Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2006. 88 leaves. / Myofascial pain syndrome is the second most common reason patients seek the help of health care workers. It costs billions of dollars each year in lost revenue due to loss of productivity and other costs. The treatment of myofascial pain syndrome has been extensively researched and it appears that dry needling and medicinal injections of trigger points are some of the most effective modalities. However, an unwanted side effect common to both these therapies is post-needling soreness. Despite being mentioned in passing by many authors, very little detail is available regarding post-needling soreness. It is unclear whether post-needling soreness arises from the trigger point itself, or whether the tissue damage caused by the needle insertion is responsible. Therefore, this study was aimed at investigating whether dry needling muscle tissue in asymptomatic subjects (i.e. subjects not suffering from myofascial pain syndrome) resulted in post-needling soreness. Two different dry needling techniques were also compared with a placebo group in order to determine which technique resulted in the least post-needling soreness. This study was designed as a prospective, randomised, placebo controlled experimental investigation. Sixty subjects were randomly allocated into three equal groups. Group one received the single needle insertion technique and the second group received the fanning dry needling technique. The last group formed the control group and the subjects were treated using the Park Sham Device (placebo needles). All the subjects were between the ages of 18 and 50 and were required to be asymptomatic in the low back region.

Forskning om stickrädda barn i elevhälsovården bedöms som otillräcklig, men betydelsefull då många vaccinationer sker i skolan. Syftet var att undersöka flickors upplevelser kring HPV- vaccination i elevhälsovården. Uppsatsstudien hade en mixad metod design och studien var baserad på enkätsvar från 14 flickor i årskurs fem och sex. Det kvantitativa resultatet visade att hälften av flickorna skattade sig som rädda i samband med HPV-vaccination och av dem skattade sig 42 % som livrädda. Upplevd smärta och rädslan för eventuell smärta var de faktorer flickorna uppgav skapade rädsla. Att ha en förälder och/eller en kompis med sig vid vaccinationen var enligt flickorna de viktigaste strategierna för att kunna minska deras rädsla. Det fanns en positiv korrelation mellan flickornas skattade rädsla och hur de upplevde att de inte kunde koncentrera sig på skolarbetet under hela veckan innan vaccination (r2=0,761; p=0,002). Det kvalitativa resultatet visade att flickorna upplevde starka fysiska och psykiska reaktioner såsom gråt, illamående, panik och stress, orsakade av rädsla inför, under och efter vaccinationen. Då elevhälsvårdens övergripande mål handlar om att förebygga både fysisk och psykisk ohälsa för barn och ungdomar är det viktigt att belysa problematiken med stickrädsla. Sammanfattningsvis behövs vidare forskning genomföras. Detta för att bättre kunna förstå hur omfattande stickrädsla är bland skolelever och för att sätta elevernas perspektiv i fokus. / Research on children with fear of needles in the student health service is estimated as inadequate but important because many vaccinations take place at school. The aim was to examine girls’ experiences of HPV-vaccination in student health services. The study had mixed method design and the study was based on survey responses from 14 girls in the fifth and sixth grade. The quantitative results showed that half of the girls estimated themselves as frightened during HPV-vaccination, and 42 % rated themselves as terrified. The percieved pain and fear of eventuall pain were the factors in the girls' experiences of HPV- vaccination that caused fear. Having a parent and/or a friend present as support are the two most common strategies for reducing the fear during the HPV-vaccination, according to the girls. There was a positive correlation between the girls' estimated fear and their percieved ability to not be able to concentrate on schoolwork during the week prior to vaccination (r2= 0.761; p = 0.002). The qualitative results showed that before, during and after vaccination, strong physical and psychological reactions such as crying, nausea, panic and stress were caused by fear. The student health services overall goal is about preventing both physical and mental health of children and adolescents and therefor it is important to highlight the problem of fear of needles. Further research is therefor needed to better understand the extent of fear of needles among schoolchildren and focus on their perspective.

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Myofascial pain syndrome is the second most common reason patients seek the help of health care workers. It costs billions of dollars each year in lost revenue due to loss of productivity and other costs. The treatment of myofascial pain syndrome has been extensively researched and it appears that dry needling and medicinal injections of trigger points are some of the most effective modalities. However, an unwanted side effect common to both these therapies is post-needling soreness. Despite being mentioned in passing by many authors, very little detail is available regarding post-needling soreness. It is unclear whether post-needling soreness arises from the trigger point itself, or whether the tissue damage caused by the needle insertion is responsible. Therefore, this study was aimed at investigating whether dry needling muscle tissue in asymptomatic subjects (i.e. subjects not suffering from myofascial pain syndrome) resulted in post-needling soreness. Two different dry needling techniques were also compared with a placebo group in order to determine which technique resulted in the least post-needling soreness. This study was designed as a prospective, randomised, placebo controlled experimental investigation. Sixty subjects were randomly allocated into three equal groups. Group one received the single needle insertion technique and the second group received the fanning dry needling technique. The last group formed the control group and the subjects were treated using the Park Sham Device (placebo needles). All the subjects were between the ages of 18 and 50 and were required to be asymptomatic in the low back region. / M

Percutaneous kidney biopsies have been performed since 1944 to establish diagnoses and treatment. Risk factors based on a limited amount of data have shown age, blood pressure, kidney function and needle size as some risk factors for biopsy complications. Although the techniques of biopsy have improved over the years, it is still an invasive procedure and serious complications can occur. The overall aim of this thesis was to obtain a large series of data from biopsy procedures and to use these to bring further light on risk factors to help minimize the risk for patients and to optimize diagnostics. Specific aims were to clarify if different factors, such as gender, diagnoses, localization of biopsies, needle types and sizes, could be useful to help minimize complication risks in native kidney biopsies (Nkb) and transplant kidney biopsies (Txb). Another point to investigate was the value of the Resistive Index (RI) obtained at ultrasound before performing Txb. Materials and methods: A protocol for prospective multicentre registration of various factors and complications associated with Nkb and Txb was designed. Consecutive data were obtained from seven hospitals. All biopsies, except one computer tomography-guided Nkb, were performed using real-time ultrasound guidance and an automated spring-loaded biopsy device. For the biopsies 14- to 20- Gauge (G) needles were used. The kidney function level, i.e. estimated glomerular filtration rate (eGFR), was calculated using the Modification of Diet in Renal Disease (MDRD) formula (GFR in mL/min per 1.73m2). For statistical analyses the IBM SPSS Statistic 22 (Armonk, NY, USA) and OpenEpi (Open Source Epidemiologic Statistics for Public Health, www.OpenEpi.com) were used. Data were presented as Odds Ratio (OR), Risk Ratio (RR) and Confidence Intervals (CI). A two sided p-value of <0.05 was considered significant. In total 1299 consecutive biopsies (1039 native and 260 transplant kidneys) in 1178 patients (456 women and 722 men) were used for investigation. The median age of patients was 55 years (range 16 to 90 years). Major (require an intervention) and minor biopsy complications (no need of intervention) were registered. Results: The overall frequency of biopsy complications for Nkb was 8.8% (major 6.7%, minor 2.1%) and for Txb was 6.5% (major 3.8%, minor 2.7%); no death. Women had a higher risk for development of major (10.7% versus 4.7%, OR 2.4, CI 1.4-4.2) and overall biopsy complications (13.2% versus 6.5%, OR 2.2, CI 1.4-3.5) compared to men in Nkb. In Nkb, major complications were more common after biopsies from the right kidney in women versus men (10.8% vs 3.1%, OR 3.7, CI 1.5–9.5), in patients with lower versus higher BMI (25.5 vs 27.3, p=0.016) and for younger versus older age (44.8 vs 52.3 years, p=0.002). Lower (90 mmHg) compared to higher (98 mmHg) mean arterial pressure in Txb indicated a risk of major complications (p=0.039). Factors such as number of passes and kidney function did not influence complication rates. Biopsy needles of 16 G compared to 18 G showed more glomeruli per pass in Nkb (11 vs 8, p<0.001) and in Txb (12 vs 8, p<0.001). Sub-analysis revealed that 18 G 19 mm side-notch needles in Nkb resulted in more major (11.3% vs 3%, OR 4.1, CI 1.4-12.3) and overall complications (12.4% vs 4.8%, OR 2.8, CI 1.1-7.1) in women than in men. If the physician had performed less compared to more than four Nkb per year, minor (3.5% vs 1.4%, OR 2.6, CI 1.1-6.2) and overall complications (11.5% vs 7.4%, OR 1.6, CI 1.1-2.5) were more common. The localization of biopsy within the kidney (Nkb and Txb) was not a risk factor for complications. Patients with IgA-nephritis compared to patients with other diseases had a higher risk of major complications (11.7% vs 6.4 %, OR 1.8, CI 1.1–3.2). More major complications were found in Nkb if they had higher versus lower degree of glomerulosclerosis (31% vs 20 %, p=0.008) and in Txb if there was a higher versus lower degree of interstitial fibrosis (82% vs 33%, p<0.001). Re-biopsies (Nkb) were more common in patients with IgA-nephritis than those with other diseases (4.7% vs 1.3 %, OR 4, CI 1.5–11), in younger versus older age (42.6 vs 52.3 years, p=0.031), and in those with a higher versus lower degree of interstitial fibrosis (63% vs 34 %, p=0.046). In Txb, a RI≥0.8 compared to RI<0.8 predicted major (13.3% vs 3.2%, RR 4.2, CI 1.3-14.1) and overall biopsy complications (16.7% vs 5.3%, RR 3.2, CI 1.2-8.6). In the group <0.8, RI correlated with age (rs=0.28, p<0.001) and systolic blood pressure (rs=0.18, p=0.02). In the group ≥0.8, RI correlated with degree of interstitial fibrosis (rs=0.65, p=0.006) and systolic blood pressure (rs=0.40, p=0.03). The multiple regression analysis showed that the <0.8 RI group correlated only with age (p<0.001), whereas the ≥0.8 RI group correlated only with the degree of interstitial fibrosis (p=0.003). Conclusions: The present results motivate greater attention to be paid to the possibility of major side-effects after Nkb in women and biopsies from their right side, but as well in younger patients, and in those with lower BMI. This also applies for patients with presumptive IgA-nephritis and higher degree of glomerulosclerosis. In Txb, patients with higher degree of interstitial fibrosis had a greater risk of major complications. Moreover, the present data indicate that Nkb and Txb should be preferably taken with 16 G needles with 20 mm sample size. This results in better histological quality and there is a lower risk for major complications as compared to 18 G needles. The localization of biopsy within the kidney (Nkb and Txb) does not alter complication rates. For Nkb there were fewer complications if the physician had performed at least four biopsies per year. A RI≥0.8 in Txb indicates a greater risk for major and overall complications.

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.

Att bli vaccinerad kan för skolbarnet vara en jobbig upplevelse. Om barnet dessutom ärstickrädd blir situationen ännu jobbigare. Skolsköterskan ger en del av vaccinationerna somingår i det nationella vaccinationsprogrammet som Socialstyrelsen (2004) tagit fram. I den härstudien belyses de åtgärder som skolsköterskan gör för att underlätta vaccinationssituationenså långt det är möjligt. Genom att genomföra intervjuer med sex skolsköterskor och därav fåfram ett datamaterial som sedan analyserades enligt kvalitativ innehållsanalys, kunde dettaämne belysas. Resultatet som framkom var att skolsköterskorna gav skolbarnen stöd ochtrygghet genom motivationsarbete. Information var en stor del av skolsköterskornas åtgärder.Enskilda samtal och att ge extra mycket tid till barn med särskild stickrädsla var också enåtgärd. Genom omvårdnad som kunde ges genom lekande och lärande kunde skolsköterskange den trygghet som krävdes för vaccinationstillfället. För att stickrädsla hos skolbarn skakunna förebyggas måste skolsköterskan få den tid som krävs för dessa förebyggande åtgärder.Detta förebyggande arbete kan förhindra att skolbarnen blir stickrädda om de behöversjukvård senare som barn eller vuxen. / Having a vaccination can, for the child, be a difficult experience. In case of the child having afear of needles the experience becomes even more difficult. The school nurse gives some ofthe vaccinations included in the national program of vaccinations as the National board ofhealth and welfare (2004) have established. In this study, the measures made by school nursesto facilitate the vaccination situation as far as possible, are illuminated. To implementinterviews with six school nurses and thereby receiving interview material, later analysedaccording to qualitative content analysis, could this subject be illuminated. The resultreceived, was school nurses giving schoolchildren support and security through motivationalwork. Information was a significant part of the measures made by the school nurses.Individual conversations and the providing of extra time for children with a particular needlephobia was a measure aswell. Through care that could be given through playing and learning,school nurses could provide safety which was crucial at the time of the vaccination. Toprevent fear of needles, a school nurse has to be given the time required for these preventingmeasures. This preventing work will reduce the risk that the schoolchildren will have a fear ofneedles if care is needed later on as children or as adults.

Traditional methods of drug delivery to the eye include topical application, intraocular injection and systemic administration; however, each method has its limitation to efficiently delivery drugs to the back of the eye. In this study, microneedles were tested to provide targeted drug delivery into the eye in a minimally invasive way. To better interpret subsequent microneedle studies, we first quantified lateral drug diffusion profile within the sclera, by carrying out a diffusion study of a model compound, sulforhodamine, through human cadaver sclera, and developing a theoretical model for prediction of drug delivery kinetics and distribution. The results showed that measurable amounts of sulforhodamine were detected at distances of 5 and 10 mm from the sulforhodamine donor reservoir at 4 h and 3 days, respectively. The effective lateral diffusivity of sulforhodamine was determined to be 3.82 x 10-6 cm2/s, which is similar in magnitude to the transverse diffusivity. We next assessed the capability of using coated solid metal microneedles to deliver drugs into the ocular tissue in both in vitro and in vivo scenarios. The in vitro insertion tests showed that these microneedles were mechanically strong enough to penetrate into human cadaver sclera, and the coating solution rapidly dissolved off the needles after insertion and had been deposited within the tissue. In the in vivo experiments, microneedle delivery exhibited elevated fluorescein levels in the rabbit eye 60 times greater than that delivered by topical application of the equivalent dose. Similarly, microneedle delivery of pilocarpine caused rapid and extensive pupil constriction. Safety exams reported no inflammatory responses in the eye after microneedle administrations. We also used hollow glass microneedles to infuse solutions into the sclera tissue in vitro and examined the physiological barriers for flow. On average, 18 microliters of sulforhodamine solution and a solution containing nanoparticles was delivered into the sclera upon retraction of the microneedle. Successful delivery of micron-sized particles into the sclera could be improved by breaking down tightly packed collagen and GAG fibers using either collagenase or hyaluronidase.

This thesis describes the fabrication of plastic microneedle devices, their fabrication by injection molding, and analysis of the penetration mechanics. Injection molding is an economical mass-production technique that may encourage widespread adoption of microneedles for drug delivery. Four polymers were injection molded into hexagonal and square patterns of between 91 and 100 needles per array. The patterns and geometries were chosen to study the effect of needle spacing and array design on penetration force. Two needle spacings of approximately 1 mm and 1.5 mm were employed for both patterns. Molded parts showed tip radii below 15 microns, heights of 600 to 750 microns, and an included angle of approximately 30 degrees. An economic analysis performed of the injection molded polymer devices showed that they can be manufactured for approximately $0.10 - $0.179 per part, which should be low enough to gain market acceptance. The added benefits of low pain perception, improved drug delivery for certain treatments, and the possibly of being recyclable make injection molded micro-needle devices a desirable alternative to silicon or metal microneedles. Penetration tests were performed with plastic micro-needle arrays and arrays of steel needles of the same spacings and patterns. Silicone rubber with mechanical properties similar to human skin was used as a skin simulant. The results showed that the micro-needles penetrated skin to depths between 120 and 185 microns depending on pattern, spacing, tip radius and needle length. This depth is sufficient to deliver drug therapies, but not so far that they stimulate the nerve endings present beyond 130 microns inside the dermis layer in human skin. An analytical model was developed to estimate the effects of various microneedle and skin characteristics on penetration force. The model was based on literature sources and derived from test results. The model accounted for coefficient of friction, tip radius, tip angle, and needle spacing, as well as the skin mimic's mechanical properties such as elastic modulus, mode I fracture toughness, and puncture fracture toughness. A Monte Carlo simulation technique was used to correct for errors in needle length and testing angle. Comparison of the experiments to the model showed good agreement.

Thesis (Ph.D.)--University of Canterbury, 2007. / Typescript (photocopy). Includes bibliographical references ([399]-463). Also available via the World Wide Web.

Magistro darbe tiriama paprastosios pušies (Pinus sylvestris L.) spyglių histologinės savybės pramoninės taršos poveikyje. Darbo objektas - paprastoji pušis (Pinus sylvestris L) auganti prie didžiausių Lietuvos gamyklų AB „Achema“, AB „Akmenės cementas“, AB „Mažeikių nafta“. Darbo tikslas - įvertinti spyglių histologines savybes priklausomai nuo pramoninės taršos. Darbo metodai - paprastosios pušies spyglių histologinės savybės tirtos mikroskopu. Išmatuoti paprastosios pušies spyglių audiniai: spyglio ilgis, skerspjūvio storis, skerspjūvio plotis, centinio cilindro storis, kutikulos storis, eridermio storis, hipodermos storis, adaksialinės laidžiosios parechimos storis, abaksialinės laidžiosios parencimos storis, adaksialinis mezofilo storis, abaksialinis mezofilo storis. Darbo rezultatai. Paprastosios pušies (Pinus sylvestris L.) spygliai tirti prie didžiausių Lietuvos gamyklų AB „Achema“, AB „Akmenės cementas“, AB „Mažeikių nafta“. Mezomorfine spyglių struktūra pasižymėjo pušys augančios arčiausiai AB „Mažeikių nafta“ gamyklos. Kseromorfinė struktūra pasireiškė spygliuose augančiuose AB „Akmenės cementas“ apylinkėse. / In the Science work of Master examined Scots pine (Pinus sylvestris L.) needles. Subject of research - Scots pine (Pinus sylvestris L.) Goal of the research - To evaluate histology of the needles of Scots pine growing at different distance from a nitrogen fertilizer factory, a cement factory, an oil refinery factory. Methodology - light microscopy of cross sections of the needles (needle thickness, needle width, adaxial mesophyll thickness, abaxial mesophyll thickness, epidermis, hypodermis, cuticle, central cylinder, parenchyma, needle lenght). Research results. Scots pine (Pinus sylvestris L.) needles were examined near the biggest technogenic polluters (cement factory, oil refinery, nitrogen fertilizer factory) in Lithuania. The most mesomorphic structure of the needles was registered for the pines growing close to the oil refinery and the most xeromorphic structure was characteristic for the pines near the cement factory.