This master thesis focuses on subjectively percieved quality of sleep and its connections - fatigue, daytime sleepiness and insomnia in older age. Attention is brought to psychological methods of sleep measurement in comparison with objective methods (polysomnography and actigraphy). Theoretical part is based on current scientific knowledge of sleep quality and deals with psychological factors that contribute to improvement or reduction of sleep quality in older age. In context with quality of sleep focus is aimed also at presence of insomnia in older age compared to younger age and possibilities of enhancing sleep quality. Overview of subjective and objective methods of measuring sleep quality and other sleep characteristics is part of the theoretical background. Empirical part of the thesis is divided into two sections. First section compares sleep quality, fatigue, daytime sleepiness and insomnia of younger and older adults. This research is based on following questionnaire data: PSQI (Pittsburgh Sleep Quality Index), FSS (Fatigue Severity Scale), ESS (Epworth Sleepiness Scale) and ISI (Insomnia Severity Index). Second section of the research verifies the validity of psychological methods of measuring sleep quality - questionnaires PSQI, FSS, ESS, ISI and sleep diaries of older adults by...

Syfte: Att utvärdera patientnyttan av behandling med apnébettskena vid obstruktivt sömnapnésyndrom (OSAS) på avdelningen för Orofacial smärta och käkfunktion på Odontologiska fakulteten, Malmö Universitet, samt att undersöka vilka subjektiva och kliniska faktorer som kan förutsäga ett lyckat behandlingsutfall samt om behandlingsbiverkningar uppstår. Material och metod: I en retrospektiv kvalitetsstudie utvärderades 183 konsekutiva patientjournaler mellan 2017/01–2020/05. Data från journalerna granskades avseende subjektiva symtom och kliniska fynd för att kunna besvara på befintliga frågeställningar. Data inhämtades från ett standardiserat formulär och klinisk undersökning från baseline (n=183), 3 månader (n=143) samt 1 årsuppföljning (n=93). Datamaterialet analyserades i SPSS 27. Resultat: En god behandlingseffekt rapporterades av 66% vid 3 månaders och 64% vid 1 årsuppföljningen. En signifikant kvarstående förbättring av morgontrötthet (p<0,000), dagtrötthet (p<0,000) och sömnighet (p<0,000) registrerades. Sömnighet graderades med Epworths sömnighetsskala. Antal uppvaknande per natt minskade (p<0,000). Följsamheten var god, 71% använde skenan 6–7 nätter i veckan. Den vanligaste biverkningen var övergående smärta i tuggsystemet. Bettavvikelser i form av minskad vertikal och horisontell överbitning förekom hos 22 respektive 14 patienter vid 3 månaders uppföljningen. Inga predikterande faktorer för en positiv behandlingseffekt kunde registreras i denna studie. Slutsats: Majoriteten av patienter upplevde en god behandlingseffekt, hade minskad morgon och dagtrötthet och uppvisade en god följsamhet av att använda apnébettskenan. Inga prediktiva värden kunde identifieras för gott behandlingsutfall. Smärta och bettavvikelse rapporterades av var femte patient, minskad horisontell och/eller vertikal överbitning registrerades hos ungefär var 10:e patient / Aim: To evaluate the long-term effect of treatment with an oral appliance in patients withobstructive sleep apnea syndrome (OSAS) at the Department of Orofacial Pain and JawFunction, Faculty of odontology, Malmö University, and to investigate which subjective andclinical factors can predict a successful treatment outcome and whether side effects occur. Material and method: In a retrospective quality study, 183 consecutive patient records wereevaluated between 2017/01-2020/05. Data from the records were examined for subjectivesymptoms and clinical findings in order to answer stated questions. Data were obtained froma standardized inquiry and a clinical examination from baseline (n=183), 3 months (n=143)and a one-year follow-up (n=93). The data material was analysed with SPSS 27. Results: A good treatment effect was reported by 66% at 3 months and 64% at 1 year followup. A significant sustained improvement in morning sleepiness(p<0.000), daytime sleepiness(p<0.000), and sleepiness (p<0.000) was recorded. Sleepiness was graded according to theEpworth sleep index. The number of awakenings per night decreased (p<0.000). Compliancewas good, 71% of patients used the splint 6-7 nights a week. Most common dental sideeffects were transient pain in the masticatory system. Dental side-effects in the form ofreduced vertical and horizontal overbite occurred in 22 respectively 14 patients at the 3months follow up. No predictive factors could be found in this study. Conclusion: The majority of patients experienced a good treatment effect, had reducedmorning fatigue and daytime sleepiness and showed a good consistency of using an oralappliance. No predictive values could be identified for good treatment outcomes. Pain anddental changes were reported by one in five patients, decreased overbite and/or overjet wasrecorded in approximately one in 10 patients.

No description available.

A large literature has not reached consensus on foreign aid’s economic effects. Using geolocated aid data and daytime satellite images over nearly 10,000 African neighborhoods, I examine the economic growth impact of World Bank and Chinese aid to 36 Africa countries from 2002-2013, covering 88% of the continent’s population, by sector (e.g. Health, Education, Water Supply and Sanitation, etc.).  I estimate each funder and aid sector’s average treatment effect with an inverse probability weighting approach and adjust for two types of confounders: those I provide in a tabular format and proxies based on satellite images of each neighborhood. The use of image-based confounders may reduce bias due to omitted variables and measurement errors when unobserved or mis-measured variables are visible remotely.  To measure economic outcomes, I use a new wealth index generated by a machine learning algorithm trained to associate USAID-funded DHS survey wealth measures with daytime and nighttime satellite imagery from the same years and locations. The availability of the wealth estimate for 3-year periods over thirty years enabled the analysis to use panel data and fixed effects at the second administrative division (e.g. county, district, city) level. The results are heterogenous across sectors but generally show small positive effects of World Bank aid and larger positive effects of Chinese aid.  Substantive results are generally robust to the choice of computer vision image model, except for three funder-sectors where wide confidence intervals make one model but not the other statistically insignificant.

Background: Snoring and obstructive sleep apnea (OSA) are both common disorders with a number of negative health effects. The safety and efficacy of treating snoring and OSA surgically have been questioned and there has been a lack of studies in the field. Aims: 1) To investigate the frequency of serious complications, including death, after surgery for the treatment of snoring and sleep apnea; 2) to evaluate the effect on daytime sleepiness after radiofrequency surgery of the soft palate in snoring men with mild or no OSA; 3) to evaluate the effect of tonsillectomy on sleep apnea in adults with OSA and tonsillar hypertrophy; 4) to investigate the morphology and cytoarchitecture of muscle fibers in human soft palatal muscles with immunohistochemical and morphological techniques. Methods and results: In paper 1, a retrospective database study. All Swedish adults who were treated surgically because of snoring or OSA from January 1997 to December 2005 were identified in the National Patient Register. None of the surgically treated patients died in the peri- and postoperative period. Severe complications were recorded in 37.1 of 1,000 patients treated with uvulopalatopharyngoplasty (UPPP), in 5.6 of 1,000 patients after uvulopalatoplasty (UPP) and in 8.8 of 1,000 patients after nasal surgery. In paper 2, the study was designed as a randomized, controlled trial. 35 snoring men with mild or no OSA were randomized to either radiofrequency or sham surgery of the soft palate. Radiofrequency surgery was not found to be effective since there was no significant difference between the two groups in relation to the Epworth Sleepiness Scale (ESS) or apnea-hypopnea index (AHI) at follow-up. Paper 3 was a prospective study, including 28 patients with an AHI of >10 and with large tonsils. In these patients, tonsillectomy was an effective treatment for OSA; the mean AHI was reduced from 40 units/h to 7 units/h (p<0.001), and the mean ESS was reduced from 10.1 to 6.0 (p<0.001) at the six-month follow-up after surgery. Minor and moderate swallowing dysfunction was found in seven of eight patients investigated before surgery and the swallowing function improved in 5 of them after surgery, while no one deteriorated. In paper 4, we investigated the morphology and cytoarchitecture in normal soft palate muscles. Human limb muscles were used as reference. The findings showed that the soft palate muscle fibers have a cytoskeletal architecture and cellmembrane complex that differs from that of the limb muscles. Conclusions No case of death related to surgery was found among 4,876 patients treated with UPPP, UPP or nasal surgery for snoring or OSA in Sweden between 1997 and 2005. Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring or apnea frequency in snoring men with mild or no OSA. Tonsillectomy can be an effective treatment for OSA in adults with large tonsils. A subgroup of muscle fibers in the human soft palate appears to have special biomechanical properties and their unique cytoarchitecture must be taken into account while assessing function and pathology in oropharyngeal muscles. / Snarkning och obstruktiv sömnapné (OSA) är idag en global folksjukdom. Snarkning är det ”oljud” som uppstår när luftvägen under sömn förminskas och vävnaden börjar vibrera under andning. Vid obstruktiv sömnapné faller vävnaden samman och blockerar luftflödet till lungorna. Ett andningsuppehåll, en s.k. apné inträffar. Ett andningsuppehåll kan pågå allt ifrån några sekunder till mer än en minut och kan uppstå hundratals gånger per natt. För att klassificeras som en patologisk apné enligt internationell standard måste andningsuppehållet vara längre än 10 sek. Snarksjukdomen förvärras sannolikt över tid och övergår succesivt i obstruktiv sömnapné med ökande antal andningsuppehåll under sömn. Detta leder till ett stresspåslag för kroppen med oftast uttalad dagtrötthet och en mängd negativa hälsoeffekter. Snarksjukdom och sömnapné ökar risken för bl.a. högt blodtryck och hjärt-kärlsjukdom samt också för att den drabbade ska orsaka trafikolyckor på grund av försämrad koncentrationsförmåga och trötthet. En del av den negativa utvecklingen från snarkning till sömnapné anses bero på att snarkvibrationer kan ge neuromuskulära skador i gom och svalg. Dessa vävnadsskador anses också vara orsaken till att personer som snarkat länge ofta uppvisar störd sväljningsfunktion i form av felsväljning, där maten i uttalade fall hamnar i luftstrupen istället för i matstrupen. I dagsläget är förstahandsbehandling vid sömnapné CPAP, en mask som placeras över näsa och mun och som skapar ett övertryck i luftvägen vilket förhindrar att luftvägen faller samman och att andningsstopp uppstår. CPAP har enligt flera studier den bästa effekten mot andningsuppehåll. En annan vanlig behandling är en bettskena som för underkäken nedåt och framåt så att luftvägen bli mer öppen. Bettskenan är en vanlig och effektiv behandlingsmetod för personer utan kraftig övervikt vid vanemässig snarkning eller måttlig sömnapné. För ett tjugotal år sedan var kirurgi förstahandsmetoden vid behandling av snarkning och måttlig sömnapné. Man utförde då ofta operationer i svalg och gomm, s.k. gomplastiker. Bruket av kirurgisk behandling har dock minskat med tiden, dels p.g.a. biverkningar men också för att det saknades vetenskapliga studier som bevisade att kirurgin gav önskad och långsiktig effekt. Kirurgi utgör dock fortfarande ett komplement till behandling av snarkning och sömnapné när CPAP eller bettskena av olika skäl inte fungerar eller kan tolereras av patienten. 8 Även barn kan lida av snarkning och sömnapné men behandlingsprinciperna för barn skiljer sig från dem hos vuxna och berörs inte i avhandlingen. I denna avhandling studeras: i) biverkningsfrekvenser efter olika typer av snarkkirurgi, ii) effekten av radiovågsbehandling i mjuka gommen på vuxna män med snarkning, iii) effekten av att operera bort halsmandlarna på vuxna med sömnapné och stora halsmandlar, iv) muskelvävnadens struktur och molekylära uppbyggnad i mjuka gommen hos friska personer som inte snarkar. Avhandlingen består av fyra delstudier: 1. En registerstudie med kartläggning av svåra biverkningar efter kirurgi i form av uvulopalatopharyngoplastik, uvulupalatoplastik samt näskirurgi för behandling av sömnapné och snarkning och utfört i Sverige mellan åren 1997-2005. Studien omfattade 4 876 patienter. Inga dödsfall noterades. Komplikationsrisken var störst vid operationer där man tog bort delar av mjuka gommen samt halsmandlarna, där i snitt 37 av 1000 opererade fick biverkningar, framförallt p.g.a. infektioner eller blödningar. 2. I en prospektiv, randomiserad placebostudie utvärderades effekten av radiovågsbehandling i mjuka gommen vid snarkning och lindrig sömnapne. Trettiotvå patienter lottades till att få radiovågsbehandling eller placebo behandling. Patienterna visste inte vilken grupp de tillhörde. Vid uppföljning efter 12 månader var det inga statistiska belägg för att radiovågsbehandling minskade vare sig antal andningsuppehåll eller dagtrötthet. 3. Effekten av att ta bort halsmandlarna på patienter med stora halsmandlar och olika grad av sömnapné utvärderades i denna studie. Totalt deltog 28 patienter. Vid uppföljning 6 månader efter operationen hade antalet andningsuppehåll sjunkit drastiskt, från i snitt 40 till 7 andningsuppehåll per timme nattsömn. Inga allvarliga biverkningar uppstod. Dessa fynd talar för att man som förstahandsmetod ska erbjuda patienter med sömnapné och stora halsmandlar att ta bort halsmandlarna. 4. I detta projekt undersökte vi utseendet och uppbyggnaden av cellskelettet i två normala muskler i mjuka gommen hos friska personer utan känd snarkning och sömnapné. Muskler från armar och ben användes som referens. Fynden i studien visar att de normala muskelfibrernas uppbyggnad i mjuka gomen skiljer sig från jämförade muskler i armar och ben. Detta kan vara ett uttryck för en evolutionär utveckling för att möjligöra de komplexa funktioner som krävs av svalgets muskulatur. 9 Sammanfattningsvis kan vi konstatera: Att inga dödsfall har skett i Sverige efter operationer i gom, svalg eller näsa, utförda för att behandla snarkning och sömnapné under åren 1997 till 2005. Att radiovågsbehandling av mjuka gommen hos snarkande män med lindrig sömnapné inte har någon effekt på dagtrötthet, snarkning eller andningsuppehåll vid uppföljning efter 12 månader. Metoden kan därför inte rekommenderas. Att när man opererar bort stora halsmandlar på personer med andningsuppehåll så leder detta ofta till att andningsuppehållen minskar drastiskt. Metoden kan därför oftast rekommenderas som en förstahandsbehandling för denna patientgrupp. Att mjuka gommens muskelfibrer är uppbyggda på ett unikt sätt indikerar att deras specifika biomekaniska egenskaper skiljer sig från referens muskler i armar och ben.

研究背景與目的：近年來，有不少研究指出阻塞性睡眠呼吸中止疾患（簡稱OSA）患者呈現出高比例的憂鬱情緒，但其盛行率結果分歧，回顧過往文獻也發現OSA與憂鬱情緒的關聯性之結果亦呈現分歧的結果。值得注意的是，OSA與憂鬱情緒之間存在著類似的症狀表現——白天嗜睡，OSA患者可能依據OSA伴隨的嗜睡症狀，回應憂鬱問卷或診斷中的問題，而使其受到誤診或是使盛行率受到高估。為探討此議題，本研究進行兩項研究，分別以橫斷及長期追蹤的資料，探討（一）OSA患者的憂鬱情緒是否聚焦於身體面向，且OSA與憂鬱情緒之間是否受到白天嗜睡中介，以及（二）OSA患者睡眠檢查長期追蹤資料中憂鬱情緒的改變，是否與白天嗜睡程度有關。 研究方法：研究一以台北醫學大學附設醫院睡眠中心資料庫中，2010至2015年到台北醫學大學附設醫院睡眠中心看診並進行PSG檢測時所收集的資料（AHI、醒覺指標、缺氧指標、平均血氧飽和度、最低血氧飽和度、BDI-IA、ESS）進行分析，在排除小於20歲與睡眠疾患共病之後，共有2140位OSA（364女、1776男）患者資料被納入分析。本研究針對OSA患者的憂鬱情緒（BDI-IA）分數進行探索性因素分析，並以此因素結構與Beck與Steer（1993）所得之憂鬱情緒面向結構進行模型競爭，以求更適配於OSA患者之因素結構。再者，本研究取具輕度以上憂鬱情緒的OSA患者資料，以線性迴歸分析了解OSA嚴重度（AHI）、嗜睡程度（ESS得分）與憂鬱情緒（BDI-IA、身體面向、認知面向）之間的關聯性，並以拔靴法進行中介模型的檢定。此外，欲探討OSA患者的憂鬱情緒可能聚焦於身體面向，本研究亦將OSA患者依症狀嚴重度分組，並比較不同症狀嚴重度OSA患者的認知面向與身體面向憂鬱分數。研究二則是以台北醫學大學附設醫院睡眠中心資料庫追蹤一年至兩年間的OSA患者的資料進行資料分析，由於女性人數過少，因此僅納入81位男性OSA患者資料進行統計分析。 研究結果：研究一探索性因素分析結果顯示，「體重減輕」與「煩躁易怒」在因素分析結果的負荷量相當低，無法歸類至其一面向，予以排除，且「不滿自我」、「社交退縮」、「優柔寡斷」三題（原認知面向題項）在OSA患者樣本中被歸類至身體面向。競爭模型結果顯示，本研究所得之因素結構AIC值較低，因此以本研究所得之因素結構進行後續分析中認知面向與身體面向憂鬱情緒之計分與分析。以具憂鬱情緒的OSA患者資料進行相關分析結果發現，AHI 、覺醒指標、 缺氧指標、平均血氧飽和度、最低血氧飽和度皆與ESS呈現顯著相關；且ESS與BDI、身體面向、認知面向憂鬱情緒皆呈現顯著正相關。值得注意的是，OSA症狀嚴重度AHI雖未與BDI呈現顯著關聯性，但與身體面向憂鬱情緒達顯著正相關，且OSA病理機轉——醒覺指標、缺氧指標、平均血氧飽和度亦與身體面向憂鬱情緒達顯著關聯性。拔靴法結果顯示，在控制年齡與BMI後，ESS僅中介於醒覺指標與身體面向憂鬱情緒間的關聯性。將男女性分組後，女性患者的ESS中介於AHI與身體面向憂鬱情緒、醒覺指標與身體面向憂鬱情緒、以及缺氧指標與身體面向憂鬱情緒之間的關聯性，但男性OSA患者則無此中介效果。將OSA患者依症狀嚴重度分組，針對不同症狀嚴重度OSA患者的認知面向與身體面向憂鬱分數進行重複量數檢定，發現不論AHI為輕、中、重度，身體面向憂鬱分數皆較認知面向來得高。研究二檢視OSA患者一年至兩年間追蹤的結果，發現AHI改變量與BMI改變量，無論對於ESS的改變量、BDI-IA總分的改變量、認知面向以及身體面向憂鬱情緒的改變量，皆無顯著相關性；而ESS改變量則與BDI-IA總分的改變量、認知面向憂鬱情緒的改變量、身體面向憂鬱情緒的改變量呈現顯著相關性。依ESS改變量分組後，進一步以單因子變異數分析對BDI-IA改變量、認知面向憂鬱情緒改變量、身體面向憂鬱情緒改變量進行檢定，結果顯示，無論在BDI-IA改變量、認知面向憂鬱情緒改變量、或身體面向憂鬱情緒改變量，皆達顯著差異；而事後檢定顯示，無論在BDI-IA改變量、認知面向、身體面向憂鬱情緒，ESS升高組與ESS無變化組、ESS降低組呈現顯著差異，而ESS無變化組則與ESS降低組無顯著差異。 結論：本研究OSA患者自評BDI-IA的結果發現有高達35%的患者至少有輕度以上的憂鬱情緒，且本研究發現在女性OSA患者身上，OSA嚴重度、睡眠片段化病理機轉，與憂鬱情緒間，受到白天嗜睡程度中介；且OSA患者的憂鬱情緒明顯聚焦於身體面向上，此結果說明OSA患者的憂鬱情緒可能受到白天嗜睡程度所影響，本研究在於提醒臨床工作者對OSA患者進行憂鬱症臨床診斷時，需注意與釐清OSA患者是否以白天嗜睡的情況，來回應憂鬱症狀相關的嗜睡表現，以降低誤判OSA患者憂鬱情緒的可能性。 / Aims: Recent years, researchers found high prevalence of depression occurred in OSA patients. However, the inconsistency was also found in depression prevalence and in the association between OSA and depressive mood. Notably, excessive daytime sleepiness is one of common symptoms of both OSA and depression. High prevalence of depression might be an overestimation due to excessive daytime sleepiness reported by OSA patients. Two studies (cross-sectional and longitudinal studies) were conducted to examine (1) whether the depressive symptoms in OSA patients are more somatic in nature and whether mediation effect between OSA and depression exist, and (2) whether the changes in depressive mood correlate with the changes in excessive daytime sleepiness showed in long term follow-up data. Methods: Sleep test data (including AHI, arousal index, desaturation index, mean SaO2, lowest SaO2, BDI-IA, ESS) retrieved from database of Taipei Medical University Hospital Sleep Center from year 2010 to 2015 was used in Study 1. 2140 OSA patients (364 F、1776 M) were included after rule out patients who is under 20 year-old or comorbid with other sleep disorders. Exploratory factor analysis was conducted to extract the dimensions of depressive mood in OSA patients and the dimensions obtained were further compared with those of Beck and Steer (1993) through competing models. Furthermore, correlations between OSA severity, OSA pathological mechanism, excessive daytime sleepiness, and depressive mood were analyzed in the data of OSA patients with depressive mood, and boostrapping method was conducted to test mediation effect. For examining whether the depressive symptoms in OSA patients are more somatic in nature, cognitive dimension and somatic dimension were compared within different OSA severity. One to two year follow-up sleep test data retrieved from database of Taipei Medical University Hospital Sleep Center was analyzed in Study 2. There were only 81 male OSA patient data included due to the small numbers of female patients. Results: Exploratory factor analysis in Study 1 showed that “weight loss” and “irritability” should be excluded due to low factor loading in depressive mood of OSA patients. “Dissatisfaction”, “social withdrawal” and “indecisiveness” were categorized into somatic dimension in OSA patients. Competing models indicated the factors obtained in exploratory factor analysis were preferred due to lower AIC value, which suggested the model was better fit to OSA patients. Correlation analysis showed that AHI, arousal index, desaturation index, mean SaO2, lowest SaO2, BDI-IA score, somatic dimension and cognitive dimension significantly correlated with ESS. Notably, although the correlation between AHI and BDI-IA was non-significant, AHI positively correlated with somatic dimension. OSA pathological mechanism (arousal index, desaturation index, mean SaO2) also significantly correlated with somatic dimension on BDI-IA. After controlling age and BMI, mediation effects of excessive daytime sleepiness were only found on the relation of arousal index and somatic dimension. Mediation effects were also found on the relation of AHI and somatic dimension, on the relation of desaturation index and somatic dimension, and on the relation of arousal index and somatic dimension in female OSA patients, but the mediation effect was not found in male OSA patients. Furthermore, 3 X 2 ANOVA repeated measurement showed somatic dimension was significantly higher than cognitive dimension on BDI-IA in different AHI severity group. Follow-up data in Study 2 showed the change of AHI and BMI were not correlated with the change of ESS, BDI-IA, cognitive dimension and somatic dimension on BDI-IA. However, the change of ESS was significantly correlated with the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA. Furthermore, the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA were tested in different ESS change group. Results showed that the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA were significant in different ESS change group. Post-hoc analysis indicated the change of BDI-IA, cognitive dimension and somatic dimension in ESS elevated group were significantly different from ESS maintained group and ESS descend group but the difference between ESS maintained group and ESS descend group was non-significant. Conclusion: 35% of OSA patients were classified as co-occurring depressive mood using BDI-IA. However, mediation effect of excessive daytime sleepiness was found in female patients on the relation of OSA severity and depressive mood, and also on the relation of sleep fragmentation and depressive mood. Furthermore, depressive symptoms in OSA patients are more somatic in nature. The results showed depressive mood in OSA patients was probably affected by the excessive daytime sleepiness. The findings suggested the need to clarify the effect of excessive daytime sleepiness to prevent the overestimation of depressive mood in OSA patients.

Made available in DSpace on 2017-05-12T14:47:09Z (GMT). No. of bitstreams: 1 Jiam Pires_ Frigo.pdf: 2243207 bytes, checksum: 76a818d3ba4a98ecda459c13486050ca (MD5) Previous issue date: 2014-06-02 / The sprinkler irrigation system is widely used because of the possibility of high uniform distribution and to adapt itself to different crops and soils. On the other hand, the water uniform application in irrigation is affected by meteorological factors that decrease the system efficiency. There has always been some concern about the quality of products and services in human history, since all products should have desirable characteristics to be accepted by consumers. Currently, development, improvement and monitoring of new management models quality during the production process have become essential for many organizations. Thus, inspection control has enhanced by statistical techniques, losses have been decreased and it was possible to stimulate some trading competition. In this context, this study aimed at evaluating the irrigation system in a conventional sprinkler using the Christiansen Uniformity Coefficient (CUC) and the index Process Capability (CP) to correlate techniques with the system efficiency as well as verify the wind influence on irrigation by Shewhart control chart and compare the results of Shewhart control charts use with the EWMA and tabular CUSUM control charts, applied in quality control of the conventional sprinkler irrigation. In this study, 60 essays were carried out on a four irrigation sprinklers system, Xcel-Wobbler model, 1.0 m height above soil and 6.0 x 6.0 m spaced. The collectors were 1.0 m spaced apart with 0.5 m height from soil. The service pressure was monitored and appropriate to the sprinklers specifications, while wind was monitored in situ by a 2.0 m high digital anemometer. In order to evaluate the system, Christiansen Uniformity Coefficient (CUC), the index Process Capability (CP), Shewhart charts (Xbarra) and the charts of exponentially weighted moving average (EWMA) and cumulative sum (CUSUM) were used. The irrigation sprinkler system showed the best performance and was under control when the average wind speed was less than 1.0 m s-1. The use of individual Shewhart control charts visually allowed affirming that wind has a direct influence on CUC. Night irrigation showed less variability on the studied data, when compared to daytime ones and this has resulted in greater efficiency in irrigation. The CPi index showed great similarity with the Christiansen Uniformity Coefficient (CUC). It proved to be very sensitive to efficiency sprinkler (Ea) variation and able to indicate the quality of sprinkler irrigation. The EWMA chart, when compared to the control charts, was susceptible when used in autocorrelated data, according to the occurrence of false alarms. But, to the residue data without autocorrelation (the ARIMA model), the CUSUM tabular chart was more sensitive to detect variations in irrigation due to wind speed, when compared to EWMA and Shewhart charts for the same data. In sprinkler irrigation, when there is a relation between CUC and wind speed, the Shewhart chart was more indicated by simplicity, reliability and ease of interpretation, even in the presence of autocorrelated data. / O sistema de irrigação por aspersão é muito utilizado, devido à possibilidade de elevada uniformidade de distribuição e por adaptar-se às diversas culturas e solos. Porém, a uniformidade de aplicação de água nas irrigações é afetada por fatores meteorológicos que diminuem a eficiência do sistema. A preocupação com a qualidade de produtos e serviços oferecidos sempre esteve presente na história da humanidade, pois para que os produtos fossem aceitos, deveriam possuir características desejáveis pelos consumidores. Atualmente, com o surgimento de novos modelos gerenciais, a melhoria e o monitoramento da qualidade durante o processo de produção tornaram-se uma necessidade para muitas organizações. Assim, aprimorou-se o controle da inspeção por meio de técnicas estatísticas, reduziram-se perdas e foi possível competir no mercado. Neste contexto, o objetivo deste estudo foi avaliar a irrigação em um sistema por aspersão convencional, utilizando o Coeficiente de Uniformidade de Christiansen (CUC), o índice de Capacidade do Processo (CP) para correlacionar as técnicas com a eficiência do sistema, verificar a influência do vento na irrigação pelo gráfico de controle de Shewhart e confrontar os resultados da utilização dos gráficos de controle de Shewhart, com os gráficos de controle MMEP e CUSUM tabular, aplicados no controle de qualidade da irrigação por aspersão convencional. Neste estudo, foram realizados 60 ensaios em um sistema de irrigação por aspersão convencional. O sistema era constituído de quatro aspersores, modelo Xcel-wobbler, altura de 1,0 m em relação ao solo e espaçamento de 6,0 x 6,0 m. Os coletores foram espaçados em 1,0 m entre si com altura de 0,5 m do solo. A pressão de serviço foi monitorada e adequada às especificações dos aspersores, e o vento monitorado in loco, por um anemômetro digital com 2,0 m de altura. Para a avaliação do sistema, foram utilizados o Coeficiente de Uniformidade de Christiansen (CUC), o índice de Capacidade do Processo (CP), gráficos de Shewhart (Xbarra) e os gráficos de média móvel exponencialmente ponderada (MMEP) e de soma cumulativa (CUSUM). O sistema de irrigação por aspersão convencional teve melhor desempenho e esteve sob controle, quando a velocidade média do vento esteve menor que 1,0 m s-1. O uso dos gráficos individuais de controle de Shewhart possibilitou afirmar visualmente que o vento tem influência direta sobre o CUC. A irrigação noturna apresentou menor variabilidade nos dados, quando comparados aos dados do período diurno e isso resultou em maior eficiência na irrigação. O índice CPi teve grande similaridade com o Coeficiente de Uniformidade de Christiansen (CUC); mostrou-se bastante sensível à variação da eficiência de aspersão (Ea) e capaz de indicar a qualidade da irrigação por aspersão. Em comparação aos gráficos de controle, o gráfico MMEP mostrou-se suscetível quando utilizado em dados autocorrelacionados, pelas ocorrências de alarmes falsos. Para dados de resíduos, sem autocorrelação (pelo modelo ARIMA), o gráfico CUSUM tabular foi mais sensível ao detectar as variações ocorridas na irrigação devido à velocidade do vento, quando comparado aos gráficos MMEP e Shewhart para os mesmos dados. Na irrigação por aspersão, relacionando CUC com velocidade do vento, o gráfico de Shewhart foi mais indicado pela simplicidade, confiabilidade e facilidade de interpretação, mesmo na presença de dados autocorrelacionados entre si.

The current research considered parent report of sleep problems in children with an intellectual disability (ID). Of specific interest were parents who reported child sleep issues/disturbances but who did not consider their child to have a sleep problem. Also of interest was the use of a general parent-training program to treat both the sleep and behaviour problems in children with an ID. Study 1 examined parent perceptions regarding sleep in children with an ID. Parents who reported a child sleep problem provided information on the types of sleep treatment tried and rated their effectiveness. Overall, 243 questionnaires were completed by parents of children with a range of disabilities aged between 3.1 to 18.7 years. While 62% of parents rated their child as displaying problematic night settling, night waking, early waking, or other disturbing sleep behaviours, only 27% of parents considered their child to have a sleep problem. A higher number of parents (75%) than expected had tried at least one type of intervention, although it was not possible to discern 'self help' treatments from 'professionally sought' treatments. Study 2 investigated child and parent factors associated with parent perception of sleep problems in children with an ID. Seventy-six parents from Study 1 completed measures in relation to child adaptive and daytime behaviour, parent stress, locus of control, personality (extraversion, neuroticism, and psychoticism), parenting competence, and perceived control over the child's sleep and daytime behaviour. Based on parent report on a sleep measure and response to the question 'do you think your child has a sleep problem' parents were allocated into one of three sleep groups: Parents who recognised a sleep problem (RSP, N=20), parents whose child did not have a sleep problem (NSP, N=35), and parents who did not recognise their child to have a sleep problem (USP, N=21). The results revealed differences between parents who do (RSP) and parents who do not (USP) recognise their child's sleep problem. These differences related to amount of child sleep (as reported by parents) and parent perceived control over the child's sleep and daytime behaviour. Study 3 examined the efficacy of a general parent-training (behaviour management) program, with sleep used as the training exemplar, for the treatment of sleep problems in children with an ID. Of the 20 parents in the RSP group in Study 2, five agreed to take part in Study 3 and three completed the intervention. The effect of the intervention on (a) a targeted sleep problem, (b) a targeted behaviour problem, (c) other sleep and daytime behaviours, (d) parent stress, (e) parent sleep, (f) parent sense of competence, and (g) parent perceived control over the child's sleep and daytime behaviour were examined. All parents reported an improvement in target sleep behaviour, and at follow-up all of the parents no longer considered their child to have a sleep problem. One parent reported a decrease in stress and an increase in measures of perceived control, and parenting competence, while two parents showed minimal to no improvement on child and parent outcomes.

INTRODUÇÃO: A síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) é uma doença crônica que se caracteriza por ronco e apneias que causam microdespertares e fragmentação do sono. O impacto da doença sobre o humor e a qualidade de vida não é bem conhecido. OBJETIVO: Avaliar o impacto do uso da pressão positiva contínua nas vias aéreas (CPAP) sobre sintomas depressivos e qualidade de vida em pacientes com SAHOS. MATERIAL E MÉTODOS: Pacientes com diagnóstico polissonográfico de SAHOS foram avaliados antes e seis meses após o tratamento com CPAP. Foram coletadas as seguintes medidas antropométricas: peso, altura, índice de massa corporal (IMC), circunferência do pescoço, medida da cintura e do quadril. A sonolência foi avaliada pela escala de sonolência diurna de Epworth, o sono pelo índice de qualidade do sono de Pittsburgh, a qualidade de vida através dos questionários SF-36 e FOSQ e os sintomas depressivos pelo inventário de depressão de Beck. RESULTADOS: Foram estudados 61 pacientes, sendo 42 homens e 19 mulheres, com índice de apneias e hipopneias (IAH) de 40,3 ± 27,2 eventos/hora. A média de idade foi de 53,2 ± 9,0 anos e do IMC 30,36 ± 3,93 kg/m², sendo que 96,7% dos pacientes apresentavam sobrepeso ou obesidade. Valores acima do normal para a circunferência do pescoço foram observados em 73,8% e da cintura em 72% dos indivíduos. Com o tratamento com CPAP observou-se redução da sonolência (13,2 ± 4,8 vs 7,9 ± 3,3 pontos; p=0,0001), melhora da qualidade do sono (escore 10,1 ± 4,5 vs 4,1 ± 2,5; bons dormidores pré 9 vs 36 pós; p<0, 01), melhora da qualidade de vida em todos os domínios do FS-36 (p<0,01) e do FOSQ (81,9 ± 19,5 vs 91,7 ± 14,4 pontos; p=0,00001). Os sintomas depressivos melhoraram após o uso do CPAP (12,0 ± 8,6 vs 7,5 ± 5,1; p<0,01), os quais estavam presentes em 33 pacientes antes do tratamento e em 19 após 6 meses de seguimento. Não houve associação entre sintomas depressivos e sonolência. Houve correlação fraca entre sintomas depressivos e IAH (r=0,28; p=0,02), e moderada a forte com todos os domínios do SF-36 (r entre -0,58 e - 0,72; p=0,0001). CONCLUSÕES: Nosso estudo demonstra que a terapia com CPAP tem impacto positivo sobre a sonolência, qualidade do sono e melhora a qualidade de vida e os sintomas depressivos dos portadores de SAHOS. Os sintomas depressivos não se relacionaram com a sonolência e com a gravidade da doença, mas se associaram com a qualidade de vida. / INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by snoring and apneas that cause microarrousals and sleep fragmentation. The effects of the disease on mood and health related quality of life is not well known. OBJECTIVE: To evaluate the impact of the use of continuous positive airway pressure (CPAP) on depressive symptoms and quality of life in patients with OSAS. MATERIAL AND METHODS: Patients with OSAS diagnosed by polyssomnography underwent evaluation before and after 6 months treatment with CPAP. Weight, height, body mass index (BMI), neck, waist and hip circumference were measured. Daytime sleepiness was evaluated using the Epworth scale, sleep quality using the Pittsburgh sleep quality index and quality of life using SF-36 and FOSQ. Depressive symptoms were detected through the Beck Depression Inventory. Data were analized by Student T test, McNemar test and Pearson correlation test. RESULTS: We studied 61 patients with OSAS, 42 males and 19 females, with apnea hypopnea index (AHI) of 40.3 ± 27.2 events/hour. The mean age was 53.2 ± 9.0 years, BMI was 30.4 ± 3.9 kg/m², and 90.7% of the patients were overweight or obese. Abnormal neck and waist circumference were observed in 73.8% and 72% of patients, respectively. After treatment with CPAP there was a decrease in daytime sleepiness (13.2 ± 4.8 vs 7.9 ± 3.3 points; p=0.0001), an increase in sleep quality (10.1 ± 4.5 vs 4.1 ± 2.5; the number of good sleepers 9 before vs 36 after CPAP; p<0.01), and in quality of life as shown by SF-36 (p<0.01) and FOSQ (81.9 ± 19.5 vs 91.7 ± 14.4 points; p=0.00001). Depressive symptoms improved after use of CPAP (12.0 ± 8.6 vs 7.5 ± 5.1; p<0,01), they were reported by 33 patients before treatment and by 19 after six months of follow up. There was a weak correlation between depressive symptoms and AHI (r=0.28; p=0.02) and no association between depressive symptoms and daytime sleepiness. The correlation among depressive symptoms and SF-36 domains varied from r=-0.58 and r=-0.72 (p=0.0001). CONCLUSIONS: Our study demonstrates that the CPAP therapy has a positive impact on daytime sleepiness and sleep quality and improves quality of life and depressive symptoms in patients with OSAS. Depressive symptoms were not related to daytime sleepiness or disease severity, but were associated with quality of life.

Doctor of Philosophy / Civil Engineering / Sunanda Dissanayake / Safe and efficient flow of traffic through work zones must be established by improving work zone conditions. Therefore, identifying the factors associated with the severity and the frequency of work zone crashes is important. According to current statistics from the Federal Highway Administration, 2,372 fatalities were associated with motor vehicle traffic crashes in work zones in the United States during the four years from 2010 to 2013. From 2002 to 2014, an average of 1,612 work zone crashes occurred in Kansas each year, making it a serious concern in Kansas. Objectives of this study were to analyze work zone crash characteristics, identify the factors associated with crash severity and frequency, and to identify recommendations to improve work zone safety. Work zone crashes in Kansas from 2010 to 2013 were used to develop crash severity models. Ordered probit regression was used to model the crash severities for daytime, nighttime, multi-vehicle and single-vehicle work zone crashes and for work zones crashes in general. Based on severity models, drivers from 26 to 65 years of age were associated with high crash severities during daytime work zone crashes and driver age was not found significant in nighttime work zone crashes. Use of safety equipment was related to reduced crash severities regardless of the time of the crash. Negative binomial regression was used to model the work zone crash frequency using work zones functioned in Kansas in 2013 and 2014. According to results, increased average daily traffic (AADT) was related to higher number of work zone crashes and work zones in operation at nighttime were related to reduced number of work zone crashes. Findings of this study were used to provide general countermeasure ideas for improving safety of work zones.