access to malaria.Our observations in health facilities in Cabinda Province show that these exams are very little taken into account. When a RDT is negative, a thick blood test is often required. This thick drop can in a quarter of the cases be declared positive with a very low parasitaemia and the diagnosis of malaria access retained. Microscopic examinations are perceived as more reliable than RDTs.Most children and febrile adults receive antimalarial treatment regardless of test results. This treatment is most often a combination therapy based artemisinin. The choice to use the parenteral route by treating with quinine or derivatives of artemisinin is not reserved for the most serious cases.These antimalarials are available in private pharmacies as well as in the informal sector outside any prescription. Artemesia derivatives in monotherapy are also available.Improving the training of health personnel and their working conditions appear to be the most relevant measures to change the situation. The development of a referral center, by providing up-to-date knowledge of malaria, is also needed. In addition, the prevention of transmission through the use of long-lasting insecticidal nets must be developed.

Resumo: O objetivo deste trabalho foi avaliar a influência da produção de perifíton na qualidade da água em viveiros escavados de produção intensiva (7 t/ha1) de juvenis de tilápia do Nilo (Oreochromis niloticus) com baixa renovação da água (6,2% dia-1). O experimento foi iniciado em maio/2018 a julho/2018 com alevinos de tilápia do Nilo com peso médio de 2 gramas e foi encerrado quando os peixes atingiram o peso médio de 35 gramas. Cada unidade experimental foi representada por um viveiro escavado de 130 m2, com água de entrada e saída independentes. O delineamento experimental constou de dois tratamentos e três repetições, sendo testada presença ou ausência de substrato nos viveiros escavados. No tratamento com inclusão de substrato atrator, foram instalados módulos compostos por hastes de bambu ocupando 50% da área superficial do viveiro. Em cada viveiro, foram inseridos módulos de substratos desprotegidos e protegidos dos peixes. Os resultados mostraram que a temperatura, condutividade elétrica, transparência, pH e alcalinidade da água não foram alterados pela produção de perifíton nos substratos de bambu na produção de perifíton nos viveiros escavados no cultivo de juvenis de tilápias do Nilo. A comunidade perifítica presente nos substratos de bambu nas condições deste experimento foi classificada como heterotrófica durante todo o período experimental. A proporção na inserção de substratos de bambu em 50% da área de superfície da água dos viveiros foi suficiente para proporciona... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The objective of this work was to evaluate the influence of the insertion of the bamboo substrate on the water quality in intensive nursery (7 t/ha1) of juvenile Nile tilapia (Oreochromis niloticus) with low water renewal (6.2% Day-1). The experiment was started in 2018/May to 2018/July with Nile tilapia fingerlings with an average weight of 2 grams and was closed when the fish reached the average weight of 35 grams. Each experimental unit was represented by a nursery excavated of 130 m2, with water of independent entrance and exit. The experimental design consisted of two treatments and three replicates, being tested the presence or absence of substrate in the excavated nurseries. In the treatment with inclusion of substrate attractor, modules composed of bamboo stems occupying 50% of the surface area of the nursery were installed. In each nursery, substrate modules were inserted unprotected and protected from fish. The results showed that the temperature, electrical conductivity, transparency, pH and alkalinity of the water were not altered by the inclusion of bamboo substrates in the production of periphyton in nurseries excavated in the cultivation of Nile tilapia juveniles. The periphytic community present in the bamboo substrates under the conditions of this experiment was classified as heterotrophic throughout the experimental period. The proportion in the insertion of bamboo substrates in 50% of the water surface area of the nurseries was sufficient to provide the mai... (Complete abstract click electronic access below) / Mestre

It is of crucial importance to identify and disseminate effective treatments for paediatric obsessive-compulsive disorder (OCD). OCD is time-consuming and distressing, and can substantially disable functioning at school, at home, and with peers (Piacentini, 2003). Children who do not receive treatment are at risk of psychological difficulties in adulthood, including continued OCD, clinical anxiety and depression, personality disorders, and social maladjustment (Wewetzer et al., 2001). Two-thirds of adult cases of OCD develop in childhood, and adults with OCD have lower employment, poorer academic achievement, and lower marital rates compared to non-OCD adults (Hollander et al., 1996; Koran, 2000; Lensi et al., 1996; Steketee, 1993). The distressing nature of OCD in childhood, accompanying psychosocial impairment and risk of future psychopathology, underscore the need to identify effective treatments. The primary aim of this thesis was to expand knowledge of evidence-based treatments for paediatric OCD. A mixed-methodology approach was employed to examine key issues in this area. The first study used meta-analytic methodology to determine the evidence supporting available treatments for paediatric OCD. An extensive literature search revealed over 100 published reports of treatments, encompassing a broad array of theoretical approaches and treatment strategies. Examples of treatments used for paediatric OCD included psychodynamic therapy, pharmacotherapy, cognitive-behavioural therapy (CBT), hypnosis, family therapy, immunotherapy, and homeopathy. / Study 1 comprised the first known meta-analysis of randomised, controlled treatment trials (RCTs) for paediatric OCD. Included studies were limited to RCTs as they are the most scientifically valid means for determining treatment efficacy and provide a more accurate estimate of treatment effect by removing error variance associated with confounding variables. The literature search identified 13 RCTs containing 10 pharmacotherapy to control comparisons (N = 1016) and 5 CBT to control comparisons (N = 161). Random effects modelling yielded statistically significant pooled effect size (ES) estimates for pharmacotherapy (ES = 0.48, 95% CI = 0.36 to 0.61, p < .00001) and CBT (ES = 1.45, 95% CI = 0.68 to 2.22, p =.002). The results support the efficacy of CBT and pharmacotherapy, and confirm these approaches as the only two evidence-based treatments for paediatric OCD. Implications and suggestions for future research are discussed. The effectiveness of CBT provided impetus to further examine this treatment. Group CBT is an understudied treatment modality among children with OCD. It was hypothesised that group CBT would possess efficacy because of the effectiveness of individual CBT for children with OCD, the demonstrated effectiveness of group CBT among adults with OCD, the practical and therapeutic advantages afforded by a group treatment approach, and the embeddedness of the approach in robust psychological theory. The aim of the second study was to evaluate the efficacy of group CBT. The study comprised the largest known conducted randomised, placebo-controlled trial of group CBT for paediatric OCD. / Twenty-two children and adolescents with a primary diagnosis of OCD were randomly assigned to a 12-week program of group CBT or a credible psychological placebo. Children were assessed at baseline, end of treatment, and at 1 month follow-up. Outcome measures included the Children’s Yale-Brown Obsessive-Compulsive Scale, global measures of OCD severity, Children’s Depression Inventory, and parent- and child-rated measures of psychosocial functioning. An intention-to-treat analysis revealed that children in the group CBT condition had statistically significantly lower levels of symptomatology at posttreatment and follow-up compared to children in the placebo condition. Analysis of clinical significance showed that 91% of children that received CBT were ‘recovered’ or ‘improved’ at follow-up, whereas 73% of children in the placebo condition were ‘unchanged’. Effect size analysis using Cohen’s d derived an effect of 1.14 and 1.20 at posttreatment and follow-up, respectively. These effects are comparable to results from studies of individual CBT. This study supported group CBT as an effective treatment modality for paediatric OCD and demonstrated that the effect extends beyond placebo and nonspecific treatment factors. In addition to treatment efficacy, the inherent worth of a treatment lies in its adoption by the relevant clinical population. Children with OCD are known to be secretive and embarrassed about symptoms, and there is often a long delay between onset of symptoms and treatment-seeking (Simonds & Elliot, 2001). An important observation during the course of conducting the RCT was that a high rate (39%) of eligible families declined participation. / This led to the question, "What barriers prevent participation in group CBT for paediatric OCD?" Qualitative methodology was employed to address this research question. Eligible families that had declined participation in the RCT were contacted and invited to participate in semi-structured interviews that explored reasons for non-participation and positive and negative perceptions of group CBT. The average time between non-participation and interview was 1.33 years (SD = 3 months). Data were collected from nine families and thematic analysis methodology was utilised to identify emergent themes. Failure to participate was predicted by practical and attitudinal barriers. Practical barriers included a lack of time, distance, severity of OCD symptoms, financial, and child physical health. Attitudinal barriers included child embarrassment about OCD symptoms, child belief that therapy would be ineffective, fear of the social aspect of the group, lack of previous success with psychology, lack of trust in strangers, parental concern about the structure of the group, denial of a problem, and ‘not being ready for it’. Attitudinal barriers more frequently predicted treatment non-participation. Positive and negative perceptions of this treatment modality were informative. Parents showed no differences in preference for individual or group CBT. An important finding was that 56% of the children had not received treatment since parental expression of interest in the group CBT program. Application of the findings to methods that promote service utilisation is discussed.