Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p. 47-53).

Thesis (Ph.D.)--University of Cincinnati, 2008. / Includes bibliographical references (leaves 92-102). Also available online.

Resumo: Diversas situações provocam alterações significativas na estrutura óssea, tais como a permanência de astronautas no espaço, imobilizações ortopédicas e permanência prolongada de pacientes em leito. A atividade física é contra medida para a recuperação dessas alterações causadas no sistema ósseo. O objetivo deste estudo foi avaliar a influência da suspensão, do treinamento físico e da movimentação livre, através de análises biomecânicas, densitométricas e histomorfométricas em terço médio de fêmures de ratos. Foram utilizados setenta e cinco ratos machos, distribuídos em cinco grupos experimentais. Destes, dois utilizados como controle CI (21 dias) e CII (42 dias) e três suspensos por 21 dias. Dos suspensos um foi sacrificado logo após a suspensão, S, outro foi submetido a período de atividade física em esteira por 21 dias, SE, e o terceiro à movimentação livre por 21 dias, SL. A análise biomecânica não expressou diferenças significativas nos grupos SE e SL em nenhum dos parâmetros analisados (Força Máxima, Rigidez e Resiliência), já o grupo S apresentou redução significativas em todas as propriedades mecânicas estudadas. Na análise de densidade óssea, pelo Principio de Arquimedes, encontrou-se diferença significativa entre o grupo S e CI e em relação aos grupos SE e SL. Ocorreu diferença entre o grupo SE e SL. Na densidade óssea, pela Densitometria Radiográfica, o grupo S diferiu do CI, SE e SL e não ocorreu diferença entre os grupos SE e SL. A espessura óssea compacta pela análise histomorfométrica não sugeriu diferença significativa entre os grupos analisados. A suspensão de ratos pela cauda provocou reduções importantes nos valores de propriedades mecânicas e densitométricas do osso, o treinamento físico em esteira foi mais eficiente que a movimentação livre apenas na variável de densidade óssea pelo Princípio de Arquimedes. / Abstract: Different situations provoke significant alterations in bone structure. The permanence of astronauts in the space, orthopedics immobilizations and drawn out permanence of patients in stream bed. The physical activity is against measure for the recovery of these alterations caused in the bone system. The objective of this study was to evaluate the influence of the suspension, the physical training and the released movement, through biomechanical, densitometry and histomorphometry analyses in mid third of femurs of rats. Seventy-five male rats were used, distributed in five experimental groups. Of these, two were used as control CI (21 days) and CII (42 days) three were suspended by 21 days. One of the suspended groups, S, was sacrificed soon after suspension, other one was submitted to 21 days treadmill physical exercise, SE, and the third group was submitted to 21 days released walking, SL. The biomechanical analysis did not express significant differences in SE and SL groups in none of the analyzed parameters (Maximum Force, Rigidity and Resilience), the S group presented significant reduction in all the mechanical properties analyzed. In the bone density analysis by Archimedes method, significant difference between group S and CI and in relation to groups SE and SL were found. Differences between group SE and SL occurred. In bone density, by Radiographic Densitometry, group S differed from the CI, SE and SL and did not occur difference between SE and SL groups. The histomorphometry analyses had not suggested significant differences between the analyzed groups. The suspension of rats by the tail provoked important reductions in the values of mechanical properties and densitometry of the bone tissue, the treadmill physical training was more efficient than the released walking only in the variable of bone density by Archimedes Method. / Orientador: Mário Jefferson Quirino Louzada / Coorientador: Luciana Del Rio Pinoti Ciarlini / Banca: Keico Okino Nonaka / Banca: João Cesar Bedran de Castro / Mestre

Orientador: Luciana Patrícia Fernandes Abbade / Resumo: Introdução: A biomembrana produzida com celulose é usada como pele substituta temporária no tratamento de úlceras de difícil cicatrização. Esse estudo avaliou a eficácia e segurança da biomembrana de celulose comparada ao curativo com colagenase para a redução de área de úlceras venosas, durante um período de 90 dias. Método: ensaio clínico controlado, randomizado e aberto com dois grupos de tratamento paralelos - grupo biomembrana de celulose e grupo colagenase – em participantes com úlcera venosa. Os dois grupos receberam terapia compressiva. O desfecho primário foi redução da área da úlcera (em centímetros quadrados) depois de 90 dias de tratamento (T90). Os desfechos secundários foram cicatrização, redução de tecidos desvitalizados, redução de exsudato, angiogênese, mudanças na qualidade de vida e segurança. A análise estatística foi por intenção de tratar e os dados foram analisados utilizando o software SPSS 20.0. Foi considerado significante p<0,05. Resultados: Foram randomizados 46 participantes com 73 úlceras venosas, 21 participantes com 36 úlceras no grupo colagenase e 25 participantes com 37 úlceras no grupo biomembrana. Houve uma redução de área da úlcera no T90 nos dois grupos, sem diferença estatística entre as duas intervenções (p=0,66). Cicatrização completa no T90 ocorreu em sete úlceras no grupo colagenase e 12 úlceras no grupo biomembrana, sem diferença significante (p= 0,20); contudo, a biomembrana promoveu uma maior proporção de cicatrização precoce (p=0... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: A biomembrane produced from cellulose is used as temporary replacement skin in the treatment of ulcers with healing difficulties. This study assessed the efficacy and safety of cellulose biomembrane compared to those of a collagenase dressing in decreasing venous ulcer area during a 90 day period. Methods: controlled, randomized and open clinical trial with two parallel treatment groups - a cellulose biomembrane group and a collagenase group - in participants with venous ulcer. Both groups received compression therapy. The primary outcome was a reduction in ulcer area (square centimeters) after 90 days of treatment (T90). Secondary outcomes were healing status, devitalized tissue reduction, exudate reduction, angiogenesis, quality of life change and safety. The statistical analysis was of intention to treat, and data were analyzed using the software SPSS 20.0. A p<0.05 value was considered significant. Results: We randomized 46 participants with 73 venous ulcers and 21 participants with 36 ulcers in the collagenase group and 25 participants with 37 ulcers in the biomembrane group. There was an ulcer area reduction at T90 in both groups, but the difference was not significant (p=0.66). Complete healing prior to T90 occurred in seven ulcers in the collagenase group and 12 ulcers in the biomembrane group, without a significant difference (p= 0.20); however, the biomembrane promoted a greater proportion of precocious healing (p=0.02). There was improved bed vitality a... (Complete abstract click electronic access below) / Doutor

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting an estimated 1% of the global population. Joint protection is one intervention with some quality evidence of efficacy for RA self-management. However, joint protection education is often provided only in urban centres during Arthritis Self-Management Programs (ASMPs) in classroom sessions at designated times. These programs, therefore, may not be available to all who need them. Providing and testing more accessible methods of delivering joint protection education to people living with RA may improve accessibility. Aims: (i) To develop a virtual world (VW) intervention available via the Internet in Second Life®, that aims to improve the knowledge of joint protection among people with RA and (ii) to undertake a pilot randomised controlled trial (RCT) to assess the feasibility of conducting a subsequent large scale RCT. Methods: First, qualitative interviews with occupational therapists and clients living with RA who had previous experiences teaching or taking arthritis self-management programmes were undertaken and thematically analysed. This analysis informed the design of the VW joint protection education intervention. Second, the intervention was constructed and tested with these same participants. Their feedback helped refine the VW intervention and select assessment tools for the pilot RCT. Third, in a pilot RCT, three primary methods of advertising and invitation were used to recruit subjects: (i) poster invitations with take-home paper copies from clinical settings; (ii) direct messages to Twitter® users living with RA; and (iii) online discussion forums. Participants were recruited after contacting the principal investigator, reading an invitation letter and giving written informed consent. Participants were randomised to intervention or (30-day) waiting list control group, and completed a series of measures. These were completed after 30 days of program access for the treatment group and on enrolment in the study for the control group. Survey completion was online and included piloted knowledge-based questions about joint protection, validated during the second phase of the study with occupational therapists who were experts in joint protection education. A higher score was indicative of better joint protection knowledge. Standardized measures used on the survey included the Arthritis Impact Measurement Scale, Short Form, version II (AIMS2SF) and Pain Self-Efficacy Questionnaire (PSEQ). Results: It was possible to develop a VW education program focused on RA and joint protection based on the content identified by participants in the first part of the study and test with the tools selected. The program developed included input from client users, following the theorectical basis of occupational therapy as a client-centred practice. Additionally, the program developed applied principles of adult-learning and the recommendations of existing programs regarding chronic disease management. Recruitment of 50 participants for the pilot RCT was challenging, taking 6 months with low response rates for all three methods. The poorest response rates were to poster and paper invitations in clinical settings. The most effective means of recruitment was via electronic bulletin boards, such as blogs. All subjects, once randomised to the control or intervention group completed the online questionnaire. However, adherence to the intervention was poor; only 15 out of 25 randomised reported using the program. On the other hand, all 15 who used the program indicated that this medium was acceptable to learn about joint protection, despite 5/15 of these subjects reporting some difficulty accessing the program. All participants completed the three questionnaires (knowledge, impact, pain self-efficacy) and these may be useful in a definitive RCT. Although the main purpose of using Intention to Treat Analysis in pilot studies is to practice and check that analysis is feasible, there was a positive statistically significant difference between the treatment (x̄=52.8%) and control (x̄=24%) group scores on a test of joint protection knowledge using an independent samples t-test (F value, 20.8 p < 0.05) comparing joint protection knowledge scores after the treatment group had access to the program for 30 days. A higher score was indicative of better joint protection knowledge. The difference between the two groups was considerable, with the intervention group score mean being more than double that of the control group. Given the magnitude of this difference between groups, a smaller difference between groups would also be worth finding. The difference between groups for the AIMS2SF and PSEQ were not statistically significant using an independent samples t-test (F values, 0.5 and 0.2) but there was some suggestion that the intervention group scored more favourably on some of the subscales more relevant to joint protection on both the AIMS2SF and PSEQ, particularly noteworthy was a higher score pertaining to ability to carry out work on both measures. In a definitive trial a sample size of 1250 participants would give 80% power to find a difference of 28.8% on joint protection knowledge, weighted score of 1.8 on the AIMS2SF and overall score of 1.8 on the PSEQ at 5% level of significance. Smaller samples would be required if the PSEQ was dropped as a measure in a future study. Sample sizes of 14 and 558 would be required for the joint protection knowledge and AIMS2SF respectively at the same level of power and significance. Conclusion: A VW intervention to improve joint protection knowledge has been developed and is worth testing further. The intellectual contribution of the creation of this program using this methodology is that an occupational therapy based study using client input and priniciples of adult learning to create the intervention has been conducted, applying client-centred practice in research, which is, in reality, present in a minority of studies at this time. A full RCT would be feasible, though very challenging, given the numbers of subjects required for recruitment, most likely recruiting via the Internet on relevant RA focus sites, such as RA bloggers, and using the same outcome measures as in this study. A sample size of 1250 could feasibly be recruited in 36 months if a full time study were undertaken with suggestions discussed to assist with future study recruitment. However, given the number of study dropouts at enrolment seen in this study, close to double this number would be needed, entailing a recruitment period of up to 72 months, or 6 years, making a full RCT less practical. A future study may need to consider either a longer enrolment period, different outcome measures as well as address the limitations of this study, including the limited time of enrolment in this pilot RCT. However, longer enrolment duration would increase the amount of time required for a future full RCT, reducing the feasibility of a future study. Findings from this study indicate that the program developed would likely to be useful to people who are not able to access the urban centred classroom based program. On the other hand, those participants who used the program incurred no costs, appeared to have no risks or detrimental impact with possible improvement in knowledge and self-efficacy. Now the intervention has been developed, refinement, maintenance, and use is low cost for service providers, so it could be used routinely now for those who prefer it to ASMPs with an ongoing preference trial.

abstract: An ever expanding body of research has shown that children of divorce are at increased risk for a range of maladaptive outcomes including academic failure, behavior problems, poor psychological adjustment, reduced self-concept, and reduced social competence (Amato, 2001). Furthermore, the widespread prevalence of divorce makes preventing these poor outcomes a pressing public health concern. The Children of Divorce-Coping with Divorce (CoD-CoD) program is an internet-based selective prevention that was derived from recent research identifying modifiable protective factors in children of divorce including active and avoidant coping, divorce appraisals, and coping efficacy. CoD-CoD addresses these putative mediators through careful adaptation of intervention components previously demonstrated to be effective for children from disrupted families (Pedro-Carroll & Alpert-Gillis, 1997; Stolberg & Mahler, 1994; Sandler, et al., 2003). In the CoD-CoD efficacy trial, 147 children ages 11-16 whose family had received a divorce decree within 48 months of the intervention start date served as participants. Participants were assessed in two waves in order to test the small theory of the intervention as well as the interventions effects on internalizing and externalizing behaviors. Analyses indicated that the program effectively reduced the participants total mental health problems and emotional problems as reported on the Strengths and Difficulties Questionnaire (SDQ) (d = .37) and for total mental health problems this effect was stronger for children with greater baseline mental health problems (d = .46). The program also had mediated effects on both child and parent-reported total mental health problems whereby the program improved coping efficacy for children with low baseline coping efficacy which led to reduced parent-reported mental health problems. To the author's knowledge this is the first randomized controlled trail of internet-based mental health program for children or adolescents which utilizes an active control condition. / Dissertation/Thesis / Ph.D. Psychology 2011

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Background: Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. We assessed factors of early terminated/withdrawn oncology trials focusing on trials with immune checkpoint inhibitors (ICI), hypothesizing that the latter may be associated with lower rates of premature discontinuation. Materials and Methods: We reviewed all adult, intervention, oncology trials registered in ClinicalTrials.gov (November 16, 2011, to April 16, 2015) to identify all terminated/withdrawn trials and reasons for termination. Logistics regression model was used to identify factors associated with early termination/withdrawal. Discontinuation rate was compared in trials with and without ICI. Results: We identified 12,875 trials (35% industry funded, 12% federal funded), of which 8.5% were prematurely terminated (5%) or withdrawn (3.5%); the main reasons were poor accrual (33%) and logistical (24%). ICI trials (n = 350) had a nonsignificant lower rate of termination or withdrawal compared with all other oncology trials (5.4% vs. 8.5%; p =.9) and were less likely to discontinue due to poor accrual (nonsignificant difference: 21% vs. 33%; p =.4). ICI trials were also less likely to discontinue compared with all other oncology drug trials (e.g., chemotherapy, targeted inhibitors, antiangiogenesis, biologics; 5.4% vs. 7.9%, respectively, nonsignificant difference). The 4-year cumulative incidence of failing to complete for reasons unrelated to toxicity or efficacy was 18% (95% confidence interval 16%–20%). There was no association between annual incidence across different tumor types or accrual goal and rate of trial termination. Conclusion: Poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in ICI compared with other trials. Clinical trial completion remains a high priority and can be influenced by provider and patient factors. Implications for Practice: Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. This study assessed factors of early terminated/withdrawn oncology trials, focusing on trials with immune checkpoint inhibitors (ICI), and found that poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in immune checkpoint inhibitor trials compared to other trials. The discussion herein is focused on measures taken by the National Cancer Institute and other institutions to improve clinical trial accrual and prevent premature clinical trial discontinuation. / Revisión por pares

En théorie des organisations, une conception dominante étudie la construction de l’identité individuelle lors d’événements majeurs de l’existence. En contrepoint, suivant une approche processuelle, nous cherchons à mieux comprendre la construction identitaire en situation de travail. Pour opérationnaliser la notion de situation, nous empruntons le concept d’épreuve au sociologue Danilo Martuccelli. Nous réalisons une étude de cas multiples. 29 récits d’épreuves de gestion de collaborateurs en détresse sont collectés via 45 entretiens auprès de 24 managers et plusieurs journées d’observation. Au travers de l’analyse approfondie de quatre cas choisis pour leur intérêt intrinsèque et d’une analyse inter-cas, nous faisons émerger trois grands types de dynamiques identitaires. Ces dynamiques sont ensuite regroupées dans une modélisation de la construction identitaire en situation capable d’intégrer simultanément divers degrés de changement et de maintien identitaire. Nous montrons ainsi que l’apparente stabilité de l’identité dissimule un processus permanent de reconstruction de soi indissociables de la réalisation des tâches du travail quotidien / Previous work about identity construction in management studies has focused on a stable individual identity that only evolves with major events. Conversely, this research aims to explore a more situated identity construction in front of day-to-day working activities. We borrow Danilo Martuccelli’s concept of trial in order to operationalize what a situation is. Through a multiple qualitative case study, we analyse 29 narratives of managers’ trial of their subordinates’ distress. These data were collected through 45 semi-structured interviews with managers and several days of observation inside one organization. Our analysis emcompasses the in-depth presentation of four cases and a global comparative analysis of the 29 narratives. Our findings are composed of the identification of three main dynamics of identity construction. Finally, we offer an integrative processual representation of identity construction during work situations. We show that the underlying stability of identity is better conceived as the result of an ongoing process of identity (re)construction

OBJECTIVE: The aim of this study was to investigate the safety and tolerability of a novel anti-folate drug, pemetrexed, in the setting of a phase I clinical trial in patients with non-HIV related central nervous system lymphoma (CNSL). METHODS: In this multicenter, open-label, phase I dose finding clinical trial, pemetrexed was investigated as a single agent treatment for primary or secondary CNSL. RESULTS: A total of 18 patients were enrolled between January 2009 and November 2014. The mean age was 64.6 years old (range: 47-79). The ratio of male to female was 1:1. One out of six patients experienced a dose limiting toxicity (DLT) at dose level 1 (600mg/m2). There were no DLTs among the four patients enrolled at dose level 2 (900m/m2). Two of six patients experienced a DLT at dose level 3 (1200mg/m2). The MTD was therefore determined to be 900mg/m2. Overall, pemetrexed was well tolerated but toxicities were seen and need to be monitored. All patients experienced at least one type of toxicity of any grade. Most patients (92.9%) experienced at least one type of neurological toxicity. Grade-3 toxicities included confusion, speech impairment, and psychosis. Twelve patients (85.7%) experienced at least one bone marrow type of toxicity of any grade. These toxicities included anemia (78.6%), thrombocytopenia (57.1%), neutropenia (50%), leukocytopenia (42.9%), and lymphopenia (42.9%). Four patients experienced either grade-3 (14.3%) or grade-4 (14.3%) neutropenia. Three patients experienced grade-3 leukopenia (21.4%). One patient experienced grade-3 lymphopenia (7.1%) and two patients experienced grade-4 lymphopenia (14.3%). Twelve patients (85.7%) experienced at least one metabolic type of toxicity of any grade. A majority of these were also grade-1 or 2, with the exception of hypophosphatemia (grade-4), hyperglycemia (grade-3) and increased ALT (grade-3), increased AST (grade-3) and increased creatinine phosphokinase (CPK) (grade-4). Constitutional and gastrointestinal symptoms were seen in >60% of patients. These consisted mainly of fatigue, constipation, nausea, and anorexia. Musculoskeletal symptoms were seen in greater than 60% of patients. Less common adverse events included pain (<60%), infection (<40%), dermatologic, ocular/visual, and pulmonary/upper respiratory (<30%). The average number of cycles on treatment for all patients was 5.5 cycles. 14 patients were evaluated for response to treatment by neuroimaging (MRI) while on treatment. Of these, four patients (28.6%) showed a complete response (CR). Of those patients, 2 patients achieved this response after only 2 doses, and 2 patients after a total of 8 doses. 5 patients (35.7%) showed a partial response (PR) and four patients (28.6%) achieved stable disease (SD). The overall response rate (ORR) was determined at 92.9% (SD, PR and CR combined). CONCLUSIONS: Given this data, pemetrexed is a powerful drug and feasible alternative to existing treatment options; however, certain toxicities need to be closely monitored. Further studies are needed to assess the efficacy of pemetrexed in a larger cohort of patients with CNSL.

The aim of this diploma thesis was to analyse waste water quality from RAS, verification of its possible cleaning in a model of wastewater treatment plant using heterotrophic bacteria, experimentally compare the influence of used carbon source in the initial phase of bacteria cultivation and evaluation of biofloc usage in fish feed. Analysed water was obtained from rearing tanks, sewage water from mechanical filtration and tap water for filling the system. Wastewater treatment plant (built according to AS VARIOcomp K model) was divided into 3 parts (primary settling, activated part, secondary settling) and then filled with water from running BFT system. For carbon source comparing experiment 4 groups were used: flour, glucose, acetate and glycerol, each in 3 replications. Cultivation took 28 days and at the end the nutritional composition of each BFT system was evaluated. Water analyses showed that sewage water from mechanical filtration is nutrient rich and contain big amount of undissolved solids. This water is not suitable for purification in conventional system without pre-treatment. The model of water treatment plant purified approximately 50 l of water from vortex per day which was pumped back into RAS. Probably it would be capable of purifying bigger volume. Bacteria cultivation using different carbon sources is very similar to start-up of nitrifying bacteria in biofilter at the beginning. It was proved that biofloc is also capable of removing nitrates from water. The biggest measured concentration among groups was 1695 +- 438 mg.l-1 NO3- and in 6 days it decreased to 493 +- 409 mg.l-1. The average FVI for flour, glucose, acetate and glycerol were 102 +- 57; 267 +- 59; 219 +- 26 and 293 +- 9 ml.l-1 at the end of cultivation. Experiment comparing carbon sources also proved that nutritional composition of biofloc is similar to composition of commercial feed. Heterotrophic bacteria are also capable to cumulate heavy metals and mineral matter over time. Experiment with added biofloc to feed in amount 0 %, 25 % and 50 % did not show any statistically significant differences (p < 0,05) on survival rate, FCR and SGR between the groups of juvenile grass carp (Ctenopharyngodon idella).