Made available in DSpace on 2014-07-29T15:23:44Z (GMT). No. of bitstreams: 1 Dissertacao Marta I V Andrade.pdf: 1042992 bytes, checksum: 4667b810c3cd428f39ff87e1357a4645 (MD5) Previous issue date: 2012-03-02 / BACKGROUND: Protein energy wasting commonly occur in patients with chronic kidney disease. Changes in muscle function arise even before changes in anthropometric and biochemical parameters.Thus, a method for evaluating muscle function and strength becomes essential for these patients. OBJECTIVES: To evaluate the handgrip strength (HGS) and its association with nutritional status of patients with chronic kidney disease on hemodialysis. METHODS: A cross-sectional study conducted between May and July/2011. The sample included 90 patients, 48.8% male and 51.2% female. The HGS was performed three times with a hydraulic hand dynamometer (Takei) in the arm without fistula. For each patient were considered the best strength measure. Values lower than percentile 10 were considered as low HGS. The nutritional status diagnosis was given by Subjective Global Assessment (SGA). RESULTS: The average age was 52 ± 14.7 years. The hypertensive nephrosclerosis was the most frequent cause of chronic kidney disease (31.1%). The average HGS was among 32.0 ± 8.7kgf in men and 20.7 ± 6.1kgf in women (p<0.001). 11.3% of men and 21.7% of woman were classified as moderatey malnourished by SGA, 31.8% and 34.8% of men and women, respectively, were classified with low muscle function. Low HGS was associated with time on hemodialysis for men and showed good sensitivity (73.3%) and specificity (74.7%) for malnutrition diagnosis. In multiple logistic regression analysis, low-power handgrip strength prevalence was two times higher (PR =2.00, 95% CI: 1.19 to 3.34) for patients classified as moderate malnourished by SGA. CONCLUSION: This study showed high prevalence of low muscle function and good association between HGS and SGA in patients with chronic kidney disease on hemodialysis classified by dynamometry. It is suggested that HGS, an inexpensive and noninvasive measurement, can be used in clinical practice as a screening tool of nutritional status. It is sensitive for malnutrition diagnosis. / INTRODUÇÃO: A desnutrição energética proteica é frequente nos pacientes com doença renal crônica. As alterações da função do músculo surgem antes das modificações dos parâmetros antropométricos e bioquímicos. Assim, torna-se importante um método para avaliar a função e força muscular. OBJETIVOS: Avaliar a força de aperto de mão e sua associação com estado nutricional de pacientes com doença renal crônica em hemodiálise. MÉTODOS: Estudo transversal, realizado em maio a julho de 2011. Foram incluídos no total 90 pacientes. A Força de Aperto de Mão (FAM) foi realizada três vezes com dinamômetro hidráulico no braço sem a fístula. Considerou o melhor desempenho da medida da FAM. Os valores menores que o percentil 10 foram considerados como baixa FAM, de acordo com ponto de corte proposto para população para população de Niterói, Rio de Janeiro, Brasil. O diagnóstico do estado nutricional foi realizado por meio da Avaliação Subjetiva Global (ASG). RESULTADOS: Do total da amostra 48,8% eram do sexo masculino e 51,2% do sexo feminino. A média de idade foi 52±14,7 anos. A nefroesclerose hipertensiva foi a causa mais frequente de doença renal crônica (31,1%). A FAM média entre os homens foi de 32,0 ± 8,7kgf e entre as mulheres 20,7 ± 6,1kgf (p=<0,001). Pela classificação da ASG, 11,3% dos homens e 21,7% das mulheres foram classificados como desnutridos moderados; 31,8% e 34,8% dos homens e mulheres, respectivamente, foram classificados com baixa força de aperto de mão. Os homens com maior tempo em hemodiálise apresentaram baixa FAM. A sensibilidade (73,3%) e especificidade (74,7%) da FAM para o diagnóstico de desnutrição foi adequada. Na regressão logística múltipla a prevalência de baixa força de aperto de mão foi duas vezes maior (RP=2,00; IC95%: 1,19-3,34) para os pacientes classificados com desnutrição moderada pela ASG. CONCLUSÃO: Este estudo mostrou alta frequência de baixa FAM e associação da FAM com a ASG em pacientes com doença renal crônica em hemodiálise. Sugere-se que a FAM, uma medida barata e não invasiva, possa ser usada na prática clínica como ferramenta de triagem do estado nutricional, pois apresenta boa capacidade de predizer a desnutrição.

Elektroneurografi är en undersökningsmetod som används för att undersöka nervledingskapaciteten i perifera nerver. Det är en metod som ofta används på sjukhuskliniker vid diagnostisering av perifera nervsjukdomar. Syftet med studien är att undersöka om det finns en signifikant skillnad i motorisk och sensorisk nervledningshastighet, amplitud och F-respons mellan dominant och icke-dominant hand. I studien undersöktes det även om en korrelation finns mellan handgreppsstyrka och svarsamplitud från motorisk elektroneurografi.  I studien deltog 26 testpersoner från biomedicinska analytikerprogrammet i termin 6. Testpersonernas genomsnittsålder är 24 år (range 21-32 år), och testpersonernas kroppslängd är i genomsnitt 169 cm (range 155- 185). Elektroneurografi utfördes motoriskt och sensoriskt på nervus medianus bilateralt. Handgreppsstyrka undersöktes bilateralt med Jamar Hydraulic Hand dynamometer. För samtliga mätvariabler bestämdes signifikantnivån till α=0,05.  Resultatet visar att det finns en signifikant skillnad i sensorisk nervledningshastighet, motorisk amplitud och sensorisk amplitud mellan dominant och icke-dominant hand. Sensorisk nervledningshastighet är högre i icke-dominant hand, medan motorisk och sensorisk amplitud är högre i dominant hand. Däremot kan inte en signifikant skillnad påvisas i motorisk nervledningshastighet, FM-latens samt antalet F-svar mellan dominant och icke-dominant hand. Resultatet visar att det inte finns någon korrelation mellan handgreppsstyrka och amplitud i motorisk elektroneurografi. I dag används samma referensvärden för dominant och icke-dominant hand. Den här studien visar att det kan finnas ett värde i att utforma referensintervall som baseras på handdominans. / Electroneurography is an examination method used for examining the nerve conduction capacity of the peripheral nerve. The method is often used in hospitals in the diagnosis of peripheral nerve injuries. The aim of this study is to examine if there is a significant difference in motor and sensory nerve conduction velocity, amplitude, and F-response between dominant and non-dominant hands. The correlation between hand grip strength and the amplitude in motor electroneurography was also examined in this study.  The study involved 26 students from Biomedical Scientist Programme term 6. The average age of the participants is 24 years (range 21-32 years), and the participants body length is on average 169 cm (range 155-185 cm). Electroneurography was performed on the median nerve bilaterally. Hand grip strength was examined bilaterally with Jamar Hydraulic Hand dynamometer. For all measurement variables, the significant level was determined to α=0,05.  The result shows that there is a significant difference in sensory nerve conduction velocity, motor amplitude, and sensory amplitude between dominant and non-dominant hands. Sensory nerve conduction velocity is higher in non-dominant hand, while motor and sensory amplitude is higher in dominant hand. However, a significant difference cannot be detected in motor nerve conduction velocity, FM-latency, and the number of F-responses between dominant and non-dominant hands. The result shows no correlation between hand grip strength and the amplitude in motor electroneurography.  Today, the same reference values are used for dominant and non-dominant hands. This study shows that there may be a value in creating reference intervals based on hand dominance.

Contexte :Le conditionnement précédant la greffe de cellules souches hématopoïétiques (CSH) a été associé avec des taux élevés de malnutrition meme à 100 jours après la greffe. Objectif: Cette étude évalua l'impact du conseil nutritionel fournie à la sortie de l'hôpital sur l'état nutritionnel,100 jours après la greffe de CSH (dit T4).Conception: Il s'agissait d'un essai contrôlé randomisé monocentrique. Les patients adultes étaient randomisés à un groupe témoin (GT) recevant des soins habituels et un groupe d'intervention (GI) recevant des conseils nutritionnels mensuels après la sortie de l’hôpital. Le résultat principal était le score de l'évaluation globale subjective générée par le patient (PGSGA) à T4. La malnutrition était évalué aussi par le score de la société américaine de nutrition parentérale et entérale/Académie de nutrition et diététique (AND-ASPEN).Résultats: 52 participants ont été randomisés (août 2016 jusqu'en août 2017) et 46 ont été analysés [65% d'hommes, 63% de greffes autologues, GI (n = 22), GT (n = 24)]. Les deux groupes etaient comparable au moment de randomization.A T4, le pourcentage de patients bien nourris n'était pas significativement différent entre les groupes selon le PGSGA (72% GI vs 43% GT, p = 0,063). Le pourcentage de patients bien nourris selon AND-ASPEN s'est améliorré à T4 dans le GI (50% vs 14%, p = 0,02) et non pas dans le GT par rapport aux valeurs d'admission. A T4, le GI avait un apport de protéines et de calories plus élevé que le GT(p<0.05).Conclusion:Le conseil nutritionnel après la greffe de CSH a amélioré l’apport en protéines et calories ainsi que le score AND-ASPEN mais non pas le score PGSGA. / Background: Conditioning preceding Hematopoietic Stem Cell Transplantation (HSCT) has been associated with elevated rates of malnutrition until 100 days post HSCT.Objective: This study aimed to assess the impact of nutritional counseling provided at hospital discharge on nutritional status 100 days post HSCT (defined as T4). Design: This was a single center randomized controlled trial among adult HSCT patients. Around discharge from the hospital, recruited patients were randomized to a Control Group (CG) receiving usual care and to an Intervention Group (IG) receiving nutritional counseling on a monthly basis post discharge.The primary outcome was the Patient Generated Subjective Global Assessment (PGSGA) scores at T4. Malnutrition was also assessed though the American Society for Parenteral and Enteral Nutrition/ Academy of Nutrition and Dietetics malnutrition score.Results: 52 participants were randomized (August 2016 until August 2017) and 46 were analyzed [65% males, 63% autologous HSCT, IG (n=22), CG (n=24)]. Groups were comparable at randomization. At T4, the percent of well-nourished patients was not significantly different between groups when assessed via PGSGA (72% IG vs. 43% CG, p=0.063).The percent of wellnourished patients as per AND-ASPEN criteria improved in IG at T4 (14% vs. 50%, p=0.02) and remained the same in CG (48% vs. 50%, p=1) compared to admission values. IG had higher protein and caloric intake (p<0.05). Conclusion:Nutritional counseling post HSCT improved patients’ protein and caloric intake and AND-ASPEN score but did not significantly improve PGSGA score.

Human ageing is accompanied by characteristic metabolic and endocrine changes, including altered hormone profiles, insulin resistance and deterioration of skeletal muscle. Obesity and diabetes may themselves drive an accelerated ageing phenotype. Untangling the causal web between ageing, obesity and diabetes is a priority in order to understand their aetiology and improve prevention and management. The role of biological ageing in determining the risk of obesity and associated conditions has often been examined using mean leukocyte telomere length (LTL), a marker of replicative fatigue and senescence. However, considering phenotypes which represent different domains of biological and functional ageing as exposures for obesity and related traits could allow the elucidation of new understudied phenotypes relevant to cardio-metabolic risk in the wider population. This PhD considers the causal role of (1) hand grip strength (HGS), a marker of overall strength and physical functioning, and (2) resting energy expenditure, an indicator of overall energy metabolism and the major component of daily energy expenditure, in cardio-metabolic risk. I also characterise a new and readily-quantifiable marker of age-related genomic instability, mosaic loss of the Y chromosome (mLOY). Observational evidence implicates each of these phenotypes in cardio-metabolic conditions and intermediate phenotypes. However, it is not possible to infer causality from these observational associations due to confounding and reverse-causality. Mendelian randomisation offers a solution to these limitations and can allow the causal nature of these relationships to be investigated. Using population-based data including UK Biobank, this thesis presents the first large-scale genetic discovery effort for each trait and provides new biological insight into their shared and separate aetiology. I used identified variants to investigate the bidirectional causal associations of each trait with cardio-metabolic outcomes, intermediate phenotypes and other related traits such as frailty and mortality. In total I identified 16 loci for hand grip strength, 19 for mLOY, and one signal for REE. I have shown that HGS is likely to be causally linked to fracture risk, and I have identified the important shared genetic architecture between mLOY, glycaemic traits and cancer. I have also demonstrated that at least one known genetic variant contributing to obesity risk acts partially via reduced REE. Overall the findings of my PhD contribute to our wider understanding of the aetiological role of ageing processes in metabolic dysfunction, and have implications for both basic science and translational applications.

The study investigated the impact of computer simulations on the teaching and learning of electromagnetism in grade 11. Electromagnetism is a section of the Physical Science curriculum. Two grade 11 classes in the Mgwenya circuit in Mpumalanga province of South Africa were used as a case study. Using a pre-test, post-test non-equivalent control group design, it was found that learners in the experimental group (n = 30) who were taught using the simulations achieved significantly higher scores on the post-test than learners in the control group (n = 35) who were taught using traditional teacher-centred teaching method; (t statistic = 3.582, df = 56, p<0.05). Learners were more active during the lessons, predicting, observing, discussing and explaining concepts. The use of simulations also provided support (scaffolding) that the learners need to enhance learning. The Hake’s normalized gain for the experimental group <g> = 0.32 compared to <g> = 0.18 for the control group confirmed conceptual improvement. Both teachers and learners indicated that they accept the use of computer simulations in teaching and learning of electromagnetism. / Science and Technology Education / M. Sc. (Mathematics, Science and Technology Education)

Patients in the intensive care unit (ICU) setting are prone to develop muscle weakness and the causes are multi-factorial. Muscle strength in adult, critically ill patients on mechanical ventilation decreases with immobility. The influence of muscle strength on different muscle groups and its influence on progressive mobility in the adult, critically ill patient on mechanical ventilation has not been examined. Identifying muscle strength in this patient population can benefit overall muscle health and minimize muscle deconditioning through a progressive mobility plan. The objective of this dissertation was to describe muscle strength in different muscle groups and to describe the influence of muscle strength on mobility in critically ill adult patients on mechanical ventilation (MV). Fifty ICU patients were enrolled in this descriptive, cross sectional study. Abdominal core, bilateral hand grip and extremity strength was measured using three measurement tools. Mobility was measured using the following scale: 0=lying in bed; 1=sitting on edge of bed; 2=sitting on edge of bed to standing; 3=walking to bedside chair and 4=walking >7 feet from the standing position. Predictors of mobility were examined using stepwise regression. Abdominal core, bilateral hand grip and extremity strength demonstrated statistically significant relationships with all variables. Extremity strength accounted for 82% of the variance in mobility and was the sole predictor (β=0.903; F=212.9; p=0.000). Future research addressing the outcomes of implementing a mobility protocol in this patient population and prioritizing when such a protocol should be implemented would be beneficial to ongoing plans to decrease MV, ICU and hospital days. Muscle strength tests implemented at the bedside are crucial to implementing a progressive mobility plan for critically ill adults while they are on MV therapy.

The factor of precision has always been the mastermind of the shooting sport. With new shooters coming into the field every day and with more aspiring shooters bringing laurels, a help of technology for training can make a difference. When advanced systems like the SCATT, Electronic Target Systems, etc. are marked for the people of the higher background, an easy handle autonomous system for self-monitoring training of precision improvement has always been a question of far reach. This project is about developing an external removable device, which will monitor and evaluate the shooter efficiency of gripping weapon, measure by pressure given at the contact points of the weapon. In the contact points, such as the trigger, the hand grip, cheek rest, butt plate and the hand rest; we use force sensitive resistors, which are connected to an automatic monitoring system built over an Arduino platform. The system analyses the shots based on the variation in the pressure at each point of contact for every shot. By further analysis and consolidation, the average pressure over a range of shots, an optimal pressure point can be fixed individually for the respective shooter. This pressure points are used as references, by rating them in comparison with the corresponding shot acquired in the target. The system includes a pre-designed training program, which autonomously monitors and trains the shooter to achieve the optimum grip in every shot, thereby increasing the accuracy and precision in a sequence of shots. With time, it helps the body to develop a muscle memory based on controlled training and learn the rhythm of applying optimum pressure to achieve better results. / <p>Noted the puBlication content is patented.</p>

The study investigated the impact of computer simulations on the teaching and learning of electromagnetism in grade 11. Electromagnetism is a section of the Physical Science curriculum. Two grade 11 classes in the Mgwenya circuit in Mpumalanga province of South Africa were used as a case study. Using a pre-test, post-test non-equivalent control group design, it was found that learners in the experimental group (n = 30) who were taught using the simulations achieved significantly higher scores on the post-test than learners in the control group (n = 35) who were taught using traditional teacher-centred teaching method; (t statistic = 3.582, df = 56, p<0.05). Learners were more active during the lessons, predicting, observing, discussing and explaining concepts. The use of simulations also provided support (scaffolding) that the learners need to enhance learning. The Hake’s normalized gain for the experimental group <g> = 0.32 compared to <g> = 0.18 for the control group confirmed conceptual improvement. Both teachers and learners indicated that they accept the use of computer simulations in teaching and learning of electromagnetism. / Science and Technology Education / M. Sc. (Mathematics, Science and Technology Education)

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Syfte och frågeställningar Syftet med den här studien har varit att undersöka och jämföra kvinnor och män i åldersgrupperna 30-39 år respektive 40-49 år avseende antropometriska mått samt prestation på GIH:s hälsotester. En vidare målsättning var att undersöka om det förekom några skillnader mellan två separata testtillfällen. Frågeställningarna har varit om resultaten på hälsotesterna skiljer sig mellan könen, åldersgrupperna samt mellan två separata testtillfällen. Metod Totalt fullföljde 41 deltagare GIH:s hälsotester, av dem var 20 kvinnor och 21 män mellan 30-49 år. Det enda som krävdes för att delta var att man uppfattade sig själv som frisk. Personer som tidigare haft stroke, hjärtinfarkt eller opererats på grund av hjärtproblem har inte inkluderats, ej heller gravida och personer med ledbesvär. Testerna utfördes på LTIV (Laboratoriet för tillämpad idrottsvetenskap) mellan februari och mars 2016. Resultat Signifikanta skillnader mellan de två separata testtillfällena noterades för några av styrketesterna framför allt hos männen: axelpressar, handgrip och stolresningar. Mellan könen sågs signifikanta skillnader i de antropometriska måtten, samt i flera konditions- och styrketester. Bland dessa kunde signifikant högre värden ses för kvinnorna än för männen i ryggstyrketestet.  Signifikanta skillnader mellan åldersgrupperna 30-39 år och 40-49 år sågs näst intill endast för kvinnor. De yngre jämfört med de äldre kvinnorna presterade bättre i flera av testerna, de vägde mindre och hade mindre kroppsmått. Slutsats Det framkom vanligtvis inte några signifikanta skillnader mellan det första och andra testtillfället, med enstaka undantag. När så är fallet behövs bara ett test utföras initialt inför en period med exempelvis fysisk aktivitet som senare kanske ska följas upp med ett återtest. Skillnader mellan könen och olika åldersgrupper framkom i vissa tester men inte i alla. Resultaten i denna studie beror bland annat på urvalet av individer. Eftersom att syftet med den här studien har varit att endast utföra de tester som ingår i GIH:s hälsotester har inga tester lagts till eller exkluderats. I arbetet diskuteras bland annat hur optimala testerna är som ett mått på hälsa. För att effektivisera hälsotestundersökningar framöver behöver nödvändigtvis inte alla tester utföras.