Cholinergic input to, and cholinergic mechanisms within the lower lumbar (L6) and upper sacral (S1) spinal cord of rat may influence neuronal excitability and afferent transmission (Thor et al, 2000) and may provide the environment necessary for appropriate central nervous system control of bladder and bowel function. It is unclear, however, if cholinergic terminals and receptors are present in the L6 & S1 spinal segments of rat and when this may develop. Cholinergic mechanisms have been shown to alter sensory afferent transmission, enhance motoneuron excitability, induce plateau potentials via non-linear membrane properties in motoneurons and reveal oscillations in locomotor-related interneurons. The enhanced activity of sphincter motoneurons was attributed to non-linear properties during the continence phase of distention-evoked voiding in the decerebrate cat (Paroschy & Shefchyk, 2000). Candidate neurotransmitters inducing non-linear properties in cat sphincter motoneurons are 5-HT (Paroschy & Shefchyk, 2000) and acetylcholine via motoneuron axon collaterals (Sasaki, 1994) and other spinal sources. We have established using the antibody to the vesicular acetylcholine transporter (VAChT) that cholinergic terminals are present on ventrolateral Onuf (VLO), dorsomedial Onuf (DMO) motoneurons and parasympathetic preganglionic motoneurons (PGN) in the L6 and S1 rat spinal cord segments. Muscarinic receptor (M2), nicotinic-α4 and α7 receptor subunit immunoreactivity was also present on Onuf motoneurons and in regions dorsal to the PGN. One source of the cholinergic puncta on Onuf motoneurons may be from motoneuron axon collaterals which we observed on a postnatal day 15 VLO motoneuron. Cholinergic terminals were observed on vasoactive intestinal polypeptide-immunoreactive (VIP) afferents, interneurons in the intermediolateral (IML) region and perhaps on other afferents in the lateral and medial collateral pathway of L6 and S1 spinal segments. In the ventral horn, the cholinergic puncta and receptors appear to have a mature distribution around two weeks postnatal and the cholinergic terminals appeared to have a mature distribution in the IML region by three weeks postnatal. Using whole cell patch clamp recording techniques and thick slices of the L6 and S1 rat spinal cord, we observed excitatory responses of ventral horn neurons and motoneurons to carbachol (10-50 μM), a non-specific cholinergic agonist. Ventral horn neurons (postnatal day 8- 16) exhibited prolonged firing and prolonged depolarizations (plateau potentials) beyond the duration of the applied excitatory input from cholinergic (n=6/33) and other (n= 4/37) neurotransmitter systems. In a selection of the neurons with plateau potentials, the L-type calcium current played a role in the plateau production (n=5/5) and low frequency oscillations (n=2/2) as revealed by nifedipine. Postnatally, the voiding reflex changes from a perineal-evoked reflex, to the adult bladder-bladder reflex. Cholinergic input may be responsible in part for the bursting activity of the external urethral sphincter and the activation of the bladder, which is required for complete voiding reflexes in the adult rat. Plateau potentials and enhanced excitability due to cholinergic mechanisms could render inessential a constant excitatory drive that is required in the perineal-evoked voiding reflex in the neonatal rat and may underlie changes in the voiding reflexes that occur during postnatal development.

Abstract The aims were to evaluate the occurrence of vesicoureteral reflux (VUR) in children, to assess the frequency of significant ultrasonography (US) abnormalities and to study whether abandoning the use of voiding cystourethrographies (VCUG) is safe in children with urinary tract infection (UTI). We analysed reports on US and VCUG in a consecutive series of 406 paediatric patients and in a large population-based group of 2036 children with UTI. Based on the urine culture data, we analysed the frequencies of VUR and US abnormalities in relation to the reliability of the UTI diagnoses. Using a cohort of 1185 children on whom both VCUG and US had been performed, we evaluated whether US imaging alone is sufficient. In a follow-up study, we excluded 24 cases with major renal dysplasia or obstruction of the urinary tract from this cohort of 1185 children leaving a series of 1161 cases, of which 228 were randomly selected for follow-up and 193 (85%) participated, with a mean follow-up time of 11 years (range 6 to 17 years). The occurrence of VUR was similar among the children with proven (37%) or certain (36%) versus false (35%) or improbable (36%) UTI and decreased with increasing age. Significant US abnormalities were found in 10% and the frequency increased as the diagnostic reliability improved (15% in the proven UTI class and 8% in the false class). In the cohort of 1185 children, initial US was normal in 861 (73%), out of whom VCUG identified two cases of urethral valves and 40 cases of grade III to V VUR who could have benefited from surgical treatment, giving a figure of 42/861 (5%) for pathological findings that might have been missed if VCUG had not been performed. In the follow-up study, unilateral renal parenchymal defect was found in 22 (15%) out of the 150 patients who underwent control US, all except one of these being in patients with grade III to V VUR. Serum cystatin C concentration, estimated glomerular filtration rates and blood pressure were within the normal ranges in all the patients despite the defects seen in US. We conclude that VUR is a common age-related phenomenon in children and is not as closely associated with UTI as was previously thought. Children with UTI could be examined using US alone. Once obstructive uropathy and major renal dysplasia have been ruled out, the risk of long-term consequences in a case of childhood UTI is very low. / Tiivistelmä Tutkimuksen tavoitteena oli selvittää virtsan takaisinvirtauksen (vesikoureteraalinen takaisinvirtaus, VUR) esiintyvyyttä lapsilla sekä arvioida merkittävien virtsateiden rakennepoikkeavuuksien yleisyyttä ja ultraäänitutkimuksen (UÄ) riittävyyttä virtsatieinfektion (VTI) sairastaneilla lapsilla. Analysoimme sairastetun VTI:n vuoksi tehtyjen UÄ- ja miktiokystografiatutkimusten löydökset 406 lapsen potilassarjassa ja 2036 lapsen väestöpohjaisessa aineistossa. Virtsaviljelytulosten pohjalta luokittelimme potilaat VTI-diagnoosin luotettavuuden mukaan. Väestöpohjaisen aineiston 1185 lapselle oli tehty sekä UÄ-tutkimus että miktiokystografia, ja tässä kohortissa arvioimme pelkän UÄ:n riittävyyttä virtsateiden kuvantamisessa. Seurantatutkimusta varten 1185 lapsen kohortista jätimme pois 24 potilasta, joilla oli todettu munuaisdysplasia tai virtsateiden virtauseste. Jälkitarkastukseen kutsuimme tästä 1161 potilaan tutkimusaineistosta ryväsotannalla 228 potilasta, joista 193 (85 %) osallistui. Keskimääräinen seuranta-aika oli 11 vuotta (vaihtelu 6–17 vuotta). Tutkimuksemme mukaan VUR on yleinen myös lapsilla, jotka eivät ole sairastaneet varmennettua VTI:ta. Näillä lapsilla VUR:n esiintyvyys oli 35–36 %, joka oli sama kuin varman VTI:n sairastaneilla (36–37 %), ja esiintyvyys väheni merkittävästi iän myötä. Merkittävä UÄ-poikkeavuus todettiin kaikkiaan 10 %:lla, ja riski oli suurin varman VTI:n sairastaneilla. 1185 lapsen kohortissa UÄ-tutkimus oli normaali 861:lla (73 %). Miktiokystografiassa heistä 42/861:lla (5 %) löydettiin merkittävä virtsatieanomalia (n = 2) tai VUR, joka oli hoidettu kirurgisesti (n = 40). Jälkitarkastuksessa 22:lla (15 %) UÄ:llä tutkitusta 150 potilaasta todettiin toispuoleinen munuaisarpi, ja yhtä tapausta lukuun ottamatta arvet löytyivät niiltä, joilla oli lapsena ollut III−V asteen VUR. Todetuista munuaisarvista huolimatta kaikilla seurantatutkimukseen osallistuneilla potilailla oli normaali munuaisten toiminta ja verenpaine. Aiemmasta käsityksestä poiketen VUR näyttäisi olevan yleinen, kasvun myötä häviävä ilmiö myös terveillä lapsilla. Virtsatieinfektion sairastaneilla lapsilla UÄ-tutkimus riittää virtsateiden kuvantamiseen ja kun synnynnäinen munuaisdysplasia ja virtsateiden virtauseste on poissuljettu, riski merkittäviin myöhäiskomplikaatioihin on hyvin pieni.

Urofacial syndrome (UFS; MIM# 236730) is a rare autosomal recessive condition characterised by urinary bladder and bowel voiding dysfunction with a pathognomonic abnormality of facial movement with expression. UFS can be caused by biallelic putative loss-of-function mutations in HPSE2, which encodes heparanase 2. Failure to discover HPSE2 mutations in all cases of UFS suggests genetic heterogeneity. The urinary tract features of UFS overlap those seen in the spectrum of non-syndromic non-neurogenic voiding dysfunction and vesicoureteric reflux (VUR). This overlap suggests there may be some aspects of pathogenesis in common. The project aimed to define the genotypic and phenotypic spectrum associated with mutations in HPSE2 by Sanger sequencing and multiplex ligation-dependent probe amplification (MPLA) in newly referred cases of UFS and making comparison to a review of mutations and phenotypes seen in the literature. This work discovered five further families with HPSE2 associated UFS increasing known mutations whilst, reinforced that this is an under-recognised condition and emphasised the previously under-reported feature of facial weakness. The failure to discover HPSE2 mutations in all cases referred provided further evidence of genetic heterogeneity. The project also aimed to discover further genes associated with UFS. Autozygosity mapping and whole exome sequencing was carried out in cases of UFS without mutations in HPSE2. This led to the recognition that UFS is also caused by biallelic putative loss-of-function mutations in LRIG2 encoding the leucine-rich repeats and immunoglobulin-like domains 2 (LRIG2) protein in three families. Failure to identify LRIG2 mutations in all HPSE2 negative families suggests further genetic heterogeneity. To address the question of whether the pathogenesis of UFS overlaps more common conditions with a similar spectrum of urinary tract abnormalities I aimed to examine whether pathogenic variants in HPSE2 and LRIG2 were seen in these phenotypes. Unexpectedly this led to the discovering of further families affected by UFS but failed to show an association of variants in UFS genes with non-syndromic urinary tract abnormalities. However, variants of potential interest were discovered. As part of work toward understanding the pathogenesis of UFS and designing a model to test the pathogenesis of sequence variants expression studies in a Xenopus tropicalis hpse2 knock-down model of UFS were carried out. The knock-down model provided valuable insight in to the likely pathogenesis of UFS with evidence pointing towards a congenital peripheral neuropathy with failure of correct nerve path finding. Understanding the pathogenesis of UFS has the potential to direct further research in to therapeutic intervention.

No description available.

Bakgrund: Bäckenbottendysfunktion innebär onormal funktion i bäckenbottenmuskulaturen som orsakas av ökad eller minskad muskeltonus och nedsatt koordination av bäckenbottenmusklerna.  Det innefattar flera olika funktionella problem och delas upp i urologiska, gynekologiska eller kolorektala. Biofeedback är en apparat som kan användas som ett tillägg till vanlig bäckenbottenträning. Den är till för att lära sig använda rätt teknik och kontrollera och identifiera rätt muskler. Man kan använda biofeedback till att träna styrka, uthållighet, koordination samt avslappning. Syfte: Undersöka effekten av bäckenbottenträning med biofeedback på blås- och tarmtömningsbesvär (utöver urin- och fekalinkontinens), livskvalitet och sexuell funktion jämfört med bäckenbottenträning utan biofeedback/sedvanlig behandling/ingen träning alls. Metod: Systematisk litteraturstudie med databaserna PubMed och Web of Science. Studiernas kvalitet granskades med PEDro och resultatets tillförlitlighet granskades enligt Uppsala Universitets Fysioterapeutsprograms bedömningsmall för systematiska översikter.  Resultat: Sju randomiserade kontrollerade studier inkluderades. Alla studier visade signifikant förbättring hos interventionsgrupperna. Fyra studier undersökte tömningssvårigheter, tre undersökte livskvalitet och två studier undersökte sexuell dysfunktion. Fem studier undersökte biverkningar av biofeedback utan fynd. Alla studier hade god kvalitet enligt PEDro, men samtliga visade på mycket låg tillförlitlighet (+) enligt Uppsala Universitets Fysioterapeutsprograms bedömningsmall för systematiska översikter. Konklusion: Det tyder på att bäckenbottenträning med biofeedback har positiv effekter på blås- och tarmtömningssvårigheter, livskvalitet och sexuell funktion hos personer med bäckenbottendysfunktion. Inga fynd av biverkningar av bäckenbottenträning med biofeedback hittades. Studierna hade god kvalitet enligt PEDro och dess sammanvägda resultat hade mycket låg tillförlitlighet (+). Resultatet bör därför tas med försiktighet och fler randomiserade kontrollerade studier behövs för att kunna dra några slutsatser. / Background: Pelvic floor dysfunction means abnormal function of the pelvic floor muscles caused by increased or decreased muscle tone and reduced coordination of the pelvic floor muscles. It includes several different functional problems such as urological, gynecological or colorectal. Biofeedback is a device that can be used as an addition to regular pelvic floor training. It helps people to use the right technique and to control and identify the right muscles. Biofeedback can be used to train strength, endurance, coordination and relaxation. Objective: Investigate the effect of pelvic floor training with biofeedback on bladder- and bowel voiding difficulties (except for urinary- and fecal incontinence), quality of life and sexual function compared to pelvic floor training without biofeedback/usual care/no training. Method: Systematic literature study which used the databases PubMed and Web of Science. The quality of the studies was reviewed using PEDro and the reliability of the results were reviewed according to Uppsala University's Physiotherapy program assessment template for systematic reviews. Results: Seven randomized controlled trials were included in this study. All studies showed significant improvement in the intervention groups. Four studies examined voiding difficulties, three examined quality of life and two studies examined sexual dysfunction. Five studies investigated side effects of biofeedback with no findings. All studies had good quality according to PEDro, however all showed very low reliability (+) according to Uppsala University's Physiotherapy program assessment template for systematic reviews. Conclusion: It indicates that pelvic floor training with biofeedback has positive effects on bladder- and bowel voiding difficulties, quality of life and sexual function in people with pelvic floor dysfunction. There are no findings of side effects of pelvic floor training with biofeedback. The studies were of good quality according to PEDro and their combined results had very low reliability (+). The result should therefore be taken with caution and more randomized controlled trials are needed to reach more reliable conclusions.

Depuis plus de 50 ans, l’industrie de la microélectronique ne cesse d’évoluer afin de répondre à la demande d’augmentation des performances ainsi que des fonctionnalités des composants, tout en diminuant les tailles et les prix des produits. Cela est obtenu à ce jour principalement par la réduction des dimensions des composants électroniques. Cependant les dimensions actuelles des transistors atteignent une limitation physique et de nombreux effets parasites émergent. Il devient évident que dans un avenir très proche cet axe de développement ne sera plus envisageable. L’intégration tridimensionnelle apparaît alors comme une solution très prometteuse face à cette problématique de miniaturisation. Cette architecture permet la réalisation de composants plus performants tout en augmentant les fonctionnalités de ces derniers. Son concept consiste à empiler différents circuits de natures éventuellement différentes puis de les interconnecter électriquement à l’aide de connexions verticales. Le collage direct métallique permet en ce sens d’assembler mécaniquement et électriquement deux circuits l’un sur l’autre. Le but de ce travail de thèse est d’étudier le comportement électrique du procédé de collage direct métallique avant de l’intégrer dans un composant actif. On retrouve dans la première partie de ces travaux, la description du jeu de masque ainsi que les intégrations technologiques utilisées, pour réaliser les démonstrateurs 3D permettant les différentes caractérisations électriques de ces interconnexions métalliques. L’évolution de la résistance spécifique de l’interface de collage a été investiguée en fonction de la température de recuit. Puis, la fiabilité électrique de ces interconnexions a été étudiée en analysant leurs comportements face aux risques de dégradation induits par électromigration ou sous contrainte thermique. Des études physico-chimiques ont permis d’analyser les défaillances et de proposer des mécanismes. Pour finir, dans une dernière partie, les étapes technologiques nécessaires à une intégration 3D haute densité type puce à plaque ont été développées et caractérisées. / During 50 years, semiconductor technology has been evolving in exponential rates in both productivity and performance. By following a steady technological path that consists in scaling down transistors and increasing electronic components density, the semiconductor industry was able to meet the increasing demand in high performance, low power consumption and low cost devices. However by constantly shrinking devices geometries and increasing functionalities, semiconductor industry is facing physical limitations in addition to more and more overwhelming parasitic effects. Since further miniaturisation would be made impossible in a near future, 3D integration appears as a promising approach to go beyond planar integration possibilities. This approach allows high performances and various functionalities compounds achievements. 3D integration consists on various chips stacking with vertical and electrical interconnects. The metallic direct bonding offers strong mechanical bond with a good electrical conductivity between the two bonded circuits. In this work, electrical behaviours of bonded devices achieved by direct bonding are studied. First, the various structures layout used in this study and the process flow integration for the 3D demonstrator are described. Then, electrical characterization of metallic interconnects are performed. Measurements and results are reported and discussed concerning the study of resistance evolution of the bonding interface during anneal. And the investigation of the bonded devices behaviours facing the risk of reliability issues on Cu-Cu direct bonded interconnects are achieved by addressing electromigration items and several thermal stress tests as stress voiding or thermal cycling. Finally, physical characterizations enabled failure mechanisms analysis and identification. technological steps required for a chip to wafer integration using direct bonding process has been developed and studied during this work. Results are given at the end of this report.

Det overordnede målet med denne avhandling var å få en oversikt over ulike forstyrrelser i de nedre urinveier hos gamle. Dernest var målet å beskrive oppfatninger og barrierer som influerte på personalets muligheter for å gi riktig inkontinenspleie til beboere i sykehjem. Avhandlingen består av en kvantitativ studie (artikkel I, II, III), og en kvalitativ studie (artikkel IV). Artikkel I var en tverrsnittstudie. Artikkel II og III var en prospektiv tidsdesignstudie med en oppfølgingsperiode på ett år. 183 beboere fra seks sykehjem deltok i den kvantitative studien. I artikkel I ble prevalensen av urininkontinens hos norske sykehjembeboere evaluert. I tillegg ble det forsøkt å identifisere faktorer som var assosiert med urininkontinens i denne populasjonen. I artikkel II ble det undersøkt om residualurin var en risiko for å utvikle urinveisinfeksjon hos gamle på sykehjem. I artikkel III ble det undersøkt om bleiebruk per døgn er en pålitelig metode for å kvantifisere urininkontinens hos sykehjemsbeboere. Det ble også studert om det var sammenheng mellom urinveisinfeksjon, bleiebruk per døgn og væskeinntak. I den kvalitative studien var målet å identifisere oppfatninger og barrierer som influerte på pleiernes muligheter for å gi riktig inkontinenspleie. Fem avdelingsledere, fem sykepleiere og fem hjelpepleiere ble intervjuet i til sammen tre fokusgruppeintervjuer.Analysen i artikkel I viste at 122 beboere (69 %) var inkontinent for urin og 144 (83 %) brukte bleier. 14 % brukte bleier for sikkerhets skyld. Lav ADL-skår, demens og urinveisinfeksjon var assosiert med urininkontinens (P = <0.01). I artikkel II hadde 98 beboere (63.3 %) residualurin mindre enn 100 ml, og 52 (34.7 %) hadde residualurin på 100 ml eller større. I løpet av oppfølgingsperioden hadde 51 beboere (34 %) utviklet en eller flere urinveisinfeksjoner. Forekomsten av urinveisinfeksjon var høyere hos kvinnene enn hos mennene (40.4 % versus 19.6 %; P = 0.02). Det ble ikke funnet noen signifikant forskjell i gjennomsnittlig residualurin mellom beboere som utviklet og som ikke utviklet urinveisinfeksjon (79 versus 97 ml, P = 0.26). Residualurin på 100 ml eller større var ikke assosiert med større risiko for utvikling av urinveisinfeksjon.I artikkel III brukte 118 (77 %) av beboerne bleier. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Beboere som brukte bleier hadde en økende risiko for å utvikle urinveisinfeksjon sammenlignet medvibeboere som ikke brukte bleier (41 versus 11 %; P = 0.001). Daglig væskeinntak var ikke assosiert med urinveisinfeksjoner (P = 0.46). Antall bleieskift viste ingen korrelasjon med risikoen for utvikling av urinveisinfeksjon (P = 0.62). Bleiene som beboerne brukte per døgn, viste stor variasjon i inkontinensvolum. I den kvalitative studien ledet innholdsanalysen fram til tre emner og åtte kategorier. Det første emnet, Oppfatninger og barrierer assosiert med beboerne, inneholdt en kategori ”fysiske og kognitive problemer”. Det andre emnet, Oppfatninger og barrierer assosiert med personalet, inneholdt tre kategorier: ”manglende kunnskaper”, ”holdninger og tro” og ”manglende tilgjengelighet”. Det tredje emnet, Oppfatninger og barrierer assosiert med den organisatoriske kulturen, inneholdt fire kategorier: ”rigide rutiner”, manglende ressurser”, ”manglede dokumentasjon” og ”svakt lederskap”. Resultatene i denne avhandlingen viser at forekomsten av urininkontinens i sykehjem er høy. Absorberende produkter er hyppig brukt uten en kjent historie av urininkontinens. Fysisk svekkelse, demens og urinveisinfeksjon er assosiert med urininkontinens. Residualurin er vanlig hos beboere i sykehjem. Det ble ikke funnet noen sammenheng mellom residualurin og urinveisinfeksjon. Bruk av absorberende bleier er assosiert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn og væskeinntak var ikke korrelert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Funnene fra den kvalitative studien viser at det er mange barrierer som influerer på personalets evne til å gi riktig inkontinenspleie til beboere i sykehjem. Det kan likevel se ut som om personalets oppfatninger og holdninger, samt manglende kunnskaper om urininkontinens, er de viktigste barrierene for å gi riktig inkontinenspleie. / The overall aim of this thesis was to get an overview over different dysfunction in the lower urinary tract in the elderly. Also, we wanted to describe the perceptions and barriers that influence the nursing staff`’s ability to provide appropriate incontinence care in nursing home residents. The thesis includes one quantitative study (paper I, II, III), and one qualitative study (paper IV). Paper I was a cross-sectional study. Paper II and III were a prospective surveillance with a follow-up period of 1 year. 183 residents from six Norwegian nursing homes participated. In paper I, the prevalence of urinary incontinence in Norwegian nursing home residents was evaluated. The factors possibly associated with urinary incontinence were also studied. In paper II, we investigated whether residual urine was a risk factor for developing urinary tract infections in the elderly in nursing homes. In paper III, the objective was to determine whether pads per day usage is a reliable measure of urinary incontinence in nursing home residents. Furthermore, we wanted to study the association between urinary tract infections, pads per day usage and fluid intake. In the qualitative study, the aim was to identify perceptions and barriers that influence the ability of nursing staff to provide appropriate incontinence care. Five charge nurses, five registered nurses and five certified nursing assistants participated in the focus group interviews.The analysis in paper I, showed that 122 (69 %) of the resident were incontinent for urine and 144 used absorbent pads (83 %). 14 % of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine (P = <0.01). In paper II, 93 of the residents (65.3 %) had postvoid residual urine (PVR) < 100 mL and 52 residents (34.7 %) had a PVR 100 mL. During the follow-up period, 51 residents (34.0 %) had one or more urinary tract infections (UTI). The prevalence of UTI among females was higher than among men (40.4 % versus. 19.6 %; P = 0.015). There was no significant difference in mean PVR among residents that did or did not develop UTI (79 mL versus 97mL; P = 0.26). A PVR 100 mL was not associated with an increased risk of developing UTI`s (P = 0.59).In paper III, 118 (77 %) used absorbent pads. Residents that used absorbent pads were at increased risk of developing UTIs compared to residents that did notviiiuse pads (41 % versus 11 %; P = 0.001). Daily fluid intake was not associated with UTIs (P = 0.46). The number of pad shifts had no relation with the risk of developing UTIs (P = 0.62). Residents with a given pad per day (PPD) presented a wide range of incontinence volumes.In paper IV, three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: ‘physical and cognitive problems’. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: ‘lack of knowledge’, ‘attitudes and beliefs’ and ‘lack of accessibility’. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: ‘rigid routines’, ‘lack of resource’, ‘lack of documentation’ and ‘lack of leadership’.The results of the thesis show that the prevalence of urinary incontinence in nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are associated with urinary incontinence. is common in nursing home residents. No association between PVR and UTI was found. The use of absorbent pads is associated with an increased risk of developing UTIs. PPD and daily fluid intake are not correlated with the risk of developing UTIs. PPD is an unreliable measure of urinary incontinence in nursing home residents. The findings from the qualitative study shows that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about urinary incontince, are the most important barriers to provide appropriate incontinence care.

Frontend and backend wearout mechanisms are major reliability concerns for modern microprocessors. In this research, a framework which contains modules for negative bias temperature instability (NBTI), positive bias temperature instability (PBTI), hot carrier injection (HCI), gate-oxide breakdown (GOBD), backend time-dependent dielectric breakdown (BTDDB), electromigration (EM), and stress-induced voiding (SIV) is proposed to analyze the impact of each wearout mechanism on state-of-art microprocessors and to accurately estimate microprocessor lifetimes due to each wearout mechanism. Taking into account the detailed thermal profiles, electrical stress profiles and a variety of use scenarios, composed of a fraction of time in operation, a fraction of time in standby, and a fraction of time when the system is off, this work provides insight into lifetime-limiting wearout mechanisms, along with the reliability-critical microprocessor functional units for a system. This enables circuit designers to know if their designs will achieve an adequate lifetime and further make any updates in the designs to enhance reliability prior to committing the designs to manufacture.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-07-04T10:50:56Z No. of bitstreams: 1 flaviacristinadecarvalhomrad.pdf: 25667828 bytes, checksum: 67558dd38cd5b84d1921ca5e06445e03 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-08T14:22:44Z (GMT) No. of bitstreams: 1 flaviacristinadecarvalhomrad.pdf: 25667828 bytes, checksum: 67558dd38cd5b84d1921ca5e06445e03 (MD5) / Made available in DSpace on 2017-08-08T14:22:44Z (GMT). No. of bitstreams: 1 flaviacristinadecarvalhomrad.pdf: 25667828 bytes, checksum: 67558dd38cd5b84d1921ca5e06445e03 (MD5) Previous issue date: 2012-11-23 / A disfuncão do trato urinario inferior (DTUI) é uma alteracão comum em crianças. Dados sobre sua prevalência em indivíduos com síndrome de Down (SD) são escassos. O presente estudo transversal tem como objetivo investigar a prevalência da DTUI em indivíduos com SD pertencentes ao Ambulatório da Síndrome de Down, único com critérios específicos de atendimento em Minas Gerais, Brasil. Os sintomas da DTUI foram avaliados através da aplicação da versão adaptada e validada para população brasileira do Dysfunctional Voíding Symptom Score (DVSS). No DVSS, os valores de corte para indicar a presença de DTUI foram maior do que seis para indivíduos do sexo masculino e maior do que nove para indivíduos do sexo feminino. Dos 114 indivíduos avaliados, 84 foram incluíduos, com idade variando de quatro a 57 anos (média 19,10 anos ± 12,02), sendo 66,70% do gênero feminino. A prevalência encontrada foi de 27,38%. Os sintomas foram mais frequentes nos indivíduos do gênero masculino (OR 3,06; IC 95% (1,131 a 8,321); p=0,03) e com a idade menor ou igual á 10 anos (OR 5,22; IC 95% (1,867 a 14,61); p= 0,001). Estes achados tornam-se importantes para alertar os profissionais envolvidos no seguimento destes indivíduos, orientando sobre a necessidade de investigação padronizada da DTUI, objetivando a prevenção e/ou a correta intervenção terapêutica. / Lower urinary tract dysfunction (LUTD) is a common problem in children. Data on it's prevalence in individuals with Down syndrome (DS) is scarce. This cross-sectional study aims to investigate the prevalence of LUTD in individuals with DS, members of the Down Syndrome Clinic, the only one with specific treatment criteria in Minas Gerais, Brazil. The LUTD symptoms were assessed through the application of the validated and adapted version of the Dysfunctional Voiding Symptom Score (DVSS) for the Brazilian population. The cut-point to indicate the LUTD presence were > 6 for male individuals and > 9 for female individuals. Of the 114 individuals assessed, 84 were eligible, with ages varying from 0 to 57 years (medium age 19.10 years ± 12.02), of these 66.70% being female. The prevalence found was of 27.38%. The symptoms were more frequent in males (OR 3.06; IC 95% (1.131 to 8.321); p=0.03) and of age lower or equal to 10 years (OR 5.22; IC 95% (1.867 to 14.61); p= 0.001). These findings are important to alert the professionals involved in the follow-up of such patients, informing them of the need to standardize the investigation of the LUTD, aiming to prevent and/or the correct therapeutic intervention.

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