Diagnostic Performance and Additional Value of Elastosonography in Focal Breast Lesions: Statistical Correlation between Size-Dependant Strain Index Measurements, Multimodality-BI-RADS Score, and Histopathology in a Clinical Routine Setting

Objective. To evaluate the diagnostic benefit of real-time elastography (RTE) in clinical routine. Strain indices (SI) for benign and malignant tumors were assessed. Methods. 100 patients with 110 focal breast lesions were retrieved. Patients had mammography (MG), ultrasound (US), and, if necessary, MRI. RTE was conducted after ultrasound. Lesions were assessed with BI-RADS for mammography and ultrasound. Diagnosis was established with histology or follow-up. Results. SI for BI-RADS 2 was 1.71 ± 0.86. Higher SI (2.21 ± 1.96) was observed for BI-RADS 3 lesions. SI of BI-RADS 4 and 5 lesions were significantly higher (16.92 ± 20.89) and (19.54 ± 10.41). 31 malignant tumors exhibited an average SI of 16.13 ± 14.67; SI of benign lesions was 5.29 ± 11.87 (P value <0.0001). ROC analysis threshold was >3.8 for malignant disease. Sensitivity of sonography was 90.3% (specificity 78.5%). RTE showed a sensitivity of 87.1% (specificity 79.7%). Accuracy of all modalities combined was 96.8%. In BI-RADS 3 lesions RTE was able to detect all malignant lesions (sensitivity 100%, specificity 92.9%, and accuracy 93.9%). Conclusions. RTE increased sensitivity and specificity for breast cancer detection when used in combination with ultrasound.

Heat stress, heat strain, and productivity in Washington State tree fruit harvesters

Thesis (Master's)--University of Washington, 2016-06

Estratégia de avaliação do risco de lesões músculo-esqueléticas de membros superiores ligadas ao trabalho aplicada na indústria de abate e desmancha de carne em P

RESUMO - Objectivo: As lesões músculo-esqueléticas ligadas ao trabalho (LMELT) são doenças profissionais frequentes. Neste estudo ensaiou-se uma estratégia de diagnóstico do risco e de vigilância da saúde dos trabalhadores numa empresa de abate e desmancha de carne. Métodos: Utilizou-se uma estratégia de obtenção de informação em todos os postos de trabalho e trabalhadores da empresa. Utilizaram-se: (i) adaptação do Questionário Nórdico Músculo-Esquelético, incluindo caracterização da exposição biomecânica; (ii) protocolo de avaliação clínica de LMELT; (iii) filtro RSI e método Strain Index; (iv) instrumentação, como electrogoniometria e sensores de força em postos de risco elevado. Resultados: Identificou-se a presença de sintomas e sinais de LMELT principalmente nos punhos/mãos (n=27) e região lombo-sagrada (n=32), uma importante prevalência de casos relacionados com a actividade de trabalho (30%) e níveis de risco elevados com base nas classificações do Strain Index (n=26 MSDto e n=7 MSEsq). A utilização da instrumentação permitiu obter detalhes da repetitividade, das posturas e dos momentos de aplicação de força, úteis para a intervenção. Conclusões: A prevenção só é possível através da aplicação de programas/estratégias integradas de diagnóstico e gestão do risco de LMELT que sejam eficazes no sentido da intervenção sobre a actividade e as condições de trabalho.--------------------------ABSTRACT – Background: Work-related Musculoskeletal Disorders (WRMSD) are common occupational diseases. The present study aims at examining an integrated perspective of risk assessment and health surveillance at a meatpacking plant. Methods: The strategy adopted was of obtaining information about WRMSDs awareness at all workstations and from all their workers. This was based on: (i) questionnaire application - an adaptation of the Nordic musculoskeletal questionnaire, including a biomechanical item, (ii) WRMSDs clinical protocol (iii) RSI risk filter and Strain Index application, (iv) instrumentation with electrogoniometry and force sensors at previously classified as high risk workstations. Results: WRMSDs signs and symptoms mainly in wrist/hands (n=27) and in lumbar region (n=32) were identified. Results revealed an important prevalence of WRULMSDs associated to meatpacking industry activities (30%) and high risk scores based on Strain Index (n=26 Right UL; n=7 Left UL). Instrumentation showed details of recurrency, of postures and of force, which can be used for intervention. Conclusions: It’s necessary to develop ergonomic strategies and approaches on WRMSDs prevention (risk assessment and manage

Comparação entre métodos de avaliação do risco de desenvolvimento de lesões musculoesqueléticas nas extremidades distais dos membros superiores: um estudo em trabalhos de montagem manual

Dissertação de mestrado em Engenharia Humana

Consensus recommendations on training and competing in the heat.

Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimize performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimize performance is to heat acclimatize. Heat acclimatization should comprise repeated exercise-heat exposures over 1-2 weeks. In addition, athletes should initiate competition and training in a euhydrated state and minimize dehydration during exercise. Following the development of commercial cooling systems (e.g., cooling vest), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organizers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimizing the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events for hydration and body cooling opportunities when competitions are held in the heat.

Consensus recommendations on training and competing in the heat.

Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimise performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimise performance is to heat acclimatise. Heat acclimatisation should comprise repeated exercise-heat exposures over 1-2 weeks. In addition, athletes should initiate competition and training in a euhydrated state and minimise dehydration during exercise. Following the development of commercial cooling systems (eg, cooling-vest), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organisers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimising the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events, for hydration and body cooling opportunities, when competitions are held in the heat.

Chancen und Risiken der Arbeit im E-Business

E-Business, verstanden als ganzheitliche Strategie zur Reorganisation von Geschäftsprozessen, Strukturen und Beziehungen in Unternehmen, bietet für die Arbeitsgestaltung in einer digital vernetzten Welt Chancen und Risiken in Hinblick auf die Humankriterien. Empirische Untersuchungen in 14 Unternehmen zeigen „good practice“-Ansätze im B2B-Feld (Business-to-Business). Untersucht wurden die Tätigkeiten der elektronisch vernetzten Auftragsbearbeitung, des Web-, Content-Managements, der digitalen Druckvorlagenherstellung sowie der CAD- Bauplanzeichnung. Die beobachteten Arbeitsplätze zeigen, dass Arbeitsinhalte eher ganzheitlich und komplex gestaltet sind. Planende, ausführende, kontrollierende und organisierende Anteile weisen auf eine vielfältige Aufgabengestaltung hin, die hohe Anforderungen beinhaltet. Während alle beobachteten Tätigkeiten mit Aufnahme-, Erarbeitungs-, Verarbeitungs-, Übertragungs- und Weitergabeprozessen von Informationen zu tun haben, gibt es Differenzen in Bezug auf den Arbeitsumfang, den Zeitdruck, Fristsetzungen, erwartete Arbeitsleistungen sowie die Planbarkeit der Aufgaben. Die vorgefundenen Aufgabentypen (wenig bis sehr anforderungsreich im Sinne von Denk- und Planungsanforderungen) sind gekennzeichnet durch eine unterschiedlich ausgeprägte Aufgabenkomplexität. Interessant ist, dass, je anforderungsreicher die Aufgabengestaltung, je höher die Aufgabenkomplexität, je größer die Wissensintensität und je niedriger die Planbarkeit ist, desto größer sind die Freiräume in der Aufgabenausführung. Das heißt wiederum, dass bei zunehmenden E-Business-Anteilen mehr Gestaltungsspielräume zur Verfügung stehen. Die bestehenden Chancen auf eine humane Aufgabengestaltung sind umso größer, je höher die E-Business-Anteile in der Arbeit sind. Diese Wirkung findet sich auch bei einem Vergleich der Aufgabenbestandteile wieder. Die negativen Seiten des E-Business zeigen sich in den vorgefundenen Belastungen, die auf die Beschäftigten einwirken. Diskutiert wird die Verschiebung von körperlichen hin zu psychischen und vorrangig informatorischen Belastungen. Letztere stellen ein neues Belastungsfeld dar. Ressourcen, auf welche die Mitarbeiter zurückgreifen können, sind an allen Arbeitsplätzen vorhanden, allerdings unterschiedlich stark ausgeprägt. Personale, organisationale, soziale, aufgabenbezogene und informatorische Ressourcen, die den Beschäftigten zur Verfügung stehen, werden angesprochen. In Bezug auf die Organisationsgestaltung sind positive Ansätze in den untersuchten E-Business-Unternehmen zu beobachten. Der Großteil der untersuchten Betriebe hat neue Arbeitsorganisationskonzepte realisiert, wie die vorgefundenen kooperativen Organisationselemente zeigen. Die kooperativen Organisationsformen gehen allerdings nicht mit einer belastungsärmeren Gestaltung einher. Das vorgefundene breite Spektrum, von hierarchisch organisierten Strukturen bis hin zu prozess- und mitarbeiterorientierten Organisationsstrukturen, zeigt, dass Organisationsmodelle im E-Business gestaltbar sind. Neuen Anforderungen kann insofern gestaltend begegnet und somit die Gesundheit und das Wohlbefinden der Mitarbeiter positiv beeinflusst werden. Insgesamt betrachtet, zeigt E-Business ein ambivalentes Gesicht, das auf der Basis des MTO-Modells (Mensch-Technik-Organisation) von Uhlich (1994) diskutiert wird, indem vernetzte Arbeitsprozesse auf personeller, technischer sowie organisationaler Ebene betrachtet werden. E-business, seen as more than only the transformation of usual business processes into digital ones, furthermore as an instrument of reorganisation of processes and organisation structures within companies, offers chances for a human oriented work organisation. Empirical data of 14 case studies provide good practice approaches in the field of B2B (Business-to-Business). The observed work contents show, that tasks (e.g. order processing, web-, contentmanagement, first print manufacturing and architectural drawing) are well arranged. Executive, organising, controlling and coordinating parts constitute a diversified work content, which can be organised with high demands. Interesting is the result, that the more e-business-parts are within the work contents, on the one hand the higher are the demands of the type of work and on the other hand the larger is the influence on workmanship. The observed enterprises have realised new elements of work organisation, e.g. flexible working time, cooperative leadership or team work. The direct participation of the employees can be strengthened, in particular within the transformation process. Those companies in which the employees were early and well informed about the changes coming up with e-business work, the acceptance for new technique and new processes is higher than in companies which did not involve the person concerned. Structured in an ergonomic way, there were found bad patterns of behaviour concerning ergonomic aspects, because of missing knowledge regarding work-related ergonomic expertise by the employees. E-business indicates new aspects concerning requirements – new in the field of informational demands, as a result of poorly conceived technical balance in the researched SME. Broken systems cause interruptions, which increase the pressure of time all the more. Because of the inadequate usability of software-systems there appear in addition to the informational strains also elements of psychological stress. All in all, work contents and work conditions can be shaped and as a result the health and well-being of e-business-employees can be influenced: Tasks can be structured and organised in a healthfulness way, physiological strain and psychological stress are capable of being influenced, resources are existent and developable, a human work design within e-business structures is possible. The ambivalent face of e-business work is discussed on the basis of the MTO- (Mensch-Technik-Organisation) model (Ulich 1994). Thereby new and interesting results of researches are found out, concerning the personal/human side, the technical side and the organisational side of e-business work.

Adubação com silício e tolerância ao déficit hídrico em cana-de-açúcar

Pós-graduação em Agronomia (Agricultura) - FCA

Attivita' fisica adattata nella riabilitazione post-ictus: Risultati al follow-up di 12 mesi

L’ictus è un importante problema di salute pubblica, è causa di morte e disabilità nella popolazione anziana. La necessità di strategie di prevenzione secondaria e terziaria per migliorare il funzionamento post-ictus e prevenire o ritardare altre condizioni disabilitanti, ha portato l’Italia a sviluppare un intervento di Attività Fisica Adattata (AFA) per l’ictus, che permettesse di migliorare gli esiti della riabilitazione. Obiettivo dello studio è di valutare se l’AFA unita all’Educazione Terapeutica (ET), rispetto al trattamento riabilitativo standard, migliora il funzionamento e la qualità di vita in pazienti con ictus. Studio clinico non randomizzato, in cui sono stati valutati 229 pazienti in riabilitazione post-ictus, 126 nel gruppo sperimentale (AFA+ET) e 103 nel gruppo di controllo. I pazienti sono stati valutati al baseline, a 4 e a 12 mesi di follow-up. Le misure di esito sono il cambiamento a 4 mesi di follow-up (che corrisponde a 2 mesi post-intervento nel gruppo sperimentale) di: distanza percorsa, Berg Balance Scale, Short Physical Performance Battery, e Motricity Index. Le variabili misurate a 4 e a 12 mesi di follow-up sono: Barthel Index, Geriatric Depression Scale, SF-12 e Caregiver Strain Index. La distanza percorsa, la performance fisica, l’equilibrio e il punteggio della componente fisica della qualità di vita sono migliorate a 4 mesi nel gruppo AFA+ET e rimasti stabili nel gruppo di controllo. A 12 mesi di follow-up, il gruppo AFA+ET ottiene un cambiamento maggiore, rispetto al gruppo di controllo, nell’abilità di svolgimento delle attività giornaliere e nella qualità di vita. Infine il gruppo AFA+ET riporta, nell’ultimo anno, un minor numero di fratture e minor ricorso a visite riabilitative rispetto al gruppo di controllo. I risultati confermano che l’AFA+ET è efficace nel migliorare le condizioni cliniche di pazienti con ictus e che gli effetti, soprattutto sulla riabilitazione fisica, sono mantenuti anche a lungo termine.

Abnormal bone geometry at the metacarpal bone shaft of rheumatoid arthritis patients with maintained muscle-bone relationship

OBJECTIVES:: Metacarpal juxta-articular bone is altered in Rheumatoid Arthritis (RA). However, a detailed analysis of disease related geometrical adaptations of the metacarpal shaft is missing. The aim of the present study was to assess the role of RA disease, forearm muscle cross-sectional area (CSA), age and sex on bone geometry at the metacarpal shaft. METHODS:: In 64 RA patients and 128 control subjects geometric properties of the third metacarpal bone mid-shaft and forearm muscle CSA were measured by peripheral quantitative computed tomography (pQCT). Linear models were performed for cortical CSA, total bone CSA, polar stress-strain Index (polar SSI, a surrogate for bone's resistance to bending and torsion), cortical thickness and Metacarpal Index (MI=cortical CSA/total CSA) with explanatory variables muscle CSA, age, RA status and sex. RESULTS:: Forearm muscle CSA was associated with cortical and total metacarpal CSA, and polar SSI. RA group status was associated with all bone parameters except cortical CSA. There was a significant interaction between RA status and age, indicating that the RA group had a greater age-related decrease in cortical CSA, cortical thickness and MI. CONCLUSIONS:: Bone geometry of the metacarpal shaft is altered in RA patients compared to healthy controls. While bone mass of the metacarpal shaft is adapted to forearm muscle mass, cortical thickness and MI are reduced but outer bone shaft circumference and polar SSI increased in RA patients. These adaptations correspond to an enhanced aging pattern in RA patients.

Overweight children have a greater proportion of fat mass relative to muscle mass in the upper limbs than in the lower limbs: implications for bone strength at the distal forearm

BACKGROUND: The influence of adiposity on upper-limb bone strength has rarely been studied in children, despite the high incidence of forearm fractures in this population. OBJECTIVE: The objective was to compare the influence of muscle and fat tissues on bone strength between the upper and lower limbs in prepubertal children. DESIGN: Bone mineral content, total bone cross-sectional area, cortical bone area (CoA), cortical thickness (CoTh) at the radius and tibia (4% and 66%, respectively), trabecular density (TrD), bone strength index (4% sites), cortical density (CoD), stress-strain index, and muscle and fat areas (66% sites) were measured by using peripheral quantitative computed tomography in 427 children (206 boys) aged 7-10 y. RESULTS: Overweight children (n = 93) had greater values for bone variables (0.3-1.3 SD; P < 0.0001) than did their normal-weight peers, except for CoD 66% and CoTh 4%. The between-group differences were 21-87% greater at the tibia than at the radius. After adjustment for muscle cross-sectional area, TrD 4%, bone mineral content, CoA, and CoTh 66% at the tibia remained greater in overweight children, whereas at the distal radius total bone cross-sectional area and CoTh were smaller in overweight children (P < 0.05). Overweight children had a greater fat-muscle ratio than did normal-weight children, particularly in the forearm (92 +/- 28% compared with 57 +/- 17%). Fat-muscle ratio correlated negatively with all bone variables, except for TrD and CoD, after adjustment for body weight (r = -0.17 to -0.54; P < 0.0001). CONCLUSIONS: Overweight children had stronger bones than did their normal-weight peers, largely because of greater muscle size. However, the overweight children had a high proportion of fat relative to muscle in the forearm, which is associated with reduced bone strength.

Skeletal benefits after long-term retirement in former elite female gymnasts

Bone strength benefits after long-term retirement from elite gymnastics in terms of bone geometry and volumetric BMD were studied by comparing retired female gymnasts to moderately active age-matched women. In a cross-sectional study, 30 retired female gymnasts were compared with 30 age-matched moderately active controls. Bone geometric and densitometric parameters were measured by pQCT at the distal epiphyses and shafts of the tibia, femur, radius, and humerus. Muscle cross-sectional areas were assessed from the shaft scans. Independent t-tests were conducted on bone and muscle variables to detect differences between the two groups. The gymnasts had retired for a mean of 6.1 +/- 0.4 yr and were engaged in strain index (SSIpol) were significantly greater (13-38%, p

Physiological and symptomatic responses to cycling and walking in intermittent claudication

To shed light on the potential efficacy of cycling as a resting modality in the treatment of intermittent claudication (IC), this study compared physiological and symptomatic responses to graded walking and cycling tests in claudicants. Sixteen subjects with peripheral arterial disease (resting ankle:brachial index (ABI) < 0.9) and IC completed a maximal graded treadmill walking (T) and cycle (C) Lest after three familiarization tests on each mode. During cacti test, symptoms, oxygen uptake (VO2), minute ventilation (V-E), (respiratory exchange ratio) (RER) and heart rate (HR) were measured, and for 10 min after each Lest the brachial and ankle systolic pressures were recorded, All but One subject experienced calf pain as the primary limiting symptom during T whereas the symptoms were more varied during C and included thigh pain, calf pain and dyspnoea, Although maximal exercise time was significantly longer on C than T (690 +/- 67 vs, 495 +/- 57 s), peak VO2, peak, V-E and peak heart rate during C and T were not different; whereas peak RER was higher during C. These responses during C and T were also positively 1, (P < 0.05) with each other, with the exception of RER. The postexercise systolic pressures were also not different between C and T. However, the peak decline ill ankle pressures from resting values after C and T were not correlated with each other. Thew data demonstrate that cycling and walking induce a similar level of metabolic and cardiovascular strain, but that the primary limiting symptoms and haemodynamic response in an individual's extremity, measured after exercise, can differ substantially between these two modes.

Colistin resistance in a clinical Acinetobacter baumannii strain appearing after colistin treatment: effect on virulence and bacterial fitness.

The fitness and virulence costs associated with the clinical acquisition of colistin resistance by Acinetobacter baumannii were evaluated. The growth of strain CR17 (colistin resistant) was less than that of strain CS01 (colistin susceptible) when the strains were grown in competition (72-h competition index, 0.008). In a murine sepsis model, CS01 and CR17 reached spleen concentrations when coinfecting of 9.31 and 6.97 log10 CFU/g, respectively, with an in vivo competition index of 0.016. Moreover, CS01 was more virulent than CR17 with respect to mortality and time to death.

Physiological potential of rice seeds treated with rhizobacteria or the insecticide thiamethoxam

Development of new technologies, aiming at increasing productivity in different crops, involves constant research on the effectiveness and application of these techniques in seed treatment. In this study, it was aimed at evaluating physiological potential of rice seeds treated with plant growth-promoting rhizobacteria (PGPR) (strains DFs185, DFs223, DFs306, DFs416), or with two dosages of the insecticide thiamethoxam. The variables assessed were: germination (G); first count of germination (FCG); cold test (CT); length of seedlings aerial parts (LAP), root system (LRS), and total length (TL); emergence speed index (ESI); emergence (E), at 14 days; and dry phytomass (DP). Treatments have had a positive effect on percentage of G, FCG and E. The strain DFs185 has promoted increase in percentage emergence, for five of the six lots assessed. The variables: LAP; LRS; TL; ESI; and DP have undergone low or none influence of treatments; and there has been no toxic effect of rhizobacteria or insecticide thiamethoxam. In the cold test, a negative effect of treatments has been detected. Seed treatment with rhizobacteria, as well as with thiamethoxam, improve quality of low quality rice seeds. The strain DFs185 is promising for treating rice seeds, once it stimulates seed germination and emergence.