A central component of many psychological interventions is breathing training. Breathing training protocols based on a mindfulness or a cognitive behavioral therapy (CBT) have demonstrated value in the management of psychological and medical ailments. Yet, despite the wealth of literature examining each approach, little direct comparison exists. An additional concern is the proliferation of smart phone health (mHealth) applications (apps) providing breathing training with little empirical evidence to support their clinical use. A possible explanation for the interest in breathing and mHealth apps is the growing body of literature indicating breathing training provides wide ranging health benefits through improved stasis of the autonomic nervous system (ANS). As ANS dysregulation underlies many chronic health conditions such as persistent temporomandibular disorders (TMDs), there is a need for empirical research to identify the most effective modality of breathing training and validate the clinical efficacy of breathing based mHealth apps. Study One compared the effectiveness of a mindfulness breathing meditation (MB) and a CBT based protocol teaching diaphragmatic breathing (DB) to improve biomarkers of ANS stasis. An attention control approach based on the Nolen-Hoeksema task (C) was included as a comparison group. Ninety participants were randomly assigned to either the MB, DB, or C condition. Within each condition, 30 participants were provided skills training with practice time and completed a behavioral self-regulation task. Participants in the DB condition approach had significantly lower breathing rates than those in the MB and C conditions (p < .001). DB condition participants experienced improvements on high-frequency heart rate variability (p < .05) and the standard deviation in NN intervals (p < .001), which served as indicators for ANS stasis. No differences were found between conditions on the behavioral self-regulation task (p’s > .05). Given these results, the DB training protocol was converted into a mHealth app to facilitate a clinical trial with patients suffering persistent TMDs. Study Two examined the additive benefits of including the mHealth app with standard dental care (SDC+) versus standard dental care alone (SDC). Nineteen patients seeking care for persistent TMDs were recruited. All participants were asked to track daily ratings of pain (VAS), relaxation (RR), and complete weekly assessments on several comorbid psycho-social factors. Within the SDC+ condition participants were asked to track the proximate effects of each breathing practice on VAS and RR ratings. Given a high drop-out rate (nine participants) and low overall sample size (N = 10), results are exploratory at best. Within the SDC+ condition, results indicated reliable improvements in average VAS and RR ratings from before and after SDC+ participants used the mHealth app (p’s < .05). Within a one session training paradigm, results supported the use of a DB based intervention above the use of a MB or C intervention. Future research should consider the effects of having multiple training sessions. Study Two results were complicated by a limited sample size and failed to provide a clear picture of whether the conjunctive treatment in the SDC+ condition provided additional symptom relief above traditional dental care alone. Although exploratory results indicated the mHealth app provided temporary improvements in pain and feelings of relaxation, a well powered trial is needed to clarify whether the finding represents an enduring treatment effect.

Evidence suggests that slow paced diaphragmatic breathing (DB) can significantly affect prefrontal cortex functions through increasing an individual’s physiological self-regulatory capacity. The current research demonstrates the effects of paced DB on inhibitory control, which is considered to be a reliable measure of behavioral self-regulation. Eighty healthy participants were randomly assigned to one of two conditions (20 males and females each). Participants were instructed on either DB at a pace of six-breaths per minute (BPM) or instructions on environmental awareness and asked to breathe at 12 BPM. Following training, all participants completed a computer-based task designed to examine inhibitory processes. Physiological recordings of heart rate (HR), BPM, and HRV were collected at baseline, during the breathing training, during the cued go/no-go task, and after the cued go/no-go task. The findings demonstrated that the DB condition had significantly lower BPM, HR, and higher HRV (p’s<0.05) during active training than the environmental awareness condition. Furthermore, the DB condition performed significantly better on the measure of inhibition than the environmental awareness condition (p<0.05). The use of DB as a reliable method to increase physiological self-regulatory capacity and improve behavioral self-regulation, measured as inhibitory control, should continue to be explored.

The birth of a child diagnosed with congenital diaphragmatic hernia (CDH) involves significant intensive care at the beginning of life and the need for surgery. Parents’ experiences during the acute phase of hospitalization for a critically ill infant not born premature is currently limited in the literature; in particular, there is no literature describing parents’ experiences of nursing care for having a infant with CDH in the Neonatal Intensive Care Unit (NICU). Using narrative inquiry this study explores stories of parents’ early experiences of nursing care in the NICU for an infant born with CDH. A thematic analysis revealed a main overarching theme of “not knowing” with three interrelated subthemes related to parents’ need for information and open communication; participation, power and partnership; and nursing presence to transition from not knowing to knowing their infant. The findings from this study suggest that parents want to be recognized as key members within the multidisciplinary team and that the nurse has the ability to facilitate aspects of care to impact parents positively or negatively. Implications for practice focus on supporting parents through evolving empowerment and participation in the care of their infant. / Graduate / 0569

INTRODUCTION: Pulmonary hypoplasia causes high morbidity and mortality in congenital diaphragmatic hernia (CDH) patients. MiR-10a and miR-200b are overexpressed in human CDH lungs. We aimed to define their roles in lung development. METHODS: We profiled miR-10a expression with RT-qPCR and in situ hybridization using a nitrofen rat model for CDH. The effects of miR-10a on airway branching were evaluated in lung explants. MiR-200b’s role in airway branching was assessed in miR-200b knockout lung explants. Crossing miR-200b knockout mice with CFP-E-Cadherin was used to evaluate miR-200b’s effects on epithelial differentiation. RESULTS: Expression of miR-10a was altered in the nitrofen model and miR-10a mimics reversed lung hypoplasia in vitro. Heterozygous miR-200b lung explants displayed reduced airway branching. CFP-E-Cadherin/miR-200b knockout lung explants showed reduced epithelial expression. CONCLUSION: Both miR-10a and miR-200b are critical for lung development and CDH. Normalizing their expression may reverse lung hypoplasia and reduce the associated morbidity and mortality in CDH. / February 2016

Les prothèses diaphragmatiques en ePTFE utilisées dans la hernie diaphragmatique congénitale à large défect ont une faible étirabilité, ce qui entrainera des récidives herniaires au cours de la croissance de l’enfant. En effet, l’analyse en imagerie montre que la surface du diaphragme grandit de 4-5 fois jusqu’à l’adolescence. De plus, les mesures de rigidité des surfaces de prothèses explantés, montrent l’influence des contraintes mécaniques appliquées sur la structure des matrices extracellulaires néoformées. Afin de favoriser l’intégration tissulaire du ePTFE, nous avons testé un moyen de fonctionnaliser le ePTFE avec la polydopamine sur une seule face. Le revêtement nanoscopique favorise la colonisation cellulaire. Enfin, ce travail de thèse présente une méthode originale de réalisation d’une nouvelle membrane bicouche avec des propriétés mécaniques conformes aux exigences chirurgicales. Ce biomatériau innovant et prometteur fait actuellement l’objet d’une Déclaration d’invention. / Electron microscopy assessments of ePTFE prosthesis explants for diaphragmatic congenital hernia repair strongly suggest that the tissue responses are directly related to the surface microstructure of the biomaterial. AFM measurements (Young moduli) emphasize the influence of the mechanical stress applied to the implant on the mechanical properties of the newly formed extracellular matrices. In order to guide the host responses, we undertook to functionalize with polydopamine the ePTFE biomaterial. Electron microscopy investigations reveal the interest of that surface treatment regarding cell colonization of implant. To optimize that approach, we developed an original method aimed to coat only one face of the biomaterial. After determination of the growth rate of the diaphragm from birth to adolescence, we explored the possibility to design a new double-faced mesh able to follow body growth. From this point of view, the initial prototypes are promising and under patent application.

Title: Effect of mobility exercises in offline and online environment on subjective perception of back pain Objectives: The main goal of this work was to determine whether the onset of daily mobility contributes to the reduction of individual's back pain perception. Within the work the results between the offline and online group was compared. Methods: The diploma thesis has the character of qualitative research, where case study of 20 probands was applied. Online input and output questionnaires were compiled to obtain data, which respondents filled in at the beginning and end of the intervention. Results: The research included 11 women and 9 men aged 21 - 44 years. Individuals have mostly sedentary jobs and some of them play recreational sports in their free time. At the end of the intervention, all individuals showed an improvement on the scale of the pain intensity, when the perceived back pain was alleviated or disappeared. The offline group performed better than the online group. Conclusion: The study confirmed that the inclusion of daily mobility contributes to the reduction of subjectively perceived back pain. It confirmed that exercising in offline lessons is more effective than in an online environment. Keywords: mobility, back pain, diaphragmatic breathing, torso stabilization, DNS

Bei kongenitalen Zwerchfelldefekten kommt es zu einer Herniation von abdominellen Organen in den Thorax. Es resultieren eine Lungenhypoplasie und eine pulmonale Hypertonie, die die hohe Mortalität und Morbidität bestimmen. In dieser Studie wurden prä-, peri- und postnatale Parameter von Patienten mit kongenitalen Zwerchfelldefekten retrospektiv betrachtet und auf eine mögliche Prädiktion für das Outcome sowie auf therapeutische Qualitätsänderungen überprüft. Im prospektiven Teil wurde die weitere Entwicklung der Kinder nach dem stationären Aufenthalt eruiert. Statistisch signifikante Unterschiede zeigten sich für einen höheren 1’ APGAR, eine seltenere Anwendung von NO und ein selteneres Vorkommen von assoziierten Anomalien bei den überlebenden verglichen mit den verstorbenen Patienten. Die Überlebenden hatten niedrigere Beatmungsfrequenzen, inspiratorische Spitzendrücke, Sauerstoffkonzentration sowie Mitteldrücke bei Beatmung und höhere arterieller Mitteldrücke. Als negativ für das Outcome erwiesen sich ein Polyhydramnion, eine Leberherniation oder die Notwendigkeit einer HFOV. Im zeitlichen Verlauf zeigten sich ein höherer 5’ APGAR, eine zeitigere Diagnosestellung in der Schwangerschaft, eine spätere Durchführung der Operationen und seltenere Rezidive. Die Kinder wurden mit niedrigeren Beatmungsdrücken und niedrigerem Sauerstoffgehalt beatmet, ohne dass sich das Outcome verschlechterte. Bezüglich der späteren Entwicklung gab es orthopädische und neurologische Folgen. Die Kinder hatten nur wenige Einschränkungen im Alltag. Dennoch zeigte sich das potentielle Auftreten einer Minderung der kognitiven Fähigkeiten.

Purpose: This study evaluated the effect of lung volume at the catch position to force and power outputs during single maximal effort strokes in rowing. Responses were compared when the participants were ‘fresh’ and following specific inspiratory muscle fatigue (IMF). In addition, a single subject pilot study was performed to characterise the changes in intra-thoracic (ITP), intra-abdominal (IAP) and trans-diaphragmatic (Pdi) pressures during a 30 second maximal effort piece on a rowing ergometer. Methods: Nine male rowers of international standard participated in the research. Static force, as well as the power produced during a single stroke were assessed at residual volume (RV), 25%TLC, 50%TLC, 75%TLC, total lung capacity (TLC), and a self-selected lung volume (S-S). Lung volumes were derived from maximal flow-volume loops (MFVLs) and achieved using online real-time feedback. Inspiratory muscle fatigue (IMF) was induced by breathing against an inspiratory load equivalent to 80% baseline maximal inspiratory pressure (MIP), at a breathing frequency (fB) of 15 breaths per minute, and a duty cycle of 0.6. Expiration was unimpeded. The single subject pilot study was undertaken using balloon catheters to measure ITP, IAP, and Pdi during a 30 second maximal effort free-rating piece on the ergometer. Results: There was no significant effect of lung volume upon either force or power production. The RMF protocol induced a significant reduction in MIP (159.9 ± 70.8 vs. 106.8 ± 58.7 cmH2O; p = 0.000), but not maximal expiratory pressure (MEP; 159.9 ± 79.2 vs. 166.6 ± 53.0 cmH2O; p = 0.376). RMF induced a significant reduction in force output with increasing lung volume, across all lung volumes (mean force 1313.4 ± 31.9 vs. 1209.6 ± 45.0N; p < 0.008), but not power (mean power 598.6 ± 31.9 vs. 592.7 ± 45.0W; p > 0.05). Self-selected lung volumes were consistent across all tests for force and power (mean 38.1 ± 6.9% [Force] vs. 28.2 ± 0.6% [Power]; p > 0.017). The pilot study indicated that internal pressures fluctuate markedly during maximal effort rowing (pressure, [max, min, average] cmH2O; IAP [144.69, 7.46, 73.59], ITP [75, -22.65, 15.34], Pdi [111.84, 7.09, 58.83]), suggesting that the trunk muscles play an active role in power production during rowing. Conclusion: The present study suggests that there is no significant effect of lung volume on force or power when athletes are in a fresh condition. However, a decrement in force production is present with inspiratory muscle fatigue. Combined with evidence of high internal pressures during maximal effort rowing, these data may indicate a role for the inspiratory muscles in force production during rowing.

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L’activité musculaire peut être caractérisée par la performance et un état de fatigue. Le muscle diaphragmatique est caractérisé par sa résistance à la fatigue, en faisant un témoin de capacité à l'autonomie respiratoire. Bien que cliniquement d'intérêt, la mesure de l'état de fatigue de ce muscle est difficile. Nous avons approché cette mesure en analysant les signaux de son activité électrique recueillis par contact. L'obtention des paramètres requière un traitement du signal. Nous avons développé les outils de recueil et de traitement de ce signal et les avons analysé pendant l'anesthésie. Le recueil a fait l'objet du développement d'une sonde multiélectrodes et des logiciels hardware et software de recueil du signal. L'analyse du signal a été l'objet de différentes méthodes mathématiques de débruitage temps réel sur des processeurs RISC-ARM, comparant des algorithmes de deux types d’ondelettes (MuRw, LiFw), et un filtre morphologique (MoFi), le choix portant finalement sur l'ondelette MuRw offrant le meilleur compromis en temps de calcul et en rapport signal sur bruit. L'évaluation clinique de sujets sains et de patients a montré la pertinence des paramètres fréquentiels de l'activité électrique MuRw du diaphragme comme représentants de son état de fatigue, en particulier par le rapport hautes sur basses fréquences obtenu par analyse spectrale / Muscular activity can be described in terms of performance and fatigue. Diaphragmatic muscle is charactarized by its resistance to fatigue, making of it a good representative of ventilatory autonomy. While of clinical interest, its measurement is difficult. We considered this measurement by analyzing the electrical diaphragmatic signal gathered from direct recordings. To be obtained, the parameters have to be filtered. We developped the tools to record as well as to filter the signal and have validated them in clinical settings during anesthesia and intensive care. A multielectrodes probe and the associated hardware and software were developped for the signal recording. The filtering which followed compared using differnt wavelet analysis algorithms (MuRw, LiFw), and a morphological filter (MoFi), through a RISC-ARM processor for a real-time measurement. MuRw was the best compromise for calcul duration and signal noise ratio. Clinical evaluation on patients and healthy volounteers demonstrated the pertinence of frequential parameters extracted from the filtered signal, particularly the High Low ratio obtained after spectral analysis