963 resultados para 27-31SAE-2801-21


Relevância:

20.00% 20.00%

Publicador:

Resumo:

The immune response against Salmonella is multi-faceted involving both the innate and the adaptive immune system. The characterization of specific Salmonella antigens inducing immune response could critically contribute to the development of epitope based vaccines for Salmonella. We have tried to identify a protective T cell epitope(s) of Salmonella, as cell mediated immunity conferred by CD8+ T cells is the most crucial subset conferring protective immunity against Salmonella. It being a proven fact that secreted proteins are better in inducing cell mediated immunity than cell surface and cytosolic antigens, we have analyzed all the genbank annotated Salmonella pathogenicity island 1 and 2 secreted proteins of Salmonella enterica serovar Typhimurium (S. typhimurium) and S. enterica serovar Typhi (S. typhi). They were subjected to BIMAS and SYFPEITHI analysis to map MHC-I and MHC-II binding epitopes. The huge profile of possible T cell epitopes obtained from the two classes of secreted proteins were tabulated and using a scoring system that considers the binding affinity and promiscuity of binding to more than one allele, SopB and SifB were chosen for experimental confirmation in murine immunization model. The entire SopB and SifB genes were cloned into DNA vaccine vectors and were administered along with live attenuated Salmonella and it was found that SopB vaccination reduced the bacterial burden of organs by about 5-fold on day 4 and day 8 after challenge with virulent Salmonella and proved to be a more efficient vaccination strategy than live attenuated bacteria alone.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Homelessness is a significant public health problem. It is well-documented that people experiencing homelessness exhibit more serious illnesses and have poorer health than the general population. The provision of services and interventions by health-care professionals, including pharmacists, may make a simple yet important contribution to improved health outcomes in those experiencing homelessness, but evidence of roles and interventions is limited and variable. In Australia, the Queensland University of Technology Health Clinic connects with the homeless community by taking part in community outreach events. This paper provides details of one such event, as well as the roles, interventions and experiences of pharmacists. Participation and inclusion of pharmacists in a multidisciplinary health-care team approach at homeless outreach events should be supported and encouraged.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

This study evaluates the effectiveness and social implications of home monitoring of 31 infants at risk of sudden infant death syndrome (SIDS). Thirteen siblings of children dying of SIDS, nine near miss SIDS infants and nine preterm infants with apnoea persisting beyond 40 weeks post conceptual age were monitored from a mean age of 15 days to a mean of 10 months. Chest movement detection monitors were used in 27 and thoracic impedance monitors in four. Genuine apnoeic episodes were reported by 21 families, and 13 infants required resuscitation. Apnoeic episodes occurred in all nine preterm infants but in only five (38%) of the siblings of SIDS (P<0.05). Troublesome false alarms were a major problem occurring with 61% of the infants and were more common with the preterm infants than the siblings of SIDS. All but two couples stated that the monitor decreased anxiety and improved their quality of life. Most parents accepted that the social restrictions imposed by the monitor were part of the caring process but four couples were highly resentful of the changes imposed on their lifestyle. The monitors used were far from ideal with malfunction occurring in 17, necessitating replacement in six, repair in six and cessation of monitoring in three. The parents became ingenious in modifying the monitors to their own individual requirements Although none of these 31 ‘at risk’ infants died the study sample was far too small to conclude whether home monitoring prevented any cases of SIDS.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Tutkimuksen tavoitteena on ollut kuvata pian valmistuvien sairaanhoitaja- ja laboratoriohoitajaopiskelijoiden teoreettista työnhallintaa kliinisen mikrobiologian alaan kuuluvien potilasnäytteiden ottamisessa. Tutkimuksessa haluttiin selvittää, miten peruskoulutus ja työelämän harjoittelujaksot ovat vaikuttaneet näytteenottovalmiuksien syntymiseen sekä minkälainen käsitys valmistuvilla hoitajilla on omista mikrobiologisista näytteenottotaidoistaan. Syy tutkimuksen tekemiseen oli tarve arvioida ammatillisen koulutuksen tuloksellisuutta sekä hakea mikrobiologian opetusalueelta tutkimustietoa opetuksen kehittämiseen ja sisältöjen suuntaamiseen. Tutkimukseen osallistui 21 laboratoriohoitajaopiskelijaa ja 27 sairaanhoitajaopiskelijaa. Opiskelijat olivat viimeiseltä lukukaudelta ja valmistuivat keväällä 1998. Tiedonkeruumenetelmänä oli kyselylomake, jonka alkuosa koostui neljästä mikrobiologisesta näytteenottotilanteesta. Opiskelija vastasi toimintatapansa kertoen ja perustellen, miten hän ottaisi näytteet näissä tilanteissa. Vastaukset ryhmiteltiin käyttäen luokitteluun mukaeltua Solo-taksonomiaa. Koulutusta ja opiskelijan käsityksiä kartoittavat kysymykset olivat joko puolistrukturoituja tai avoimia. Laboratoriohoitajaopiskelijoiden tiedollinen työnhallinta sijoittuu tulosten perusteella tyydyttävän ja hyvän välimaastoon. Sairaanhoitajaopiskelijoiden tietotaso oli heikko ja osin hyvin heikko. Laboratoriohoitajaopiskelijat arvioivat koulutuksen antamia mikrobiologisen näytteenoton valmiuksia pääasiassa hyviksi tai tyydyttäviksi; sairaanhoitajaopiskelijat pitivät opetuksesta saamiaan valmiuksia heikkoina. Näytteenoton arvostusta pidettiin kaiken kaikkiaan matalana, ja tietoa laadukkaasta näytteenotosta arvioitiin puuttuvan työelämässä laajasti. Tutkimuksen perusteella näyttää siltä, ettei valmistuvilla sairaanhoitajilla ole tiedollisia ja taidollisia valmiuksia suoriutua edes perusnäytteenotosta niin, että saatu näyte edustaisi laadukkaasti potilaan tilaa näytteenottohetkellä. Näytteenotto on koko laboratoriotyön prosessin kriittisin vaihe. Jos näyte on otettu, säilytetty tai kuljetettu väärin, paraskaan analyysitekniikka ei pysty tuottamaan siitä potilaan hoitoa oikeaan suuntaan ohjaavaa tulosta. Kaikkien laboratorionäytteiden oton siirtäminen laboratoriohoitajille ja runsaan lisäkoulutuksen anto tälle ammattiryhmälle voisi tuottaa parannuksen vallitsevaan tilanteeseen. Avainsanat: ammattitaito, osaaminen, ammatillinen koulutus, kliinisen mikrobiologian näytteenotto, tiedollinen työnhallinta Keywords: occupational skills, competence, vocational education, collecting of specimen in clinical microbiology, conceptual mastery of work

Relevância:

20.00% 20.00%

Publicador:

Resumo:

The response of soybean (Glycine max) and dry bean (Phaseolus vulgaris) to feeding by Helicoverpa armigera during the pod-fill stage was studied in irrigated field cages over three seasons to determine the relationship between larval density and yield loss, and to develop economic injury levels. H. armigera intensity was calculated in Helicoverpa injury equivalent (HIE) units, where 1 HIE was the consumption of one larva from the start of the infestation period to pupation. In the dry bean experiment, yield loss occurred at a rate 6.00 ± 1.29 g/HIE while the rates of loss in the three soybean experiments were 4.39 ± 0.96 g/HIE, 3.70 ± 1.21 g/HIE and 2.12 ± 0.71 g/HIE. These three slopes were not statistically different (P > 0.05) and the pooled estimate of the rate of yield loss was 3.21 ± 0.55 g/HIE. The first soybean experiment also showed a split-line form of damage curve with a rate of yield loss of 26.27 ± 2.92 g/HIE beyond 8.0 HIE and a rapid decline to zero yield. In dry bean, H. armigera feeding reduced total and undamaged pod numbers by 4.10 ± 1.18 pods/HIE and 12.88 ± 1.57 pods/HIE respectively, while undamaged seed numbers were reduced by 35.64 ± 7.25 seeds/HIE. In soybean, total pod numbers were not affected by H. armigera infestation (out to 8.23 HIE in Experiment 1) but seed numbers (in Experiments 1 and 2) and the number of seeds/pod (in all experiments) were adversely affected. Seed size increased with increases in H. armigera density in two of the three soybean experiments, indicating plant compensatory responses to H. armigera feeding. Analysis of canopy pod profiles indicated that loss of pods occurred from the top of the plant downwards, but with an increase in pod numbers close to the ground at higher pest densities as the plant attempted to compensate for damage. Based on these results, the economic injury levels for H. armigera on dry bean and soybean are approximately 0.74 HIE and 2.31 HIE/m2, respectively (0.67 and 2.1 HIE/row-m for 91 cm rows).

Relevância:

20.00% 20.00%

Publicador:

Resumo:

The purpose of this research was to evaluate the special vocational training programme, which aimed at enhancing the pupils with autism spectrum to prepare themselves for work and independent life. The vocational training programme is based on TEACCH (Treatment and Education of Autistic and Related Communication handicapped CHildren), which takes into account the autism spectrum disorders and autistic behaviour. TEACCH is based on the principles of structured teaching, functional teaching and preparation training for work and independent life. The TEACCH has been adapted to Finnish society and the educational system. Treatment programmes were individually designed for each student´s educational needs. There is also an important role for the AAPEP rating scale (Adolescent and Adult Psychoeducational Profile). The AAPEP has been the major tool for planning and following the courses. The AAPEP is an assessment instrument designed by the TEACCH programme, and it is used to provide an evaluation of current and potential skills. The AAPEP contains three scales: a direct observation scale, a home scale and a school / work scale. The AAPEP includes six test variables: vocational skills, independent functions, functional communication, interpersonal behaviour, vocational behaviour and leisure skills; these are evaluated at three levels: pass, emerge and fail. The subjects were 49 students (65% male and 35 % female) with autism spectrum, who have been followed and tested several times, also one year after the vocational training. The design is therefore a longitudinal one. The research data were collected 1997-2004 using the AAPEP rating scales. The teachers have used the AAPEP scales and the codings have been checked by the researcher. The results of the principal component analysis (PCA) suggested that the structure of AAPEP rating scales works quite well as a hypothesis. The factor structure of the scales of the AAPEP was almost the same in these data as in the original publications. The learning-and-changes results showed that learning is a slow process, but that there were also intended changes in several AAPEP areas. The Cohen´s kappa was used as an effect-size measure and the most important result of this research showed that the student´s skills were developing on a school / work scale; vocational skills variable (0,34), vocational behaviour variable (0,28), leisure skills variable (0,26) and on a direct observation scale; interpersonal behaviour variable (0,21). On a home scale skills of some students were developing negatively and also that effect-size was small. The results showed that the students´ vocational skills and vocational behaviour will continue to develop after school in many areas. There were differences between scales. The result of this research shows that the student´s skills were developing significantly in 3 of 48 variables on a direct observation scale and also on a home scale. On a school / work scale student´s skills were developing significantly in 17 of 48 variables. This result implies that students can do the work without extra assistance if there exist continuing supports for the skills after the vocational training. The fully independent life of students will be difficult, because their independent functions, functional communications and leisure skills regressed after the schooling. This seems to indicate that they will not manage their daily life without support. The students and their parents said that the treatment programmes were individually designed for each student s educational needs, and that they were satisfied with the programmes and services. Generally, it can be concluded that vocational special education can be developed for pupils with autistic syndrome and the detailed teaching can be done using TEACCH principles and applying the tool of AAPEP.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Of the 70 cases of classical biological control for the protection of nature found in our review, there were fewer projects against insect targets (21) than against invasive plants (49), in part, because many insect biological control projects were carried out against agricultural pests, while nearly all projects against plants targeted invasive plants in natural ecosystems. Of 21 insect projects, 81% (17) provided benefits to protection of biodiversity, while 48% (10) protected products harvested from natural systems, and 5% (1) preserved ecosystem services, with many projects contributing to more than one goal. In contrast, of the 49 projects against invasive plants, 98% (48) provided benefits to protection of biodiversity, while 47% (23) protected products, and 25% (12) preserved ecosystem services, again with many projects contributing to several goals. We classified projects into complete control (pest generally no longer important), partial control (control in some areas but not others), and "in progress," for projects in development for which outcomes do not yet exist. For insects, of the 21 projects discussed, 59% (13) achieved complete control of the target pest, 18% (4) provided partial control, and 41% (9) are still in progress. By comparison, of the 49 invasive plant projects considered, 27% (13) achieved complete control, while 33% (16) provided partial control, and 47% (24) are still in progress. For both categories of pests, some projects' success ratings were scored twice when results varied by region. We found approximately twice as many projects directed against invasive plants than insects and that protection of biodiversity was the most frequent benefit of both insect and plant projects. Ecosystem service protection was provided in the fewest cases by either insect or plant biological control agents, but was more likely to be provided by projects directed against invasive plants, likely because of the strong effects plants exert on landscapes. Rates of complete success appeared to be higher for insect than plant targets (59% vs 27%), perhaps because most often herbivores gradually weaken, rather than outright kill, their hosts, which is not the case for natural enemies directed against pest insects. For both insect and plant biological control, nearly half of all projects reviewed were listed as currently in progress, suggesting that the use of biological control for the protection of wildlands is currently very active.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Fig. 13 in family portrait

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Digital Image

Relevância:

20.00% 20.00%

Publicador:

Resumo:

What is calf wastage. Breeding female cattle in north Australia contribute best to business success by producing a heavy weaner each year at the first weaning round. This maximises increase in value by the cow unit over the year, generally from mid-year to mid-year. The ability to cycle in both maiden heifers and lactating cows is the primary limitation to achieving this. Wastage of a calf at any stage between conception and weaning also substantially limits fertility and value increase at a herd level. Embryo loss may result in later calves as cows re-conceive; the calves produced are smaller at weaning and have to be weaned later into the dry season. Late calf wastage usually results in breeders missing a calf for the year. Late calving often also results in failure to cycle, thus cows rear a calf in the subsequent year.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Summary Prototype sand-worm filtration beds were constructed at two prawn farms and one fish farm to assess and demonstrate their polychaete (marine worm) production and wastewater remediation capacities at semi-commercial scale. Wastewater treatment properties were monitored and worms produced were assessed and either sold for bait or used by the farms’ hatcheries as broodstock (prawn or fish breeder) feed. More than 34 megalitres of prawn- and fish-pond water was beneficially treated in the 116-319-d trial. The design of the polychaete-assisted sand filters (PASFs) constructed at each farm affected their water handling rates, which on average ranged from 315 to 1000 L m-2 d-1 at the three farms. A low profile design incorporating shallow bunded ponds made from polyethylene liner and timber stakes provided the easiest method of construction. This simple design applied at broad scale facilitated the highest quantities of treated water and the greatest worm production. Designs with higher sides increased the head pressure above the sand bed surface, thus increasing the amount of water that could be treated each day. Most water qualities were affected in a similar way to that demonstrated in the previous tank trials: dissolved oxygen, pH, total suspended solids and chlorophyll a levels were all consistently significantly lowered as pond water percolated through the sand bed, and dissolved forms of nitrogen and phosphorus were marginally increased on several occasions. However, unlike the previous smaller-scale tank trials, total nitrogen (TN) and total phosphorus (TP) levels were both significantly lowered by these larger-scale PASFs. The reasons for this are still unclear and require further research. Maximum TN and TP removals detected in the trial were 48.8% and 67.5%, respectively, and average removals (in unfed beds) at the three farms ranged from 20.0 to 27.7% for TN and from 22.8 to 40.8% for TP. Collectively, these results demonstrate the best suspended solids, chlorophyll and macronutrient removal capacities so far reported for any mariculture wastewater treatment methodology to date. Supplemental feeding of PASFs with fish meal was also investigated at one farm as a potential means of increasing their polychaete biomass production. Whilst fed beds produced higher biomass (152 ± 35 g m-2) compared with unfed beds (89 ± 17 g m-2) after 3.7 months of operation, the low number of replicates (2) prevented statistically significant differences from being demonstrated for either growth or survival. At harvest several months later, worm biomass production was estimated to be similar to, or in slight excess of, previously reported production levels (300-400 g m-2). Several qualities of filtered water appear to have been affected by supplemental feeding: it appeared to marginally lower dissolved oxygen and pH levels, and increased the TN and TP levels though not so much to eliminate significant beneficial water treatment effects. Periodic sampling during an artificial-tide demonstrated the tendency for treated-water quality changes during the first hour of filtration. Total nitrogen and ammonia peaked early in the tidal flow and then fell to more stable levels for the remainder of the filtration period. Other dissolved nutrients also showed signs of this sand-bed-flushing pattern, and dissolved oxygen tended to climb during the first hour and become more stable thereafter. These patterns suggest that the routine sampling of treated water undertaken at mid-inflow during the majority of the wider study would likely have overestimated the levels of TN and dissolved nutrients discharged from the beds, and hence underestimated the PASFs treatment efficacies in this regard. Analyses of polychaete biomass collected from each bed in the study revealed that the worms were free from contamination with the main prawn viruses that would create concerns for their feeding to commercial prawn broodstock in Australia. Their documented proximal and nutritional contents also provide a guide for hatchery operators when using live or frozen stock. Their dry matter content ranged from 18.3 to 22.3%, ash ranged from 10.2 to 14.0%, gross energy from 20.2 to 21.5 MJ kg-1, and fat from 5.0 to 9.2%. Their cholesterol levels ranged from 0.86 to 1.03% of dry matter, whilst total phospholipids range from 0.41 to 0.72%. Thirty-one different fatty acids were present at detectable (≥0.005% of dry matter) levels in the sampled worm biomass. Palmitic acid was by far the most prevalent fatty acid detected (1.21 ± 0.18%), followed by eicosapentaenoic (EPA) (0.48 ± 0.03%), stearic (0.46 ± 0.04%), vaccenic (0.38 ± 0.05%), adrenic (0.35 ± 0.02%), docosadienoic (0.28 ± 0.02%), arachidonic (AA) (0.22 ± 0.01%), palmitoleic (0.20 ± 0.04%) and 23 other fatty acids with average contents of less than 0.2% of dry matter. Supplemental feeding with fish meal at one farm appeared to increase the docosahexaenoic acid (DHA) content of the worms considerably, and modify the average AA : EPA : DHA from 1.0 : 2.7 : 0.3 to 1.0 : 2.0 : 1.1. Consistent with previous results, the three most heavily represented amino acids in the dry matter of sampled worms were glutamic acid (8.5 ± 0.2%), aspartic acid (5.5 ± 0.1%) and glycine (4.9 ± 0.5%). These biomass content results suggest that worms produced in PASF systems are well suited to feeding to prawn and fish broodstock, and provide further strong evidence of the potential to modify their contents for specific nutritional uses. The falling wild-fishery production of marine bloodworms in Queensland is typical of diminishing polychaete resources world-wide and demonstrates the need to develop sustainable production methods here and overseas. PASF systems offer the dual benefits of wastewater treatment for environmental management and increased productivity through a valuable secondary crop grown exclusively on waste nutrients.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Handwritten caption: Mein Bruder Eduard links und Familie in Mailand Italien

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Khaya senegalensis, African mahogany, a high-value hardwood, was introduced in the Northern Territory (NT) in the 1950s; included in various trials there and at Weipa, Q in the 1960s-1970s; planted on ex mine sites at Weipa (160 ha) until 1985; revived in farm plantings in Queensland and in trials in the NT in the 1990s; adopted for large-scale, annual planting in the Douglas-Daly region, NT from 2006 and is to have the planted area in the NT extended to at least 20,000 ha. The recent serious interest from plantation growers, including Forest Enterprises Australia Ltd (FEA), has seen the establishment of some large scale commercial plantations. FEA initiated the current study to process relatively young plantation stands from both Northern Territory and Queensland plantations to investigate the sawn wood and veneer recovery and quality from trees ranging from 14 years (NT – 36 trees) to 18-20 years (North Queensland – 31 trees). Field measures of tree size and straightness were complemented with log end splitting assessment and cross-sectional disc sample collection for laboratory wood properties measurements including colour and shrinkage. End-splitting scores assessed on sawn logs were relatively low compared to fast grown plantation eucalypts and did not impact processing negatively. Heartwood proportion in individual trees ranged from 50% up to 92 % of butt cross-sectional disc area for the visually-assessed dark coloured central heartwood and lighter coloured transition wood combined. Dark central heartwood proportion was positively related to tree size (R2 = 0.57). Chemical tests failed to assist in determining heartwood – sapwood boundary. Mean basic density of whole disc samples was 658 kg/m3 and ranged among trees from 603 to 712 kg/m3. When freshly sawn, the heartwood of African mahogany was orange-red to red. Transition wood appeared to be pinkish and the sapwood was a pale yellow colour. Once air dried the heartwood colour generally darkens to pinkish-brown or orange-brown and the effect of prolonged time and sun exposure is to darken and change the heartwood to a red-brown colour. A portable colour measurement spectrophotometer was used to objectively assess colour variation in CIE L*, a* and b* values over time with drying and exposure to sunlight. Capacity to predict standard colour values accurately after varying periods of direct sunlight exposure using results obtained on initial air-dried surfaces decreased with increasing time to sun exposure. The predictions are more accurate for L* values which represent brightness than for variation in the a* values (red spectrum). Selection of superior breeding trees for colour is likely to be based on dried samples exposed to sunlight to reliably highlight wood colour differences. A generally low ratio between tangential and radial shrinkages was found, which was reflected in a low incidence of board distortion (particularly cupping) during drying. A preliminary experiment was carried out to investigate the quality of NIR models to predict shrinkage and density. NIR spectra correlated reasonably well with radial shrinkage and air dried density. When calibration models were applied to their validation sets, radial shrinkage was predicted to an accuracy of 76% with Standard Error of Prediction of 0.21%. There was also a strong predictive power for wood density. These are encouraging results suggesting that NIR spectroscopy has good potential to be used as a non-destructive method to predict shrinkage and wood density using 12mm diameter increment core samples. Average green off saw recovery was 49.5% (range 40 to 69%) for Burdekin Agricultural College (BAC) logs and 41.9% (range 20 to 61%) for Katherine (NT) logs. These figures are about 10% higher than compared to 30-year-old Khaya study by Armstrong et al. (2007) however they are inflated as the green boards were not docked to remove wane prior to being tallied. Of the recovered sawn, dried and dressed volume from the BAC logs, based on the cambial face of boards, 27% could potentially be used for select grade, 40% for medium feature grade and 26% for high feature grades. The heart faces had a slightly higher recovery of select (30%) and medium feature (43%) grade boards with a reduction in the volume of high feature (22%) and reject (6%) grade boards. Distribution of board grades for the NT site aged 14 years followed very similar trends to those of the BAC site boards with an average (between facial and cambial face) 27% could potentially be used for select grade, 42% for medium feature grade, 26% for high feature grade and 5% reject. Relatively to some other subtropical eucalypts, there was a low incidence of borer attack. The major grade limiting defects for both medium and high feature grade boards recovered from the BAC site were knots and wane. The presence of large knots may reflect both management practices and the nature of the genetic material at the site. This stand was not managed for timber production with a very late pruning implemented at about age 12 years. The large amount of wane affected boards is indicative of logs with a large taper and the presence of significant sweep. Wane, knots and skip were the major grade limiting defects for the NT site reflecting considerable amounts of sweep with large taper as might be expected in younger trees. The green veneer recovered from billets of seven Khaya trees rotary peeled on a spindleless lathe produced a recovery of 83% of green billet volume. Dried veneer recovery ranged from 40 to 74 % per billet with an average of 64%. All of the recovered grades were suitable for use in structural ply in accordance to AS/NZ 2269: 2008. The majority of veneer sheets recovered from all billets was C grade (27%) with 20% making D grade and 13% B grade. Total dry sliced veneer recovery from the logs of the two largest logs from each location was estimated to be 41.1%. Very positive results have been recorded in this small scale study. The amount of colour development observed and the very reasonable recoveries of both sawn and veneer products, with a good representation of higher grades in the product distribution, is encouraging. The prospects for significant improvement in these results from well managed and productive stands grown for high quality timber should be high. Additionally, the study has shown the utility of non-destructive evaluation techniques for use in tree improvement programs to improve the quality of future plantations. A few trees combined several of the traits desired of individuals for a first breeding population. Fortunately, the two most promising trees (32, 19) had already been selected for breeding on external traits, and grafts of them are established in the seed orchard.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

This thesis utilises an evidence-based approach to critically evaluate and summarize effectiveness research on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices in children and adolescents with cerebral palsy (CP). It aims to assess the methodological challenges of the systematic reviews and trials, to evaluate the effectiveness of interventions in current use, and to make suggestions for future trials Methods: Systematic reviews were searched from computerized bibliographic databases up to August 2007 for physiotherapy and physiotherapy-related interventions, and up to May 2003 for orthotic devices. Two reviewers independently identified, selected, and assessed the quality of the reviews using the Overview Quality Assessment Questionnaire complemented with decision rules. From a sample of 14 randomized controlled trials (RCT) published between January 1990 and June 2003 we analysed the methods of sampling, recruitment, and comparability of groups; defined the components of a complex intervention; identified outcome measures based on the International Classification of Functioning, Disability and Health (ICF); analysed the clinical interpretation of score changes; and analysed trial reporting using a modified 33-item CONSORT (Consolidated Standards of Reporting Trials) checklist. The effectiveness of physiotherapy and physiotherapy-related interventions in children with diagnosed CP was evaluated in a systematic review of randomised controlled trials that were searched from computerized databases from January 1990 up to February 2007. Two reviewers independently assessed the methodological quality, extracted the data, classified the outcomes using the ICF, and considered the level of evidence according to van Tulder et al. (2003). Results: We identified 21 reviews on physiotherapy and physiotherapy-related interventions and five on orthotic devices. These reviews summarized 23 or 5 randomised controlled trials and 104 or 27 observational studies, respectively. Only six reviews were of high quality. These found some evidence supporting strength training, constraint-induced movement therapy or hippotherapy, and insufficient evidence on comprehensive interventions. Based on the original studies included in the reviews on orthotic devices we found some short-term effects of lower limb casting on passive range of movement, and of ankle-foot orthoses on equinus walk. Long term effects of lower limb orthoses have not been studied. Evidence of upper limb casting or orthoses is conflicting. In the sample of 14 RCTs, most trials used simple randomisation, complemented with matching or stratification, but only three specified the concealed allocation. Numerous studies provided sufficient details on the components of a complex intervention, but the overlap of outcome measures across studies was poor and the clinical interpretation of observed score changes was mostly missing. Almost half (48%) of the applicable CONSORT-based items (range 28 32) were reported adequately. Most reporting inadequacies were in outcome measures, sample size determination, details of the sequence generation, allocation concealment and implementation of the randomization, success of assessor blinding, recruitment and follow-up dates, intention-to-treat analysis, precision of the effect size, co-interventions, and adverse events. The systematic review identified 22 trials on eight intervention categories. Four trials were of high quality. Moderate evidence of effectiveness was established for upper extremity treatments on attained goals, active supination and developmental status, and of constraint-induced therapy on the amount and quality of hand use and new emerging behaviours. Moderate evidence of ineffectiveness was found for strength training's effect on walking speed and stride length. Conflicting evidence was found for strength training's effect on gross motor function. For the other intervention categories the evidence was limited due to the low methodological quality and the statistically insignificant results of the studies. Conclusions: The high-quality reviews provide both supportive and insufficient evidence on some physiotherapy interventions. The poor quality of most reviews calls for caution, although most reviews drew no conclusions on effectiveness due to the poor quality of the primary studies. A considerable number of RCTs of good to fair methodological and reporting quality indicate that informative and well-reported RCTs on complex interventions in children and adolescents with CP are feasible. Nevertheless, methodological improvement is needed in certain areas of the trial design and performance, and the trial authors are encouraged to follow the CONSORT criteria. Based on RCTs we established moderate evidence for some effectiveness of upper extremity training. Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most physiotherapy interventions is available to guide clinical practice. Well-designed trials are needed, especially for focused physiotherapy interventions.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

This photograph was included in the meeting's published report