This was a holistic study. Four themes were investigated to demonstrate the effectiveness of orthotic intervention for plantar ulceration affecting leprosy impaired subjects in India. 1. Efficacy Efficacy was demonstrated, primarily, through analysis of data pertaining to a controlled trial. Thirty-seven subjects, presenting with leprosy impairments including anaesthesia and plantar ulceration, were fitted with orthoses and allocated to an experimental group. Thirty-four similar subjects, were not offered orthoses and were allocated to a control group. After 8 months 52% of the ulcers presented by Experimental group and 12% of the ulcers presented by the Control group had healed. The rationale supporting the prescription of orthoses was investigated using the EMED system. It was demonstrated that intervention with orthoses resulted in significantly lower sub pedal peak pressures than intervention with leprosy sandals. 2. Implementation and Sustain ability Ulcer assessment data from March 1994 to January 1995 were used to compare the effects of orthoses supplied by the investigator with orthoses supplied by an Indian technician. The service, evaluated on the strength of these findings, was considered to have been successfully implemented. The analysis of data, collected from January 1995 to December 1995, was used to explain why the service was not sustained at an acceptable level. 3. Acceptability Interview data were analysed to describe the attitudes of the subjects to the intervention (n = 46). Indications from the analysis were that neither ulcer status (healed or unresolved) nor group allocation (Experimental or Control) affected attitudes towards the intervention. A general indication was that the intervention was favourably endorsed. 4. Appropriateness Using the Delphi technique (n = 10), a consensus on indicators of "appropriate" impairment control measures was sought. Differences of opinion were not resolved, but group priorities were ranked and a polled response was recorded. The results of the study were similar to the criteria suggested by the Delphi contributors.

Digitized by Kansas Correctional Industries

Digitized by Kansas Correctional Industries

No description available.

by Chong Wai Sing, Wilson. / Thesis submitted in: August 2002. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 116-126). / Abstracts in English and Chinese. / ACKNOWLEDGEMENT --- p.i / ABBREVIATION --- p.ii / ABSTRACT (Chinese & English) --- p.iii / TABLE OF CONTENT --- p.vii / INDEX FOR FIGURES --- p.x / INDEX FOR TABLES --- p.xiii / Chapter 1. --- Introduction --- p.1 / Chapter 1.1 --- "Bone-tendon junction - types, structures and functions" --- p.2 / Chapter 1.1.1 --- Indirect insertion --- p.3 / Chapter 1.1.2 --- Direct insertion --- p.3 / Chapter 1.1.3 --- Functional adaptations of insertions --- p.4 / Chapter 1.2 --- Incidence and type of injuries near insertion site --- p.5 / Chapter 1.3 --- Treatment protocol for injuries near insertion site --- p.5 / Chapter 1.3.1 --- Non-operative versus operative approach --- p.5 / Chapter 1.3.2 --- Previous studies on validations of outcomes of difference repair methods --- p.6 / Chapter 1.4 --- Modes of healing underlying different repair approach --- p.7 / Chapter 1.4.1 --- Fracture healing --- p.7 / Chapter 1.4.2 --- Tendon healing --- p.8 / Chapter 1.4.3 --- Bone-tendon healing --- p.9 / Chapter 1.5 --- Objectives --- p.9 / Chapter 2. --- Materials and Methods --- p.12 / Chapter 2.1 --- Animal model --- p.13 / Chapter 2.2 --- Experimental design --- p.13 / Chapter 2.3 --- Surgery --- p.13 / Chapter 2.3.1 --- Bone-to-bone repair --- p.14 / Chapter 2.3.2 --- Bone-to-tendon repair --- p.14 / Chapter 2.3.3 --- Tendon-to-tendon repair --- p.15 / Chapter 2.4 --- Post-operative follow-up --- p.15 / Chapter 2.4.1 --- Radiographic examination --- p.15 / Chapter 2.4.2 --- Polychrome sequential labeling --- p.16 / Chapter 2.4.2.1 --- Reagents --- p.16 / Chapter 2.4.2.2 --- Route of administration --- p.16 / Chapter 2.5 --- Sampling --- p.17 / Chapter 2.6 --- Histology --- p.17 / Chapter 2.6.1 --- Decalcification --- p.17 / Chapter 2.6.1.1 --- Tissue decalcification --- p.17 / Chapter 2.6.1.2 --- Tissue processing --- p.17 / Chapter 2.6.1.3 --- Immunohistochemistry of collagen type II and III --- p.18 / Chapter 2.6.1.3.1 --- Reagents and solution preparation --- p.18 / Chapter 2.6.1.3.2 --- Experimental procedures --- p.20 / Chapter 2.6.2 --- Undecalcification --- p.22 / Chapter 2.6.2.1 --- Specimen preparations --- p.22 / Chapter 2.6.2.2 --- Toluidine blue staining --- p.22 / Chapter 2.7 --- Mechanical test --- p.23 / Chapter 2.7.1 --- Sample preparation --- p.23 / Chapter 2.7.2 --- Embedding procedures --- p.23 / Chapter 2.7.3 --- Measurement of cross-sectional area of healing interface --- p.23 / Chapter 2.7.3.1 --- CSA for BB --- p.23 / Chapter 2.7.3.2 --- CSA for BT and TT --- p.24 / Chapter 2.7.4 --- Tensile test --- p.24 / Chapter 2.7.4.1 --- Testing procedures --- p.24 / Chapter 2.7.4.2 --- Interpretation of testing results --- p.25 / Chapter 2.7.5 --- Statistical analysis --- p.26 / Chapter 3. --- Results --- p.42 / Chapter 3.1 --- Surgical outcome --- p.43 / Chapter 3.1.1 --- Radiographic examination --- p.43 / Chapter 3.1.1.1 --- Bone-to-bone healing --- p.43 / Chapter 3.1.1.2 --- Bone-to-tendon healing --- p.44 / Chapter 3.1.2 --- Fluorochrome injection --- p.44 / Chapter 3.2 --- Histology --- p.45 / Chapter 3.2.1 --- Bone-to-bone healing --- p.45 / Chapter 3.2.1.1 --- Gross anatomy --- p.45 / Chapter 3.2.1.2 --- Microscopic examination --- p.45 / Chapter 3.2.1.3 --- Polarised light microscopy --- p.46 / Chapter 3.2.1.4 --- Fluorochrome microscopy --- p.46 / Chapter 3.2.2 --- Bone-to-tendon healing --- p.47 / Chapter 3.2.2.1 --- Gross anatomy --- p.47 / Chapter 3.2.2.2 --- Microscopic examination --- p.47 / Chapter 3.2.2.3 --- Polarised light microscopy --- p.48 / Chapter 3.2.2.4 --- Fluorochrome microscopy --- p.49 / Chapter 3.2.3 --- Tendon-to-tendon healing --- p.49 / Chapter 3.2.3.1 --- Gross anatomy --- p.49 / Chapter 3.2.3.2 --- Microscopic examination --- p.49 / Chapter 3.2.3.3 --- Polarised light microscopy --- p.50 / Chapter 3.3 --- Mechanical testing --- p.50 / Chapter 3.3.1 --- Bone-to-bone healing --- p.50 / Chapter 3.3.1.1 --- Change of cross sectional area --- p.50 / Chapter 3.3.1.2 --- Load at failure --- p.50 / Chapter 3.3.1.3 --- Strength --- p.51 / Chapter 3.3.1.4 --- Energy --- p.51 / Chapter 3.3.2 --- Bone-to-tendon healing --- p.51 / Chapter 3.3.2.1 --- Change of cross sectional area --- p.51 / Chapter 3.3.2.2 --- Load at failure --- p.52 / Chapter 3.3.2.3 --- Strength --- p.52 / Chapter 3.3.2.4 --- Energy --- p.52 / Chapter 3.3.3 --- Tendon-to-tendon healing --- p.52 / Chapter 3.3.3.1 --- Change of cross sectional area --- p.53 / Chapter 3.3.3.2 --- Load at failure --- p.53 / Chapter 3.3.3.3 --- Strength --- p.53 / Chapter 3.3.3.4 --- Energy --- p.53 / Chapter 3.3.4 --- "Comparison of healing quality among BB, BT, and TT repair" --- p.54 / Chapter 3.3.4.1 --- Change of cross sectional area --- p.54 / Chapter 3.3.4.2 --- Load at failure --- p.54 / Chapter 3.3.4.3 --- Strength --- p.54 / Chapter 3.3.4.4 --- Failure mode --- p.55 / Chapter 4. --- Discussion --- p.102 / Chapter 4.1 --- Use of goat calcaneus-Achilles junction as a bone-tendon reseach model --- p.103 / Chapter 4.2 --- "Bone-to-bone, bone-to-tendon, and tendon-to-tendon fixation" --- p.104 / Chapter 4.3 --- Histological characterization of different healing tissues --- p.105 / Chapter 4.3.1 --- Bone-to-bone healing (Fracture healing) --- p.105 / Chapter 4.3.2 --- Bone-to-tendon healing --- p.106 / Chapter 4.3.3 --- Tendon-to-tendon healing --- p.106 / Chapter 4.3.4 --- Regeneration versus repair --- p.107 / Chapter 4.4 --- Spatial and temporal expression of different type of collagen in different form of healing --- p.108 / Chapter 4.5 --- Mechanical properties of healing interface under different form of fixation --- p.108 / Chapter 4.5.1 --- Failure mode --- p.110 / Chapter 4.6 --- Limitations --- p.111 / Chapter 4.6.1 --- Goat animal model --- p.111 / Chapter 4.6.2 --- Immunohistochemistry --- p.111 / Chapter 4.7 --- Future study --- p.112 / Chapter 5. --- Conclusion --- p.113 / Chapter 6. --- References --- p.116

Resumo: Cerca de um terço dos traumas de tórax necessitam de hospitalização, e a grande maioria destes pacientes é tratada com toracostomia tubular fechada. A principal morbidade associada a este procedimento é o empiema pleural. Devido aos possíveis índices de morbidade e mortalidade relacionados ao empiema pós- traumático e as implicações do uso irracional de antibióticos, acreditamos ser relevante a realização desta revisão sistemática. Objetivos: Avaliar a efetividade da administração de antibiótico na redução de empiema em pacientes com toracostomia tubular devido a trauma. Métodos: Revisão sistemática de ensaios clínicos aleatorizados, utilizando a metodologia Cochrane, através de busca eletrônica e manual. Foram incluídos pacientes com trauma de tórax isolado, submetidos a toracostomia tubular fechada, sem distinção de idade e sexo, incluídos nos estudos elegíveis, cuja intervenção foi a administração de antibióticos como tratamento preventivo comparado com placebo. Resultados: Foram selecionados 6 estudos totalizando 753 pacientes com trauma torácico isolado submetidos a toracostomia tubular fechada. A metanálise demonstrou efeito de tratamento superior dos antibióticos em relação ao placebo, tanto para o desfecho empiema, RR=0,18 (IC 95% 0,07 a 0,46) como para o desfecho pneumonia, RR= 0,43 (IC 95% 0,23 a 0,82). Conclusão: Antibióticos são efetivos para reduzir a frequência de empiema e pneumonia em pacientes com trauma de tórax isolado submetidos a toracostomia tubular fechada. / Abstract: About a third of the thorax traumas need hospitalization, and the great majority of these patients is treated with closed tube thoracostomy. The main morbidity associated to this procedure is the pleural empyema. Due to the possible morbidity and mortality rates related to the empyema posttraumatic and the implications of the irrational use of antibiotics, we believed to be relevant the accomplishment of this systematic review. Objectives: to evaluate the effectiveness of the antibiotic administration in the empyema reduction in patients with tube thoracostomy trauma. Methods: Systematic review of randomized clinical trials, using the Cochrane methodology, through electronic and manual search. It was included patients with isolated thorax trauma, submitted to closed tube thoracostomy, without distinction of age and sex, included in the eligible studies, whose intervention was the administration of antibiotics as preventive treatment compared to placebo. Results: 753 patients with isolated thoracic trauma submitted to closed tube thoracostomy in 6 studies. The meta-analysis demonstrated superior effect of antibiotics treatment in relation to the placebo, as much for the outcome empyema, RR=0,18 (IC 95% 0,07 to 0,46) as for the outcome pneumonia, RR = 0,43 (IC 95% 0,23 to 0,82). Conclusion: Antibiotics are effective to reduce the pneumonia and empyema incidence in patients with trauma of isolated thorax submitted to closed tube thoracostomy. / Orientador: Antônio José Maria Catâneo / Coorientador: Paulo Eduardo de Oliveira Carvalho / Banca: Tânia Ruiz / Banca: Olavo Ribeiro Rodriguês / Mestre

Orientador: Lígia Maria Suppo de Souza Rugolo / Coorientador: Paulo Roberto Margotto / Banca: Élson Roberto Ribeiro Faria / Banca: Maria Cristina Ferreira Sena / Resumo: Avaliar a sobrevida de recém-nascidos (RN) prematuros de acordo com a idade gestacional e peso ao nascer, e identificar as complicações da prematuridade associadas à maior mortalidade. Estudo prospectivo do tipo coorte. Foram incluídos RN entre 25 e 31 semanas e 6 dias nascidos vivos sem anomalias congênitas, e admitidos na UTI neonatal do Hospital Regional da Asa Sul, Brasília, entre 1º de agosto de 2009 e 31 de outubro de 2010. Os óbitos em sala de parto, não foram incluídos. Os RN foram estratificados em três faixas de idade gestacional: 25 a 27 semanas e 6 dias; 28 a 29 semanas e 6 dias; 30 a 31 semanas e 6 dias e acompanhados até 28 dias de vida. Variáveis independentes: dados gestacionais, de nascimento e evolução neonatal. Desfechos: sobrevida aos 28 dias e alterações no ultrassom de crânio. Para análise dos resultados utilizou-se o teste do Qui-quadrado, análise de variância, teste de Kruskal-Wallis, razão de risco com intervalo de confiança e regressão logística múltipla, com significância em 5%. A coorte compreendeu 198 prematuros < 32 semanas, estratificados em três grupos: G1=59 (25 a 27semanas e 6 dias), G2=43 (28 a 29 semanas e 6 dias) e G3=96 (30-31 semanas e 6 dias). Corioamnionite e reanimação ao nascimento foram mais frequentes em G1 e G2. Parto vaginal e RN PIG foram mais frequentes em G1. A morbidade neonatal foi inversamente proporcional à idade gestacional, exceto a enterocolite necrosante e a leucomalácia periventricular, que não diferiram entre os grupos. O risco de óbito foi significativamente maior em G1 e G2 em relação ao G3 (RR:4,14; IC:2,23-7.68 e RR=2,84; IC:1,41-5.74), respectivamente. A sobrevida em G1 foi de 52,5%, em G2 foi 67,4% e em G3 88,5%. A partir de 27 semanas e do peso de 700g a sobrevida foi maior que 50%. A regressão logística mostrou... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To assess the survival rates of premature infants according to gestational age and birth weight, and to identify complications of prematurity associated with higher mortality. Prospective cohort study. Preterm infants with gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies, and admitted in the NICU of Hospital Regional da Asa Sul, Brasília, between August 1st 2009 and October 31, 2010 were included. Neonates who died in the delivery room were excluded. Neonate were stratified into three gestational age groups: 25- 27 weeks and 6 days; 28- 29 weeks and 6 days; 30-31 weeks and 6 days, and followed until 28 days of life. Gestational data, delivery data and neonatal course were analyzed. Outcome: survival at 28 days and cranial ultrasound abnormalities. Data analysis was performed using the chi-square test, analysis of variance and the Kruskal-Wallis test, hazard ratio with confidence interval and multiple logistic regression. The level of significance was 5%. The cohort comprised 198 preterm infants less than 32 weeks, stratified into three groups: G1=59 (25-27weeks and 6 days), G2=43 (28- 29 weeks and 6 days) and G3=96 (30-31 weeks and 6 days). Chorioamnionitis and resuscitation in the delivery room were more frequent in G1 and G2. Vaginal delivery and newborns small for gestational age occurred significantly more in G1. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia that did not differ between the groups. The risk of death was significantly higher in groups 1 and 2 compared to 3 (RR: 4.14, CI: 2,23-7 .68 and RR = 2.84, CI:1,41 5-.74), respectively. The logistic regression analysis showed that pulmonary hemorrhage (OR: 3.33, 95% CI 1.41 to 7.90) and hyaline membrane disease... (Complete abstract click electronic access below) / Mestre

Thesis (MSc (Physiotherapy))--University of Limpopo (Medunsa Campus), 2009 / Aim: The aim of the study was to review the current management of soccer injuries sustained by professional players and how injury recurrence is prevented among Premier Soccer League (PSL) players in RSA. Study design: Cross sectional study, descriptive survey was followed, as it allowed the researcher to observe and describe the factors that had contributed towards recurrent injuries, as well as a qualitative approach with open ended questions where participant’s expressions encountered during the study, were analyzed. Population: The population of the study included all the medical team members in the PSL teams. PSL has 16 teams. The medical team comprised of any combination of the following members: the team doctor, physiotherapist, masseur, biokineticists, physical trainer, chiropractors and podiatrist. Not all teams have the same combination nor all disciplines mentioned. Sample: Purposive sampling method was used, as the researcher selected main participants with a specific purpose. Each of the PSL teams has 7 members from different disciplines therefore, all available members of the medical team of each PSL teams participated in the study. Data Analysis: Data was analyzed using SPPSS version 13.0.Data collected was loaded onto the statistica program for processing. Frequency tables for all variables are given to demonstrate the distribution of variables. Cross tabulation was also done to establish the relationship between the predictor variables and the response. The Test Statistic CHI-Squared (χ 2 ) was calculated and pvalue of less than 0.05 was determined for the significance. Frequency distribution tables, graphs, and charts were used to analyze the data collected. Content analysis was used for qualitative data. Results: Main findings of the study reflected that the ankle was the most commonly affected body part (69.2%) while the quadriceps and tendon achillies were both less commonly affected v (15.4%). The groin was found to incur most recurring injuries (69.2%). The results revealed that injured players are adequately managed by the medical team (61.5%). Attainment of pain free and full range of movement is the consideration for return to sport however less consideration was given to the persistent biomechanical abnormality. Conclusion: The study confirms that soccer injuries amongst Premier Soccer League (PSL) teams are managed by qualified professionals. The attainment of a free, full range of movement and adequate strength are used as criteria for return to sport and as a measure of preventing injury recurrence. Factors such as players missing out on rich rewards, recognition and regaining position in the team seem to have a great influence as well. Recommendation: The primary recommendation for the player who has had multiple recurrences is to address any underlying reversible risk factors such as poor strength and poor flexibility. A session needs to be held with soccer administrators to advocate the avoidance of factors contributing to recurrent injuries.

1. Introduction Injury is the fifth leading cause of mortality and morbidity among adults in Iowa. Work-related, or occupational injuries, constitute a substantial proportion of the injury burden in the US. The Bureau of Labor Statistics reports about 4.9 million occupational injuries annually in the US and over 50,000 injuries in Iowa. The aims of this study were to assess: 1) the burden of work-related injuries using an algorithm based on analysis of the external cause of injury (i.e., E-codes) combined with injury registry variables; 2) the magnitude of disability following an occupational injury by assessing Disability Adjusted Life Years and Discharge to Long Term Care; and 3) the burden of short-term disability one year after discharge from a Level I trauma center. 2. Methods/Approach This research consisted of two observational studies of Iowa cases, ages 18-64, reported to the Iowa State Trauma Registry (STR) from January 1st 2007 to December 31st 2010. A retrospective cohort design was used to assess differences in mortality, length of stays, discharge disposition, disability risk and Disability-Adjusted Life Years (DALYs), and their associated risk factors, such as demographic characteristics, nature and severity of injury, pre-hospital and in hospital trauma care (i.e. transport, resuscitation, vascular and airway access, sedative and paralytic drug usage). A prospective follow-up study a cohort of cases discharged from the University of Iowa Resource Trauma Center was used to assess risk factors associated with short-term disabilities one year after discharge. The EuroQol-5 Dimension Questionnaire (EQ-5D) was mailed to the cohort cases, alive one year after discharge, to assess their overall health status and quality of life. The algorithm classified the study population into occupational, “Work-Likely” (WL), and non-work cases. Work-likely was defined based on work-related activities without pay, informal status or self-employed. The registry cases were matched to 2007-2011 death certificates to identify those who died after discharge and to estimate their survival time. Machine learning methods – logistic regression and 10-fold cross validation were used to validate the algorithm. The survival time from injury to death was assessed using Kaplan Meier and Cox regression modeling. The Generalized Linear Modeling, including multinomial regression, was used to analyze the mean length of stay, the risk of discharge to long term care, DALYs and disability risk. 3. Results From 2007 to 2010, there were individuals (ages 18-64) admitted (average 5,614 per year) as trauma cases to hospitals in Iowa. Based on the algorithm, 3,115 (14.0%) were classified as occupational, 847 (3.8%) as WL, and 18,454 (82.2%) were classified as non-work cases. There were notable differences in demographics, farm exposure, and rural residence. The 10-fold cross validation showed a 20% misclassification rate for occupational and 30% for WL. The area under the curve (AUC) of the receiver-operating characteristics (ROC) was measured at 0.66, which is indicative of poor discriminating effect. Overall, occupational and WL cases had better outcomes than non-work cases; they had lower mean lengths of stay and better survival rates, as detected by Kaplan-Meier and Cox regression models. WL had lower survival rates on the Kaplan Meier estimates but the Cox regression contrast statement didn't find any difference in survival between occupational and WL 30 days and one year after discharge. Multinomial regression showed major differences in the risk of discharge to long-term care (LTC) or acute care compared to discharge home between occupational, WL, and non-work cases WL cases had less risk of being discharged to LTC compared to non-work cases. There were no differences observed between occupational and non-work cases. When stratified by occupational status, the predictors of being discharged to Long term care or acute care were different for occupational, WL and non-work cases. For WL, care in Level I&II , injury type, triage mechanism, first ER systolic blood pressure were no longer good predictors of discharge to LTC compared to occupational or non-work cases. Mean DALYs were lower in the occupational (mean= 4.8; 95% CI: 4.7-4.8) and WL (mean 4.4; 95% CI: 4.4-4.7) cases than the non-work cases (mean= 5.2; 95% CI: 5.1-5.2). However, when all other risk factors were accounted for, the occupational cases had a 10% reduction in mean DALYs, and WL a 20% reduction in DALYs compared to non-work cases. When the disability was assessed separately by occupational status, the risk factors associated with disability were completely different. For WL cases, only injury location and ISS were significantly associated with DALYs. Conversely for occupational and non-work cases, injury type, coma, pre-hospital management (i.e. airway, paralytic drugs), and cause of injury were significantly associated with DALYs. The one-year follow-up questionnaire administered to 156 trauma survivors resulted in 72 (46%) valid responses. Of those who responded, 58 (81%) were occupational and 14 (19%) WL cases. Overall, from the EQ-5Dresults, 46% of the respondents reported a disability. There were no major differences in the prevalence of disability between occupational and WL injury cases. However, occupational injury cases were more likely to receive rehabilitation services. 4. Conclusions This study demonstrated the utility of using trauma registry data in epidemiologic research to study occupational injury using a unique algorithm to include informal or self-employed workers. It identified a neglected group of workers subject to occupational injury and subsequent disability.

Bibliography: leaves 168-184. The work in this study encompasses oxygen free radical related inflammation in the peripheral lung and in lung cells. Animal and human studies have been used. Methods include cell culture with function studies, protein chemistry, animal and human physiology, and cell and lung structure through histopathology, and various forms of electron microscopy. The work resulting from this thesis has formed an important basis for understanding acute and chronic lung injury.