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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
211

Die Behandlung der kindlichen Skoliose bei spinaler Muskelatrophie mit extern zu kontrollierenden magnetischen Implantaten / Externally controlled magnetic implants as a treatment for infantile scoliosis in children with spinal muscular atrophy

Badwan, Batoul 27 August 2018 (has links)
No description available.
212

Avaliação da sobrecarga em pilares e região periimplantar de implantes cone Morse, ferulizados ou não ferulizados: análise tridimensional em elementos finitos

Magalhães, Guilherme Carminati de 27 February 2015 (has links)
Fundação de Amparo a Pesquisa do Estado de Minas Gerais / This study evaluated the stress distribution in abutments on Morse taper implants and peri-implantar surrounding bone supporting fixed partial dentures, splinted or non-splinted, under axial and oblique loading. The study simulates by means of Finite Element Analysis the loss of two posterior mandibular elements: 1st premolar and 2nd premolar. For mandible simulation a tridimensional box with Type II bone was simulated. The implant system and abutment were obtained using CAD models transferred by the company. Were used Morse taper Implant Titamax CM-Cortical Ø 3.75mm x 9.0mm and Abutment Pilar CM with 2,5mm height (Neodent, Curitiba, PR, Brazil) divided in two groups according the prosthetic rehabilitation: splinted and non-splinted; subjected to two types of loading: axial simulating functional masticatory contact and oblique simulating parafunctional occlusal contact. The implants were positioned 1.5mm under bone level according manufactures recommendation and the abutments were installed with aid of CAD software. The data were analyzed after dynamic loading of 100N in axial direction in the buccal cusp and the oblique loading (angle of 45o) in the distal-lingual cusp; both on 2nd premolar. The results showed lower tensions for F Group on axial loading for both abutment (77.37MPa) and peri-implantar surrounding bone (118.58MPa); however for NF Group axial loading demonstrated similar values as described previously. The oblique loading promoted higher stress for both abutment (505,67MPa) and peri-implantar surrounding bone (505,67MPa). The crowns splinting promotes lower stress on F Group abutment when compared with NF Group regardless the loading type. The stresses on peri-implantar surrounding bone during occlusal axial loading are similar regardless the surface contact between the prosthesis. / Este trabalho avaliou a distribuição de tensões geradas nos pilares protéticos sobre implantes cone Morse e no osso periimplantar que suportam próteses parciais fixas, ferulizadas ou não ferulizadas, sob carregamento axial e oblíquo. O estudo simulou, por meio de Análise em Elementos Finitos, a perda de dois elementos dentais posteriores inferiores: 1° pré-molar e 2° pré-molar. Para simulação da mandíbula, uma caixa tridimensional com propriedades de osso tipo 2 foi confeccionada. O sistema de implante e pilares foram obtidos por meio de modelos em CAD cedidos pela empresa. O estudo utilizou implantes cone Morse (CM) Titamax CM-Cortical® Ø 3,75mm x 9,0mm e Pilar CM de 2,5mm de altura (Neodent, Curitiba, PR, Brasil) dividido em dois grupos, de acordo com a reabilitação protética: ferulizadas e não ferulizadas, cada modelo foi então submetido a dois tipos de carregamento: axial, simulando contato mastigatório funcional e obliquo, simulando contato oclusal parafuncional. Os implantes foram posicionados 1,5mm abaixo da margem óssea, segundo recomendação do fabricante, e os pilares foram instalados com auxilio de software tipo CAD. Os dados foram analisados após aplicação de carregamento dinâmico com força de 100N em direção axial na cúspide vestibular e o carregamento oblíquo (angulação de 45°) na cúspide distolingual, ambos no 2° pré-molar. Os resultados demonstram menores valores de tensão para o grupo F sob carregamento axial, tanto para o pilar (77,37MPa) quanto para o osso periimplantar (118,58MPa); entretanto, mesmo para o grupo NF o carregamento axial demonstrou valores semelhantes aos descritos anteriormente. O carregamento obliquo gera maiores tensões tanto para o pilar (505,67MPa) quanto para o osso periimplantar (505,67MPa) em ambos os grupos. Conclui-se que a ferulização das coroas gera menor tensão no pilar protético no grupo F quando comparado ao grupo NF independente do carregamento. As tensões a nível ósseo periimplantar, durante carregamento oclusal axial apresentaram-se semelhantes independente do tipo de superfície de contato entre as próteses. / Mestre em Odontologia
213

Developmental Strategies to Address Prosthetic Infection and Magneto-Responsive Biomaterials for Orthopaedic Applications

Sunil Kumar, B January 2015 (has links) (PDF)
The issue of prosthetic infection leading to implant failure due to the formation of bacterial biofilms on biomaterial surfaces has been widely recognized as a major issue, often leading to revision surgery. The growing number of patients requiring synthetic biomaterials as implants is on the rise and so is the risk of infection arising from pre/peri-/post-operative surgical procedures. Traditional antibiotic treatment has led to the emergence of bacterial drug resistance. Therefore, the development of novel bactericidal methods to combat drug resistant microbial pathogens is the need of the hour. The first part of the thesis is an attempt to address prosthetic infection by the development of novel ultrasmall gold nanoparticles (AuNPs) which are cytocompatible and present a therapeutic dosage window for eliciting antimicrobial property. Towards this end, ultrasmall AuNPs with 0.8 nm and 1.4 nm gold core sizes, stabilized by monosulphonated triphenylphosphine ligand shells were synthesized. Such intricately designed AuNPs with ultrasmall gold cores and phosphine-based ligand chemistry were demonstrated to be highly potent bactericidal agents against staphylococci, the most common human pathogen causing biomaterial associated infection. The antibacterial efficacy of these AuNPs was significant even in mature staphylococcal biofilms. In another study, the application of high strength pulse magnetic fields (1-4 Tesla) was examined for bacterial growth inactivation in vitro. A magnetic field strength dependent decrease in bacterial viability with a concomitant increase in the production of reactive oxygen species (ROS) and longer doubling times were recorded. The mechanism of action was explained through an analytical model which involves ion-transport interference of essential ions like Ca2+ and Mg2+ and disruption of FeS clusters leading to inactivation of bacterial redox enzymes. On the contrary, such high magnetic fields did not pose any detrimental effects to eukaryotic cells under similar exposure. Additionally, the potency of low intensity direct current electric field (DC EF: 1V/cm) against biofilm formation by methicillin resistant Staphylococcus aureus (MRSA) was explored on antimicrobial surfaces of hydroxyapatite and Zinc oxide (HA-xZnO; x = 0, 5, 7.5 and 10 wt%). An EF exposure time dependent decline in the viability and stability of MRSA biofilms were noted. Further, EF treatment resulted in bacterial membrane depolarization and reduced biofilm formation on HA-ZnO composites, independent of the substrate composition. In summary, the above three studies were cases of the developmental methods to address prothetic infection. The second part of the thesis is focused on the development of magneto-responsive biomaterials as implants for orthopaedic applications. Under this category, the sintering/ hot pressing of hydroxyapatite-magnetite (HA-xFe3O4; x = 0, 5, 10, 20 and 40 wt%) powders in oxidizing and inert atmospheres was carried out and the resulting phases and microstructure were characterized. A detailed analysis of the phase assemblage by Rietveld refinement of the X-ray diffraction (XRD) data and Mössbauer spectroscopy revealed the major retention of Fe3O4 along with wustite (FeO) formation under reducing conditions while hematite (α-Fe2O3) was the oxidized product of conventional sintering in ambient atmosphere. A good correlation between the unit cell volume increases in HA observed from Rietveld refinements and Fe incorporation into the apatite lattice from Mössbauer spectral parameters was evident. Further, the Mössbauer data analysis indicated a preferential occupancy of Fe at the Ca(1) site under oxidizing conditions and Ca(2) site in inert atmosphere. The above phase analyses were further confirmed by X-ray photoelectron spectroscopy (XPS), Infrared spectroscopy (FT-IR) and CHN analysis. The microstructure of the hot-pressed samples observed under transmission electron microscope (TEM) divulged similar phases as deduced from XRD as well as the formation of translational Moire fringe patterns due to inference of overlapping crystal planes of HA and Fe3O4 in the HA-40 wt% composite. Such translational Moire fringes suggest a preferred arrangement and orientation of the crystallites resulting from hot-pressing, which correlated well with the room temperature magnetic measurements made with the help of a vibrating sample magnetometer (VSM). The compositional similarity of Fe doping in HA to that of the tooth enamel and bone presents these HA-Fe3O4 composites as potent dental/ orthopaedic implant materials. In the conclusive study, the hot-pressed HA-xFe3O4 composites were tested for their efficacy in supporting the osteogenesis of human mesenchymal stem cells (hMSCs) assisted by intermittent static magnetic field exposure. The magneto-responsive substrates were applied as platforms for the culture of hMSCs and the effect of static magnetic field (SMF) exposure on the viability, proliferation and differentiation of hMSCs were elucidated. With a mild compromise in viability, SMF triggered the osteogenic differentiation of hMSCs mediated by proliferative arrest in the G0/G1 phase and elevated intracellular calcium levels. The early bone marker genes - Runx2, Col IA and ALP were significantly up regulated upon SMF exposure on pure HA and HA-Fe3O4 composites. Further, the late osteogenic markers – OCN and OPN were detected exclusively in the HA-xFe3O4 (x = 10 and 40 wt%) composites. Matrix mineralization was enhanced and CaP nodules were detected on similar SMF treated HA-Fe3O4 composites. A substrate magnetization and time dependent modulation of gene expression was recorded which corroborated well with the temporal trending of osteogenic genes during bone development. In conclusion, substrate magnetization can be applied as a tool to modulate the behavior of stem cells and direct them towards osteogenic lineage. Such a pertinent combination of substrate magnetization and external magnetic field stimulation can be applied synergistically for stem cell based bone tissue engineering applications.
214

A 3D-printed Fat-IBC-enabled prosthetic arm : Communication protocol and data representation

Engstrand, Johan January 2020 (has links)
The aim of this thesis is to optimize the design of the Fat-IBC-based communication of a novel neuroprosthetic system in which a brain-machine interface is used to control a prosthetic arm. Fat-based intra-body communication (Fat-IBC) uses the fat tissue inside the body of the bearer as a transmission medium for low-power microwaves. Future projects will use the communication system and investigate ways to control the prosthetic arm directly from the brain. The finished system was able to individually control all movable joints of multiple prosthesis prototypes using information that was received wirelessly through Fat-IBC. Simultaneous transmission in the other direction was possible, with the control data then being replaced by sensor readings from the prosthesis. All data packets were encoded with the COBS/R algorithm and the wireless communication was handled by Digi Xbee 3 radio modules using the IEEE 802.15.4 protocol at a frequency of 2.45 GHz. The Fat-IBC communication was evaluated with the help of so-called "phantoms" which emulated the conditions of the human body fat channel. During said testing, packet loss measurements were performed for various combinations of packet sizes and time intervals between packets. The packet loss measurements showed that the typical amount of transmitted data could be handled well by the fat channel test setup. Although the transmission system was found to be well-functioning in its current state, increasing the packet size to achieve a higher granularity of the movement was perceived to be viable considering the findings from the packet loss measurements.
215

Development of New Radiotracers for PET Imaging of Adrenomedullin and Angiotensin II Type 1 Receptors

Alonso Martinez, Luis Michel 05 1900 (has links)
Les récepteurs de l'adrénomédulline sont fortement exprimés dans les capillaires alvéolaires humains et fournissent une cible moléculaire pour l'imagerie de la circulation et de l'embolie pulmonaire. Au cours des années précédentes, le dérivé DFH12 marqué au 99mTc (PulmoBind) a démontré son potentiel en tant qu'agent d'imagerie SPECT de l'hypertension pulmonaire dans des études cliniques de phase I et II. L’objectif principal de mon projet est de développer le nouvel analogue DFH17 pour l’imagerie TEP des récepteurs de l'adrénomédulline via la méthode de l’Al18F. Pour atteindre cet objectif, un système d’élution semi-automatique a été conçu pour produire l’Al18F concentré directement dans le vial de réaction. En utilisant des tests de complexation avec le chélateur NOTA, des conditions optimales ont été trouvées pour le radiomarquage du DFH17 avec l’Al18F. La combinaison du rapport Al/DFH17 1:3 dans l'éthanol 50% a permis de produire le [18F]AlF-DFH17 avec des puretés radiochimiques et chimiques élevées. Les études TEP avec le [18F]AlF-DFH17 ont démontré un rapport élevé poumon-bruit de fond ainsi qu’une grande stabilité in vivo chez le rat, le chien et le primate. Des captations différenciées dans les poumons des trois espèces ont aussi été détectées par imagerie TEP et leurs différences ont été associées à des variations de la composant RAMP2. Compte tenu de l’importante captation pulmonaire, de la stabilité in vivo et de la dosimétrie favorable, le nouveau dérivé [18F]AlF-DFH17 est un excellent candidat potentiel en tant que traceur TEP des récepteurs adrénomédulline humains. L’expression des récepteurs AT1 de l’angiotensine II est altérée dans plusieurs maladies cardiovasculaires et rénales, telles la défaillance cardiaque, rénale et l’hypertension ainsi que dans certains cancers. Auparavant, le dérivé [11C]méthyl-Candesartan a démontré un potentiel comme agent d'imagerie TEP de l'AT1R rénal mais une proportion élevée du signal TEP correspondait à une liaison non-spécifique d'un radiométabolite hydrophobe. Dans ce travail, l’objectif principal est de développer le nouveau dérivé [18F]fluorobenzyl-Candesartan en utilisant le 4[18F]fluoroiodobenzène ([18F]FIB) avec un profil métabolique et de biodistribution potentiellement meilleurs. Pour atteindre cet objectif, des paramètres réactionnels de fluorination tels que le solvant, la quantité de précurseur, le catalyseur et la température ont été optimisés permettant la radiosynthèse du [18F]FIB avec des rendements et pureté élevés. Ensuite, le couplage du [18F]FIB au dérivé alcyne-trityl-Candesartan a été évalué en utilisant la réaction de Sonogashira suivie d'une détritylation acide. Suite à l’étude de plusieurs conditions de couplage, le rendement de radioconversion a été légèrement augmenté en utilisant le catalyseur Pd(PPh3)4/CuI et K2CO3 comme base. Les meilleures conditions de fluorination et de couplage ont été automatisées pour le module de synthèse Synthra® RNPlus Research. La production du [18F]FB-Candesartan été atteinte avec de faibles rendements et activités molaires en raison de la formation d’impuretés ayant des structures et temps de rétention par HPLC similaires à ceux de notre traceur. Des études supplémentaires afin d'améliorer le rendement, la purification par HPLC et l'activité molaire se sont avérées infructueuses pour l’instant. D’autres expériences devront être effectuées à cette fin. En conclusion, l'utilisation de la réaction de Sonogashira pour produire le [18F]FB-Candersartan avec des rendements et des activités molaires élevées s'est avérée difficile. / Adrenomedullin receptors are highly expressed in human alveolar capillaries and provide a molecular target for imaging the integrity of pulmonary microcirculation. In previous years, the 99mTc-labeled DFH12 derivative (PulmoBind) demonstrated its potential as a SPECT imaging agent of pulmonary hypertension in phase I and II clinical trials. In this work, we aimed to develop a NOTA-derivatized adrenomedullin analog (DFH17), radiolabeled with aluminum fluoride ([18F]AlF), for PET imaging of pulmonary microcirculation. To achieve this goal, highly concentrated [18F](AlF)2+ was produced from purified 18F using a semi-automatic system. Using inexpensive complexation assays with NOTA, optimal conditions at each step of the process were determined facilitating the radiolabeling optimization of DFH17. Furthermore, combining the Al-to-DFH17 1:3 ratio in 50% ethanol as co-solvent, allowed [18F]AlF-DFH17 production in high radiochemical and chemical purities. PET/CT and biodistribution demonstrated high [18F]AlF-DFH17 lung-to-background ratio and in vivo stability in rats, dog and primate. Contrasted inter-species uptake in the lungs associated with variations of RAMP2 were also detected by PET imaging. Considering high lung uptake, in vivo stability and favorable dosimetry observed in the monkey, the novel AM derivative [18F]AlF-DFH17 exhibits an excellent potential as a PET tracer of human AM receptors. Alterations of the expression levels of AT1R has been linked to cardiac and renal diseases, such as cardiac and renal failures, hypertension and some type of cancers. Previously, [11C]methyl-Candesartan displayed potential for PET imaging of AT1Rs, but a high proportion of PET signal corresponded to non-specific binding from a 11C-labeled hydrophobic metabolite. In this work, the main objective was to develop the novel derivative [18F]fluorobenzyl-Candesartan, with potentially better metabolic profile and biodistribution, using 4-[18F]fluoroidobenzene ([18F]FIB) as prosthetic group. To pursue this goal, radiofluorination parameters such as solvent, amount of precursor, type of catalyst and temperature were optimized to reliably synthesize [18F]FIB in high yield and purity. Coupling of [18F]FIB to the alkyne-trityl-Candesartan was evaluated using the Sonogashira cross-coupling reaction followed by an acid deprotection. After studying several Pd-cross-coupling conditions, the radioconversion yield was slightly increased by means of a Pd(PPh3)4/CuI catalyst and K2CO3 as base in DMF. Therefore, the best reaction conditions for [18F]FIB fluorination and its coupling to alkyne-Candesartan followed by an acid hydrolysis, was fully automated for Synthra® RNPlus Research synthesis module. In general, the synthesis of [18F]FB-Candesartan was achieved in low yields and molar activities due to the formation of structurally-close by-product(s) with similar HPLC retention time. Additional studies to further improve the yield, HPLC purification and molar activity (MA) have been unsuccessful. Other experiments will need to be performed to this end. In conclusion, the use of Sonogashira cross-coupling reaction to produce [18F]FB-Candesartan in high yields and molar activities was found to be challenging.
216

An investigation of circumstances surrounding prosthetic users’ fall and fear of falling : A Cross-Sectional Survey

Dyekær Nielsen, Jens, Overgaard Dich, Sara January 2022 (has links)
SummaryBackground Prosthetic users face significant challenges both physically and psychologically. Falling poses a significant risk for the individual, and a consequence of this is gaining a fear of falling and self-imposed restrictions. These consequences can have a major impact on the individuals’ health and quality of life. However, the research in this area is limited.   Objectives  This study aims to investigate prosthetic users’ fear of falling and the circumstances surrounding falls among individuals with a lower-limb amputation in England and Sweden.   Method  In April 2022 a cross-sectional survey was conducted in England and Sweden. 11 participants were recruited. The survey was aimed at the population of lower-limb amputated individuals at the age of 18 or above in the two countries. The survey consists of 111 items with mostly closed-ended questions. Descriptive and inferential statistical methods were used for the analysis of the data.       Results  The study showed that 8 (72.7%) out of 11 participants had not experienced a fall within the last 30 days and the most common frequency of falls was every six months (54,5%). 2 (18.2%) participants had a fall once every three months which was the highest frequency of falls reported in the survey. This is seen as low frequency, however, 7 (63,3%) out of 11 participants had a fear of falling. A correlation between Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC) and Gait-Specific Attentional Profile instruments (G-SAP) was performed using a Pearson’s product-moment correlation which showed there was a strong relationship between the three instruments. The correlation between the FES-I and G-SAP is 0,800, FES-I and ABC are -,853 and the correlation between ABC and G-SAP is -, 821.   Conclusion  A strong relationship was found between the Falls Efficacy Scale-International, Activities-specific Balance Confidence Scale and the Gait-Specific Attentional Profile. Regardless of having fallen within the past 30 days, a high concern of fear of falling was found, and the most common reason for falls was uneven surfaces such as gardens. / Bakgrund Protesanvändare står inför många tuffa utmaningar dagligen, beroende på såväl fysiska som psykiska faktorer. Det finns en överhängande risk att ramla för individen, en konsekvens av detta är att drabbas av fallrädsla och sedermera individutvecklade hinder i vardagen. Dessa konsekvenser och hinder kan ha stor inverkan på individens hälsa och livskvalitet. Forskningen på detta område är dock begränsad.   Mål Syftet med denna studie är att undersöka protesanvändares rädsla för att ramla, samt omständigheterna kring varför man ramlar, hos individer med underbensamputation i England och Sverige.   Metod Under april 2022 genomfördes en tvärsnittsundersökning i England och Sverige. 11 deltagare rekryterades. Undersökningen riktade sig till individer i England och Sverige som genomgått amputation av nedre extremitet och var minst 18 år. Enkäten bestod av 111 frågor med till största delen slutna frågor. Beskrivande och inferentiella statistikmetoder användes för analys av data.   Resultat Studien visade att 8 st (72,7%) av de 11 deltagarna inte hade upplevt ett fall de senaste 30 dagarna och att den vanligaste fallfrekvensen var ett fall var sjätte månad (54,5%). Två (18,2%) deltagare angav fallolyckor en gång var tredje månad, vilket var den högsta fallfrekvensen som rapporterades i undersökningen. Detta ses som en låg frekvens, men 7 st (63,3%) av de 11 deltagarna upplevde en rädsla för att ramla. En korrelationsanalys mellan Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC) och Gait-Specific Attentional Profile (G-SAP) utfördes med hjälp av Pearsons produkt-moment korrelationskoefficient, som visade att det fanns ett starkt samband mellan de treinstrumenten. Korrelationen mellan FES-I och G-SAP var 0,800, mellan FES-I och ABC var det -,853 och mellan ABC och G-SAP var det -,821.   Slutsats Ett starkt samband hittades mellan Falls Efficacy Scale-International, Activities-specific Balance Confidence Scale, och Gait-Specific Attentional Profile instrumenten. Oavsett om deltagarna hade ramlat under de senaste 30 dagarna, konstaterades en stor oro för att ramla, och den vanligaste fallorsaken var ojämna ytor såsom i trädgårdar.
217

Parazitické hlasy a protetická já: Detekce post-lyrického subjektu v dílech současné digitální literatury / Parasitic Voices and Prosthetic Selves: Detecting the Post-Lyrical Subject in the Works of Contemporary Digital Literature

Suchánek, Tomáš January 2021 (has links)
This diploma thesis explores subjectivity in the domain of so-called digital writing, that is, in texts of largely experimental nature generated by computer algorithms (or with their assistance). In order to do so, the thesis briefly covers the history of digital writing, its mediatic specificities, poetics as well as various theoretical and philosophical conceptualizations. Most importantly, it undertakes an analysis of a post-lyrical subject, a concept devised by Janez Strehovec, that is common to all cases of generative writing under focus. For its comparative analysis, the thesis deals with the recent works from contemporary creators who approach algorithmic textuality from variegated perspectives, incl. Nick Montfort, Allison Parish, Stephanie Strickland, Li Zilles, and Jörg Piringer. Texts generated by programs are conceived of as expressing a new, parasitic and prosthetic, genus of cyber-textual subjectivity that defies the traditional lyric and expands its pool "by other means," as Marjorie Perloff would say. Such a tendency results in conceptually as well as formally complex literary corpus "infected" by - to further exploit the suggested metaphor - parasitic voices and prosthetic selves. Unlike in generic lyric, the post- lyrical subject surpasses the confines of poetry as genre; it is...
218

Breast Reconstruction Post-Mastectomy : an Assessment of Rates, Limiting Factors and Attitudes at a Tertiary Care Center in Quebec

Karunanayake, Mihiran 07 1900 (has links)
La reconstruction mammaire post-mastectomie améliore le bien-être psychosocial, et l’image corporelle des patientes. Parcontre, la reconstruction mammaire demeure faiblement utilisée et même inaccessible à des patients dû à des facteurs limitants. Les taux de reconstruction et les facteurs qui influencent l’accès à la reconstruction n’ont pas été évalués dans la province du Québec. Avec une revue de dossier rétrospective, l’objectif de notre étude est d’identifier les taux de reconstruction mammaire dans un centre tertiaire à Montréal et les facteurs qui influencent l’accès à la reconstruction, avec un revu de dossier rétrospective. Ensuite, nous avons évaluer directement dans la même cohorte de patientes, leur désire d’avoir une consultation en chirurgie plastique pour discuter d’une reconstruction. Il y avait un taux total de reconstruction mammaire post-mastectomie de 21%, dont 14% était immédiat et 8% tardif. Les patientes qui ont eu une reconstruction étaient plus jeunes, plus de tendance à avoir une plus grande proportion de mastectomie bilatérale, avaient des cancers non-invasifs et habitaient plus loin de l’hôpital (>10km). Environ la moitié des patientes avec une mastectomie sont intéresser à avoir une consultation avec un chirurgien plasticien mais seulement 38% ont eu une reconstruction. Les chances d’avoir subi une reconstruction, augmentent lorsqu’une reconstruction est offerte et expliquée. Présentement, il existe des barrières autres que les désires de la patiente qui empêchent l’accès à la reconstruction mammaire post-mastectomie. / Breast reconstruction post-mastectomy has been shown to improve psychosocial wellbeing, and body image. However, accessibility and acceptance of breast reconstruction is limited, with patients being unequally privileged based a number of limiting factors. To date, no evaluation on the rates of reconstruction and the factors that influence patient access has been performed in the province of Quebec. The objective of the research was two-fold with the first component being to identify the rates of breast reconstruction at a tertiary care center in Montreal and the factors influencing the rates of reconstruction through a retrospective chart review. The second component was to directly evaluate in the same cohort of breast cancer patients; their interest in a consultation with plastic surgery through a telephone questionnaire. There was a total rate of PMBR of 21%, where 14% of patients had an immediate reconstruction and 8% of eligible patients underwent a delayed reconstruction. Patients that received a PMBR were younger, more likely to have bilateral mastectomies, had non-invasive breast cancer and resided further then 10km from the hospital. Approximately half of patients with a mastectomy were interested in consulting a plastic surgeon but only 38% of all patients underwent a reconstruction. The offer and awareness of reconstruction increased the chance of opting to have a reconstruction. There are barriers outside of the patient’s own desires that impede their access to breast reconstruction.
219

PRODUCT-APPLICATION FIT, CONCEPTUALIZATION, AND DESIGN OF TECHNOLOGIES: PROSTHETIC HAND TO MULTI-CORE VAPOR CHAMBERS

Soumya Bandyopadhyay (13171827) 29 July 2022 (has links)
<p>From idea generation to conceptualization and development of products and technologies is a non-linear and iterative process. The work in this thesis follows a process that initiates with the review of existing technologies and products, examining their unique value proposition in the context of the specific applications for which they are designed. Next, the unmet needs of novel or emerging applications are identified that require new product or technologies. Once these user needs and product requirements are identified, the specific functions to be addressed by the product are specified. The subsequent process of design of products and technologies to meet these functions is enabled by engineering tools such as three-dimensional modelling, physics-based simulations, and manufacturing of a minimum viable prototype. In these steps, un-biased decisions have to be taken using weighted decision matrices to cater to the design requirements. Finally, the minimum viable prototype is tested to demonstrate the principal functionalities. The results obtained from the testing process identify the potential future improvements in the next generations of the prototype that would subsequently inform the final design of product. This thesis adopted this methodology to initiate the design two product-prototypes: i) an image-recognition-integrated service (IRIS) robotic hand for children and ii) cascaded multi-core vapor chamber (CMVC) for improving performance of next-generation computing systems. Minimum viable product-prototypes were manufactured to demonstrate the principal functionalities, followed by clear identification of future potential improvements. Tests of the prosthetic hand indicate that the image-recognition based feedback can successfully drive the actuators to perform the intended grasping motions. Experimental testing with the multi-core vapor chamber demonstrates successful performance of the prototype, which offers notable reduction in temperatures relative to the existing benchmark solid copper spreader. </p>
220

Fluid dynamic assessments of spiral flow induced by vascular grafts

Kokkalis, Efstratios January 2014 (has links)
Peripheral vascular grafts are used for the treatment of peripheral arterial disease and arteriovenous grafts for vascular access in end stage renal disease. The development of neo-intimal hyperplasia and thrombosis in the distal anastomosis remains the main reason for occlusion in that region. The local haemodynamics produced by a graft in the host vessel is believed to significantly affect endothelial function. Single spiral flow is a normal feature in medium and large sized vessels and it is induced by the anatomical structure and physiological function of the cardiovascular system. Grafts designed to generate a single spiral flow in the distal anastomosis have been introduced in clinical practice and are known as spiral grafts. In this work, spiral peripheral vascular and arteriovenous grafts were compared with conventional grafts using ultrasound and computational methods to identify their haemodynamic differences. Vascular-graft flow phantoms were developed to house the grafts in different surgical configurations. Mimicking components, with appropriate acoustic properties, were chosen to minimise ultrasound beam refraction and distortion. A dual-beam two-dimensional vector Doppler technique was developed to visualise and quantify vortical structures downstream of each graft outflow in the cross-flow direction. Vorticity mapping and measurements of circulation were acquired based on the vector Doppler data. The flow within the vascular-graft models was simulated with computed tomography based image-guided modelling for further understanding of secondary flow motions and comparison with the experimental results. The computational assessments provided a three-dimensional velocity field in the lumen of the models allowing a range of fluid dynamic parameters to be predicted. Single- or double-spiral flow patterns consisting of a dominant and a smaller vortex were detected in the outflow of the spiral grafts. A double- triple- or tetra-spiral flow pattern was found in the outflow of the conventional graft, depending on model configuration and Reynolds number. These multiple-spiral patterns were associated with increased flow stagnation, separation and instability, which are known to be detrimental for endothelial behaviour. Increased in-plane mixing and wall shear stress, which are considered atheroprotective in normal vessels, were found in the outflow of the spiral devices. The results from the experimental approach were in agreement with those from the computational approach. This study applied ultrasound and computational methods to vascular-graft phantoms in order to characterise the flow field induced by spiral and conventional peripheral vascular and arteriovenous grafts. The results suggest that spiral grafts are associated with advanced local haemodynamics that may protect endothelial function and thereby may prevent their outflow anastomosis from neo-intimal hyperplasia and thrombosis. Consequently this work supports the hypothesis that spiral grafts may decrease outflow stenosis and hence improve patency rates in patients.

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