Many long-term wheelchair users find themselves unable to accomplish their former daily routines due to fatigue and weakness caused by cardiopulmonary decompensation (CPD). This study showed that long-term survivors of quadriplegia can improve stamina and strength, and therefore participation in daily life occupations, through participation in a regular exercise program using equipment specifically designed for them. Increased aerobic capacity, achieved through regular exercise, has proven with many populations to increase stamina and strength, thereby increasing participation in daily occupations. Whether decompensated survivors of quadriplegia could achieve this was unknown. Until recently there was no way to increase their aerobic capacity due to limited bodily function and lack of accessible fitness equipment. In this study, UPPERTONE, a recently designed fitness system for quadriplegics, was used by six veterans who had survived C-5–C-7 quadriplegia for between 18 and 48 years. They exercised for approximately 45 minutes three times a week for 36 sessions. Baseline level of exercise intensity (weight hefted and number of repetitions as tolerated) and heart rate were recorded and changes were recorded throughout the program. Subjects were interviewed regarding past and present daily life activities. They kept a daily log of activities throughout the study. Using the Canadian Occupational Performance Measure (COPM), subjects were pre-tested, rating their importance of self-identified problems with daily occupations caused by CPD and their performance in and satisfaction with those problem activities. Post-testing showed changes as a result of study participation. Subjects improved COPM scores an average of 7.4 points (greatest 17 points and least 1.5 points), reflecting satisfaction with their ability to perform identified daily activities with less fatigue. Weight hefted increased from an initial average of 22.35 lb. to 52.5 lb. Exercise heart rate increased from an average of 84.8 to 95.2. Subjects were enthusiastic regarding ability to use UPPERTONE independently and their improved quality of life. Clinicians and long-term wheelchair users with a variety of disabilities should understand CPD, its ramifications and the benefits of exercise to this population. Clients who regain ability to care for themselves will enjoy improved quality of life and have less need for long-term care.

No description available.

Intimate partner violence (IPV) is a serious social problem and a noteworthy health issue internationally. In the United States, approximately 1.3 million women and 835,000 men experience a combination of cruel and violent treatment by an intimate partner. This phenomenological study used lived experiences from both men and women ranging in various ages from 40-70 years to understand their coping and resiliency strategies post-separation from an abusive relationship for 10 or more years. The conceptual framework was guided by Lazarus' transactional theory of coping and psychological stress and the theory of psychological resiliency, which is linked to understanding the ways long-term survivors are able to master, minimize, and tolerate the events of a stressful situation. Data were gathered on 15 participants through semistructured, in-depth interviews using a series of open-ended questions that captured the details of the participants' lived experiences, and provided a textual description to understanding their coping and resiliency strategies after leaving an abusive relationship. Interviews were analyzed using a phenomenological technique by extracting themes. The central themes that emerged based on the 6 interview questions were encounters of physical and emotional abuse, passive and submissive behaviors, supportive services, becoming self-sufficient, and developing their self-efficacy. The findings and recommendations from this study can advance positive social change and interventions for mental health professionals providing services and enhance the IPV survivors' ability to find a continuum of care that could be effective in keeping a positive change while shaping the outcome of future life events.

abstract: Anti-trafficking research recognizes several populations affected by Commercial Sexual Exploitation (CSE) in the United States (U.S.), yet it has not yet recognized long-term survivors, whose experiences of CSE occurred from the 1960s through the 2000s. Rendering long-term survivors invisible erases the history of CSE in the U.S. and prevents an accurate assessment of the true scope of CSE that it extends from infancy through adulthood. The most grievous CSE cultures target both boys and girls beginning at infancy and extending through early childhood. This project provides a foundation for understanding who long-term survivors are, the types of CSE they experienced, and their experiences of survivency in the decades after exiting. This study utilized interviews and surveys to collect data from 35 long-term survivors, regarding their experiences in the years past exiting. In addition, it also included a systematic analysis of 43 survivor-authors who have documented their experiences in 76 published writings. Findings show that long-term survivors display tenacity and resourcefulness in dealing with complex, intersecting issues. Their experiences of creating new, meaning-filled identities, reconnecting with humanity, and building a positive view of the world can help pave the way for a smoother road of restoration for younger survivors. / Dissertation/Thesis / Doctoral Dissertation Justice Studies 2019

Throughout history, human populations have continuously been challenged by new and emerging infectious diseases. For the past 26 years, sub-Saharan Africa and other countries around the world have been dealing with a pandemic caused by a relatively new pathogen called the human immunodeficiency virus (HIV). Although antiretroviral (ARV) therapies effectively reduce morbidity and mortality rates, the long term use in those who have access to treatment inevitably leads to drug-related toxicity and resistance. Even with a strong commitment from governments to expand and finance prevention and treatment programs, transmission rates continue to outpace the benefits of these efforts. Therefore to effectively eradicate the disease, research is focusing on the design of protective and therapeutic vaccines. The first major step in designing these alternative therapies is to define correlates of immune protection. / The research presented in this thesis focuses on characterizing the quantitative and qualitative features of T cell immune responses in individuals who spontaneously control viral replication and exhibit a benign course of disease while remaining off ARV therapy. A comprehensive analysis of HIV-specific IFN-gamma secreting immune responses revealed that neither the breadth nor the magnitude of responses directed against the entire HIV proteome accurately predicts the viral load or rate of CD4 decline. Subsequent analyses showed that the preferential targeting of Gag was associated with reduced rates of CD4 decline and was later confirmed in a cohort of individuals in primary infection whereby the relative breadth and magnitude of Gag p24 was inversely correlated with viral load set point. / The maintenance of polyfunctional immune responses in HIV-infected subjects with a benign course of disease prompted us to develop a method that could comprehensively assess the breadth, magnitude and specificity of three functionally distinct subsets of HIV-specific lymphocytes (single IFN-gamma, single IL-2 and dual IFN-gamma/IL-2 secretors). Survey of immune responses in chronically infected individuals revealed that only the breadth and magnitude of dual IFN-gamma/IL-2 secreting lymphocytes correlated with reduced viral loads and increased CD4 counts suggesting that secretion of IFN-gamma alone was a poor correlate of protection. We also showed that the contribution of polyfunctional lymphocytes to the total response was greater for epitopes restricted by major histocompatibility complex (MHC) class I alleles associated with slow disease progression compared to those restricted by alleles associated with rapid or neutral rates of HIV disease progression. / Taken together, this work supports the view that immune monitoring of infected and vaccinated individuals should include methodologies capable of detecting both IFN-gamma and IL-2 secretion from responding T lymphocytes. The studies presented here have furthered our understanding of what constitutes protection from disease progression emphasizing that both specificity and polyfunctionality are features of effective control of viral replication.

Orientador: Rogério Antonio Oliveira / Resumo: A cirrose é uma doença hepática assintomática que, muitas vezes, é descoberta quando o quadro é irreversível. Por isso, o tratamento consiste em uma série de medidas para controlar o avanço da enfermidade, visto que a principal consequência da cirrose é o aumento da pressão na veia portal, que por sua vez, acarreta no surgimento de varizes e no seu respectivo rompimento, podendo ser fatal. Estudos relacionados à esta doença são muito importantes, pois a análise estatística é uma ferramenta que permite auxiliar na tomada de decisões nos procedimentos médicos e acompanhamento de pacientes. Um método estatístico bastante explorado nas ciências biomédicas é a análise de sobrevivência, que consiste em descrever o tempo de um evento inicial até a ocorrência de um outro de interesse. No entanto, existem situações em que uma proporção da amostra não vivencia o desfecho de interesse, mesmo que acompanhado por um período longo de tempo. Nestes casos, tais observações são dita imunes ao desfecho de interesse e as metodologias tradicionais de análise de sobrevivência não são indicadas. Logo, os modelos de fração de cura ou de longa duração, desenvolvido a partir do modelo de mistura, são os utilizados nestas situações. Neste trabalho diverso modelos foram considerados para analisar os tempos de vida de pacientes submetidos à Ligadura Elástica de Varizes Esofágicas, ao qual foram anotados os tempos até o óbito durante o acompanhamento de 129 pacientes do Hospital das Clínicas da Faculdade... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Cirrhosis is an asymptomatic liver disease that is often discovered when the patient's condition is irreversible. Therefore, the treatment consists of a series of measures to control the progression of the disease, since the main consequence of the cirrhosis is the increase of the portal venous pressure, which causes the appearance of varices and their respective rupture may be fatal. Studies related to that disease are very important, so the statistical analysis is a tool that helps to make decisions in medical procedures and patient follow-up. The most applied statistical method in the biomedical sciences is survival analysis, which consists of describing the time of occurrence until the event of interest. However, there are situations in which a proportion of the sample does not experience the interest outcome, even if they are accompanied by a long period of time. In such cases, such observations are said to be immune to the outcome of interest and traditional survival analysis methodologies are not appropriated. Therefore, the care fraction or long duration models can be used in these situations because they incorporate mixtures of models to solve the complexity inherent in the actual study. In this work, some statistical models were considered to analyze the survival times of patients, after surgery of Endoscopic Band Ligation of the Esophageal Varices, such as Exponential, Gamma and Weibull models. The data is related to survival times of 129 patients, who were treated... (Complete abstract click electronic access below) / Mestre

Submitted by AGDA JESSICA DE FREITAS GALLETTI null (aj.mat@hotmail.com) on 2018-03-23T18:26:29Z No. of bitstreams: 1 Dissertacao Agda.pdf: 8703134 bytes, checksum: 38fab95cf6a37646cb9076182d7acefe (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-26T17:31:07Z (GMT) No. of bitstreams: 1 galletti_ajf_me_bot.pdf: 8692893 bytes, checksum: 24ce44d5b41a0465faf8c7d5f279a7bb (MD5) / Made available in DSpace on 2018-03-26T17:31:07Z (GMT). No. of bitstreams: 1 galletti_ajf_me_bot.pdf: 8692893 bytes, checksum: 24ce44d5b41a0465faf8c7d5f279a7bb (MD5) Previous issue date: 2018-02-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A cirrose é uma doença hepática assintomática que, muitas vezes, é descoberta quando o quadro é irreversível. Por isso, o tratamento consiste em uma série de medidas para controlar o avanço da enfermidade, visto que a principal consequência da cirrose é o aumento da pressão na veia portal, que por sua vez, acarreta no surgimento de varizes e no seu respectivo rompimento, podendo ser fatal. Estudos relacionados à esta doença são muito importantes, pois a análise estatística é uma ferramenta que permite auxiliar na tomada de decisões nos procedimentos médicos e acompanhamento de pacientes. Um método estatístico bastante explorado nas ciências biomédicas é a análise de sobrevivência, que consiste em descrever o tempo de um evento inicial até a ocorrência de um outro de interesse. No entanto, existem situações em que uma proporção da amostra não vivencia o desfecho de interesse, mesmo que acompanhado por um período longo de tempo. Nestes casos, tais observações são dita imunes ao desfecho de interesse e as metodologias tradicionais de análise de sobrevivência não são indicadas. Logo, os modelos de fração de cura ou de longa duração, desenvolvido a partir do modelo de mistura, são os utilizados nestas situações. Neste trabalho diverso modelos foram considerados para analisar os tempos de vida de pacientes submetidos à Ligadura Elástica de Varizes Esofágicas, ao qual foram anotados os tempos até o óbito durante o acompanhamento de 129 pacientes do Hospital das Clínicas da Faculdade de Medicina da UNESP, Campus Botucatu (SP), no período de 2006 a 2010. O modelo Weibull Modificado com fração de cura foi considerado adequado, indicando que quanto maior a idade e o grau da doença hepática, se os pacientes não usam o medicamento Beta-Bloqueador e são homens, menor é a chance deles serem sobreviventes de longa duração. / Cirrhosis is an asymptomatic liver disease that is often discovered when the patient's condition is irreversible. Therefore, the treatment consists of a series of measures to control the progression of the disease, since the main consequence of the cirrhosis is the increase of the portal venous pressure, which causes the appearance of varices and their respective rupture may be fatal. Studies related to that disease are very important, so the statistical analysis is a tool that helps to make decisions in medical procedures and patient follow-up. The most applied statistical method in the biomedical sciences is survival analysis, which consists of describing the time of occurrence until the event of interest. However, there are situations in which a proportion of the sample does not experience the interest outcome, even if they are accompanied by a long period of time. In such cases, such observations are said to be immune to the outcome of interest and traditional survival analysis methodologies are not appropriated. Therefore, the care fraction or long duration models can be used in these situations because they incorporate mixtures of models to solve the complexity inherent in the actual study. In this work, some statistical models were considered to analyze the survival times of patients, after surgery of Endoscopic Band Ligation of the Esophageal Varices, such as Exponential, Gamma and Weibull models. The data is related to survival times of 129 patients, who were treated in the Hospital das Clínicas of the Medical School of UNESP, Campus Botucatu (SP), from 2006 to 2010. The Modi ed Weibull distribution with cure rate was considered adequate to the data, indicating that older male patients with higher Child-Pugh score without taking beta blockers medicine are more likely not to be a long-term survivor.

Avec l'amélioration de la prise en charge du cancer colorectal (CCR), on constate une augmentation croissante du nombre de personnes en longue rémission de ce cancer. Cependant, le CCR et ses traitements peuvent avoir des répercussions physiques et psychologiques à long terme. L'objectif était d'évaluer la QdV et la réinsertion de patients en longue rémission d'un CCR, 5, 10 et 15 ans après le diagnostic, comparées à des témoins de population générale. Etude constituée de cas de CCR tirés au sort à partir des 3 registres des tumeurs et de témoins tirés au sort à partir des listes électorales. Les participants ont complété 5 auto-questionnaires : le SF-36 et le QLQC30, le MFI-20 et le STAI, et un questionnaire de conditions de vie. Au total, 542 cas de CCR et 1181 témoins ont été inclus. Globalement, la QdV des patients était comparable à celle des témoins 15 ans après le diagnostic. Les patients atteints du cancer du rectum ont été plus affectés physiquement et ont ressenti davantage de fatigue. Quant à la réinsertion, les patients ont reporté des changements positifs tels que l'an1élioration de leur relation conjugale. Cependant les patients ont noté plus de difficultés lors de démarches de souscription à un prêt. En terme de QdV, cette étude a démontré qu'elle était globalement satisfaisante chez les patients en longue rémission de leur CCR. Ils ont reporté dans leur vie sociale et familiale plus de changements positifs que les témoins, signe d'une adaptation à la maladie. Mais il persiste encore des difficultés d'ordre professionnel et financier. Il parait nécessaire de maintenir la prise en charge médico-psycho-sociale des personnes en longue rémission d'un CCR / Given enhancing managing of colorectal cancer (CRC), we note an increasing number of long term cancer survivors. However, CRC and its treatment can cause long term physical and psychological effects. The goal was to evaluate quality of life and reintegration in long term CRC survivors, 5, 10, and 15 years after diagnostic, in comparison with population controls. Study consisted of CRC cases, randomly selected from files of three cancer registries and controls randomly selected from electoral rolls. Participants completed five self-administrated questionnaires: SF-36 and QLQC30, MFI-20 and ST Al, and a life conditions questionnaire. Five hundred forty two CRC cases and l, 181 controls were included. Globally, survivors QOL was comparable with that of controls, 15 years after diagnosis. Rectal cancer survivors were more affected in physical field and perceived more fatigue. In reintegration analyses, cancer survivors reported more positive changes than controls, as strengthening in marital relationships. However, survivors met more difficulties in loan and insurance requests. In term of QOL, this study demonstrated it was globally satisfactory in long term CRC survivors. In term of reintegration they reported positive changes and less negative changes in social and marital life, sign of an adaptation to cancer. However, they still met difficulties in professional and financial position. lt seems to be necessary to strength medical and psychosocial follow-up of CRC survivors.

No description available.

Indivíduos infectados pelo vírus da imunodeficiência humana do tipo 1 (HIV-1) que controlam a replicação viral, mesmo na ausência de tratamento com drogas antirretrovirais, representam um exemplo de contenção bemsucedida do vírus. O entendimento das respostas imunes antivirais presentes nestes indivíduos pode auxiliar no delineamento de vacinas, particularmente no caso de estratégias vacinais desenvolvidas para induzir um fenótipo de controle da replicação viral e, assim, diminuir o ritmo da progressão à AIDS e/ou a taxa de transmissão para terceiros. A resposta imune celular contra HIV-1 é geralmente mapeada em ensaios de ELISPOT-IFN-γ empregando-se peptídeos pentadecâmeros sobrepostos por 11 aminoácidos sintetizados a partir de seqüências consensuais do vírus. Contudo, este método pode subestimar a detecção da real amplitude da resposta imune celular contra epitopos contidos na seqüência autóloga do vírus infectivo. Neste trabalho, foram comparadas respostas imunes celulares contra peptídeos 15-meros baseados nas seqüências de vif e nef do consenso do subtipo B do HIV-1 e respostas imunes contra peptídeos HLA-restritos de nove ou 10 aminoácidos baseados tanto nas seqüências de vif e nef do consenso do subtipo B do HIV-1, quanto nas seqüências autólogas dos vírus seqüenciados a partir de seis pacientes controladores da replicação do HIV-1. Nossa análise revelou que três dos seis pacientes investigados mostraram maior amplitude de resposta imune celular contra epitopos em Vif e Nef quando os peptídeos HLA-restritos foram empregados, tenham sido eles preditos a partir da seqüência consensual ou a partir das seqüências do vírus autólogo. O número de respostas positivas aumentou de quatro para 16 em Vif e de oito para 22 em Nef, com o uso dos reagentes HLA-restritos. Estes resultados sugerem que emprego de peptídeos 15-meros pode sub-representar a amplitude real da resposta imune celular envolvidas no controle da replicação do HIV-1 e que o conhecimento acerca das respostas imunes de sucesso em indivíduos controladores pode ser melhorado e ampliado com a revisão dos métodos empregados. / Human immunodeficiency virus type 1 (HIV-1)-infected individuals who spontaneously control viral replication represent an example of successful containment of the AIDS virus. Understanding the anti-viral immune responses in these individuals may help in vaccine design, particularly vaccine strategies designed to induce a controller phenotype and thus, prevent disease progression and decrease risk of transmission. Immune responses against HIV-1 are normally screened using 15-mer peptides overlapped by 11 amino acids from HIV-1 consensus sequences in ELISPOT-IFN-γ assays. However, this method may underestimate the real breadth of the cellular immune responses against the autologous sequence of the infecting virus. We compared cellular immune responses against nef and vif-encoded consensus B 15-mer peptides to responses against HLA class I-predicted minimal optimal epitopes from consensus B and autologous sequences in six patients who have controlled HIV-1 replication. Interestingly, our analysis revealed that three of our patients had broader cellular immune responses against Vif- and Nef-HLA class I-predicted minimal optimal epitopes from either autologous viruses or from the consensus B sequence, when compared to responses against the 15-mer HIV-1 consensus B peptides. The number of positive responses against epitopes in these two HIV-1 proteins increased from four to 16 for Vif and from eight to 22 for Nef. These findings suggest that immune responses assessed using 15-mers peptides may underrepresent the real breadth of the immune control of the infecting virus and the knowledge about the successful responses in controller individuals could be improved after reviewing the employed methods.