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No / The global prevalence Type 2 diabetes mellitus (T2DM) is escalating at a rapid rate. Patients with T2DM suffer from a multitude of complications and one of these is impaired wound healing. This can lead to the development of non-healing sores or foot ulcers and ultimately to amputation. In healthy individuals, wound healing follows a controlled and overlapping sequence of events encompassing inflammation, proliferation, and remodelling. In T2DM, one or more of these steps becomes dysfunctional. Current models to study impaired wound healing in T2DM include in vitro scratch wound assays, skin equivalents, or animal models to examine molecular mechanisms underpinning wound healing and/or potential therapeutic options. However, these do not fully recapitulate the complex wound healing process in T2DM patients, and ex vivo human skin tests are problematic due to the ethics of taking punch biopsies from patients where it is known they will heal poorly. Here, a technique is described whereby expression profiles of the specific cells involved in the (dys)functional wound healing response in T2DM patients can be examined using surplus tissue discarded following amputation or elective cosmetic surgery. In this protocol samples of donated skin are collected, wounded, cultured ex vivo in the air liquid interface, fixed at different time points and sectioned. Specific cell types involved in wound healing (e.g., epidermal keratinocytes, dermal fibroblasts (papillary and reticular), the vasculature) are isolated using laser capture microdissection and differences in gene expression analyzed by sequencing or microarray, with genes of interest further validated by qPCR. This protocol can be used to identify inherent differences in gene expression between both poorly healing and intact skin, in patients with or without diabetes, using tissue ordinarily discarded following surgery. It will yield greater understanding of the molecular mechanisms contributing to T2DM chronic wounds and lower limb loss. / European Commission 7th Framework Programme for Research and Technical Development - Marie Curie Innovative Training Networks (ITN), Grant agreement no 607886. Aveda, Hair Innovation & Technology, USA

High-tone extensor thrust is common to those with cerebral palsy and those suffering spinal cord injuries. It is a muscle-control phenomenon that causes the body to straighten spastically. One goal of this thesis is to design a dynamic seating system that moves with respect to the wheelchair frame, allowing the seat to move with the user during an extensor thrust and reduce forces. One unique challenge is that the seat needs to remain rigid during normal functional activities and only become dynamic when an involuntary thrust is detected. A second goal of this thesis is to design a control scheme that is able to differentiate between these two types of motion. These design goals are initially investigated with a hinged-seatback system, instrumented with sensors to allow for the detection of thrusts and to actively control seating components. A full seating system is then built to allow for full-body extensor thrusts, involving the seatback, seat bottom, and leg rest of the wheelchair. This system is analyzed for effectiveness of reducing forces on the body during an extensor thrust. Another serious problem for this segment of the population is pressure ulcers. These are caused by prolonged pressure on the skin from weight-bearing bony prominences. Various seating system configurations are known to help with pressure relief. The three standard configurations for a chair are tilt, recline, and standing. The final goal of this thesis is to measure and compare the effectiveness of these three methods for their ability to relieve pressure on the seat bottom. To accomplish this, a powered wheelchair with built-in capabilities for recline and standing is mounted to a tilting mechanism. Test subjects are used to experimentally compare the effectiveness of each method for pressure reduction using pressure mats on all weight-bearing surfaces. A 2D model is also developed and validated with the experimental results.

Abstract The diploma thesis is focused on the application of a national methodics for prevalence monitoring and comparison of pressure sores (decubitus ulcers) incidence in health care facilities in the Czech Republic. Pressure sores are a global problem and their incidence should be prevented by preventive measures and high-quality nursing care. However, despite all the provisions, we are not successful in the prevention of their incidence. It is necessary to define standardized quality indicators of the nursing care, to compare the results, and to share the information with specialists, which would result in continuous quality improvement (benchmarking), and to support good practice. In the world the quality indicators monitoring of health care is quite common, in the Czech Republic the process has been only developing. In the area of Czech nursing care only the falls in health care facilities are monitored on the national level. The methodics for the monitoring of pressure sore incidence has not been established yet on the national level. In 2003 the first comparison of four teaching hospitals was carried out in the incidence of pressure sores by means of the method of prevalence investigation. In 2005 the data collection methodics was elaborated during the solution of the grant project IGA MZ Č NO 77723-3. Six teaching hospitals were compared for the prevalence of pressure sores, with division into four specialty groups: internal medicine, surgical, intensive and follow-up care. In 2008 a project of quality and safety of the Ministry of Health was implemented, with a view to elaborate uniform methodics for prevalence investigation and comparison of a standard indicator in the area of pressure sores at the national level, regardless of the type of a health care facility. At the meeting of the Work Group for Health Care Quality of the Ministry of Health of the Czech Republic I recommended to include the indicator in the National Set of Health Care Indicators. The work aims at the verification of the applicability of the new methodics and software in practice, and at the facilitation of their implementation into practice. It is focused on the opinions of the project participants on the developed software, on its application into practice and on the challenges that should be tackled during the implementation into practice. In order to get the necessary information, we have chosen a method of qualitative investigation using a semi-structured interview. Eight respondents, direct participants in the project, were interviewed. According to the results of the interviews, health facilities pay much attention to the pressure sores monitoring. The investigations are carried out by means of an incidence and prevalence method. The monitoring of pressure sores incidence has not been included in clinical information systems yet, and it is carried out in several different ways. The interest in comparison between hospitals (benchmarking) is considerable. The results of the investigation are used above all for the purpose of improvement of measures preventing the incidence of pressure sores, of the improvement of quality of nursing care, and of reducing the workload of nurses. The extent of the economic impact of the pressure sores incidence on health facilities is not clear. If we want to facilitate the application of national methodics of monitoring the pressures sores prevalence to practice and the use of application software, we should ensure adequate awareness of health care managers, training of teams of health professionals, coordinators and editors, who will go on to work with the national methodics. The monitoring of the national quality indicator in the area of pressure sores is another shift in the implementation of goals of the Ministry of Health concerning the quality of care and safety of the patients.

A Úlcera por Pressão (UP) é uma lesão na pele e em tecidos subjacentes causada pela prolongada exposição de regiões do corpo à pressão. O surgimento de UPs impacta diretamente na qualidade de vida de pacientes acamados, já que são feridas dolorosas, e levam à um aumento no tempo de internação para que seja feito o seu tratamento. Abordagens que utilizam software para monitorar automaticamente pacientes acamados vem sendo propostas para apoiar a prevenção de UP\'s. Por meio de uma revisão sistemática, pode-se identificar o estado da arte de tais abordagens, que são baseadas principalmente em sensores instalados sobre o colchão para identificar pontos de pressão. Para realização do monitoramento por essas abordagens, há necessidade do contato do equipamento com o corpo do paciente. Por conta disso, questões como conforto e a higienização ou troca do equipamento, quando um novo paciente precisa ser monitorado devem ser levadas em consideração. Neste trabalho, foi desenvolvido um sistema para apoio à prevenção de úlcera por pressão (SAPU) que realiza o monitoramento de movimentações e posição de decúbito de uma maneira alternativa às abordagens existentes. São recuperados dados de posição e imagens de profundidade do sensor de movimentos Kinect, que são utilizados por métodos de estimativa de movimentação e posição de decúbito propostos neste trabalho. Assim, não se faz necessário o contato direto do paciente com o equipamento de monitoramento. Além disso, o sistema provê, aos profissionais da saúde, indicadores de movimentação por regiões do corpo, que é uma informação que não é provida por outras abordagens existentes. Um experimento preliminar foi realizado com três participantes, que foram instruídos a realizar uma série de movimentações e troca de posição para avaliação dos métodos de estimativa da posição de decúbito e movimentação utilizados pelo SAPU. Os resultados, apesar de preliminares, dão indícios da viabilidade de sua aplicação para monitoramento de pacientes acamados. / Pressure ulcer (PU) is a lesion on the skin and underlying tissues caused by prolonged exposure of body regions to pressure. PU directly impacts bedridden patients\' quality of life since they are painful and may lead to a prolonged period of hospital internment in order to be treated. Approaches that use software to automatically monitor bedridden patients have been proposed to support pressure ulcer prevention. Through a systematic review, we identified the state of art of these approaches that are mainly based on sensors installed on a mattress to identify pressure points. Since the patient is in contact with the monitoring equipment, issues like comfort and the equipment hygiene or replacement when a new patient is monitored need to be considered. In this paper, we present a system to support pressure ulcer prevention (SAPU) that automatically monitors the patient\'s movements and decubitus positions in an alternative way. Position data and depth images are obtained from the Kinect motion sensor and used by methods we proposed to estimate movement and decubitus positions without any contact of the monitoring equipment with the patient. The system also provides movements indicators by body regions that is an information not given by other approaches. A preliminary experiment have been carried out with three participants that performed a sequence of movements and assumed different decubitus positions so that we could evaluate the methods to estimate the decubitus positions and movements detection that are used by SAPU. Even though the results are preliminary, they provide evidence that these methods can be applied in order to monitor patient\'s movements and decubitus positions.

A Úlcera por Pressão (UP) é uma lesão na pele e em tecidos subjacentes causada pela prolongada exposição de regiões do corpo à pressão. O surgimento de UPs impacta diretamente na qualidade de vida de pacientes acamados, já que são feridas dolorosas, e levam à um aumento no tempo de internação para que seja feito o seu tratamento. Abordagens que utilizam software para monitorar automaticamente pacientes acamados vem sendo propostas para apoiar a prevenção de UP\'s. Por meio de uma revisão sistemática, pode-se identificar o estado da arte de tais abordagens, que são baseadas principalmente em sensores instalados sobre o colchão para identificar pontos de pressão. Para realização do monitoramento por essas abordagens, há necessidade do contato do equipamento com o corpo do paciente. Por conta disso, questões como conforto e a higienização ou troca do equipamento, quando um novo paciente precisa ser monitorado devem ser levadas em consideração. Neste trabalho, foi desenvolvido um sistema para apoio à prevenção de úlcera por pressão (SAPU) que realiza o monitoramento de movimentações e posição de decúbito de uma maneira alternativa às abordagens existentes. São recuperados dados de posição e imagens de profundidade do sensor de movimentos Kinect, que são utilizados por métodos de estimativa de movimentação e posição de decúbito propostos neste trabalho. Assim, não se faz necessário o contato direto do paciente com o equipamento de monitoramento. Além disso, o sistema provê, aos profissionais da saúde, indicadores de movimentação por regiões do corpo, que é uma informação que não é provida por outras abordagens existentes. Um experimento preliminar foi realizado com três participantes, que foram instruídos a realizar uma série de movimentações e troca de posição para avaliação dos métodos de estimativa da posição de decúbito e movimentação utilizados pelo SAPU. Os resultados, apesar de preliminares, dão indícios da viabilidade de sua aplicação para monitoramento de pacientes acamados. / Pressure ulcer (PU) is a lesion on the skin and underlying tissues caused by prolonged exposure of body regions to pressure. PU directly impacts bedridden patients\' quality of life since they are painful and may lead to a prolonged period of hospital internment in order to be treated. Approaches that use software to automatically monitor bedridden patients have been proposed to support pressure ulcer prevention. Through a systematic review, we identified the state of art of these approaches that are mainly based on sensors installed on a mattress to identify pressure points. Since the patient is in contact with the monitoring equipment, issues like comfort and the equipment hygiene or replacement when a new patient is monitored need to be considered. In this paper, we present a system to support pressure ulcer prevention (SAPU) that automatically monitors the patient\'s movements and decubitus positions in an alternative way. Position data and depth images are obtained from the Kinect motion sensor and used by methods we proposed to estimate movement and decubitus positions without any contact of the monitoring equipment with the patient. The system also provides movements indicators by body regions that is an information not given by other approaches. A preliminary experiment have been carried out with three participants that performed a sequence of movements and assumed different decubitus positions so that we could evaluate the methods to estimate the decubitus positions and movements detection that are used by SAPU. Even though the results are preliminary, they provide evidence that these methods can be applied in order to monitor patient\'s movements and decubitus positions.

The purpose of the study was to identify factors associated with the HIV transmission rate in 18 to 24 month-old children enrolled in the PMTCT programme at two selected City of Tshwane clinics. Mother-to-child transmission of HIV during labour and breastfeeding accounts for 40% of all HIV infection in children. The prevention of mother-to-child transmission of HIV programme is one effective strategy to reduce the rate of HIV infection in children. The HIV transmission rate was low at six weeks of age but increases at 18 to 24 months of age due to several factors. The researcher selected a descriptive retrospective correlational research design. A structured questionnaire was used to collect data from 60 mothers of children aged 18 to 24 months on the PMTCT programme and a data-collection form to collect data from 152 clinic records of children of the same age on the programme. The study found that the PMTCT guidelines were not properly adhered to by the nurses and the respondents. Prophylactic treatment was not provided as required and mixed feeding was prominent. The uptake of HIV test at 18 to 24 months was low compared to at 6 weeks. The transmission rate was high at 18 to 24 months compared to at 6 weeks. No factors were associated with the transmission rate / Health Studies / M.A. (Public Health)

The purpose of the study was to identify factors associated with the HIV transmission rate in 18 to 24 month-old children enrolled in the PMTCT programme at two selected City of Tshwane clinics. Mother-to-child transmission of HIV during labour and breastfeeding accounts for 40% of all HIV infection in children. The prevention of mother-to-child transmission of HIV programme is one effective strategy to reduce the rate of HIV infection in children. The HIV transmission rate was low at six weeks of age but increases at 18 to 24 months of age due to several factors. The researcher selected a descriptive retrospective correlational research design. A structured questionnaire was used to collect data from 60 mothers of children aged 18 to 24 months on the PMTCT programme and a data-collection form to collect data from 152 clinic records of children of the same age on the programme. The study found that the PMTCT guidelines were not properly adhered to by the nurses and the respondents. Prophylactic treatment was not provided as required and mixed feeding was prominent. The uptake of HIV test at 18 to 24 months was low compared to at 6 weeks. The transmission rate was high at 18 to 24 months compared to at 6 weeks. No factors were associated with the transmission rate / Health Studies / M.A. (Public Health)