Bakgrund: Stickrädsla är ett vanligt problem hos barn och vuxna, vilket innebär ett lidande för dessa patienter. Rädslan och oron gör att vissa patienter även utvecklar en fobi. Sjukvården är ofta förknippad med provtagningar som innebär nålstick. Då vissa patienter är så rädda för nålar medför det att vård inte söks eller uteblir, fast vissa patienter vore i behov av vård. Det kan även gå så långt att kvinnor undviker att skaffa barn. Syfte: Syftet med denna studie är att genom litteraturstudier belysa stickrädsla och undersöka vad sjuksköterskan kan göra för att lindra lidandet hos stickrädda patienter såväl barn som vuxna. Design/ Teoretisk Referensram: Beskrivande litteraturstudie valdes som metod för denna studie, granskning skedde av 13 artiklar vilka presenteras i resultatet. Katie Erikssons teori om lidande användes som teoretisk referensram. Resultatet: I resultatet visas hur lidandet kan lindras av sjuksköterskans förhållningssätt genom: bemötande, stöd, delaktighet, miljö, farmakologiska metoder, icke farmakologiska metoder och reaktioner hos barn och vuxna. I de olika kategorierna framkommer vad som kan lindra rädslan respektive vad som bidrar till en ökad rädsla för dessa patienter. Exponering för nålar kan bidra till både en ökad rädsla. Design på den medicinsk tekniska utrustningen kan bidra till en minskad rädsla. Det gäller att se den unika patienten och vad som lindrar dennes rädsla. Slutsats: Stickrädsla innebär för många patienter ett stort lidande. Sjuksköterskor bör uppmärksamma detta lidande och lindra det genom att vidta omvårdnadsåtgärder. / Background: Needle Fear is a problem in children and adults so painful for these patients. Fear and anxiety cause some patients also to develop a phobia. While some patients are so afraid of needles it implies that care is not appealed or absent, although some patients were in need of treatment, although it may go so far that women avoid having children. Aim: The purpose of this study is, by studying literature, to highlight needle fear and examine what the nurse can do to alleviate the suffering of the needle fear patients both children and adults. Design/ Theoretical Frame of reference: Descriptive design was chosen as the method of this study, examination was done of 13 articles which are presented in the results. Katie Erikssons theory and her view of the suffering were used as a theoretical frame work. Result: The result shows how suffering can be alleviated by the nurses´ attitudes: attitude, support, participation, environment, non- pharmacological approaches, pharmacological methods and reactions in children and adults. In each category is found as can alleviate fear and in contributing to an increased fear of these patients. Exposure to needles can contribute to both an increased fear. Design of the medical technical equipment can help to reduce any fear. You have to see the unique patient and what relieves his fear. Conclusion: Needle Fear means for many patients a great deal of suffering. Nurses should pay attention to alleviate this suffering and by providing care and empathy for the patients.

Ultrasound imaging is a rapid and noninvasive tool ideal for the imaging of soft tissue infections and is associated with a change of clinician management plans in 50% of cases. We developed a realistic skin abscess diagnostic and therapeutic training model using fresh frozen cadavers and common, affordable materials. Details for construction of the model and suggested variations are presented. This cadaver-based abscess model produces high-quality sonographic images with internal echogenicity similar to a true clinical abscess, and is ideal for teaching sonographic diagnostic skills in addition to the technical skills of incision and drainage or needle aspiration.

Die Stanzbiopsie ist ein etabliertes minimalinvasives Verfahren im Rahmen der interventionellen Diagnostik, bei der Proben menschlichen Gewebes für histologische Untersuchungen zur Erkennung bzw. zum Nachweis u. a. karzinogener Gewebe entnommen werden. Zur Gewebeentnahme wird ein zweiteilig aufgebautes Nadelsystem in das Zielgewebe eingeschossen. Bei der Beobachtung dieses Prozesses sind auffällige Nadelablenkungen des Systems erkennbar. Ursächlich dafür sind die an der Nadelspitze unsymmetrisch angreifenden Kräfte in Verbindung mit der geringen Biegesteifigkeit des Nadelsystems. Im Rahmen eines öffentlich geförderten Projektes konnten an realitätsnahen Gewebephantomen experimentelle Untersuchungen zur Quantifizierung der Nadelablenkungen durchgeführt sowie ein mathematischer Ansatz zur Simulation dieses Effekts entwickelt werden. Darauf aufbauend wurde ein neuer Nadelschliff entwickelt, der eine wesentliche Verbesserung des aktuellen Status bringt. / Biopsy is an established method of the minimally invasive medicine to take human tissue samples for examination determining the presence or extent of a disease. Frequently applied method to detect a prostate or breast cancer is the punch biopsy. The components of the used devices include an inner needle with a notch sampling the tissue and an outer cannula to cut the tissue. During the biopsy, the doctor inserts the needle system into the human tissue under supervision by sonography to support the needle steering. After pushing the trigger, the components of the needle system move successively and penetrate the desired area. The device consists of a two-part spring mechanism to generate the needle movement. Observations of the needle movement by a highspeed camera shows a considerable deflection of the needle tip which makes tapping and tissue sampling more difficult. This is caused by unbalanced forces acting on the needle tip and the low bending stiffness of the needle. Publicly financed experimental studies in the quantification of the needle deflection were undertaken and a mathematical approach for the simulation of these effects was developed. The model, which consists of a flexible needle and a parameterized tissue model, is implemented in the multibody simulation software Recurdyn.

Bakgrund: Studier visa att ca 10 % av världens befolkning lider av stickrädsla. Konsekvenser för person som känner stickrädsla är ångest och oro samt undvikande av medicinska procedurer som innefattar injektioner. Detta kan leda till hälsoproblem för individen och i värsta fall leda till att personen undviker all hälso- och sjukvård. Det är viktig att sjuksköterskan har kunskaper om vilka omvårdnadshandlingar som kan lindra lidande för patienten. Syfte: Syftet med denna litteraturstudie var att utifrån ett sjuksköterskeperspektiv belysa omvårdnadsåtgärder som kan förbygga stickrädsla hos barn. Syftet var också att beskriva urvalsgrupperna i de inkluderade artiklarna. Metod: En litteraturstudie där resultatet av 12 artiklar granskats, analyserats och sammanställts. Sökningar utfördes i databaserna PubMed, CINAHL samt PsycINFO. Huvudresultat: I resultatet framkom att miljöns utformning är viktig då barn ska få injektioner och att barn, behövde var väl förbered på vad som skulle hända innan nålinförandet. I resultatet framkom också att även mindre barn har möjlighet att tillgodogöra sig utbildning om nålrelaterade procedurer. Att anpassa tiden efter barnets behov var viktigt och att det är barnets behov som skulle få styra vården. Distraktion under själva nålinförandet visade på minskad rädsla hos barnen men att det bästa var dock om distraktion inte behövdes. Slutsatser: Vårdmiljöns utformning är viktig när barn ska få ett nålinföranden och sjuksköterska kan minska känslan av sjukhus eller vårdcentral genom att anpassa miljön och att tillhanda ha distraherande leksaker. Det är viktigt att barn vet vad som skulle hända vid ett nålinförande och även mindre barn kan tillgodogöra sig utbildning om nålrelaterade procedurer samt förstå vikten av dem. Sjuksköterskan kan genom att anpassa besökstiden efter barnets behov och bekräfta barnets känslor minska oro och rädsla hos stickrädda barn. / Background: Studies show that about 10% of the world population suffer from needle fear. Consequences for the person with this phobia who knows needle fear is anxiety and avoidance of medical procedures involving injections. This can lead to health problems for the individual and in the worst case lead to the person avoiding all healthcare. It is important that the nurse has knowledge of the factors that can lead to needle fear and what the nursing interventions that can alleviate the suffering of the patient. Aim: The purpose of this study was to highlight nurses nursing care measures required to preclude the fear of needles in children. The aim was also to describe the selection groups in the included articles. Method: A literature review in which the results of the 12 articles reviewed, analyzed and compiled. Searches were conducted in PubMed, CINAHL and PsycINFO. Main Results: The result showed that the environment's design is important as children get injections, and how well the child was prepared for needle insertion. The result showed that even small children have the opportunity to benefit from training on needle insertion procedures. Adjusting the time it takes for a baby and a toddler to adapt must be allowed to steer healthcare. Distraction was used as a method before the needle insertion but that the best were of distraction was not needed. Conclusions: The environment´s design is important as children get injections and nurse can reduce the feeling of a hospital or clinic by adapting the environment and provide for distracting toys. It is important that children know what would happen at the needle insertion procedure and even smaller children can benefit from education about needle injection procedures and understand the importance of them. The nurse can by adjusting the session time for the child's needs and validate the child's feelings reduce anxiety and fear of the needle fearing children.

The unsafe use of needles propagates cross infections with bloodborne pathogens and reduces the positive impact of vaccinations on global health. While a plethora of needle-free injection devices exist, the reformulation of protein-based vaccines is largely empirical and costly, which presents a barrier to their widespread clinical application. This thesis contributes to the identification of approaches that facilitate rapid vaccine reformulation and enhance the immunogenicity of needle-free dry-powder vaccines with the help of novel antigen delivery platforms. We hypothesised that the thermodynamic stabilisation of diphtheria toxin mutant 197 (CRM197), a glycoconjugate vaccine carrier protein, may enhance its structural preservation during spray-freeze-drying (SFD), and that its formulation in either soluble, surface-adsorbed, or nanoparticle form impacts the elicited immune response. Differential scanning fluorimetry was used to study the effect of excipients on the thermal stability of CRM197. Dry-powder formulation of CRM197 used i) encapsulation into a thermodynamically stabilising excipient matrix by SFD, ii) surface-immobilisation via physisorption onto a novel potassium-doped hydroxyapatite (kHA) carrier microparticle formed by molten salt synthesis, and iii) chemical conjugation and surface presentation on amphiphilic block copolymer nanoparticles that were incorporated into SFD-powders (SFD-NP). The structural integrity of CRM197 was assessed by size separation in addition to various spectral and thermal analysis methods. The immunogenicity of dry-powder CRM197 formulations was subsequently tested in vivo. The results suggest that the thermodynamic stability of CRM197 in solution does not ensure its structural stability during SFD. While needle-free dermal vaccination with kHA-adsorbed CRM197 induced comparable antibody titres to conventional IM injection of alum-adjuvanted CRM197, needle-free SFD and SFD-NP powders were less immunogenic. The highest mean IgG titre and most balanced Th1/Th2 response was achieved with nanoparticle-conjugated CRM197 by IM, which outperformed the current clinical standard. Therefore, future vaccine design should combine thermodynamic and kinetic stability screening, and place special emphasis on the delivery and structural presentation of the antigen to the immune system.

The purpose of this study was to determine the effects of needle play in reducing pre-school children's anxiety concerning injections. The Pre-school Observational Scale of Anxiety was used to measure the degree of anxiety experienced by the children. The hypothesis stated that there would be a significant decrease in anxiety of pre-school children who participated in needle play as compared with the anxiety scores of pre-school children who did not participate in needle play.The sample consisted of 20 pre-school children who were receiving routine health care and injections for immunizations or PPDs (purified protein derivative) at a county health department in the southeast. After obtaining informed consent, children were randomly assigned to either a control group (n = 10) or experimental group (n = 10). The control group was involved in putting together a puzzle with the investigator prior to their injection. The experimental group participated in needle play with the investigator prior to their injection. The Pre-school Observational Scale of Anxiety (POSA) which specifies behavioral indicators of anxiety in children was used on all subjects immediately prior to the actual needle penetration and a score was given to each subject.The scores on the Pre-school Observational Scale of Anxiety showed no statistically significant difference between the control group and the experimental group when analyzed using the Mann-Whitney U Test. On the basis of these findings, the hypothesis that pre-school children who participate in needle play immediately prior to receiving an injection would show a significant decrease in anxiety when compared to pre-school children who did not-participate in needle play prior to an injection was not accepted.

4 Abstract The aim of this study was to determine whether oribatid mites affect the variety of fungi in litter of Scots pine (Pinus sylvestris), and if the dispersibility of fungi particles is related to oribatid mite species. To this end, I have prepared several semi-natural systems, in which I observed dispersion of fungi separately and in the presence of two oribatid mite species: Phthiracarus sp. and Adoristes ovatus. I assessed the experiment in two ways, by a cultivation of washed needles on agar medium and direct observation of needles under a binocular magnifier. In the next part of this study I isolated particles of fungi present on the surface and in the faeces of oribatid mites Adoristes ovatus, Porobelba spinosa and Spatiodamaeus verticillipes and compared it with the respective oribatid mite species. The most frequent needles fungi spread by oribatid mites were Oidiodendron maius var. maius, Oidiodendron muniellense, Oidiodendron setiferum, Umbelopsis ramanniana, Mucor hiemalis f. hiemalis and Mortierella hyalina. On the mites body surface the most commonly recorded fungi were Beauveria bassiana, Umbelopsis ramanniana, Cladosporium cladosporioides s.l., Cladosporium herbarum s.l. and unknown species of the genus Penicillium. Fungi species Acrodontium crateriforme, Umbelopsis ramanniana and...

Les travaux de cette thèse proposent une nouvelle approche pour le guidage assisté par robots d'aiguilles flexibles pour des procédures percutanées. La méthode est basée sur l'utilisation d'une rotation de l'aiguille avec un rapport cyclique variable pour réaliser une insertion avec des arcs de rayons de courbure différents. Elle combine un retour visuel avec une stratégie de planification adaptative pour compenser les incertitudes du système et les perturbations. Par rapport aux approches présentées précédemment dans la littérature, la stratégie de planification en boucle fermée est adaptée à des scènes dynamiques qui présentent des changements de position des obstacles et de la cible. Cette approche a été implémentée sur un système robotique et les résultats obtenus in vitro confirment tout l'intérêt de cette technique. / This thesis proposes a robot-assisted approach for automatic steering of flexible beveled needles in percutaneous procedures. The method uses duty-cycled rotation of the needle to perform insertion with arcs of adjustable curvature, and combines closed-loop imaging feedback with an intraoperative motion replanning strategy to compensate for system uncertainties and disturbances. Differently from previous approaches, the closed-loop replanning strategy is suitable for dynamic scenes that present changes of obstacles and target positions. Indeed, we implemented the proposed system using a robotic manipulator, and the results obtained from in vitro tests confirmed the viability of our method.

L’objectif de cette thèse est l’étude et le développement d’un outil de planification de trajectoires adaptatives guidée par robot afin d’assister l’insertion des aiguilles biseautées semi-rigides en procédures percutanées sous imagerie scanner ou IRM. L’approche est basée sur un nouveau modèle de la déflexion de l’aiguille qui permet une prédiction hors ligne des déformations de l’aiguille et une amélioration des performances d’insertion en ligne. Cette amélioration permet de compenser les incertitudes sur les connaissances de l’environnement et les approximations lors de la modélisation de l’aiguille. Les résultats des tests in vitro pour différentes plateformes robotiques ont confirmé la viabilité de la méthode proposée. / The goal of this thesis is the study and development of a tool for robot-driven adaptive needle insertion planning in order to assist percutaneous insertions of beveled semi-rigid needles guided by CT or MR images. The approach is based on a novel needle deflection prediction model that provides offline predictions and improve online the needle insertion performance. This improvement allows to compensate for environment uncertainties and approximations of needle-tissue interactions modeling. Results obtained from in vitro tests, using different robot platforms confirmed the viability of our method.

O presente estudo teve como objetivos avaliar a sensibilidade, a especificidade e a acurácia da Punção Aspirativa por Agulha Fina (PAAF) em nódulos submucosos da cavidade bucal e da região de cabeça e pescoço como ferramenta auxiliar de diagnóstico. Foram selecionados 50 pacientes consecutivamente que procuraram a Clínica da Disciplina de Estomatologia Clínica da FOUSP, portadores de lesões em boca e em região de cabeça e pescoço. O material obtido pela PAAF foi enviado a um mesmo patologista apenas com o diagnóstico clínico e após a emissão do laudo da PAAF o laudo do anátomo patológico era emitido servindo como padrão ouro. Após os cálculos, o resultado da sensibilidade foi de 75%, a especificidade foi de 96%, a acurácia foi de 58,8%, o valor preditivo positivo foi de 86% e o valor preditivo negativo foi de 93%. A significância foi estabelecida para 5% e o teste usado foi o teste de Kappa com valor de P<0,001 e um teste qui-quadrado, com valor de P=0,788. Pela análise dos resultados a PAAF teve uma alta sensibilidade para identificar lesões malignas, uma alta especificidade para identificar lesões benignas e uma baixa acurácia para se obter um diagnóstico definitivo. / The objectives of this present study are to evaluate the sensitivity, specificity and accuracy of Fine Needle Aspiration Biopsy (FNAB) in submucous nodules of oral cavity and nodules of head and neck region as an auxiliary tool of diagnoses. 50 patients that looked for the Clinic of the Discipline of Oral Stomatology of FOUSP were consecutively selected, carrying lesions in the oral cavity and the head and neck region. The material obtained by FNA was sent to only one pathologist with the clinical diagnosis and after the emission of FNAB report the biopsy report was emitted serving as the gold standard. After the calculation, the results of sensibility was 75%, the specificity was 96%, the accuracy was 58,8%, the positive predict value was 86% and the negative predict value was 93%. The significance was established for 5% and the tests used was Kappa with P<0,001 and a Chi-square with a P value of 0,778.With the results analysis the FNAB had a high sensibility to identify malignant lesions, a high specificity to identify benign lesions and a low accuracy to obtain final diagnoses.