Introdução: Os pacientes com fissura labiopalatina, com deficiências maxilares muito severas, geralmente são tratados com avanço maxilar por meio da osteotomia tipo Le Fort I. Entretanto, a distração osteogênica com o distrator externo rígido (RED) pode funcionar como uma alternativa terapêutica para a correção da discrepância esquelética. Proposição: O objetivo do presente estudo é avaliar os efeitos do avanço maxilar por meio da distração osteogênica com distrator externo rígido (RED), associada à osteotomia tipo Le Fort I, em pacientes com fissura transforame unilateral ou bilateral, quanto à quantidade de avanço maxilar e à sua estabilidade a médio e longo prazo. Materiais e Métodos: Para a realização deste estudo longitudinal e retrospectivo, foram usadas telerradiografias em norma lateral de 9 pacientes (6 do gênero masculino e 3 do gênero feminino), onde 4 apresentaram fissura transforame unilateral e 5 apresentaram fissura transforame bilateral, submetidos ao avanço maxilar por meio da distração osteogênica com distrator externo rígido (RED). Foram estabelecidos três tempos de avaliação: fase pré-distração (T1), fase pós-distração imediata (T2) e fase pós-distração controle, com o mínimo de 1 ano após a finalização da distração (T3). A demarcação dos pontos cefalométricos e a obtenção das medidas das variáveis cefalométricas foram realizadas através do software Dolphin Imaging®, versão 11.5. Para a análise dos resultados, o teste estatístico ANOVA de medidas repetidas foi utilizado, adotando-se o nível de significância de 5%. Resultados: No início da distração, a idade média foi de 14 anos e 4 meses (idade mínima de 9 anos, e máxima de 21 anos). O período médio de distração foi de 18 dias, com uma média de ativação no distrator de 1,0mm/dia. O avanço médio da maxila medido em LVR-A, em T2, foi de 15,6mm (p<0,001), com recidiva não estatisticamente significante de 21,79% (p=0,102), em T3. O aumento médio de SNA, em T2, foi de 14,8º (p<0,001), com recidiva não estatisticamente significante de 18,90% (p=0,130), em T3. Os valores médios das medidas SN.GoMe, 1.PP e IMPA não apresentaram variação estatisticamente significante (p>0,05) entre T1, T2 e T3. Conclusão: A terapia de distração osteogênica para avanço maxilar com o RED mostrou ser eficiente, com aumentos significantes das medidas cefalométricas lineares e angulares relacionadas ao avanço maxilar, demonstrando efeito predominantemente esquelético, e estabilidade no período pós-distração médio (T3) de 1 ano e 8 meses. / Introduction: Patients with unilateral and bilateral cleft lip and palate, with significant maxillary hypoplasia are commonly treated with maxillary advancement by Le Fort I osteotomy. However, distraction osteogenesis with a rigid external distraction (RED) device can function as an alternative option for treatment of the skeletal discrepancy. Purpose: The aim of this study is to assess the effects of maxillary advancement by distraction osteogenesis using a rigid external distraction (RED) device, associated with the Le Fort I osteotomy in patients with unilateral or bilateral cleft lip and palate, as the amount of maxillary advancement and their stability in the medium and long term. Materials and Methods: To perform this retrospective longitudinal study, lateral cephalograms of 9 patients (6 males and 3 females) were used, where 4 had unilateral cleft lip and palate and 5 had bilateral cleft lip and palate, who underwent maxilla advancement by distraction osteogenesis with RED device. Three stages of evaluation were established: pre-distraction (T1), immediate post-distraction (T2) post-distraction control, with a minimum of 1 year after completion of distraction (T3). The anatomic landmarks and measurements of cephalometric variables were performed by using the Dolphin Imaging® version 11.5 software. To evaluate the results, the ANOVA test for repeated measures was used, adopting a significance level of 5%. Results: At the start of distraction, mean age was 14 years and 4 months (minimum age 9 years old and maximum of 21 years old). The mean distraction period was 18 days, with a mean rate of distractor activation in 1.0 mm / day. The mean maxillary advancement in LVR-A, at T2, was 15.6 mm (p<0.001), with no statistically significant relapse of 21.79% (p=0.102) at T3. The SNA angle increase, at T2, was 14.8º (p<0.001), with no statistically significant relapse of 18.90% (p=0.130), at T3. The mean values of SN.GoMe, IMPA and 1.PP measures showed no statistically significant variation (p>0.05) between T1, T2 and T3. Conclusion: The therapy of distraction osteogenesis for maxillary advancement with RED is efficient, with significant increases in the linear and angular cephalometric measurements related to the maxilla advancement, demonstrating predominantly skeletal effect and stability in mean post-distraction period (T3) of 1 year and 8 months.

Introdução: O uso de molas metálicas para o tratamento das craniossinostoses têm ganho cada vez mais espaço no arsenal terapêutico do cirurgião Crânio-Maxilo-Facial, na intenção de minimizar procedimentos extensos e mórbidos. Apesar da simplificação cirúrgica promovida pela mesma ainda persiste a necessidade de sua remoção. Objetivos: Realizar expansão craniana cirúrgica em modelo animal, utilizando-se de um implante (mola) totalmente integrado, confeccionado em blenda polimérica bioabsorvível. Testar sua eficácia e realizar análise histológica. Material e Métodos: Estudo experimental, aberto e prospectivo, utilizando doze coelhos fêmeas da raça New Zealand (Oryctolagus cuniculus) com seis semanas de vida. Os animais foram randomizados em dois grupos: controle (G1) aonde foi realizada craniectomia linear, e estudo (G2) aonde além da craniectomia foi inserida uma mola confeccionada a partir de uma blenda de POLI ÁCIDO LÁCTICO-CO-GLICÓLICO/POLI ISOPRENO, com o objetivo de realizar expansão craniana no sentido transversal à ostectomia. A movimentação craniana foi mensurada radiologicamente nas 12 semanas seguintes, através de marcadores e ao final foi realizada análise histológica para avaliação de reação inflamatória. Resultados: As molas confeccionadas apresentaram uma força média de 4,2N. A expansão craniana no grupo estudo no nível do marcador frontal foi de 9,6mm a 11,67mm e foi significante em relação a grupo controle. A análise histológica demonstrou pequena reação inflamatória. Conclusão: É possível a realização de expansão craniana em modelo animal utilizando-se uma mola bioabsorvível através de craniectomia linear, com boa tolerabilidade dos tecidos circunjacentes ao implante. / Introduction: The use of metal springs for the treatment of craniosynostosis have gaining more and more posicion in the therapeutic armory of the Craniofacial surgeon in the intention to minimize morbid and extensive procedures. Objectives: Perform cranial expansion surgery in an animal model, using an implant elastic (spring) fully integrated, made of bio-absorbable polymeric material. Test its efficacy and histological analysis Methods: An experimental study, open, prospective, using twelve New Zealand female rabbits (Oryctolagus cuniculus) with six weeks. The animals were randomized into two groups: control (G1) where linear craniectomy was performed and study (G2) where besides the craniectomy a spring made from a blend of POLY LACTIC ACID-CO-GLYCOLIC / POLI ISOPRENE, in order to perform cranial expansion in the transverse osteotomy. The cranial movement was assessed radiographically at 12 weeks following the surgical procedure and the final histological analysis was performed to evaluate the inflammatory reaction. Results: The springs made showed a medium force of 4,2N. The cranial expansion in the study group in the level of the frontal marker was of 9,6mm to 11,67 and was significant in relation to the control group. The histological analysis showed a small inflammatory reaction. Conclusion: It is possible to perform cranial expansion in an animal model using a bio-absorbable spring through the linear craniectomy. There was good tolerability of the surrounding tissues to the implant.

Barn kommer i kontakt med hälso- och sjukvård för olika mer eller mindre smärtsamma procedurer. Minnet av tidigare obehagliga erfarenheter kan ofta skapa rädsla inför framtida besök och risk för bestående sjukvårdsrädsla. I många studier beskriver barn att nålstick i huden är en av de mest smärtsamma procedurerna inom sjukvården. Samhället har ett ansvar och det finns reglerat genom lagar hur barn skall bemötas inom sjukvården. Barn i skolåldern har ofta en livfull fantasi och magiskt tänkande och upplever smärta annorlunda än vuxna. Skolbarn behöver konkreta handlingar för att förstå information, vilket gör det viktigt med åldersanpassade förberedelser.Syftet med studien är att beskriva stödjande åtgärder som underlättar för skolbarn, 6-12 år, att hantera medicinska nålrelaterade procedurer. I denna litteraturstudie har tio vetenskapliga artiklar valts ut med både kvalitativ och kvantitativ design. Två huvudteman framkom i resultatet, där barns inre bemästringsstrategier står för den ena delen och yttre stödjande faktorer för den andra. Vad som framkom mycket tydligt var vikten av att personalen var känd för barnet. Vidare stödjer resultaten betydelsen av att personalen hade utbildning med barnperspektiv, så att de kunde förbereda och förmedla information och kunskap om olika bemästringsstrategier till både barn och närstående. Dessutom visade artiklarna på att barn har stort behov av kontroll, information och att få vara delaktiga vid proceduren, speciellt hos dem som tillbringar mycket tid på sjukhus. Det var betydelsefullt att barnen själva fick välja distraktionsmetod. I resultatet framkom även att distraktion var en bra metod att lindra rädsla och oro i samband med nålstick, men hade ingen större effekt på smärta.

Orientador: Luiz Gonzaga Gandini Júnior / Banca: Ana Claudia Moreira Melo / Banca: Ary dos Santos Pinto / Resumo: O objetivo deste trabalho foi avaliar, por meio de modelos de estudo, os efeitos da Distração Osteogênica Médio-Sagital da Mandíbula (DOMM) no arco mandibular de pacientes que utilizaram aparelhos dento-suportados. A amostra consistiu de 14 pacientes (5 do gênero masculino e 9 do gênero feminino) com idades variando de 13 a 19 anos e média de idade de 15,74 ± 1,89 anos no início do tratamento. Modelos de estudo foram obtidos de cada paciente no início do tratamento (T1), três meses após a DOMM (T2) e no momento da remoção dos aparelhos fixos (T3). Os dados foram submetidos à Análise de Variância e teste complementar de Duncan e demonstraram que todas as dimensões transversais aumentaram com a DOMM, o comprimento do arco não sofreu alteração estatisticamente significante, o perímetro do arco aumentou e o Índice de Irregularidade diminuiu consideravelmente, refletindo a correção do apinhamento ântero-inferior. Os dentes posteriores apresentaram maior expansão das cúspides do que das cervicais, indicando uma possível inclinação causada pelo uso de aparelho dento-suportado. Todas a medidas mostraram algum grau de recidiva, que variou de 2,8% a 8,84%. Os achados desta pesquisa permitiram concluir que a DOMM é uma alternativa eficaz para o tratamento do apinhamento associado à deficiência transversal de mandíbula. / Abstract: The purpose of this study was to evaluate the effects of Mandibular Symphyseal Distraction Osteogenesis (MSDO) with a tooth-borne distraction device, analysed in dental casts. The sample included 14 patients (5 males and 9 females) between 13 and 19 years of age, with a mean age of 15,74 ± 1,89 years at the start of treatment. Dental casts were obtained at the start of treatment (T1), three months after distraction (T2) and at the end of treatment, when fixed appliances were removed (T3). The data were analysed statistically using ANOVA and Duncan's test and showed that all transverse widths increased, arch length was maintained, arch perimeter increased significantly and Irregularity Index decreased, showing the correction of crowding. Molars and premolars had a disproportionate pattern of distraction, characterized by greater cusps expansion than cervical one. This pattern might be caused by the use of a tooth-borne distraction device. All the measurements demonstrated evidence of relapse, that varied from 2,8% to 8,84%. The findings of this study indicate that MSDO is an efficient treatment alternative for dental crowding and mandibular transverse deficiency. / Mestre

Distraction during driving is one of the leading contributors to injury and mortality rates in traffic accidents. The aim of this current thesis was to consider 1) whether oculomotor and electrophysiological metrics could act as markers of cognitive distraction; 2) whether decrements in hazard perception performance caused by secondary cognitive task demand are to some extent due to cognitive load interfering with processes of alerting, orienting, inhibitory control and visual search; 3) what elements of secondary cognitive tasks have the greatest impact on hazard perception performance; and 4) whether the susceptibility of previously identified markers of cognitive distraction are affected by primary task difficulty. Over the course of four Experiments we recorded the effects of secondary cognitive task demand on behavioural, oculomotor and electrophysiological metrics during a variety of low-level and complex visual tasks. Taken together the experiments of this thesis have demonstrated that secondary cognitive task demand interferes with not just one but every component process of hazard perception performance that was examined. Next, this research has demonstrated that measures such as blink rates, saccade peak velocities, the spread of fixations along the horizontal axis as well as reductions in alpha and beta power output may be reliable indicators of secondary cognitive task demand regardless of the type of primary task. Finally we have shown that the co-registration of eye movements, EEG and ERP measures is a viable method with which to study the cognitive processes involved in visual processing within low level and complex visual tasks.

Kan, Ka Lai Carrie. / "May 2008." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 118-125). / Abstracts in English and Chinese, some text in appendix also in Chinese. / Chapter CHAPTER 1: --- INTRODUCTION --- p.1 / Chapter CHAPTER 2: --- LITERATURE REVIEW / Introduction --- p.3 / Medication error --- p.4 / Definition of medication error --- p.4 / Incidents of medication error --- p.6 / The issues of defining medication error --- p.7 / The issue of medication error reporting --- p.8 / Near miss --- p.9 / Factors associated with medication error --- p.10 / System factors --- p.10 / Environmental factors --- p.12 / Human factors --- p.13 / Slips and lapses and medication error --- p.14 / "Distraction, slips and lapses and medication error" --- p.15 / Distraction --- p.15 / Definition of distraction --- p.15 / Consequences of distraction --- p.16 / Factors associated with distraction --- p.16 / Cognitive factors --- p.17 / Personality factors --- p.18 / Environmental factors --- p.18 / Studies on distraction during medication administration --- p.19 / Distraction and medication error --- p.21 / Strategies to reduce distraction --- p.22 / Visual Sign --- p.23 / Definition of visual sign --- p.23 / Nature of visual sign --- p.24 / Studies on visual sign to reduce distraction --- p.25 / Summary of literature review --- p.25 / Chapter CHAPTER 3: --- METHODOLOGY / Introduction --- p.27 / Aims and objectives --- p.27 / Operational definitions --- p.28 / Research design --- p.28 / Setting --- p.31 / Stage one --- p.32 / Setting --- p.32 / Sampling --- p.33 / Instrument --- p.35 / Data collection method --- p.36 / Data analysis --- p.37 / Stage two --- p.38 / Stage three --- p.40 / Pilot study --- p.40 / Validity and reliability of methodology --- p.41 / Interview --- p.41 / Observation --- p.42 / Ethical considerations --- p.43 / Chapter CHAPTER 4: --- FINDINGS / Introduction --- p.44 / Stage one --- p.44 / Baseline interview --- p.44 / Informants' characteristics --- p.44 / Categories and sub-categories --- p.45 / Feelings of medication error --- p.46 / Causes of medication error --- p.47 / Causes of distraction --- p.49 / Perception of distraction --- p.50 / Feelings about distraction --- p.52 / Strategies to reduce distraction --- p.53 / Strategies to reduce medication error --- p.54 / Baseline observation --- p.56 / Findings of stage one --- p.59 / Stage two --- p.60 / One week after implementation observation --- p.60 / Findings of stage two --- p.63 / Stage three / Three months after implementation observation --- p.63 / Follow-up interview --- p.66 / Informants' characteristics --- p.66 / Categories and sub-categories --- p.67 / Conflicting feelings --- p.68 / Different effects on nursing service --- p.69 / Feelings about wearing the red vest --- p.70 / Enhanced a non-distractive culture --- p.72 / Improved cognitive process --- p.73 / Improved performance --- p.75 / Findings of stage three --- p.76 / Comparison of the three stages of quantitative observational data --- p.77 / "Lapse time, items given, and number of patients" --- p.77 / Comparison of lapse time and total distraction --- p.78 / Comparison of the ten items on distraction --- p.78 / Comparison of total distraction --- p.79 / Comparison of near misses --- p.80 / Overall Summary of the findings --- p.80 / Chapter CHAPTER 5: --- DISCUSSION / Introduction --- p.82 / Characteristics of informants and observational data --- p.82 / Nurseśة perception of distraction as a cause of medication administration error --- p.83 / Causes of distraction during medication administration --- p.87 / Evaluation outcome --- p.91 / Evaluation process --- p.98 / Chapter CHAPTER 6: --- "LIMITATIONS, IMPLICATIONS AND RECOMMEDATIONS" / Limitations --- p.111 / Setting --- p.111 / Population and sampling --- p.111 / Observer's influence --- p.112 / Interviewer's influence --- p.112 / Implications for nursing practice --- p.113 / Recommendations for future studies --- p.114 / Conclusion --- p.116 / REFERENCES --- p.118 / APPENDICES / Chapter 1: --- Literature search --- p.126 / Chapter 2: --- Medication Administration Distraction Observation Sheet (MADOS) --- p.127 / Chapter 3: --- Adapted MADOS --- p.128 / Chapter 4: --- Baseline interview guide --- p.129 / Chapter 5: --- Interview consent form --- p.130 / Chapter 6: --- Observation consent form --- p.136 / Chapter 7: --- Informal letter to nursing staff --- p.142 / Chapter 8: --- Follow-up interview guide --- p.144 / Chapter 9: --- Rationale for pilot study --- p.145 / Chapter 10: --- Ethical approval (CUHK) --- p.147 / Chapter 11: --- Ethical approval ( Hospital Administrative Council) --- p.148 / Chapter 12: --- Baseline interview (1) --- p.149 / Chapter 13: --- Baseline observation (MAC 4) --- p.154 / Chapter 14: --- One week after observation (MAC 01) --- p.155 / Chapter 15: --- Three months after observation (MAC 005) --- p.156 / Chapter 16: --- Follow-up interview (08) --- p.157 / TABLES / Chapter 1: --- Different units and the approximate numbers of nurses --- p.30 / Chapter 2: --- Proposed sample size for baseline interview --- p.33 / Chapter 3. --- Medication administration at different scheduled time --- p.35 / Chapter 4. --- Informantśة characteristics at baseline interview --- p.45 / Chapter 5: --- Categories and subcategories: baseline interview --- p.46 / Chapter 6: --- "Elapse time, items given, number of patients, distractions and near misses at baseline observation" --- p.57 / Chapter 7: --- Frequency of the ten items of distraction at baseline observation --- p.57 / Chapter 8: --- Ranking of the ten items on distraction at baseline observation --- p.58

A key term in the cultural criticism of Walter Benjamin is his notion of "reception in distraction" as an antidote to ideology's domination over the mass society in the modern age. This dissertation attempts to illuminate this idea by offering case studies of three projects that summon into existence a new kind of reader, one capable of a trained apperception we may describe as "distracted."; One objective of the mass society according to a Frankfurt model of culture is the erasure of the subject; reception in distraction serves at once to create a space for the social dream and to re-inscribe the subject at the moment of reception through an insistence on its unruly, embodied presence. "Reception in Distraction" creates a cognitive space for disengagement from ideology, modeling what Michael Denning called the "dream work of the social." Critical theory is thus available to the mass public in the form of the "dream of history" that is solely accessible to a distracted apperception and whose subject is the faint possibility that the crisis of the present may be redeemed and repaired in the future. This project attempts to locate this dream of history in the autobiographical writings of Gertrude Stein, the detective fiction of Kenneth Fearing and the late silent cinema of Charlie Chaplin, each of which illustrates clearly the manner in which "distraction" functions to generate contradiction in the face of ideology's mass cultural form. Stein's experiments with the autobiographical form call for exactly this manner of reception, for which "Alice B. Toklas" becomes a key model. Similarly, Kenneth Fearing's Marxist detective novel The Big Clock and Modern Times , Charlie Chaplin's final silent film, reflect on the possibility of a productive reception-in-distraction that may co-opt the social forms of capitalism into a project of resistance and counter-discourse. "Distraction" is therefore more than merely an attitude of reception: it occasions a cognitive distance from ideology that is a key form of critical theory in the modern period.

Cell phone ownership among student populations is approaching ubiquity and many cell phone owners interact with their devices frequently throughout the day. Since cell phones often hold the power to connect and entertain their owners at any given moment, it is possible that students' increased proximity to cell phones during a classroom lecture may lead to increased distraction from academic tasks. This study investigated whether the mere presence of a cell phone, self-reported general frequency of cell phone use, and anxiety related to being separated from one’s cell phone were related to classroom lecture outcomes. Undergraduate participants (N=72) unknowingly signed up for one of three groups: phone-on-desk, phone-under-desk, or phone-at-front-of-room. In each condition, participants were asked to take notes during a video lecture; their protocols were subsequently scored for lecture note quantity, lecture note quality, and performance on a lecture content quiz. After controlling for self-reported general cell phone use frequency and cell phone separation anxiety, results indicated participants who had their phones on their desks during the lecture wrote more complete ideas in their notes than participants who had their phones under their desks or at the front of the room. Additional analyses indicated the phone-on-desk group wrote significantly more propositions and complete ideas in their notes than the other two groups. These outcomes fall in the direction opposite to the stated hypothesis. Future investigations should consider students’ habituation to having their cell phones present and the possibility that the absence of one’s cell phone could be distracting enough to suppress academic performance.

Complex behaviors require selectively attending to task-relevant items, and ignoring conspicuous, irrelevant items. For example, driving requires selectively attending to other cars on the road while ignoring flashing billboards. Dominant models of attentional control posit that we avoid distraction by biasing attention towards task-relevant items, and our ability to avoid distraction depends on the strength and specificity of this bias. I find that a strong, specific bias towards task-relevant items is insufficient for preventing distraction. Instead, preventing distraction also requires past experience ignoring distractors. I also find that long-term memory systems, rather than visual short-term memory or priming memory systems, maintain this experience. Based upon these findings, I propose that effective attentional control not only demands a strong, specific bias towards task-relevant items, but also requires that observers learn to ignore conspicuous, irrelevant items.

Les variables neurovégétatives permettent d'évaluer l'état fonctionnel de l'individu, et représentent un intérêt pour mieux comprendre le comportement du conducteur, facteur déterminant de la sécurité routière. Ce travail est centré sur l'évaluation de la charge mentale du conducteur automobile par l'analyse de l'activité électrodermale. L'objectif est d'extraire les meilleurs indicateurs du signal électrodermal pour différencier la charge mentale induite par des situations de conduite réelle. L'analyse d'une trentaine d'indicateurs phasiques a permis de différencier des situations de conduite nominale, comparables en termes d'exigence comportementale mais différentes au niveau cognitif. Après traitement approprié du signal, en particulier en appliquant des transformations log, l'amplitude des réponses électrodermales est apparue comme un des indices les plus discriminants. Toutefois, les différences de charge mentale induites par les situations de conduite n'ont pas exactement correspondu à celles qui avaient été supposées. Une explication alternative mettant en avant des processus d'anticipation est proposée. Trois indicateurs toniques, dont deux sont nouveaux, ont ensuite été testés dans une expérience de double tâche, où une activité secondaire distractive était effectuée simultanément à la conduite. L'un s'est révélé inadapté au profil des signaux, mais les deux autres ont permis d'établir une hiérarchisation partielle de la surcharge induite. Particulièrement sensible à l'aspect cognitif de la distraction, l'évaluation psychophysiologique de la charge mentale par l'activité électrodermale apparaît complémentaire de l'analyse de la performance de conduite.