Relação entre testes clínicos e desfechos de dor e incapacidade de pacientes com dor lombar crônica não específica submetidos ao programa de controle motor

Pós-graduação em Fisioterapia - FCT

RP93-395 Liability Insurance and the Family Child Care Provider

Life other small business owners, family child care providers need adequate life, health, and disability insurance to protect their families from the loss of their income. However, child care providers also face unique risks. Perhaps the most important of these risks is the financial loss that would result if the provider were found liable or responsible for the injury or death of a child or a child's parent. If a claim were filed against you as a provider, three different types of financial losses are possible: medical expenses, damages awarded to the victim or his/her family after a lawsuit, and court costs related to your defense. This booklet will help you to: (1) evaluate options for insuring a family child care operation, and (2) evaluate available liability insurance policies.

International collaborative project to compare and monitor the nutritional composition of processed foods

Background: Chronic diseases are the leading cause of premature death and disability in the world with overnutrition a primary cause of diet-related ill health. Excess energy intake, saturated fat, sugar, and salt derived from processed foods are a major cause of disease burden. Our objective is to compare the nutritional composition of processed foods between countries, between food companies, and over time. Design: Surveys of processed foods will be done in each participating country using a standardized methodology. Information on the nutrient composition for each product will be sought either through direct chemical analysis, from the product label, or from the manufacturer. Foods will be categorized into 14 groups and 45 categories for the primary analyses which will compare mean levels of nutrients at baseline and over time. Initial commitments to collaboration have been obtained from 21 countries. Conclusions: This collaborative approach to the collation and sharing of data will enable objective and transparent tracking of processed food composition around the world. The information collected will support government and food industry efforts to improve the nutrient composition of processed foods around the world.

Morbidity among nursing personnel and its association with working conditions and work organization

Introduction: Work organization patterns and working conditions experienced by nursing personnel in the hospital settings may be associated to increased morbidity among these health workers. Aim: To estimate the prevalence and factors associated with self-reported diseases among nursing personnel at the emergency hospital in Rio Branco/ State of Acre, Brazil. Methods: A cross-sectional study was conducted involving 272 participants who answered a questionnaire including sociodemographic characteristics, working conditions, lifestyles, work ability, and a fatigue perception scale. The self-reported diseases in the 12 months prior to data collection were considered the dependent variable. Results: A total of 85.7% of the participants reported one or more diseases in the past 12 months. Most prevalent diseases were: musculoskeletal diseases (37.1%), digestive diseases (28.7%), mental disorders (28.3%), work injuries (27.9%), and respiratory diseases (26.8%). The following significant variables remained in the final model: high work demands (OR 2.69), reported fatigue (OR 3.59), night work (OR 6.55) and being a technician or nursing assistant (OR 4.23). Conclusions: Variables related to working conditions and work organization were associated with the occurrence of reported diseases among nursing professionals. Health promotion measures at work require a comprehensive approach including the working conditions and the work organization.

Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial

Background: Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short- term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. Methods/Design: Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes-Moleca (R)-for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca (R) is a women's double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention to treat analysis, as well as general linear models of analysis of variance for repeated measure to detect treatment-time interactions (alpha = 5%). Discussion: This is the first randomized, clinical trial protocol to assess the chronic effect of minimalist footwear on the clinical and functional aspects and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca (R) shoes for six months will provide pain relief, reduction of the knee adduction moment when walking, and improve joint function in elderly women with knee OA, and that the treatment, thus, can be considered another inexpensive and easy-to-use option for conservative OA treatment.

Growth of the crabgrass species Digitaria ciliaris and Digitaria nuda

The aim of this research paper was to compare the growth of D. ciliaris and D. nuda crabgrass species under non-competitive conditions. To this end, two experiments were conducted, one from March - July 2010 and the other from February - June 2011. The experimental design of both trials was completely randomized making a factorial (2 seasons x 2 species crabgrass x 12 evaluation periods) with four replications. Assessments began at 15 days after sowing (DAS), and repeated weekly until 92 DAS. The variables evaluated were total dry matter (roots+leaves+stems), leaf area, leaf number and tiller. The results were submitted to analysis of variance and the absolute growth rate, relative growth rate and leaf area ratio were calculated using the means, which were adjusted regression models. The crabgrass species were significantly different in leaf area, leaf number, tiller number and dry matter per plant. D. ciliaris for all variables was statistically higher than D. nuda. Regarding the speed at which the growth of the species occurred, the absolute growth rate and relative growth rate of D. ciliaris was also greater than D. nuda. In addition, D. ciliaris also had a lower leaf area ratio indicating greater efficiency in converting light energy into carbohydrates. It can be concluded that D. ciliaris has a higher growth rate in conditions where there is no limitation of nutrients and water availability in relation to D. nuda, mainly due to D. ciliaris have greater leaf area, number of leaves and dry matter accumulation per plant.

Mass spectrometry-based protein profiling strategies for biomarker discovery in liver and inflammatory bowel diseases

The study of protein expression profiles for biomarker discovery in serum and in mammalian cell populations needs the continuous improvement and combination of proteins/peptides separation techniques, mass spectrometry, statistical and bioinformatic approaches. In this thesis work two different mass spectrometry-based protein profiling strategies have been developed and applied to liver and inflammatory bowel diseases (IBDs) for the discovery of new biomarkers. The first of them, based on bulk solid-phase extraction combined with matrix-assisted laser desorption/ionization - Time of Flight mass spectrometry (MALDI-TOF MS) and chemometric analysis of serum samples, was applied to the study of serum protein expression profiles both in IBDs (Crohn’s disease and ulcerative colitis) and in liver diseases (cirrhosis, hepatocellular carcinoma, viral hepatitis). The approach allowed the enrichment of serum proteins/peptides due to the high interaction surface between analytes and solid phase and the high recovery due to the elution step performed directly on the MALDI-target plate. Furthermore the use of chemometric algorithm for the selection of the variables with higher discriminant power permitted to evaluate patterns of 20-30 proteins involved in the differentiation and classification of serum samples from healthy donors and diseased patients. These proteins profiles permit to discriminate among the pathologies with an optimum classification and prediction abilities. In particular in the study of inflammatory bowel diseases, after the analysis using C18 of 129 serum samples from healthy donors and Crohn’s disease, ulcerative colitis and inflammatory controls patients, a 90.7% of classification ability and a 72.9% prediction ability were obtained. In the study of liver diseases (hepatocellular carcinoma, viral hepatitis and cirrhosis) a 80.6% of prediction ability was achieved using IDA-Cu(II) as extraction procedure. The identification of the selected proteins by MALDITOF/ TOF MS analysis or by their selective enrichment followed by enzymatic digestion and MS/MS analysis may give useful information in order to identify new biomarkers involved in the diseases. The second mass spectrometry-based protein profiling strategy developed was based on a label-free liquid chromatography electrospray ionization quadrupole - time of flight differential analysis approach (LC ESI-QTOF MS), combined with targeted MS/MS analysis of only identified differences. The strategy was used for biomarker discovery in IBDs, and in particular of Crohn’s disease. The enriched serum peptidome and the subcellular fractions of intestinal epithelial cells (IECs) from healthy donors and Crohn’s disease patients were analysed. The combining of the low molecular weight serum proteins enrichment step and the LCMS approach allowed to evaluate a pattern of peptides derived from specific exoprotease activity in the coagulation and complement activation pathways. Among these peptides, particularly interesting was the discovery of clusters of peptides from fibrinopeptide A, Apolipoprotein E and A4, and complement C3 and C4. Further studies need to be performed to evaluate the specificity of these clusters and validate the results, in order to develop a rapid serum diagnostic test. The analysis by label-free LC ESI-QTOF MS differential analysis of the subcellular fractions of IECs from Crohn’s disease patients and healthy donors permitted to find many proteins that could be involved in the inflammation process. Among them heat shock protein 70, tryptase alpha-1 precursor and proteins whose upregulation can be explained by the increased activity of IECs in Crohn’s disease were identified. Follow-up studies for the validation of the results and the in-depth investigation of the inflammation pathways involved in the disease will be performed. Both the developed mass spectrometry-based protein profiling strategies have been proved to be useful tools for the discovery of disease biomarkers that need to be validated in further studies.

Vascular wall stem cells. Selection and conditioning of progenitors useful for cell therapy. A pathological case study

The arterial wall contains MSCs with mesengenic and angiogenic abilities. These multipotent precursors have been isolated from variously-sized human adult segments, belying the notion that vessel wall is a relatively quiescent tissue. Recently, our group identified in normal human arteries a vasculogenic niche and subsequently isolated and characterized resident MSCs (VW-MSCs) with angiogenic ability and multilineage potential. To prove that VW-MSCs are involved in normal and pathological vascular remodeling, we used a long-term organ culture system; this method was of critical importance to follow spontaneous 3-D vascular remodeling without any influence of blood cells. Next we tried to identify and localize in situ the VW-MSCs and to understand their role in the vascular remodeling in failed arterial homografts. Subsequently, we isolated this cell population and tested in vitro their multilineage differentiation potential through immunohistochemical, immunofluorescence, RT-PCR and ultrastructural analysis. From 25-30cm2 of each vascular wall homograft sample, we isolated a cell population with MSCs properties; these cells expressed MSC lineage molecules (CD90, CD44, CD105, CD29, CD73), stemness (Notch-1, Oct-4, Sca-1, Stro-1) and pericyte markers (NG2) whilst were negative for hematopoietic and endothelial markers (CD34, CD133, CD45, KDR, CD146, CD31 and vWF). MSCs derived from failed homografts (H-MSCs) exhibited adipogenic, osteogenic and chondrogenic potential but scarce propensity to angiogenic and leiomyogenic differentiation. The present study demonstrates that failed homografts contain MSCs with morphological, phenotypic and functional MSCs properties; H-MSCs are long-lived in culture, highly proliferating and endowed with prompt ability to differentiate into adipocytes, osteocytes and chondrocytes; compared with VW-MSCs from normal arteries, H-MSCs show a failure in angiogenic and leiomyogenic differentiation. A switch in MSCs plasticity could be the basis of pathological remodeling and contribute to aneurysmal failure of arterial homografts. The study of VW-MSCs in a pathological setting indicate that additional mechanisms are involved in vascular diseases; their knowledge will be useful for opening new therapeutic options in cardiovascular diseases.

Structural and functional analysis of the hepatitis C virus non-structural protein 5A

Das Hepatitis C Virus (HCV) ist ein umhülltes RNA Virus aus der Familie der Flaviviridae. Sein Genom kodiert für ein ca. 3000 Aminosäuren langes Polyprotein, welches co- und posttranslational in seine funktionellen Einheiten gespalten wird. Eines dieser viralen Proteine ist NS5A. Es handelt sich hierbei um ein stark phosphoryliertes Protein, das eine amphipatische α-Helix im Amino-Terminus trägt, welche für die Membran-Assoziation von NS5A verantwortlich ist. Welche Rolle die Phosphorylierung für die Funktion des Proteins spielt, bzw. welche Funktion NS5A überhaupt ausübt, ist zur Zeit noch unklar. Beobachtungen lassen Vermutungen über eine Funktion von NS5A bei der Resistenz infizierter Zellen gegenüber Interferon-alpha zu. Weiterhin wird vermutet, das NS5A als Komponente des membranständigen HCV Replikasekomplexes an der RNA Replikation beteiligt ist. Das Ziel dieser Doktorarbeit war es, die Funktion von NS5A für die RNA Replikation zu untersuchen. Zu diesem Zweck wurde eine Serie von Phosphorylierungsstellen-Mutanten generiert, die auf Ihre Replikationsfähigkeit und den Phosphorylierungsstatus hin untersucht wurden. Wir fanden, dass bestimmte Serin-Substitutionen im Zentrum von NS5A zu einer gesteigerten RNA Replikation führten, bei gleichzeitig reduzierter NS5A Hyperphosphorylierung. Weiterhin studierten wir den Einfluß von Mutationen in der Amino-terminalen amphipatischen α-Helix von NS5A auf die RNA-Replikation, sowie Phosphorylierung und subzelluläre Lokalisation des Proteins. Wir fanden, dass geringfügige strukturelle Veränderungen der amphipatischen Helix zu einer veränderten subzellulären Lokalisation von NS5A führten, was mit einer reduzierten oder komplett inhibierten RNA Replikation einherging. Zudem interferierten die strukturellen Veränderungen mit der Hyperphosphorylierung des Proteins, was den Schluß nahe legt, dass die amphipatische Helix eine wichtige strukturelle Komponente des Proteins darstellt, die für die korrekte Faltung und Phosphorylierung des Proteins essentiell ist. Als weitere Aspekte wurden die Trans-Komplementationsfähigkeit der verschiedenen viralen Komponenten des HCV Replikasekomplexes untersucht, sowie zelluläre Interaktionspartner von NS5A identifiziert. Zusammenfassend zeigen die Ergebnisse dieser Doktorarbeit, dass NS5A eine wichtige Rolle bei der RNA-Replikation spielt. Diese Funktion wird wahrscheinlich über den Phosphorylierungszustand des Proteins reguliert.

The oxidation capacity of the atmosphere - OH and HO 2 radical measurements in a boreal forest environment using laser induced fluorescence spectroscopy

Das wichtigste Oxidationsmittel für den Abbau flüchtiger Kohlenwasserstoffverbindungen (VOC, engl.: volatile organic compounds) in der Atmosphäre ist das Hydroxylradikal (OH), welches sich in einem schnellen chemischen Gleichgewicht mit dem Hydroperoxylradical (HO2) befindet. Bisherige Messungen und Modellvergleiche dieser Radikalspezies in Waldgebieten haben signifikante Lücken im Verständnis der zugrundeliegenden Prozesse aufgezeigt.rnIm Rahmen dieser Doktorarbeit wurden Messungen von OH- und HO2-Radikalen mittelsrnlaserinduzierten Fluoreszensmesstechnik (LIF, engl.: laser-induced fluorescence) in einem Nadelwald in Süd-Finnland während der Messkampagne HUMPPA–COPEC–2010 (Hyytiälä United Measurements of Photochemistry and Particles in Air – Comprehensive Organic Precursor Emission and Concentration study) im Sommer 2010 durchgeführt. Unterschiedliche Komponenten des LIF-Instruments wurden verbessert. Eine modifizierte Methode zur Bestimmung des Hintergrundsignals (engl.: InletPreInjector technique) wurde in den Messaufbaurnintegriert und erstmals zur Messung von atmosphärischem OH verwendet. Vergleichsmessungen zweier Instrumente basierend auf unterschiedlichen Methoden zur Messung von OH-Radikalen, chemische Ionisationsmassenspektrometrie (CIMS - engl.: chemical ionization mass spectrometry) und LIF-Technik, zeigten eine gute Übereinstimmung. Die Vergleichsmessungen belegen das Vermögen und die Leistungsfähigkeit des modifizierten LIF-Instruments atmosphärische OH Konzentrationen akkurat zu messen. Nachfolgend wurde das LIF-Instrument auf der obersten Plattform eines 20m hohen Turmes positioniert, um knapp oberhalb der Baumkronen die Radikal-Chemie an der Schnittstelle zwischen Ökosystem und Atmosphäre zu untersuchen. Umfangreiche Messungen - dies beinhaltet Messungen der totalen OH-Reaktivität - wurden durchgeführt und unter Verwendung von Gleichgewichtszustandsberechnungen und einem Boxmodell, in welches die gemessenen Daten als Randbedingungen eingehen, analysiert. Wenn moderate OH-Reaktivitäten(k′(OH)≤ 15 s−1) vorlagen, sind OH-Produktionsraten, die aus gemessenen Konzentrationen von OH-Vorläuferspezies berechnet wurden, konsistent mit Produktionsraten, die unter der Gleichgewichtsannahme von Messungen des totalen OH Verlustes abgeleitet wurden. Die primären photolytischen OH-Quellen tragen mit einem Anteil von bis zu einem Drittel zur Gesamt-OH-Produktion bei. Es wurde gezeigt, dass OH-Rezyklierung unter Bedingungen moderater OH-Reaktivität hauptsächlich durch die Reaktionen von HO2 mit NO oder O3 bestimmt ist. Während Zeiten hoher OH-Reaktivität (k′(OH) > 15 s−1) wurden zusätzliche Rezyklierungspfade, die nicht über die Reaktionen von HO2 mit NO oder O3, sondern direkt OH bilden, aufgezeigt.rnFür Hydroxylradikale stimmen Boxmodell-Simulationen und Messungen gut übereinrn(OHmod/OHobs=1.04±0.16), während HO2-Mischungsverhältnisse in der Simulation signifikant unterschätzt werden (HO2mod/HO2obs=0.3±0.2) und die simulierte OH-Reaktivität nicht mit der gemessenen OH-Reaktivität übereinstimmt. Die gleichzeitige Unterschätzung der HO2-Mischungsverhältnisse und der OH-Reaktivität, während OH-Konzentrationen von der Simulation gut beschrieben werden, legt nahe, dass die fehlende OH-Reaktivität in der Simulation eine noch unberücksichtigte HO2-Quelle darstellt. Zusätzliche, OH-unabhängigernRO2/HO2-Quellen, wie z.B. der thermische Zerfall von herantransportiertem peroxyacetylnitrat (PAN) und die Photolyse von Glyoxal sind indiziert.

The course of chronic and recurrent low back pain in the general population

Using latent class analysis (LCA), a previous study on patients attending primary care identified four courses of low back pain (LBP) over the subsequent 6 months. To date, no studies have used longitudinal pain recordings to examine the "natural" course of recurrent and chronic LBP in a population-based sample of individuals. This study examines the course of LBP in the general population and elaborates on the stability and criterion-related validity of the clusters derived. A random sample of 400 individuals reporting LBP in a population-based study was asked to complete a comprehensive questionnaire at the start and end of the year's survey, and 52 weekly pain diaries in between. The latter were analyzed using LCA. 305 individuals returned more than 50% of the diaries. Four clusters were identified (severe persistent, moderate persistent, mild persistent, and fluctuating). The clusters differed significantly with regards to pain and disability. Assessment of cluster stability showed that a considerable proportion of patients in the "fluctuating" group changed their classification over time. Three of the four clusters describing the typical course of pain matched the clusters described previously for patients in primary care. Due to the population-based design, this study achieves, for the first time, a close insight into the "natural" course of chronic and recurrent low back pain, including individuals that did not necessarily visit the general practitioner. The findings will help to understand better the nature of this pain in the general population.

Measuring attitudes, behaviours, and influences in inner city victims of interpersonal violence (VIVs) - a Swiss emergency room pilot study

Background Switzerland is confronted with the problem of interpersonal violence. Violence is in the increase and the potential for aggression seems to be rising. Observations by hospitals discern an appalling increase of the severity of the injuries. The aim of this study is to collect accurate information about the social environment, the motivation and possible reasons for violence. We also intend to investigate whether sociocultural, or ethnic differences among male victims exist. Materials and methods For the first time in Switzerland, this survey employed a validated questionnaire from the division of violence prevention, Atlanta, Georgia. The first part of the questionnaire addressed social and demographic factors which could influence the risk of violence: age, gender, duration of stay in Switzerland, nationality and educational level. Beside these social structural factors, the questionnaire included questions on experience of violent offences in the past, information about the most recent violent offence and intra and interpersonal facts. The questionnaire itself consists of 27 questions, translated into German and French. In a pilot study, the questionnaire was checked with adolescents for feasibility and comprehensibility. Results 69 male VIVs were interviewed at two hospitals in the Canton of Bern. Most of the adolescents emphasised that weapons were not used during their confrontations. It is astonishing that all of the young men considered themselves to be victims. Most of the brawls were incited after an exchange of verbal abuse and provocations with unfamiliar individuals. The rivals could neither be classified with the help of ethnic categories nor identifiable groups of the youth scenes. The incidents took place in scenes, where violence was more likely to happen. Interestingly and contrary to a general perception the offenders are well integrated into sport and leisure clubs. A further surprising result of our research is that the attitude towards religion differs between young men with experience of violence and non-violent men. Discussion Youth violence is a health issue, which concerns us globally. The human and economic toll of violence on victims and offenders, their families, and on society in general is high. The economic costs associated with violence-related illness and disability is estimated to be millions of Swiss francs each year. Physicians and psychologists are compelled to identify the factors, which cause young people to be violent, to find out which interventions prove to be successful, and to design effective prevention programs. The identification of effective programs depends on the availability of reliable and valid measures to assess changes in violence-related attitudes. In our efforts to create healthier communities, we need to investigate; document and do research on the causes and circumstances of youth violence.

A Metric to Evaluate and Synthesize Distributed Compliant Mechanisms

Compliant mechanisms with evenly distributed stresses have better load-bearing ability and larger range of motion than mechanisms with compliance and stresses lumped at flexural hinges. In this paper, we present a metric to quantify how uniformly the strain energy of deformation and thus the stresses are distributed throughout the mechanism topology. The resulting metric is used to optimize cross-sections of conceptual compliant topologies leading to designs with maximal stress distribution. This optimization framework is demonstrated for both single-port mechanisms and single-input single-output mechanisms. It is observed that the optimized designs have lower stresses than their nonoptimized counterparts, which implies an ability for single-port mechanisms to store larger strain energy, and single-input single-output mechanisms to perform larger output work before failure.

Prefrailty and chronic morbidity in the youngest old: an insight from the Lausanne cohort Lc65+

To estimate the prevalence of prefrailty, frailty, comorbidity, and disability in the youngest old and to identify chronic diseases associated with individual frailty criteria.

Restructuring Justice: Moving Towards Gender-Responsive Programming and Alternatives to Incarceration for Non-Violent Female Offenders

The United States¿ Federal and State laws differentiate between acceptable (or, legal) and unacceptable (illegal) behavior by prescribing restrictive punishment to citizens and/or groups that violate these established rules. These regulations are written to treat every person equally and to fairly serve justice; furthermore, the sanctions placed on offenders seek to reform illegal behavior through limitations on freedoms and rehabilitative programs. Despite the effort to treat all offenders fairly regardless of social identity categories (e.g., sex, race, ethnicity, socioeconomic status, age, ability, and gender and sexual orientation) and to humanely eliminate illegal behavior, the American penal system perpetuates de facto discrimination against a multitude of peoples. Furthermore, soaring recidivism rates caused by unsuccessful re-entry of incarcerated offenders puts economic stress on Federal and State budgets. For these reasons, offenders, policy-makers, and law-abiding citizens should all have a vested interest in reforming the prison system. This thesis focuses on the failure of the United States corrections system to adequately address the gender-specific needs of non-violent female offenders. Several factors contribute to the gender-specific discrimination that women experience in the criminal justice system: 1) Trends in female criminality that skew women¿s crime towards drug-related crimes, prostitution, and property offenses; 2) Mandatory minimum sentences for drug crimes that are disproportionate to the crime committed; 3) So-called ¿gender-neutral¿ educational, vocational, substance abuse, and mental health programming that intends to equally rehabilitate men and women, but in fact favors men; and 4) The isolating nature of prison structures that inhibits smooth re-entry into society. I argue that a shift in the placement and treatment of non-violent female offenders is necessary for effective rehabilitation and for reducing recidivism rates. The first component of this shift is the design and implementation of gender- responsive treatment (GRT) rather than gender-neutral approaches in rehabilitative programming. The second shift is the utilization of alternatives to incarceration, which provide both more humane treatment of offenders and smoother reintegration to society. Drawing on recent scholarship, information from prison advocacy organizations, and research with men in an alternative program, I provide a critical analysis of current policies and alternative programs, and suggest several proposals for future gender- responsive programs in prisons and in place of incarceration. I argue that the expansion of gender-responsive programming and alternatives to incarceration respond to the marginalization of female offenders, address concerns about the financial sustainability of the United States criminal justice system, and tackle high recidivism rates.