Typescript (photocopy). / Digitized by Kansas Correctional Industries

Identificar las diferencias en esquemas maladaptativos tempranos, según el tipo de dependencia a sustancias psicoactivas de los residentes de un centro de rehabilitación de lima. Materiales y métodos. Estudio transaccional y descriptivo. De una población de 70 pacientes varones con edades de 18 entre 50 años de edad Identify the differences in early maladaptive schemes, according to the type of dependence to psychoactive substances of the residents of a rehabilitation center in Lima. Materials and methods. Transactional and descriptive study. From a population of 70 male patients aged 18 to 50 years old

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The aim of this study was to clarify the relationship between the dosage parameters and temperature increase at the target tissues (up to 5 cm below the skin surface), and to explore the possibility of proposing a preliminary model to guide clinicians and researchers in determining treatment dosages based on expected increase in temperatures at the target tissue. Prior to the conduct of the main study several protocol-related issues were investigated. These included the reliability of the measurement procedures, the optimum speed of movement of the transducer, the optimum size of the treatment area, and the maximum output intensity that could be considered safe for treatment applications and investigations. An in-vitro post-mortem pig model was chosen for the experimental design using only adult-sized pigs, weighing between 60 to 80 kilograms. A total of 76 specimens were obtained from the shoulder and thigh sections of 19 pigs. The therapeutic ultrasound machine used throughout the study was the Omnisound 3000TM (Physio Technology Inc., Topeka, Kansas, USA) Output from the Omnisound 3000TM was checked and calibrated as necessary prior to each experiment using a power meter (Model UPM-DT-10, Ohmnic Instruments Co., St. Michaels, Maryland 21663, USA). Calibration was only performed when the checks demonstrated an error in the output intensity of the machine exceeded ±10%. The Minolta spot thermometer (HT-11, Minolta Co. Ltd., Japan) and the Avio thermal video system (TVS) 2000TM (Nippon Avionics Co. Ltd., Japan) were used to measure the change in tissue temperatures (dependent variable) at the skin surface and subcutaneously (at l, 2, 3, 4 and 5 cm below skin surface) respectively. The prepared specimen was mounted on a fixed table, with the clean cross-section facing the infrared thermographic camera. / The camera to specimen distance was standardised at 50 cm for all experiments. Markers corresponding to 1, 2, 3, 4, and 5 cm on the specimen were plotted on the display unit, and saved to a 3.5 inch floppy disk. Measurements were recorded at baseline (prior to commencement of the experiment) and subsequently at 1-minute intervals during 10 minutes of exposure to the ultrasound, and for a further 10 minutes post-exposure, until the end of the experiment at 20 minutes. In general, there were five main parameters for all the studies: the movement speed of the transducer, the size of the treatment, and the frequency, intensity and duration of exposure and post-exposure to ultrasound. These five parameters represented the independent variables for all the studies. The dependent variable throughout was change in tissue temperature (measured in °C) at the skin surface, and at 1, 2, 3, 4 and 5 cm below the skin surface. Data were analysed using the SPSS for Windows software, Version 10.0 (SPSS Inc., 444N Michigan Avenue, Chicago, Illinois 60611, USA). Analyses of the data, using a repeated measures analysis of variance procedure, were performed on change in temperature, rather than actual temperature measured at selected time points. Only data from the 5th, 10th, 15th, and 20th minutes were analysed. This corresponded to the middle and end of the ultrasound exposure phase (5th and 10th minute) and post-exposure phase (15th and 20th minute), as these were considered to be representative of both these phases of data collection. / Data for all 20-minute sampling is provided in the table of means for each experiment. The level of statistical significance was set at 0.05. Results of the reliability study showed that both the infrared spot thermometer and the video thermography unit were reliable within acceptable limits (as defined in this study). The latter, however, was more reliable than the former. In addition, the reliability was better for the post-exposure phase compared with the exposure phase, and for deeper tissues compared with the superficial and surface tissues. An unplanned analysis of the twenty minutes of data (at one minute intervals) suggested the possibility of reducing the duration factor from 20 to 4 (5th, 10th, 15th and 20th minute). In this manner, the data analyses for subsequent studies could be simplified considerably without affecting the overall results. Results of the other protocol-related studies showed that: a. There was no difference in change in temperatures between the slow (60 beats/min or 7cm/s), moderate (120 beats/min or 14cm/s) and fast (180 beats/min or 21cm/s) movement speeds of the transducer. However, for practical reasons, the moderate speed was recommended for subsequent studies; b. There was a significant difference in change in temperatures between the small (2X ERA), medium (3X ERA) and large (4X ERA) treatment sizes. The small treatment size provided the most effective and deeper heating, and was the recommended treatment size for subsequent studies; c. For both 1 and 3 MHz, tissue damage did not occur for intensities up to 1.5 Watts/cm[superscript]2. However, irreversible thermal injury to the tissues occurred at 2.0 Watts/cm[superscript]2 (1 MHz). / Therefore, the recommended maximum intensity at which investigations could be carried out without any risks of thermal injury to the tissues was 1.5 Watt s/cm[superscript]2 for both 1 and 3 MHz. The results from the main study demonstrated that the increase in temperature due to absorption of the ultrasonic energy at any of the investigated target sites (up to 5 cm below surface) was related to the ultrasound frequency, intensity and duration of exposure. For the frequency factor, the evidence seems to suggest that compared with the 3 MHz ultrasound, the 1 MHz frequency may be more appropriate for clinical applications as it does not overheat surface tissues, and at the same time, is able to increase the temperatures of target tissues up to a depth of 5 cm. For the intensity factor, the results suggest that the therapeutic range of intensities which can be considered neither too low (as to be ineffective) nor too high (as to be damaging) are 0.5 to 1.3 Watts/cm 2 and 0.3 to 0.5 Watts/cm[superscript]2 for 1 and 3 MHz respectively The narrow therapeutic range for 3 MHz could render it questionable for clinical applications. In contrast, the larger therapeutic range available for the 1 MHz frequency suggests that it is more suitable for clinical applications and research. For the duration factor, the results demonstrated that the temperatures at all tissue sites increased as the duration of exposure increased. / However, for the post-exposure phase, while the superficial tissues decreased with time, the deeper tissues continued to increase in their temperatures, albeit gradually. In summary, the results demonstrated that a higher frequency, a higher intensity, a greater exposure time and a more superficial site all contribute to a greater change in mean temperature. From these results, a preliminary model to guide clinicians and researchers in determining treatment dosages, based on expected increase in tissue temperatures at the target site, was proposed. While the preliminary model provided is only a first step effort, it is hoped that it can be refined further through use by physical therapists and other users of therapeutic ultrasound.

Master of Dental Surgery / It has been considered for the purpose of this review unnecessary to discuss in detail the Morphology of the dental pulp and dentine, as this may be found in any recognised text-book, but to concentrate on the clinical problems involved. The materials discussed are those in current usage for exposed pulp preservation, whilst other materials may be touched upon and it is the endeavour of the author to review as many results as possible in this field and to draw sound conclusion from statements made. The field of corticosteroids in dentistry is comparatively new and here it is the aim to provide a basis from which further research may be undertaken. Thus, this thesis is divided into two distinct sections. The first section dealing with non-corticoid drugs and the second sections dealing with cortico-steriods and their combinations, exclusively, utilising the commercial product Ledermix as their prime example. However, when considering pulp therapy one must delve into the past to understand the thought and effort that has gone into this realm of dentistry and to note the lack of the true scientific attitude by some into this work. This may then allow us to look again at our own statements to note how much controversy there was, and still is concerning a question such as “should an attempt on the pulp once exposed ever be made to maintain its vitality?” It will be shown at a later stage that the pulp has marvellous recuperating powers if treated in a conservative manner, something which was hardly considered even early this century. Castognola, Quigleyand Berman have all reviewed this subject before. However, my aim is to bring together all of their information as a preface to the important work of considering the immediate study being carried out in this field. The first attempted vital capping was carried out by Philip Pfaff in 1756 with a small piece of gold foil adapted to the base of the cavity. Then in 1826 it was reported that Lenoard Koeker cauterized the exposed pulp with a hot iron wire and placed silver or lead caps over the exposures. It then appeared that little further was written concerning pulp capping until the middle of the 19th century when Albrecht (1856) utilised opiates, caustics and eugenol on the exposed pulp. McKown (1859) recommended cotton soaked in creosote and tannic acid, whilst Taft (1859) was in favour of cauterizing recently exposed pulps with nitric acid and placing a filling immediately. These results were purely a subjective evaluation. In fact Mc Kown’s results were produced on one of his own teeth. The history of pulp preservation really begins in the early 1860’s. Allport (1866) and Atkinson (1866-1868) suggested amputation of all projecting cornua of exposed pulps and placement of a temporary filling until it was healthy. Allport used the b lood clot formed during operation as his means of capping. J Foote (1866) also, believed the blood clot to be the best means of covering the pulp. This certainly appeared to be a reasonable assumption, considering medical knowledge of the day.

Oral administration of live probiotics such as Lactobacillus and Bifidobacterium spp. possess numerous beneficial effects. However, delivering viable probiotics to the host intestine has been a challenge due to poor survival of these bacteria during the gastric transit. An improved oral delivery system (modified alginate microcapsules) was developed in this study for targeted release of viable probiotics to the host intestine. Effect of various encapsulation parameters such as capsule size, alginate concentration, calcium chloride concentration, gelling/hardening time of microcapsules, addition of prebiotics and polymer coating, were individually investigated for improving the stability of microcapsules under simulated gastrointestinal (GI) conditions. Ability of microcapsules in protecting the viability of encapsulated bacteria improved significantly (p<0.05) in improving the stability of microcapsules. Optimisation of encapsulation parameters significantly improved the viability of encapsulated probiotics under simulated GI conditions. Furthermore, co-encapsulation of probiotics with complementary prebiotics (such as Hi-Maize starch) and chitosan coating provided additional protection to the encapsulated bacteria under simulated GI conditions. Release profile of chitosan-coated alginate-starch (CCAS) encapsulated bacteria was investigated in the GI tracts of different animal models. Addition of CCAS encapsulated bacteria to porcine GI contents (ex vivo) resulted in complete release of microencapsulated bacteria in the ileal contents within 8 h, while there was no significant release (p>0.05) of encapsulated bacteria in the gastric contents even after 24 h of incubation. In another experiment, CCAS microcapsules containing Lactobacillus casei Shirota (LCS) was orally administered to mice and the release profile of encapsulated bacteria was monitored throughout the murine GI tract for 24 h. Partial release of microencapsulated LCS was observed in duodenal and jejunal regions, while no significant (p>0.05) release of microencapsulated bacteria was observed in the stomach during the 24 h monitoring period. However, a significant release (nearly complete release) of microencapsulated bacteria was observed in ileal and colon of murine GI tract after 24 h. Elevated counts of LCS in ileum and colon indicated the most favorable site for the release of CCAS encapsulated bacteria. Further studies investigated the immunomodulatory activity of microencapsulated probiotic bacteria in a murine model. Lactobacillus casei Shirota was orally administered to mice either as microencapsulated or as free bacteria (non encapsulated) for two weeks. On day 14, the splenocytes from different experimental groups were harvested and assessed for ConA induced cytokine levels. A significant increase (p>0.05) in IFN-γ levels was observed in the activated splenocytes of groups treated with microencapsulated and free (non-encapsulated) LCS, compared to the control group (no LCS treatment). However, there was no significant difference (p<0.05) in the IFN-γ concentration between the groups treated with microencapsulated and free (non-encapsulated) LCS. No significant difference (p<0.05) in the IL-10 concentration was observed in the activated splenocytes of groups treated with microencapsulated and free (non-encapsulated) LCS. Finally, the stability of microencapsulated probiotics in different dairy products was investigated. CCAS microcapsules significantly protected the viability of probiotic bacteria in set and stirred yoghurts over 6-week refrigerated storage conditions compared to free (non-encapsulated) probiotics. Overall, chitosan-coated alginate-starch microcapsules developed in this study effectively protected the viability of probiotics from adverse gastric conditions and released the bacteria in the host intestine without detrimentally affecting its immunomodulatory properties. / Doctor of Philosophy

The aim of this project was to investigate a range of medicinal herbs which have radical scavenging and antioxidant activities and then apply novel mass spectrometric techniques to investigate and analyse active components responsible for their pharmaceutical actions. A sensitive electron capture negative ionization of gas chromatography-mass spectrometry (ECNI-GC-MS) method was developed to assess hydroxyl radical production, as indicated by 3.4-dihydroxyphenylacetic acid (DOPAC) production, which allows excellent evaluation of hydroxyl radical scavenging and antioxidant activity of a number of medicinal Chinese herbs. Melatonin is an effective multiple radical scavenger and antioxidant and has been used in this study for the comparison of radical scavenging activity with medicinal herbs. To analyse active compounds from herbal extracts, mass spectrometric techniques were used to separate components that suppressed hydroxyl radical production from Dimocarpus longan Lour, determine known ginsenosides from ginseng extracts as well as to identify and quantify melatonin in ten herbal extarcts. The results obtained indicated that 1) the utilization of alumina in the ECNI-GC-MS method diminished interferences from ???noise??? products in a Fenton-type reaction, which allows obtaining pure final hydroxyl radical product and this method demonstrated optimal sensitivity and reliability; 2) Aqueous extracts of all herbs analysed showed different levels of hydroxyl radical scavenging activity. Dimocarpus longan Lour, Chrysanthemum morifolium Ramat, Lonicera hypoglauca Miq, Ginkgo biloba L, Rehmannia flutinosa and Libosch Cornus officinalis Sieb all exhibited stronger inhibitory effect on hydroxyl radical production than melatonin. 3) Aqueous extract of Dimocarpus longan Lour. showed the greatest inhibitory effect on hydroxyl radical production among the other herbs tested. The active fractions of this herb eluted just after the void volume using HPLC suggesting that the active compounds responsible for radical scavenging activity are polar and water soluble. They may belong to phenol group of chemicals. 4) Herbal extracts using non-polar solvents showed no effect on hydroxyl radical production suggesting active compounds in those herbs are water soluble. 5) Different species and origins of ginseng were compared for their radical scavenging activity. Chinese fresh ginseng (Oriental ginseng) showed higher activity than Korean ginseng tablet and American ginseng. Seven known active ginsenosides were identified using HPLC-MS-MS. 6) Melatonin was found at varying concentrations in ten herbs, which may contribute to the radical scavenging activity of herbs, on the other hand, it may provide the justification of clinical use and food resources, particularly for those herbs contain high level of melatonin.

Anorexia nervosa (AN) is a chronic and complex psychosomatic condition, characterised by a primary drive to be thin and a refusal to maintain normal body weight. Only a minority of people diagnosed with AN ever become asymptomatic and more research has been called for to address high drop-out rates and lack of engagement in AN treatment services, in particular psychotherapeutic treatment. Prior studies have generally examined this problem in terms of patient mediated variables, such as attitudes and behaviours, with little focus on contextual factors. Research that has studied therapeutic engagement in the area of AN has yet to examine psychotherapeutic treatments-in-practice. Guided by this gap in the literature this thesis examines ways in which therapists engage with adolescents diagnosed with AN in naturally occurring psychotherapeutic interactions. A secondary and concurrent focus is to look at how the therapists’ underlying theoretical models are reflected in in situ practice. The data corpus comprises twenty-four therapy sessions recorded in an eating disorders programme based in a children’s hospital. In contrast to eating disorders treatment statistics reported in the literature, the programme has a low drop-out rate, zero mortality rate and good long-term patient outcomes, making it an especially suitable setting to examine engagement. Drawing on methods from discursive psychology (DP) and conversation analysis (CA), a number of interactional practices are found which show how the key principles of engagement and neutrality are brought off, or achieved as such in turn-by-turn interaction. Central to the analysis, is the recurrent production of patients’ bodily states and conduct as delicate items. As these topics are also the primary focus of the institutional setting, the analysis shows how practices such as perspective display series and dispositional management allow delicately marked institutional tasks to be carried out. The analysis also examines how patients’ bodies and conduct are embedded in, and constituted as problematic in the interactions. Regularities, such as agentic repositioning in accounts, demonstrate the co-production of patients as psychologically compliant with treatment while physically non-compliant. This thesis contributes to work in applied CA concerning links between theoretical models and interactional practices by demonstrating naturally occurring regularities that describe key guiding principles of the eating disorders programme. It also builds on work in DP concerning examinations of the body and embodiment, by showing how patients’ physical bodies are an integrated feature of the interactions. Finally, this thesis has implications for a clinical audience in terms of extending therapists’ awareness of how engagement with patients is constituted interactionally, which also contributes to wider AN literature on ‘resistance’ to therapy.

Decision support systems (DSS) are traditionally designed to optimise the outcomes of a decision. This thesis explores how DSS design can also be driven by the optimisation of the decision process leading to the decision, and how it may enhance the human uptake and use of DSS. It identifies which tasks could be simplified by decision support, and how to build DSS that are likely to be readily adopted and so improve decision outcomes. It tests the hypotheses that: (a) The analysis of specific process attributes of a given clinical decision task, as well as the information needs of its users, improves the design of DSS and enhances systems?impact and acceptance. (b) The complexity of the decision task is the key process attribute that, in conjunction with the information seeking of users, shapes the outcome of the design process. The work is applied to the domain of antibiotic prescribing in critical care. To explore the first hypothesis, the key attributes of prescribing decisions associated with specific prescribing subtasks and different decision-makers and decision contexts are identified and then analysed. Based on our findings, an information-processing model of decision support for an antibiotic-prescribing task is proposed. The second hypothesis is addressed by applying and comparing metrics for decision complexity including minimum message length, cognitive effort assessment and clinical algorithm structure analysis to the prescribing task. A framework is developed to select clinical decision tasks that may benefit from automation, by characterizing decision support as a process of complexity reduction for users, and these ideas are tested in the context of antibiotic prescribing for ventilator-associated pneumonia. The hypotheses are then tested by applying the task complexity framework to the design of a DSS for antibiotic prescribing in critical care. A web-based experiment and a clinical trial of the DSS are described, both of which study the acceptability and effectiveness of the system and verify the usefulness of the design framework. Specifically, in a before-after controlled trial, with no difference in patient mortality or severity of presentation between the two periods, the use of the DSS was associated with statistically significant improvements in patient outcomes and a reduction in antibiotic usage. The length of stay and total consumption of antibiotics decreased respectively from 7.15 to 6.22 days (P=0.02) and from 1767 to 1458 defined daily doses/1000 patient days (P=0.04). The introduction of a hand-held computer-based DSS was associated with less administration of ???broad-spectrum?antibiotics. The relative impact of the uptake of the DSS on the prescribing quality was quantified. Clinicians chose to use guidelines for one third, and pathology data or the DSS for about two thirds of cases for which they were available to assist their prescribing decisions. When used, the DSS plus pathology data improved the agreement of decisions with those of an expert panel - from 65% to 97% (P=0.002). The impact of the DSS was more significant on prescribing decisions of higher complexity. The level of decision complexity appeared to affect the choice of decision support type. Prescribing guidelines were accessed more often for lower complexity decisions, whereas the infection risk DSS plus pathology data were preferred for decisions of higher complexity. The need for measurement of the effectiveness of a DSS in improving decisions, as well as their likely rate of adoption in the clinical environment, was demonstrated. The thesis concludes with a proposal to apply the framework described to the modelling of the DSS adoption and to include task complexity and user information seeking as determinants of the design and evaluation of clinical DSS.

The purpose of this research was to evaluate the effects of a long-term static stretching program on flexibility and spinal reflexes in the human soleus muscle. Day-to-day reliability over two days of H-reflex gain (Hslp/Mslp) and pre-synaptic inhibition of spinal reflexes in the human soleus was measured in an initial study. Thirty subjects (age=23.4 ± 3.9 yr, height=175.64 ± 10.87 cm, weight=84.5 ± 24.18 kg) with no history of lower leg pathology and/or injury within the previous 12 months volunteered. The slopes of the ascending portions of the H-reflex and M-wave recruitment curves were used to evaluate H-reflex gain (Hslp/Mslp). The mean soleus H-reflex from 10 conditioning stimulations and 10 unconditioned stimulations was used to calculate the amount of pre-synaptic inhibition. Measurements of H-reflex gain and pre-synaptic inhibition yielded test-retest reliability of R=.95 and R=.91, respectively. The contribution of pre-synaptic and post-synaptic reciprocal mechanisms in flexibility adaptations has not been measured during the same study. A long-term static stretching program (5 times per week for 6 weeks) of the soleus implemented within an experimental group of 20 subjects was used as an intervention to measure both spinal control flexibility changes. Additionally, 20 control subjects were measured that did not participate in the stretching program. Passive ankle dorsiflexion, Hmax/Mmax, H-reflex gain (Hslp/Mslp), pre-synaptic and post-synaptic reciprocal mechanisms were measured at baseline, 3 weeks, and 6 weeks for all 40 subjects. A 2 (Group) X 2 (Sex) X 3 (Time) mixed MANOVA with Tukey HSD with (a<0.05) was used. Only ROM had a significant interaction between Group and Time, whereas, a significant difference was not detected in the other dependent variables. The experimental group demonstrated significantly improved dorsiflexion ROM from baseline to 3 weeks (mean=6.2 ± .88, P<0.001), 3 weeks to 6 weeks (mean=4.9 ± .84, P<0.001), and baseline to 6 weeks (mean=11.2 ± .91, P<0.001). Consequently, the increase in flexibility by 42% after 30 stretching sessions was not the result of spinal reflex changes. / Graduation date: 2006