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Nilsson, Heléne. "Demand for Rapid and Accurate Regional Medical Response at Major Incidents." Doctoral thesis, Linköpings universitet, Kirurgi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-86597.
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The ultimate goal in major incidents is to optimize care for the greatest number of patients. This means matching patients with facilities that have the appropriate resources available in sufficient quantities to provide the necessary care. A major incident is a situation where the available resources are inadequate in relation to the urgent need. As health care resources have become increasingly constrained, it is imperative that all resources be optimized from a regional and sometimes a national perspective. In Sweden, the number of major incidents per year is still unknown. In order to implement effective quality control of response to major incidents, specific standards for regional medical response need to be set and agreed on from a national perspective. This will probably also enhance follow-up and comparison of major incidents in the future. The overall aim of this thesis is to improve understanding of the demand for rapid and accurate regional medical response at major incidents. The objectives were to systematically analyse specific decisions within regional medical response and to identify factors that can influence patient outcome in major incidents. This research is based on four studies in which a set of 11 measurable performance indicators for initial regional medical command and control have been used as an evaluation instrument together with a simulation system where the assessment of each patient could be evaluated. The collection of data was made during several disaster management programs but also in real major incidents that occurred in two county councils in Sweden. In one of the studies, the national disaster medical response plan for burns was evaluated. This research shows that measurable performance indicators for regional medical response allow standardized evaluation such that it is possible to find crucial decisions that can be related to patient outcome. The indicators can be applied to major incidents that directly or indirectly involve casualties provided there is sufficient documentation available and thereby could constitute a measurable part of regional and national follow-up of major incidents. Reproducible simulations of mass casualty events that combine process and outcome indicators can create important results on medical surge capability and may serve to support disaster planning. The research also identified that there is a risk for delay in distribution of severely injured when many county councils needs to be involved due to different regional response times to major incidents. Furthermore, the coordination between health care and other authorities concerning ambulance helicopter transport in mass casualty events needs to be further addressed. It is concluded that there is a demand for rapid and accurate response to major incidents that is similar in all county councils. Like all other fields of medicine, these processes need to be quality assured.
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Chen, Chien-Hung. "Optimization and decision strategies for medical preparedness and emergency response." Diss., Georgia Institute of Technology, 2013. http://hdl.handle.net/1853/52939.
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The public health emergencies, such as bioterrorist attacks or pandemic outbreaks, have gained serious public and government attentions since the 2001 anthrax attacks and the SARS outbreak in 2003. These events require large-scale and timely dispensing of critical medical countermeasures for protection of the general population.
This thesis research focuses on developing mathematical models, real-time algorithms, and computerized decision support systems that enable (1) systematic coordination to tackle multifaceted nature of mass dispensing, (2) fast disease propagation module to allow immediate mitigation response to on-site uncertainties, and (3) user-friendly platform to facilitate modeling-solution integration and cross-domain collaboration. The work translates operations research methodologies into practical decision support tools for public health emergency professionals.
Under the framework of modeling and optimizing the public health infrastructure for biological and pandemic emergency responses, the task first determines adequate number of point-of-dispensing sites (POD), by placing them strategically for best possible population coverage. Individual POD layout design and associated staffing can thus be optimized to maximize throughput and/or minimize resource requirement for an input throughput. Mass dispensing creates a large influx of individuals to dispensing facilities, thus raising the risk of high degree of intra-facility infections. Our work characterizes the interaction between POD operations and disease propagation.
Specifically, fast genetic algorithm-based heuristics were developed for solving the integer-programming-based facility location instances. The approach has been applied to the metro-Atlanta area with a population of 5.2 million people spreading over 11 districts. Among the 2,904 instances, the state-of-the-art specialized integer programming solver solved all except one instance to optimality within 300,000 CPU seconds and solved all except 5 to optimality within 40,000 CPU seconds. Our fast heuristic algorithm returns good feasible solutions that are within 8 percent to optimality in 15 minutes. This algorithm was embedded within an interactive web-based decision support system, RealOpt-Regional©. The system allows public health users to contour the region of interest and determine the network of PODs for their affected population. Along with the fast optimization engine, the system features geographical, demographical, and spatial visualization that facilitate real-time usage. The client-server architecture facilities front-end user interactive design on Google Maps© while the facility location mathematical instances are generated and solved in the back-end server.
In the analysis of disease propagation and mitigation strategies, we first extended the 6-stage ordinary differential equation-based (ODE) compartmental model to accommodate POD operations. This allows us to characterize the intra-facility infections of highly contagious diseases during local outbreak when large dispensing is in process. The disease propagation module was then implemented into the CDC-RealOpt-POD© discrete-event-simulation-optimization. CDC-RealOpt-POD is a widely used emergency response decision support system that includes simulation-optimization for determining optimal staffing and operations. We employed the CDC-RealOpt-POD environment to analyze the interactions between POD operations and disease parameters and identified effective mitigation strategies. The disease propagation module allows us to analyze the efficient frontier between operational efficiencies and intra-POD infections. Emergency response POD planners and epidemiologists can collaborate under the familiar CDC-RealOpt-POD environment, e.g., design the most efficient plan by designing and analyzing both POD operations and disease compartmental model in a unified platform. Corresponding problem instances are formed automatically by combining and transforming graphical inputs and numerical parameters from users.
To facilitate the operations of receiving, staging and storage (RSS) of medical countermeasures, we expanded the CDC-RealOpt-POD layout design functions by integrating it with the process flow. The resulting RSS system allows modeling of both system processes along with spatial constraints for optimal operations and process design. In addition, agent-based simulation was incorporated inside where integrated process flow and layout design allow analysis of crowd movement and congestion. We developed the hybrid agent behavior where individual agents make decision through system-defined process flow and autonomous discretion. The system was applied successfully to determine guest movement strategies for the new Georgia Aquarium Dolphin Tales exhibit. The goal was to enhance guest experience while mitigating overall congestion.
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Thomas, David H. "Acoustic investigation of microbubble response to medical imaging ultrasound pulses." Thesis, University of Edinburgh, 2010. http://hdl.handle.net/1842/4516.
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Ultrasound contrast agents have the ability to provide locally increased echogenicity, improving the sensitivity and specificity of images. Due to the unique interaction of microbubbles with the imaging ultrasound field, contrast ultrasonography offers both improved diagnostic techniques, and the potential therapeutic uses of gene and drug delivery through the use of targeted agents. By enhancing the contrast at the tissue-blood interface, an improved image of the structure of organs can be achieved, which is useful in many areas of medical ultrasound imaging. Monitoring the flow of contrast agent in the blood stream also offers information on the degree of blood perfusion into an organ or microvasculature. Present knowledge of the interaction of microbubbles with ultrasound is far from complete. The full potential of contrast agents in improving diagnostic and therapeutic techniques has therefore not yet been achieved. The nonlinear and dynamic properties of microbubble response offer potentially large improvements in contrast to tissue ratio, through intelligent pulse sequence design and/or improved signal processing. Due to various drawbacks of populations studies, only by studying the response from single microbubbles can the interaction be fully understood. The variations of microbubble size and shell parameters within a typical sample of contrast agent dictate that a large number of single scatterer data are necessary to obtain information on the variability of microbubble response, which is not possible with current optical systems. This thesis aims to be a contribution to the understanding of contrast behaviour in response to medical imaging ultrasound pulses. A fully characterized microacoustic system, employing a wide-band piezoelectric transducer from a commercial ultrasound imaging system, is introduced, which enables the measurement of single scattering events. Single microbubble signals from two commercially available contrast agents, Definity R and biSphereTM, have been measured experimentally in response to a range of clinically relevant imaging parameters. The data has been analyzed, together with the results from appropriate theoretical models, in order to gain physical insight into the evolution and dynamics of microbubble signals. A theoretical model for the lipid shelled agent Definity has been developed, and the predicted response from a real sample of single microbubbles investigated. Various characteristics of resonant scatter have been identified, and used to distinguish resonant scatter in experimental acoustic single bubble data for the first time. A clear distinction between the populations of resonant and off-resonant scatter has been observed for a range of incident frequencies and acoustic pressures. Results from consecutive imaging pulses have been used to gain understanding of how initial size, shell material and encapsulated gas may effect the lifetime of a microbubble signal. The response to a basic pulse sequence is also investigated, and an alternative processing method which takes advantage of observed behaviour is presented. Improved understanding of the contrast-ultrasound interaction will provide the basis for improved signal processing tools for contrast enhanced imaging, with potential benefits to both diagnostic techniques and microbubble manufacture.
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Atenstaedt, Robert Leslie. "The trench diseases : the British medical response in the Great War." Thesis, University of Oxford, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423662.
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Martin, Bruce K. "Collaboration in the San Francisco Bay area Metropolitan Medical Response System." Thesis, Monterey, California. Naval Postgraduate School, 2010. http://hdl.handle.net/10945/5189.
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Within the San Francisco Bay Area there are four cities that host a Metropolitan Medical Response System (MMRS) program: San Francisco, San Jose, Oakland and Fremont. The four Bay Area MMRS cities are within fifty miles of each other. The MMRS resources could be used to reinforce each other's planning and response. The 103-city, 10-county Bay Area is under one Urban Area Security Initiative (UASI). Currently though, the MMRS programs in the four cities work independently of each other and of the UASI. How can these agencies collaborate to address mission gaps and overlaps? This thesis uses a Delphi survey methodology to ascertain institutional perspectives on benefits, processes, enablers and barriers to collaboration in the San Francisco Bay Area. With collaborative effort, gaps and overlaps in San Francisco Bay Area mass casualty preparedness and response can be mitigated. This thesis recommends short term and long term actions to encourage collaboration in the Bay Area, which, in turn, can lead to better patient outcomes in infrequent mass casualty incidents.
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Shires, Karen Lesley. "Characterisation of the cold-shock response in Mycobacterium smegmatis." Doctoral thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/25670.
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The response of Mycobacterium smegmatis to a cold shock was investigated in order to gain insight into the stress responses of members of the genus Mycobacterium. Mycobacterium smegmatis cultures were shocked from 37°C to 30°C, 25°C, 15°C, and 10°C and the effects on both growth (ATP concentration, culture turbidity, colony-forming units) and metabolism (incorporation of ¹⁴C-leucine and ³H-uracil) were investigated. The magnitude of the cold-shock response was found to be dependent upon the degree of the cold shock. A cold shock to 10°C had the greatest effect and resulted in a "lag period" of 24 hours in both the growth and metabolism of the culture. The synthesis of proteins was reduced 20-fold during this period, indicating at block in translation. The cold-shock response in Mycobacterium smegmatis was an adaptive response with growth eventually being resumed at the colder temperature, but at a reduced rate. Using the techniques of one-dimensional sodium-dodecyl-sulphate polyacrylamide gel electrophoresis and two-dimensional protein gel electrophoresis, ³⁵S-methiononine-labelled proteins that were synthesised during the cold shock were analysed. At least fourteen radio-labelled proteins were induced during the first 24-hour period and these demonstrated two distinct patterns of cold-shock induced expression: transient and continuous. Depending upon the pattern of expression and size, the cold-shock proteins were classified as "cold-induced proteins", "cold-shock proteins" or "cold-acclimation proteins". CipM, a 27kDa protein, was identified as the major cold-shock protein through one-dimensional protein electrophoresis. From N-terminal sequence data generated from a protein (CipM.1) within this band, a corresponding degenerate DNA probe was used to isolate cipM.1. This gene was cold-inducible, with mRNA levels transiently increasing 5-7 fold after a 37°C to 10°c cold-shock. Homologues of this cold-shock gene are found in the genomes of Mycobacterium tuberculosis and Mycobacterium leprae. The corresponding mycobacterial proteins showed homology at the N-terminus to the HU~ subunit of HU of Escherichia coli and possessed similar C-terminal praline, lysine and alanine degenerate repeats to the mycobacterial heparin-binding hemagglutinin. The response of several mycobacterial cold-shock gene homologues to a cold shock was also investigated, by northern-hybridisation and S1 nuclease analysis. The cspA homologue of Mycobacterium smegmatis demonstrated a 16-24 fold transient induction in mRNA levels following a 37°C to 10°C temperature-shift, while gyrA mRNA levels were maintained at a constant level throughout the cold shock. Although some similarities were demonstrated between the cold-shock response of Escherichia coli and Mycobacterium smegmatis, definite differences occur in the proteins that are involved in the adaptive stages of the response.
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Post, Frank A. "Mycobacterial strain diversity : impact on the host immune response." Doctoral thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/2717.
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Rutledge, Thomas. "Psychological response styles and cardiovascular health : confound or independent risk factor?" Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0002/NQ34622.pdf.
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Simmons, Ruth April. "Characterisation of the immune response to PARV4." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:85f81b48-d9ad-467e-a266-5d3b103798f4.
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PARV4 is a novel human parvovirus initially identified in an intravenous drug user at risk of HIV infection. PARV4 is a small single stranded DNA virus principally absent from the general population, but common in HCV- and HIV-infected individuals. Until 2009, most published PARV4 studies related to the prevalence of PARV4 in various risk groups. PARV4 has been detected in the liver of HCV-patients and the bone marrow of HIV-patients. Parvovirus B19, the closest related virus, elicits a strong immune response and can cause serious disease. Thus, this project was initiated to characterise the immune response to PARV4, and investigate the clinical significance of this virus. Cohorts of HCV-infected, HIV-infected, HCV-HIV co-infected, healthy and acute parvovirus B19-infected individuals were screened for humoral and cellular responses in both acute and chronic PARV4 infection. HCV- and HIV-related disease progression was also assessed relative to PARV4 infection. This study demonstrates that the highest prevalence of PARV4 infection is found in HCV-HIV co-infected intravenous drug users, and provides additional evidence for parenteral transmission. I present here the first data on the cellular immune response to PARV4 in acute and chronic infection and define PARV4 as a persistent virus. Although no clear correlation could be found between PARV4 and HCV or HIV disease progression, the high prevalence rates emphasize the importance of investigations into emerging infections such as PARV4.
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Mitchell, Veronica Ann. "Medical students’ response-ability to unjust practices in obstetrics: A relational perspective." University of the Western Cape, 2019. http://hdl.handle.net/11394/6946.
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Philosophiae Doctor - PhDThis study is located in the fourth-year obstetrics curriculum that undergraduate medical students at the University of Cape Town, South Africa, traverse, and in which they are initiated into the knowledge and skills of practical obstetrics practices in local birthing facilities. I investigate student learning and what contributes to students being rendered in/capable when they find themselves immersed in the high levels of prevailing injustices to women in labour. Disrespect during the intrapartum period is a local as well as global problem which has actually reached epidemic levels. Drawing on the theoretical frameworks of posthumanism and feminist new materialism, and using post-qualitative inquiry and non-representational methods, I put forward a novel perspective for interrogating responsibilities in terms of students’ ability to respond to unjust practices they observe, I discern what matters for student learning, exploring the troubled practices that emanate through/with/from the curriculum-student relationships in the past/present, and what it means for the future. Assemblage thinking provides a relational tool to understand the impact of the curriculum, assessment processes and other materialising forces that have agency as students are becoming-with human and more-than-human bodies. An initial survey was followed up with interviews and focus groups with students, midwives, educators and administrators. My study revealed hidden aspects of student engagement with their curriculum in obstetrics. What emerged was that students are entangled in a mesh of forces influencing their ability and capacity to respond to the injustices they witness. These forces arise from the discursive and material practices and the in-between relationships that are generated in the learning processes. The study also brought to the fore the intensive forces of affect that appeared to be obfuscated in terms of students’ response-abilities. My findings foreground how reciprocal relationships matter and that a relational ontology can provide helpful insights to engage with responsibility, response-ability and social justice. Students’ capacity to respond to the injustices they witness is limited by multiple forces that include the curriculum itself and other materialising forces generated, for instance by floors, beds, curtains and the student logbook. Time is also a crucial issue amidst the tensions emerging in the complex and risky process of birthing. What matters to students, such as their assessment needs, appears to undermine their efforts to offer care and to promote social justice. Affect plays a powerful part in shaping students’ actions, yet there are few opportunities for acknowledgement of affect. I used drawings as data-in-the making. The process of drawing contributed an extra material force to the study illuminating the power of an affective pedagogical approach for fostering students’ capability to respond to injustice. This socially just pedagogy as well as classroom performances and online collaborative engagement contributed to a collective effort to engage with obstetric disrespect in an innovative and empowering manner that gave voice to students’ experiences and the emerging forces. My study contributes to the field of medical education by opening up a relational perspective to issues of social justice and responsibility that moves beyond individualist and human-centred conceptions of student learning. Through a relational ontology, students’ clinical encounters can be conceived as enactments of the multiple prevailing forces. Each moment matters.
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Roque, Thais Soleimani. "Using metabolic medical imaging to model tumour growth and response to therapy." Thesis, University of Oxford, 2018. http://ora.ox.ac.uk/objects/uuid:53c261bf-f06e-44b7-b28b-0ca0bba6145b.
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The number of cancer related deaths is predicted to reach over 13.1 million in 2030. Understanding the spatio-temporal evolution of tumours and their response to therapy is crucial to thwart this gloomy prognosis. Mathematical models have been used to elucidate the biological processes involved in tumour growth, but their complexity severely limits their clinical value. Effective models should base predictions on patient-specific data that can be obtained and tested in the clinic. This thesis aims to develop novel clinically-relevant methodologies to model solid tumour growth and reaction to therapy. Models are developed that predict the macroscopic tumour evolution as a result of complex biological processes happening at the microscopic scale (such as cell proliferation, hypoxia, necrosis and oxygenation) while retaining simplicity in terms of the number of parameters that require calibration. This facilitates integration of medical imaging-derived tumour descriptor maps (e.g. for cellularity and nutrient availability) to initialise, calibrate and verify the models. In addition to the models themselves, this thesis contributes to the literature by introducing novel frameworks to 1) derive maps of proliferative, hypoxic and necrotic cells using only Dynamic Contrast Enhanced Magnetic Resonance Imaging data; 2) apply these maps to constrain the models and obtain subject-specic predictions of tumour evolution; 3) account for tumour vascularisation, focusing on the angiogenesis-driven macroscopic changes observed longitudinally on medical imaging scans; and 4) produce a proof-of-concept updated model that could support medical decision in the treatment and management of cancer patients. The results demonstrate the feasibility of using information derived from imaging data to quantify and predict subject-specic global and local tumour evolution and reaction to therapy. Experimentally validated comparison between model predictions and tumour imaging data obtained at later time points of the tumours' evolution show noticeable improvements in prediction accuracy, model complexity and clinical value over state-of-the-art methods. Nevertheless, additional imaging information on complementary aspects of tumour growth and response to therapy could render our models even more relevant to clinical practice.
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Landahl, Mark R. "First responder identity management policy options for improved terrorism incident response." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2006. http://library.nps.navy.mil/uhtbin/hyperion/06Sep%5FLandahl.pdf.
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Thesis (M.A. in National Security Studies (Homeland Security And Defense))--Naval Postgraduate School, September 2006.Thesis Advisor(s): Robert Bach. "September 2006." Includes bibliographical references (p. 75-78). Also available in print.
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Pravincumar, Priyanka. "Viscoelastic response of cells snd the role of actin cytoskeletal remodelling." Thesis, Queen Mary, University of London, 2012. http://qmro.qmul.ac.uk/xmlui/handle/123456789/3357.
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The mechanical properties of living cells provide useful information on cellular structure and function. In the present study a micropipette aspiration technique was developed to investigate the viscoelastic parameters of isolated articular chondrocytes. The Standard Linear Solid (SLS) and the Boltzmann Standard Linear Solid (BSLS) models were used to compute the instantaneous and equilibrium moduli and viscosity based on the response to an aspiration pressure of 7 cm of water. The modulus and viscosity of the chondrocytes increased with decreasing pressure rate. For example, the median equilibrium moduli obtained using the BSLS model increased from 0.19 kPa at 5.48 cmH2O/s to 0.62 kPa at 0.35 cmH2O/s. Cell deformation during micropipette aspiration was associated with an increase in cell volume and remodelling of the cortical actin visualised using GFP-actin. Interestingly, GFP-actin transfection inhibited the increase in cell moduli observed at the slower aspiration rate. Thus actin remodelling appears to be necessary for the pressure rate-dependent behaviour. A hypothesis is proposed explaining the role of actin remodelling and interaction with the membrane in regulating cell mechanics. Further studies investigated a mechanical injury model of cartilage explants which resulted in significant increases in all three viscoelastic parameters. Treatment with IL-1β also increased the instantaneous moduli of cells treated in explants but there was no difference in equilibrium moduli or viscosity. IL-1β treatment in monolayer had no effect on cell mechanics suggesting that previously reported changes in actin associated with IL-1β may be lost during cell isolation or trypsinisation. Separate studies demonstrated increases in chondrocyte moduli and viscosity during passage indicating changes in cell structure-function associated with de-differentiation in monolayer. In conclusion, this study has developed an optimised micropipette aspiration technique which was successfully used to quantify chondrocyte viscoelastic behaviour and to elucidate the underlying role of actin dynamics and response to pathological stimuli and in vitro culture.
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Sanders, Carolyn L. "Clinical antecedents of a medical emergency team response as predictors of ICU transfer /." Connect to full text via ProQuest. Limited to UCD Anschutz Medical Campus, 2008.
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Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008.Typescript. Includes bibliographical references (leaves 100-107). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;
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Omukunyi, Bernard. "The Bamasaaba people's response to the safe medical male circumcision policy in Uganda." University of the Western Cape, 2021. http://hdl.handle.net/11394/8113.
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Philosophiae Doctor - PhDThe Joint United Nations Programme on HIV (UNAIDS) strongly recommends that developing countries regard medical male circumcision as a biomedical intervention. This recommendation has caused developing countries seeking a radical solution to the prevailing and persistent social problem of HIV to reform their health policies. Most now discourage traditional male circumcision and promote safe medical male circumcision (SMMC) as a strong contributor to reductions in HIV transmission. This has introduced conflicts in traditional African societies such as the Bugisu, where male circumcision is culturally motivated, symbolising a rite of passage from boyhood to manhood. In the Bugisu sub-region, the local Bamasaaba regard their cultural practice of traditional male circumcision (TMC) as prestigious.
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Skenderi, Durim. "Acute response in body composition to fed versus fasted high intensity training in young healthy men." Thesis, Högskolan i Halmstad, Akademin för företagande, innovation och hållbarhet, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-43790.
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Background: High bodyfat is linked to a greater risk of chronic diseases for example diabetestype 2 and cardiovascular diseases. This has led to body composition analysis being a way ofmeasuring overall health. There are different ways to perform the body composition analysis.One of the more common and less expensive, yet very accurate methods, are throughbioelectrical impedance. Compared to the gold standard of body composition analysis,DEXA, the Inbody-770 showed a 99% correlation. The Inbody-770 uses bioelectricimpedance and is used through this study. Purpose: This study was performed in order toinvestigate how fed vs fasted state influence Inbody measurements and whether acute trainingeffects the results of bioelectric impedance. This is done to test the manufacturers pretestguidelines. Method: Fifteen young men with a mean age of 19 (years) measured their bodycomposition with the Inbody on two different occasions; one was in a fed state and the otherwas in a fasted. After the Inbody, the test persons performed a modified version of theWingate test. When the Wingate was done, they rested for five minutes before taking theInbody test again. Results: A decrease in bodyweight and muscle mass and an increase in fatmass was observed after the Wingate test both in fasting and fed conditions. Conclusion: Foroptimal usage of Inbody a well-structured protocol is needed. Training and food intake didhave acute effect on Inbody measurement when comparing pre and posttest.Bakgrund: Högt kroppsfett är kopplat till högre risk för diabetes och hjärt- ochkärlsjukdomar samt även andra kroniska sjukdomar. Detta har gjort att mätning avkroppssammansättning har blivit ett mått på generell hälsa. Det finns flera sätt att mätakroppssammansättning. En av de vanligare och billigare alternativen är via bioelektriskimpedans vilket har en korrelation på 99% till den bästa mätmetoden inom området. Inbody770 användes i denna studien vilket använder sig av bioelektrisk impedans. Syfte: Dennastudie undersökte hur resultatet av Inbody påverkas när man mäter i ett fastande tillstånd ochefter man har ätit samt hur akut träning påverkar resultatet av bioelektrisk impedans. Dettagjordes för att testa rekommendationerna satta av tillverkarna av Inbody-770. Metod: Femtonunga män med en medianålder på 19 år utförde testerna vid två olika tillfällen. Ett avtillfällena var i ett fastande tillstånd och det andra efter att de hade ätit frukost. När de kom påplats fick de utföra Inbody testet och efter detta utförde de en modifierad version av Wingatetestet. Efter Wingate vilade de i fem minuter för att sedan utföra Inbody igen. Resultat: Minskning i vikt och muskelmassa och ökning i fettmassa observerades efter Wingate testetvid både fastande och efter att testpersonerna hade ätit. Konklusion: För att få fullanvändning av Inbody så behövs ett protokoll så att varje testtillfälle har sammautgångspunkt. Denna studie visade att träning och matintag har en akut påverkan på Inbodymättningar när man jämför före och efter Wingate testet.
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Patricia, van Es Nina. "Illness and the Treatment Response: The Patient's View." PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4886.
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In American society, where the biomedical profession is institutionalized and its therapies dominate health care, a decision to deviate from prevailing norms can be considered remarkable. Yet research done by Eisenberg et al. (1993) found that unconventional or alternative medicine had an "enormous presence" in U.S. health care and that one in three persons had utilized an unconventional therapy in 1990. The objective of this thesis was to explore this phenomenon. Individuals who had used alternative and biomedical intervention to treat a disorder were recruited through practitioners of alternative therapies. Through semi-structured interviews, case histories focusing on the illness trajectory and treatment choices were obtained. These were analyzed following a method outlined by Glaser and Strauss (1967) for generating grounded theory. The specific purpose of this study was to examine the case histories for a basic social process and to identify key variables which influenced the utilization of both a biomedical and alternative intervention. It was the position of this thesis that treatment responses involved more than the decision to accept or decline a specific therapy. Rather, choices were made by social actors embedded within unique social worlds which were differentiated by social variables (e.g., culture, ethnicity, social class) particular to the individual (see, among others, Brown 1989, Fitzpatrick 1989, Freund and McGuire 1991, Gerhardt 1989, Kleinman 1988, Mumford 1983). Treatment decisions were made within a framework of internalized patterns of interpretation and meaning, dynamically influenced by ongoing interactional and relational patterns; an individual's treatment response could be conceptualized as an emergent, multi-phased process (Pescosolido 1992). Analysis of respondents' case histories supported the notion of a dynamic response process. Individuals described an evolving illness trajectory directed at achieving a desired state of wellness. Disparities between treatment outcomes and the desired goal prompted an evaluation and choice-making process. All respondents had developed a health care conceptualization in which biomedical and alternative therapies were either categorized as effective for specific conditions or occupied a particular place on a health care continuum, thereby perceiving a scope of treatment options beyond those available within biomedicine.
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Edbom, Fredrik. "Pulmonary Response During Exercise: an Invasive Study on Mean Pulmonary Artery Pressure in Relation to Cardiac Output." Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-93724.
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Al, Jahdal K. H. A. "Efficiency of emergency medical services response to road traffic accidents in Riyadh, Saudi Arabia." Thesis, Swansea University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.635686.
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Road traffic accidents are a prolonged and on-going problem of modern times. The objective of this study is to characterise the distribution of road traffic accidents with Riyadh City and provide recommendations and suggestions to improve the existing emergency medical services system. A pilot study was undertaken using two forms designed for collection of the data; one was for the Red Crescent Society (RCS) and one was for the police. The above mentioned forms were applied for a period of two weeks, one week in the wet season and the second in the dry season, plus many meetings and interviews with people with relevant responsibilities in the health field. A comprehensive review was undertaken of both the RCS and Public Safety documents. The findings suggest the need to construct safety programmes to modify the behaviour of the individual at risk, the vehicle and the environment. In addition the study provides an evaluation of the present emergency medical services system and the means to improve it. Thus the findings should be of value in determining the need to improve the system and to make more efficient and better emergency medical services available.
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Kelly, Tara B. "Plants, power, possibility : maneuvering the medical landscape in response to chronic illness and uncertainty." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:7d502bb7-8773-41f8-b71e-fe3f78b89cb0.
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This thesis is concerned with plants, chronic illness and medicine in Oku, Northwest Region, Cameroon. I focus on patient strategies to obtain effective medical outcomes, and on how such outcomes may be obtained through seeking traditional medicine in Oku. I argue that biomedical notions of efficacy do not appropriately represent the central and diverse roles that plants play in traditional medicine nor do they correctly represent how people in Oku evaluate the efficacy of plant-based traditional medicine. I argue instead that efficacy must be understood in terms of the emic concept of power. This power is understood to be located in the Oku landscape, which is still uniquely forested and said to embody powerful ancestral spirits. With plants as the primary tangible material of power, and traditional doctors in Oku as those who claim exclusive rights to manipulate and disperse such power, I discuss traditional medicine in Oku as a system wherein power from the natural landscape is drawn upon to challenge harmful powers feared to derive from the social arena. Using the pragmatic and phenomenological approaches, I show how patients evaluate the efficacy of a medical treatment based on their bodily experiences, and how their actions, as revealed in their therapeutic trajectories, reveal their satisfaction or dissatisfaction with a given diagnosis and/or therapy. I discuss how enduring illness generates and exacerbates bodily, treatment-outcome, social, and psychological uncertainties. In this context, effective outcomes can be understood as those which address and limit these uncertainties and anxieties while offering ways to imagine hopeful prognoses. This thesis then outlines the major sources of uncertainty, people’s responses to such uncertainties, and what people might achieve in terms of limiting uncertainties by seeking traditional medicine in Oku.
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Antonsson, Sara. "A comparison of the accommodative response and contrast in young adults fitted with multifocal and monofocal contact lenses." Thesis, Linnéuniversitetet, Institutionen för medicin och optometri (MEO), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-76406.
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Aim: The aim of this study was to compare the effect of multifocal and monofocal contact lenses in the accommodative response and contrast sensitivity in young emmetropic adults. Method: The requirements to take part in the current study were no ocular pathology, healthy corneas, no refractive surgery and an acuity of at least 1.0 on the Snellen chart with a good binocular vision. Thirteen individuals participated in the study, 9 females and 4 males, with an mean age of 22.6 years (SD=3.4). In separated fittings, participants were fitted with: 1) multifocal lenses, centre-distance design and 0.00D (add +2.00D) (Coopervision Biofinity) and with 2) single vision +2.00D (Coopervision Biofinity. Refraction was assessed 3 times in both eyes: with each fitting and also without any lens. A Metropsis system (CRS) was used to measure the contrast sensitivity and visual acuity. Results: In this study we found statistically significant differences in accommodative response between the conditions non-lens and multifocal contact lens (p<0.05) and non-lens and monofocal lens (p<0.001). The difference between the multifocal lens and monofocal lens was not statistically significant. The results from the contrast measurement showed an increased contrast thresholds with the multifocal contact lens when compared with non-lens. Conclusion: This study shows that the multifocal lens reduce only partially the accommodative response in young individuals. In addition multifocal contact lenses, fitted in emmetropic participants, reduced contrast sensitivity.
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Twiss, Megan Margaret Jean. "Multimodality approach to predicting response of vestibular schwannomas to radiation therapy." Thesis, University of British Columbia, 2009. http://hdl.handle.net/2429/3803.
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Despite that most vestibular schwannomas are successfully treated with radiotherapy, current follow-up protocols entail years of serial magnetic resonance imaging (MRI) scans to ensure cessation of growth. This pilot study sought to identify early predictors of radiation treatment response using a non-invasive multi-modality imaging approach. We hypothesized that by combining information acquired from dynamic contrast-enhanced MRI (DCE-MRI), diffusion tensor imaging (DTI), and L-¹¹C-methionine positron emission tomography (MET-PET) treatment response could be identified sooner than the current several year waiting period. This thesis presents the baseline MRI and MET-PET results of the pilot study acquired to-date with follow-up data to be acquired in the next six months.
Baseline results suggest that DTI and DCE-MRI yield information that may be useful in identifying the response of vestibular schwannomas to radiotherapy. In particular, vestibular schwannomas display elevated mean diffusion coefficients relative to the contra-lateral cerebellum. Also, the novel use of arterial input functions derived from the anterior inferior cerebellar arteries has led to the successful implementation of DCE-MRI pharmaco-kinetic models which may be used to quantitatively monitor tumor response to radiotherapy. Furthermore, MET-PET has shown promise as a tool for evaluating response as all tumors exhibited enhancement under this modality as compared to the contra-lateral side of the brain. Single-voxel spectroscopy with 3T MRI has proven to be a poor technique with which to examine vestibular schwannomas since only two of eight spectra were acquired successfully. All of the techniques that have shown promise as investigatory tools of tumor response can potentially be implemented clinically in the near future.
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Österberg, Lovisa. "Characterization of genetic alterations in ovarian cancer associated with chemotherapy response /." Göteborg : Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, 2009. http://hdl.handle.net/2077/20291.
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Hajameeran, Alima Jafreen. "A System-wide Planning Tool to Evaluate Access from Crash Sites to Medical Facilities in Virginia." Thesis, Virginia Tech, 2019. http://hdl.handle.net/10919/88881.
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Crash response planning is a vital component of emergency management and highway emergency response planning. Evaluation of coverage of medical facilities is required to determine adequate access from crash sites to medical facilities. This study proposes a proof of concept for a planning tool that evaluates fatal and serious injury crash response coverage from crash sites to medical facilities in the Commonwealth of Virginia.
Calculated travel times from fatal crash sites to medical facilities are compared with reported travel times to better estimate travel time modification factors. The modified travel times are used to determine coverage areas and evaluate serious injury crash response coverage of medical facilities in Virginia.
A geo grid approach is used to demonstrate the proof of concept for a crash response planning tool. A risk grid is developed based on the aggregate number of fatal and serious injury crashes. This study includes serious injury crash response coverage because the number of serious injuries and serious injury rate are now included as reportable safety performance measures for state highway safety agencies. A mitigation grid is developed based on the travel time to the closest facility. Finally, a planning grid that combines risk and mitigation factors based on a decision matrix is presented. The resulting tool serves as a proof of concept for developing a crash response planning tool which enables planners to identify areas that do not have timely access from crash sites to medical facilities.Master of Science
An objective of emergency responders is to safely transport crash victims from crash sites to medical facilities. Ensuring adequate access is an important goal of highway safety professionals. This study proposes a proof of concept for a planning tool that evaluates this access in the Commonwealth of Virginia. This study focuses on serious injury crash sites because the number of serious injuries and serious injury rate are now included as reportable safety performance measures for state highway safety agencies. Travel times from serious injury crash sites to medical facilities are used to identify areas that do not have timely access. Risk and mitigation assessments are performed by dividing the study area into equal sized cells. Risk and mitigation assessments are based on number of crashes and response travel times to the closest medical facility, respectively. These assessments are used to generate a proof of concept for a crash response planning tool which enables planners to identify areas that do not have timely access from crash sites to medical facilities.
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Rosemar, Daniel. "Inflammatory response and Patient characteristics in Open and Laparoscopic Sigmoidectomy." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-73270.
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Background and Aims Colorectal cancer is the third most common type of cancer in Sweden, male and female, with 6500 (4500 colonic/2000 rectal) new cases each year. Surgery remains the treatment of choice. Previous studies show that laparoscopic procedure may lead to fewer complications, shorter postoperative stays and a lesser inflammatory response compared to open procedure. The study examines whether laparoscopic surgery of sigmoid cancer differs from open surgery, regarding inflammatory response through analysis of routine measurements. It also investigates differences in peri- and postoperative quality data from Swedish Colorectal Cancer Registry. Material and Methods 307 consecutive patients underwent surgical sigmoidectomy from February 2007- February 2017, from which elective patients with sigmoid cancer were included. Pre-and postoperative CRP and postoperative WBC, Haemoglobin and Creatinine were collected from medical records at the Department of Surgery, Örebro University hospital. Patient related and perioperative variables were collected from SCRCR (e.g. postoperative stay, bleeding, complications). Results 158 patients fulfilled the inclusion criteria. There was a marked increase in CRP postoperative in both laparoscopic (89) and open (69) groups, but no significant difference comparing the groups. There was a significant difference in perioperative bleeding (p<0.05) and length of stay (p<0.05). Conclusion Sigmoidectomy, laparoscopic or open, cause an increase in CRP. No significant difference in inflammatory response was noted between the groups. Patients undergoing laparoscopic, compared to open sigmoidectomy has: less perioperative bleeding, shorter postoperative stay and a longer duration of surgery, like previous studies.
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Sarkar, Rajesh. "The innate immune response to Mycobacterium tuberculosis is dependent on strain lineage and on host population." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2719.
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Includes abstract.Includes bibliographical references.
The genome structure of Mycobacterium tuberculosis is strongly clonal, in the absence of horizontal gene transfer. Thus it is feasible that clonal lineages may exhibit particular phenotypic characteristics, which may, in turn, result in differences in virulence or influence their association with particular host populations. Indeed, the global distribution of M. tuberculosis strains is not uniform and certain strain lineages predominate in particular geographical areas. Further, there is evidence that some strain lineages are emerging, suggesting differences in virulence. Firstly, we investigated the association between strain genotype of M. tuberculosis and in vitro correlates of virulence such as growth phenotype and cytokine induction in the monocyte-derived macrophage (MDM) model.
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Chakradeo, Shweta. "ROLE OF AUTOPHAGY IN THE RESPONSE OF HS578T BREAST TUMOR CELLS TO RADIATION." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2919.
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Breast cancer is the most commonly observed cancer type in women and is the second leading cause of cancer death in women. Radiation can be used to debulk tumors prior to surgery as well as to treat patients after surgery and/or chemotherapy. Previous studies from our laboratory have shown that the anti –malarial drug chloroquine sensitizes breast cancer cell lines to radiation by suppression of autophagy which is a conservative catabolic process that can be cytoprotective. The scientific literature has demonstrated that many tumor cell systems undergo cytoprotective autophagy and that pharmacological or genetic inhibition of autophagy leads to other modes of cell death such as apoptosis. Acridine orange staining was used for determination of acidic vacuole formation, an indication of autophagy and DAPI/TUNEL staining was used to identify apoptotic cells. Our studies in Hs578t breast tumor cells show the lack of sensitization by chloroquine upon autophagy inhibition with minimal apoptosis when cells are treated with 5 × 2Gy radiation. The extent of apoptosis was not increased upon autophagy inhibition by Chloroquine as determined by DAPI/TUNEL assays and quantified by Flow Cytometry using AnnexinV/PI. The potential role of senescence in the effects of radiation in the Hs578t cells was determined with the use of β-Galactosidase dye staining for senescence. It appears from these studies that autophagy need not to be cytoprotective in all breast cancer cell lines. Additional studies are in progress to effort to identify the factors that might distinguish between cytoprotective and non-cytoprotective autophagy.
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Trück, Johannes. "B cell response to pneumococcal vaccines." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:4bbccd8c-febd-4713-a97b-d6a8a08e3979.
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Streptococcus pneumoniae is a significant cause of mortality and morbidity in both children and older adults, with infection resulting in invasive disease, pneumonia and otitis media. The inclusion of pneumococcal conjugate vaccines in routine infant immunisation programmes has had a major impact on disease rates. Vaccine-induced protection against pneumococcal infection is thought to be mediated by the generation of persistent serotype-specific functional antibodies and antigen-specific memory B cells, the latter capable of generating a rapid secondary antibody response on re-exposure to antigen. Although many studies have investigated the immunogenicity of pneumococcal vaccines in different age groups by measuring serotype-specific antibodies, there is more limited information about the B cells underlying such an immune response. Important areas to investigate include the identity of the B cell subsets involved in antibody production and the potential link between memory B cells (BMEM) and persistent antibody production by long-lived plasma cells. In this thesis I have investigated in detail the immune response to pneumococcal vaccines given to children and adults by a variety of different methods. By examining the variability of a BMEM ELISpot method, it was shown that this assay is robust and reproducible and can be performed on fresh or frozen samples and in different laboratories. Using this technique, in a study of pre-school children, it was demonstrated for the first time that the level of pre-existing serotype 3-specific antibody is negatively correlated with, and may directly impair the BMEM response to a booster dose of 13-valent pneumococcal conjugate vaccine (PCV-13) containing serotype 3 glycoconjugate. In the same study, it was shown that antibody persistence against most vaccine serotypes can be expected until the age of 3.5 years. A novel antigen-labelling technique was used in a detailed kinetics study of antigen-specific B cell subsets in response to either PCV-13 or 23-valent pneumococcal polysaccharide vaccine in adults. The results of this study revealed distinct B cell subset response patterns that were observed in all study participants indicating that IgM BMEM seem to play a major role in the immune response to pneumococcal vaccines. In addition, in the same study, genome wide analysis of gene expression was performed and it was shown that vaccination with either a pneumococcal conjugate or polysaccharide vaccine results in a marked difference in numbers of differentially expressed genes 8 days following vaccination. A further tool likely to be of use in investigating B cell responses is the analysis of the antibody repertoire using next-generation sequencing techniques. In order to test the ability of these methods to detect vaccine responses, a large dataset of high-throughput B cell receptor sequences was analysed and revealed convergence of antigen-specific complementary-determining region (CDR)3 amino acid (AA) sequences following vaccination and identified antigen-specific sequences. It was further demonstrated that for sequences directed against the H. influenzae type b (Hib) polysaccharide, diversity of immunoglobulin gene rearrangements is much greater than previously recognised. Frequencies of Hib-specific CDR3 AA sequences were linked with anti-Hib avidity indices highlighting the potential of this method as an alternative (functional) measure of vaccine immunogenicity. These data suggest that studying the B cells and antibody repertoire post-vaccination can give novel insights into the biology that underlies the immune responses.
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Mbulawa, Zizipho Ziphozakhe Anita. "A study of genital human papillomavirus (HPV) infection and antibody response in heterosexually active South African couples." Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10931.
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This study constitutes the first report on type-specific human papillomavirus (HPV) concordance and transmission in heterosexually active couples that are human immunodeficiency (HIV)-seronegative, HIV-seropositive or HIV-discordant and in which 71% of female participants have normal cervical cytology.
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Enocsson, Helena. "Biomarkers and mediators in systemic lupus erythematosus : IFNα versus the CRP response, and evaluation of suPAR and anti-dsDNA antibody assays." Doctoral thesis, Linköpings universitet, Avdelningen för inflammationsmedicin, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-105505.
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Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease which may affect multiple organ systems. Interferon alpha (IFNα) and autoantibodies that form immune complexes with nuclear antigens (ANA) are hallmarks believed to drive the disease into a vicious circle of inflammation, tissue damage, autoantigen exposure and autoantibody production. In SLE, the disease course is characterized by episodes of exacerbations alternating with remissions. In order to best treat the patient it is important to closely monitor symptoms and signs of disease activity. Because of the disease heterogeneity, no single biomarker has yet been found to reflect SLE disease activity in general, although antidouble stranded DNA (anti-dsDNA) antibodies sometimes indicate activity, primarily with renal involvement, and constitutes an item of the SLE disease activity score SLEDAI-2K. However, the method of anti-dsDNA measurement is not standardized and therefore varies between different laboratories. In many other inflammatory conditions, such as rheumatoid arthritis and during bacterial infections, the C-reactive protein (CRP) level is a good indicator of ongoing inflammation, but in SLE and during viral infections, CRP commonly fails to reflect the degree of inflammation. Both viral infections and SLE are characterized by IFNα, and we thus aimed to elucidate whether IFNα can inhibit CRP production. Further, four assays for anti-dsDNA antibody measurements were evaluated with regard to SLE disease specificity and activity, and a new potential biomarker of inflammation, the soluble urokinase plasminogen activator receptor (suPAR), was assessed in relation to disease activity and organ damage. An in vitro inhibitory effect of IFNα on CRP transcription and production was found in hepatocytes, and this was consolidated by in vivo studies of CRP and IFNα in sera from well-characterized SLE patients (KLURING; Kliniskt lupusregister i nordöstra Götaland). Here, CRP and disease activity were associated among patients without IFNα and without a CRP lowering gene variant (SNP rs1205). The poor disease activity compliance of CRP could therefore be explained, at least in part, by polymorphisms in the CRP gene and increased levels of IFNα. Critical differences between the methods measuring anti-dsDNA were found regarding disease specificity and ability to reflect disease activity and the results suggests the Crithidia luciliae immunofluorescence test (CLIFT) for diagnostic purposes and a bead-based multiplex assay (FIDIS) for monitoring of disease activity. Evaluation of suPAR in SLE revealed no association of suPAR with disease activity, but interestingly instead with accumulated organ damage. suPAR could therefore possibly be used to advert patients at high risk of organ damage. A detailed biological and clinical characterization of established and emerging SLE biomarkers is of importance since it may improve the clinical management as well as increase the knowledge about disease mechanisms.
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Peterson, Amanda. "Designing an Experimental Protocol for Separating Active Diameter Response from Passive Response in Small Blood Vessels." Thesis, KTH, Skolan för teknik och hälsa (STH), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-211726.
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The knowledge of blood vessel biomechanics is used for understanding and developing treatments for cardiovascular disease. The objective of this project was to develop an experimental protocol, for education and research, that separates active diameter response from the passive, as a function of the intraluminal pressure in a pressure myograph. The design process was performed in three steps. First the protocol was designed for an artificial vessel and then expanded to include passive properties of blood vessels, finally further developments needed to analyze active blood vessels were suggested. The system was built as a pressure myograph containing a vessel chamber where the vessel was mounted on two cannulas, two pressure sensors for calculating the intraluminal pressure, and one microscope equipped with a camera for diameter observations. Reference data for the artificial vessel material was acquired from a uniaxial tensile test. The results was in the form of stress-stretch relations. Both the results from the artificial vessel and the passive blood vessel was in a acceptable reference range. The results indicate that the experimental protocol can be used for testing passive properties of both artificial vessels and small blood vessels. No results were obtained for active blood vessels, thus the experimental protocol can not be used for separating the active response to diameter change of blood vessels. However, further developments of the experimental protocol are discussed.Kunskap om blodkärlens biomekanik används för att förstå och utveckla behandlingsmetoder mot hjärt- och kärlsjukdomar. Syftet med det här projektet var att utveckla ett experiment som mäter små blodkärls diameter och vätsketryck in vitro. Experimentet skulle sedan separera det aktiva muskelbidraget till diameterförändring från det passiva bidraget. Genom att göra detta kan kunskapen om biomekaniken hos blodkärl utvecklas inom såväl forskning som utbildning. Experimentet utvecklades i tre steg. Först utvecklades det för artificiella blodkärl och anpassades sedan för passiva blodkärl. Slutligen diskuteras vidareutvecklingar av experimentet gällande de aktiva egenskaperna för blodkärl. Experimentet utformades genom att ett kärl placerades i en kammare. Blodkärlet fästes i vardera ände på varsin kanyl som var kopplade till trycksensorer. För att registrera diametern placerades kammaren under ett kameramikroskop. Resultatet består av spänning-sträcknings diagram. Både resultatet för det artificiella blodkärlet och det passiva blodkärlet var inom ett godkänt referensintervall. Dessa resultat stödjer antagandet att experimentet kan användas för att studera passiva egenskaper av artificiella och verkliga blodkärl med storlek mellan 1.9-4.4 mm i ytterdiameter. Ingen mätdata från aktiva blodkärl kunde samlas in, utan utvecklingskrav på systemet för hantering av aktiva blodkärl har föreslagits.
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Broby, Nicolette. "Development of an Effective International Medical Disaster Relief Team: A Qualitative Descriptive Study." BYU ScholarsArchive, 2017. https://scholarsarchive.byu.edu/etd/6823.
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Natural and manmade disasters are occurring at an unprecedented rate. Injuries and sickness are among the most widespread types of suffering caused by disasters, making medical aid essential. However, medical response depends on multiple factors to be timely and effective. The process of building a competent international medical disaster relief organization is complex, yet many well-intentioned, charitable organizations react hastily after a disaster, sending medical teams without truly understanding what an effective response requires. Consequently, in their genuine effort to help, they may end up hindering the response effort more than helping. Meanwhile, successful organizations implement principles conducive to an effective response. This research identifies three key characteristics of success found in effective, well-established international medical disaster relief organizations. These characteristics are first, ensuring an official invitation has been extended and the need for assistance has been identified. Second, the response to that need is done in an effective and sustainable manner. Third, effective organizations strive to obtain high quality volunteers. By following these basic characteristics, organizations are likely to improve the efficiency and quality of their work.
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Ouk, LaShonda. "Improving Gonorrhea Result Notification and Response Among African American Women." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7714.
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Previous research has shown that 45% of malpractice claims are due to insufficient and late follow-up of test results and limited communication methods provided to patients. This study explored the preferred communication methods between a patient and a healthcare provider. The technology acceptance model served as the conceptual framework. A quantitative research design was used to examine patients’ perceived usefulness, attitude, perceived ease of use, and adaptability regarding mobile technology. The primary means of data collection was the use of a survey questionnaire. Participants included a random sample of 118 women seen in a local health department in the women’s clinic and sexually transmitted disease clinic. The research questions focused on exploring test result notification using an electronic mobile device. A chi-squared test was used to answer each research question. The results of the chi-squared analysis revealed no significant association between the use of text messaging and communication with a health provider. There was a significant difference in the mean score in the preferred method of communication of an abnormal test result and a normal test, and that there is not a significant association between the use of a mobile device (IV) and response rate (DV) to test result notification with a health provider. The results from this study offer public health departments a better understanding of patients' preferred test notification method, which untimely creates a positive social change by reducing untreated sexually transmitted diseases.
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Morse, David Linn. "Choline metabolites as diagnostic and therapeutic response indicators for breast cancer." Diss., The University of Arizona, 2004. http://hdl.handle.net/10150/280525.
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Choline metabolites are elevated in breast cancer, decrease in response to effective therapy and are detected non-invasively by magnetic resonance modalities. Decreases in choline metabolites occur early-on after initiation of treatment. There is potential for use of choline metabolites as non-invasive diagnostic and therapeutic response indicators. Choline metabolites are detected in vivo by magnetic resonance spectroscopy (MRS) in broad resonances which are composites of multiple compounds. Tumor extract studies have suggested that phosphocholine (PCho) is the component of these resonances with the greatest potential for use as a diagnostic marker or therapeutic response indicator. Since other compounds present in these broad resonances vary in concentration with cancer progression and in response to therapy, changes in these other resonances can potentially diminish the overall signal or dampen the detectable therapeutic response. The ability to resolve and quantify PCho in vivo increases the sensitivity of this detection method, and hence, increases its potential utility. Herein is reported the in vivo resolution and quantification of PCho in a human breast cancer xenograft model in mice. A significant PCho decrease is detected following treatment with the taxane docetaxel. This PCho decrease is correlated with the diffusion-weighted magnetic resonance imaging (DWMRI) measured increase in tumor water mobility, and with mitotic catastrophe, a non-apoptotic mode of cell death. By studying model system of human breast cancer cells, other metabolites in the choline pathway varying with cancer progression are determined, and the transcriptional expression of genes in the choline pathway is quantified. From these data and enzyme activity data reported by other groups, a model is proposed where a number of metabolic perturbations combine to elevate PCho in breast cancer. These perturbations include the elevation of choline transporter, choline kinase, and phospholipase activities, in combination with decreased CTP:PCho cytidylyltransferase (CCT) activity. By changes in metabolites and gene expression following therapy, it is proposed that increased CCT activity combined with decreased phospholipase and GPC phosphodiesterase activity lead to decreased PCho. In addition, expression of a putative choline transporter (CTL1 variant A) and a putative choline kinase (CHKL) is quantified in human breast cells.
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Stein, Christopher Owen Alexander. "Emergency medical service response system performance in an urban South African setting: a computer simulation model." Doctoral thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/9523.
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Includes bibliographical references.This study investigated the effects of different response strategies, vehicle location strategies and vehicle numbers on response times in a simulated Emergency Medical Services system. The simulation was a computer model using discrete-event simulation and the model was based on Western Cape Emergency Medical Services operations in Cape Town. The study objectives were to (i) create the simulation model, (ii) determine the best-performing combination of explanatory factors and (iii) determine the effect of increasing vehicle numbers on response time performance. The simulation model took into account incident arrival rates, incident and hospital spatial distributions, vehicle numbers and dispatch practices in the modelled system. Verification and validation of the simulation model utilised a combination of quantitative and qualitative methods. The validated simulation model was changed in two ways: (i) the response strategy was changed to either single or two-tier (the response model factor) and (ii) the vehicle location strategy was changed to either dynamic or static (the vehicle location factor). This yielded four individual models each representing one combination of these factors. Each simulation model was run for a simulated period of seven days. Output data were analysed using multivariate analysis of variance in order to identify differences in response time between the factor combinations. A single-tier model using dynamic vehicle locations produced the best response performance. This model was run repeatedly, increasing vehicle numbers incrementally with each run to assess the effect of increased vehicle numbers on response time performance. A doubling of vehicle numbers resulted in an 14% increase in the number of responses meeting the national performance target for high acuity incidents, while a seven-fold increase in vehicle numbers increased this to 15%. No further performance increases were seen beyond this with increased vehicle numbers. A 2% performance increase for lower acuity incidents was seen with the same increase in vehicle numbers. In the system modelled, increasing vehicle numbers should not be expected to realise anything more than small improvements in response time performance, at a high operational cost. Fine-grained dynamic deployment of vehicles in anticipation of system demand appears to be a more important determinant of response performance than vehicle numbers alone.
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Ntolosi, Bongi Audrey. "The Mycobacterium smegmatis "Proteome" : effects of growth phase on total protein synthesis and on the response to heat shock." Doctoral thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/25661.
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As an initial step towards characterisation of the molecular processes that define the phenotype of the mycobacterial stationary phase, the effect of growth phase of Mycobacterium smegmatis on total protein synthesis and on the heat shock response was investigated. De novo protein synthesis was monitored by labelling with 35 [S]methionine and the protein expression profiles analysed using one- and/two-dimensional polyacrylamide gel electrophoresis, autoradiography, and/or immunoblot analysis. The ATP content of the culture was found to be a more accurate indicator that cells were entering stationary phase than the number of colony forming units (CFU). A plateau in the ATP growth curve preceded several stationary phase-induced events : a transitory cessation in the increase in number of CFU ; a decrease in the rate of accumulation of the cell division protein FtsZ; inhibition of the synthesis of 58, 30.5, and 20 kDa exponential phase proteins; induction of the 48, 46, 32, 31, 25, and 20 kDa stationary phase (postexponential phase) proteins ; and the highest induction of the 95 kDa, 75 kDa (DnaK), 66 kDa ( GroEL ), and - 17 kDa (doublet) proteins in response to heat shock. Identification of the stationary phase-induced proteins should enable their roles in the multigenic processes that occur during transition into stationary phase to be determined. The amino acid sequence of one of the - 17 kDa heat shock proteins (with an apparent molecular weight of 16.8 kDa, named Hspl7-2) showed significant homology to open reading frame 28 of M tuberculosis cosmid MTCY01B2. This is the first time a functional characteristic has been assigned to this open reading frame, and it remains to be seen if Hspl 7-2 represents a new family of heat shock proteins. Synthesis and secretion of the antigen (Ag)-85 complex proteins was demonstrated for the first time in M smegmatis. Heat shock resulted in increased release of Ag85A and Ag85B but not of Ag85C in M smegmatis. No heat-induction of the Ag85 complex could be demonstrated in My cobacterium bovis BCG. Whereas heat shock resulted in increased release of the 19 kDa lipoprotein antigen in both M bovis BCG and M tuberculosis H37Rv, its presence in M smegmatis could not be demonstrated. This study presents an experimental approach which may prove useful in investigating the effect of various environmental stresses on the profile, and hence the function of secreted proteins.
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Swanton, Amanda Rachel. "Evaluation of trauma response to agricultural injuries." Diss., University of Iowa, 2017. https://ir.uiowa.edu/etd/5654.
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Agriculture is a hazardous industry with high rates of occupational industry. Due to a variety of occupation-related factors, farmers may also be at risk for delays in reaching trauma services. Though the state of Iowa has a comprehensive trauma system implemented to provide an efficient response to traumatic injuries, it is unknown how farmers fare in this system. The aims of this study were to determine if the use of emergency medical services (EMS), the occurrence of interfacility transfers, the time to definitive care in severely injured patients, and the length of prehospital intervals for those using EMS differs between farmers and other workers.
A population-based, retrospective observational study was performed using data from the Iowa State Trauma Registry for the years 2005-2011. Eligible entries included adults (≥15 year old) sustaining an occupational injury within the state of Iowa and treated in an Iowa trauma center. Multiple imputation was performed to replace values for missing covariates. Logistic regression modeling was performed to examine the use of EMS and the occurrence of interfacility transfers among farmers compared to non-farmers. Survival analysis was performed to determine the time to definitive care for severely injured farmers compared to severely injured non-farmers; similarly, a survival-based multi-state model was performed to compare the prehospital time intervals for farmers to non-farmers among EMS users.
The study demonstrated that the likelihood of EMS use was dependent on injury severity. For lower severity injuries, farmers were less likely to use EMS, but there was no difference in EMS use for high severity injuries. The occurrence of interfacility transfers was also dependent on injury severity as well as rurality. Farmers tended to be less likely to receive an interfacility transfer in more rural areas; in large town and urban areas, farmers tended to be more likely to receive an interfacility transfer, particularly for moderate and severe injuries. These trends were slightly stronger for EMS non-users than EMS users; however, the results did not reach statistical significance for most levels. The median time to definitive care for farmers was nearly an hour longer for farmers compared to non-farmers (1h48m vs. 2h46m, respectively). In the survival analysis, time to definitive care for severely injured farmers compared to severely injured non-farmers was found to be time-dependent, and was only significant in the first hour after injury. When the prehospital time intervals for farmers using EMS (included all severities) were compared to non-farmers, farmers took longer to complete the discovery, response, and transport intervals; the scene interval was the only interval that did not reach statistical significance.
The results obtained from this study provide useful information about the operation of the Iowa State Trauma System. While EMS use was lower for minor injuries, farmers with severe injuries had no significant difference in EMS use compared to non-farmers, suggesting comparable access. Likewise, the probability of transfer was only higher in specific instances when the patient did not use EMS. However, the fact that both time to definitive care and several prehospital intervals were longer suggest that occupation-specific factors may contribute to delay. Further research is needed to identify these barriers and develop new strategies to improve the response to traumatic agricultural injury.
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Arroyave, Veronica Margoth. "Networks in the Disaster Response and Global Health Domain: A case study of The Partnership for Quality Medical Donation's response to the 2010 Haitian Earthquake." Diss., Virginia Tech, 2013. http://hdl.handle.net/10919/50643.
Full textAbstract:
The 2010 Haitian earthquake underscored the fact that disaster response is increasingly complex, multi-sectoral and multi-faceted in character. Nonetheless, disaster relief operations both globally and nationally tend to operate within a highly fragmented context in which potentially overwhelming human and infrastructure needs must be served by limited material and financial aid delivered by disparate humanitarian actors specializing in varying functional domains. Such a chaotic environment demands highly effective communication, collaboration and coordination among a variety of humanitarian actors if relief efforts are to be successful. Even though the coordination mechanisms of multi-organizational actors during disaster response have been studied in a variety of contexts, much less attention has been paid to how international non-governmental (INGOs) and private sector actors may be able to operate collaboratively in disaster settings.This dissertation provides a case analysis of the efforts of one set of cross-sectoral humanitarian actors that worked through a network in response to the 2010 Haitian earthquake. This mixed methods case study incorporates interview, personal observation, and survey data from INGO field staff, headquarters personnel, and corporate donor representatives, all of whom were members of the cross-sectoral Partnership for Quality Medical Donation (PQMD) that responded to the 2010 Haitian earthquake. The inquiry explores what the coordination-related challenges to disaster response are for network members and then examines whether and in what ways a cross-sector network, PQMD in this instance, can effectively mitigate or overcome those obstacles. This study contributes to the body of disaster coordination and cross-sector network scholarship in two ways. First, the analysis reviews prevailing trends within the cross-sector network and disaster coordination-related literature concerning the requisites and challenges of coordination in humanitarian relief emergencies. Second, this study augments existing understanding of the extremely complex processes involved in coordinating INGO-business disaster response as part of efforts to mobilize multi-sectoral humanitarian action.
This research suggests that efforts to develop cross-sector networks prior to disaster events can build communication, collaboration and coordination pathways that later enhance coordinated INGO-business disaster response to crises. It argues that current theoretical horizons in both network and disaster coordination studies need to be broadened. Specifically, this inquiry highlights the importance of incorporating cross-sector networks (i.e., INGO and corporate actors) into all planning efforts aimed at enhancing collaboration and coordination practices in disaster relief.
Ph. D.
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Schödel, Johannes. "Genome-wide mapping of the hypoxic response." Thesis, University of Oxford, 2012. http://ora.ox.ac.uk/objects/uuid:5701c6b5-f397-4b21-a66b-cfc02043fe40.
Full textAbstract:
Hypoxia regulates many hundreds of genes with important roles in ischemic and neoplastic disorders. Central to this response are the hypoxia inducible transcription factors (HIF). This work aimed to better understand the direct transcriptional response to HIF by mapping HIF-binding sites across the genome using chromatin immunoprecipitation coupled to high-throughput sequencing (ChIP-seq). ChIP-seq for HIF in MCF-7 breast cancer cells under hypoxic conditions revealed more than 400 high-stringency HIF-binding sites genome-wide. Each member of the HIF heterodimer was present with near complete concordance. Binding of the two principle isoforms revealed a high degree of overlap with no differences in the DNA-binding motif. HIF-binding was associated with upregulation, but not downregulation of genes indicating that it functions as a transcriptional activator but not as a repressor. HIF-binding occurred preferentially at gene promoters, but was also present at promoter-distant sites, which were also associated with gene regulation, implicating long-range interactions in hypoxic gene activation. HIF-binding was associated with markers of open chromatin and active enhancers that were present in normoxia, indicating that HIF-binding sites are already “prepared” to bind HIF before the hypoxic stimulus. Analysis of normoxic and hypoxic RNA pol2 and H3K4me3 signals revealed distinctive hypoxia-inducible changes unique to HIF-binding genes. Comparable numbers of HIF-binding sites were observed in a second cell line (von Hippel-Lindau defective 786-O renal cancer cells) as in MCF-7 breast cancer cells, although approximately 65% were unique to 786-O cells. These unique sites were more frequently promoter-distant. Correlation with expression analyses from renal tumours indicated that many HIF-binding genes were upregulated in renal cancer. One such RCC unique promoter-distant HIF-binding site was identified at an intergenic locus on chromosome 11q13.3 that has been associated with renal cancer in Genome-Wide Association Studies. The HIF-binding site was in high linkage disequilibrium with the disease associated SNP and had the epigenetic hallmarks of an enhancer. Analysis of pan-genomic expression analyses identified the cell-cycle regulator cyclin D1 as highly HIF-regulated, and a physical association between the HIF-binding site and the CCND1 promoter could be determined. Furthermore, in a renal cancer cell line heterozygous at this locus, the RCC-protective allele disrupted HIF-binding leading to an allelic imbalance in cyclin D1 expression.
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Edvinsson, Olivia, and Johanna Ekelund. "A pilot study: Double-blinded local injection of active/non-active agents: Normal response and importance of expectations." Thesis, Malmö universitet, Odontologiska fakulteten (OD), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19771.
Full textAbstract:
SyfteAtt undersöka hur stor bedövningseffekt som kan uppnås efter injektion med aktiv (lidokain) eller in-aktiv substans (koksaltlösning) samt att undersöka om deltagarna korrekt kan identifiera vilken injektion de fått, när de vet att det är en 50/50 chans att de har fått lidokain eller koksalt.Material och metod20 friska frivilliga deltagare randomiserades in i två grupper. En grupp fick injektion med aktiv substans och en med in-aktiv substans. Deltagarna informerades om att chansen att få aktiv eller in-aktiv substans var lika, 50 %. Deltagarna utsattes för ett specifikt smärtsamt stimulus före och efter injektionen. De graderade sedan sin smärtintensitet på en 0-10 NRS-skala. Följande dag tillfrågades deltagarna vilken substans de trodde de hade fått.Students T-test användes för att beräkna skillnaden i smärtintensitet före och efter injektion i båda grupperna. Fischer’s exakta test användes för att beräkna kvalitativa data. P <0,05 ansågs vara statistiskt signifikant.ResultatDet var en statistiskt signifikant skillnad mellan den aktiva (NRS 2,9) och den in-aktiva (NRS 0,0) gruppen gällande förändringen i smärtintensitet före injektion och efter injektion. Alla deltagare kunde korrekt identifiera vilken injektion de fått.SlutsatsIngen bedövningseffekt kunde mätas efter injektion med inaktiv substans hos friska individer när deltagarna visste att det var en 50/50 möjlighet att de skulle få den aktiva substansen. Alla individer kunde korrekt avgöra om de fått injektion med aktivt bedövningsmedel eller in-aktivt koksalt.AimTo investigate the amount of anesthetic effect that can be achieved following injection with active (lidocaine) or non-active (saline) agent and to examine if the participants correctly can identify which injection they received when there is a 50/50 chance that they have received lidocaine or saline.Materials and Method20 healthy volunteers were randomized in two groups. One group got injection with active agent and one with non-active agent. The participants were instructed that chances of receiving active versus non-active agent were equal, 50 %. The participants were exposed to a specific painful stimulus before and after the injection and they had to rate their pain score on an 0-10 NRS-scale. The following day, the participants were asked what agent they thought they had received.Students T-test was used to calculate the difference in pain intensity between pre- and post-injection in both groups. Fisher's exact test was used to calculate qualitative variables. P<0.05 was considered statistically significant.ResultsThere was a statistically significant difference between the active (NRS 2.9) and the non-active (NRS 0.0) group regarding the change in pain intensity rating from pre-injection to post-injection. All participants could correctly identify which injection they received.ConclusionNo anesthetic effect could be measured after injection with non-active substance in healthy individuals when there was a 50/50 level of uncertainty that the individual would receive the active agent. All individuals could correctly determine whether they received active anesthesia or non-active saline.
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Arroyave, Veronica Margoth. "Networks in the Disaster Response and Global Health Domain: A case study of The Partnership for Quality Medical Donation\'s response to the 2010 Haitian Earthquake." Diss., Virginia Tech, 2005. http://hdl.handle.net/10919/50643.
Full textAbstract:
The 2010 Haitian earthquake underscored the fact that disaster response is increasingly complex, multi-sectoral and multi-faceted in character. Nonetheless, disaster relief operations both globally and nationally tend to operate within a highly fragmented context in which potentially overwhelming human and infrastructure needs must be served by limited material and financial aid delivered by disparate humanitarian actors specializing in varying functional domains. Such a chaotic environment demands highly effective communication, collaboration and coordination among a variety of humanitarian actors if relief efforts are to be successful. Even though the coordination mechanisms of multi-organizational actors during disaster response have been studied in a variety of contexts, much less attention has been paid to how international non-governmental (INGOs) and private sector actors may be able to operate collaboratively in disaster settings.This dissertation provides a case analysis of the efforts of one set of cross-sectoral humanitarian actors that worked through a network in response to the 2010 Haitian earthquake. This mixed methods case study incorporates interview, personal observation, and survey data from INGO field staff, headquarters personnel, and corporate donor representatives, all of whom were members of the cross-sectoral Partnership for Quality Medical Donation (PQMD) that responded to the 2010 Haitian earthquake. The inquiry explores what the coordination-related challenges to disaster response are for network members and then examines whether and in what ways a cross-sector network, PQMD in this instance, can effectively mitigate or overcome those obstacles. This study contributes to the body of disaster coordination and cross-sector network scholarship in two ways. First, the analysis reviews prevailing trends within the cross-sector network and disaster coordination-related literature concerning the requisites and challenges of coordination in humanitarian relief emergencies. Second, this study augments existing understanding of the extremely complex processes involved in coordinating INGO-business disaster response as part of efforts to mobilize multi-sectoral humanitarian action.
This research suggests that efforts to develop cross-sector networks prior to disaster events can build communication, collaboration and coordination pathways that later enhance coordinated INGO-business disaster response to crises. It argues that current theoretical horizons in both network and disaster coordination studies need to be broadened. Specifically, this inquiry highlights the importance of incorporating cross-sector networks (i.e., INGO and corporate actors) into all planning efforts aimed at enhancing collaboration and coordination practices in disaster relief.
Ph. D.
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Smith, Iain David. "Doctoring in a whisky-injured nation : the medical response to the "alcohol question" in Scotland, 1855-1925." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/8672/.
Full textAbstract:
Scottish people have a reputation for being high consumers of alcohol. Certainly this is the case today and was also the case throughout the nineteenth century - the most obvious comparison to be made, a comparison often made both then and now, is with supposedly more moderate English drinking habits. Less well known is the reversal of this perspective during the inter-war years (1918–1939), when Scotland was held in many quarters to be more sober than England. This turnaround was brought about by changes in popular culture alongside specific alcohol control legislation that had a greater impact in Scotland. This thesis is not an exploration per se of why alcohol consumption rose in nineteenth-century Scotland, fell in the first half of the twentieth century and rose again to damaging levels at the end of the twentieth century. This high level of consumption persists in 2017 and the Scottish government is still acting to reduce alcohol-related harm by a variety of measures. Rather this thesis seeks to explore the response of the Scottish medical profession to the changing conditions in relation to alcohol over a seventy-year period from 1855 to 1925. (Chapter 3 and Chapter 4 set the scene). The starting point of 1855 for the period examined in this thesis is taken from the 1855–57 Inquiry by the Scottish Lunacy Commission, which led to the Lunacy Act (Scotland) of 1857. This report demonstrates that Scottish psychiatry was already having to deal with the mental consequences of alcohol and describes oinomania, an early term for alcohol dependence. The report introduces the idea that alcohol can itself cause insanity – an estimated 20% or more of the cases in asylums were caused by intemperance around that time and this figure was deemed to rise as the century wore on. This seems like a curious and excessive causal attribution from today’s perspective. In this thesis I trace how the idea of a persistent form of alcoholic insanity evolved in the Scottish context (Chapters 4 and 6), and I outline changing terminology and ideas around the mental consequences of alcohol (Chapters 5, 6, 7 and 8). These ideas were expounded by physicians and alienists/psychiatrists in the public arena of parliamentary inquiries in the second half of the nineteenth century (Chapter 4) as well as in the specialised literature of the time (Chapters 5, 6, 7 and 8), including the medical reports within the Annual Reports of asylums. Original to this thesis in relation to primary sources is an in-depth analysis of the alcohol cases received by the Delirium Ward at the Royal Infirmary of Edinburgh between 1856 and 1867, in the May to July period of each of these years (Chapter 5). These 178 recorded cases (57% of all admissions with threatening or actual delirium) illustrate that alcohol problems in the form of incipient or established delirium tremens were a common reason for admission to hospital at this early date and that such cases were of particular interest to physicians. It is striking that beyond the acute episode of what was erroneously thought to be an intoxication-induced illness there is no apparent attempt to help the person with their underlying intemperance (Chapter 5). The idea that later emerged of an underlying condition of inebriety, differentiated from insanity, was to have practical consequences in that it led to the setting up and running of Inebriate Reformatories in Scotland, as elsewhere in the British Isles, in the first quarter of the twentieth century (Chapters 7 and 8). I trace this story in detail through to the closure of the Inebriate Reformatories in 1925,whilst examining this in a Scottish context. Other scholars have looked at the era of the Inebriate Reformatories in Scotland from the perspectives of sociology, of history and of feminist theory. I review the previous literature in Chapter 2, and provide a historiography spanning the last hundred years. I also bring a fresh medical perspective to the topic in Chapter 7, which uses records not available to some of the previous scholars, and produce a very detailed analysis of the female cases sent to the Glasgow Reformatory (Girgenti House). This is presented in Chapter 8. The time period cut-off of 1925 for the end of the thesis is made for pragmatic reasons, as the trends in the conception of alcoholism and alcohol use disorders, and in treatment provision, since 1925 would merit separate full consideration. I do, however, sketch out these trends for this later period in a Postscript (Chapter 9) in order to give a context for drawing out some historic lessons from 1855–1925 in my Conclusion and Discussion (Chapter 10) about the “alcohol question” in the Scotland of today. The period I cover therefore includes an historic high in alcohol consumption in the late nineteenth century and an historic low in the 1920s. I aim to show how practice and theory interconnected during these years in the work of medical men such as Thomas Laycock, David Yellowlees, Sir Thomas Clouston, William Tennent Gairdner, James Craufurd Dunlop, John Cunningham and Sir David Henderson. I also describe some of the connections between these key medical figures within the Scottish system in Chapter 4. The post-1920 period also illustrates a sea change from a time where psychiatrists were arguing for the separation of the “inebriate” from the “lunatic” in terms of service provision to one where the “alcoholic” is seen as deserving of new forms of psychiatric help. This shift in practice, around the end of the period of my study, is seen in the context of a changing emphasis from a more biological view of the problem to a more psychodynamic, or dynamic, view as seen in the work of Henderson and others. The fact that this shift in theory and practice coincides with a decline in the alcohol problem is discussed in the light of Skog’s idea that our concerns around alcohol vary in relation to where we are in relation to “waves of consumption” (Chapter 10). My overall aim in this thesis, then, is to set out how from 1855 to 1925 medicine in Scotland responded to the idea that habituated use of alcohol might represent a disease in its own right. The idea of such a “disease of the will” remains both legally and philosophically controversial to this day. This is perhaps why our diagnostic systems continue to change in this area without final resolution. An associated aim of the thesis is to look at three aspects of the “drinking disease”, in Scotland, namely delirium tremens, alcoholic insanity and inebriety, where practice can be examined from case records and related to theory as represented in a range of publications. I also prove, and highlight the fact, that institutionalised medicine cannot escape engagement with the problem of alcohol. From the beginning, Scottish doctors in both infirmaries and asylums were presented with the consequences of heavy drinking in a sizeable proportion of patients. As with recent epidemiological analyses, alcohol consumption levels in the general population during the nineteenth and early twentieth century are shown to correlate highly with the incidence and prevalence of such disease consequences from the Scottish national and local statistics available. Then, as now, doctors were inevitably drawn into the issue of how best to respond to the underlying habit of drinking both at an individual and societal level. I draw lessons from my study of the past for our continuing struggle in this regard.
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Toufani, Tina. "A systematic review of health problemsfollowing tsunamis." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-73273.
Full textAbstract:
Asystematic review of health problems following tsunamis Introduction: Tsunamis are sudden onset disasters with substantial impact on human health. Toidentify the relationship between tsunamis and health problems, the evidence must besystematically reviewed. Through this, health care response can be planned accordingly. Aim: To identify the health problems following tsunamis in order to guide medical response.Methods and materials: Four databases (Medline, Global Health, Web of Science CoreCollection and Embase) were searched using an inclusive search strategy in September 2018.The inclusion criteria were published, peer-reviewed articles on morbidity with data frommedical health facilities following tsunamis, where a control or comparison group was used toanalyze the tsunami outcome. Studies on mental health problems were excluded. The studieswere analyzed through narrative synthesis. Results: Eleven articles were included in the review. There was an increase in non-traumaticconditions reported in the immediate aftermath of tsunamis. Long-term health problems on thetsunami-affected population were seen up to three years after a tsunami. There is a lack of highqualityarticles on health problems after tsunamis. Conclusions: Medical response should prepare for trauma and non-trauma care shortly after atsunami and expect an increase in certain health problems several years post-tsunami. Existing,high-quality research is limited, and this review could not capture all tsunami-related healthproblems. Future studies that identify available evidence on health care needs after tsunamisshould consider using scoping reviews to cover a broader base of literature.
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Krogh-Madsen, Trine. "Effects of single-channel noise on spontaneous beating and the phase-resetting response of cardiac oscillators." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=85562.
Full textAbstract:
From our everyday life, we know that our hearts beat with a rhythm which is not perfectly periodic. Even an isolated spontaneously beating cardiac cell, devoid of neural, hormonal, and intracardiac regulatory input, does not beat perfectly regularly. I investigate the hypothesis that the beat-to-beat fluctuations in transmembrane potential of spontaneously beating cardiac cells are due to stochastic gating of the ionic channels in the cell membrane.Recordings of transmembrane potential from small clusters of spontaneously beating 7-day-old embryonic chick ventricular cells were analyzed to characterize the voltage waveform and the regularity of beating. I constructed a deterministic Hodgkin-Huxley-type ionic model which reproduces spontaneous activity in our experimental recordings, as well as the experimental results of applying various ion channel blockers (D-600, almokalant, and Ba2+). The model consists of six currents: a calcium current (ICa), three potassium currents (IKs, I Kr, IK1), a background current ( Ib), and a seal-leak current (I seal).
The deterministic Hodgkin-Huxley-type model was then reformulated into a stochastic single-channel model. The single-channel model reproduces the irregularity of beating seen experimentally: e.g. the coefficient of variation of interbeat interval was 4.4% vs. 3.9% in the clusters. In the model, IKs is the current giving the major contributions to fluctuations in interbeat interval.
Phase resetting of the spontaneous activity of cardiac pacemaker cells by a brief stimulus pulse was simulated in Hodgkin-Huxley-type models and single-channel models of slow-upstroke (central) and fast-upstroke (peripheral) rabbit sinoatrial node cells. In the Hodgkin-Huxley-type models the phase-resetting response is continuous, but can be extremely delicate in the fast-upstroke model, in that a tiny difference in the stimulus timing can change the stimulus response from a delayed action potential to an advanced one. Therefore, the noise in the fast-upstroke single-channel model can cause a stimulus with fixed amplitude and fixed timing to have widely different effects: sometimes it will induce an action potential but in other cases it will delay an action potential, as seen previously in experiments on cardiac preparations.
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Vidmark, Jessica Sofie Louise. "An investigation of the relationships between electrotactile stimulus parameters, primary afferent response, and perceived sensation." Thesis, KTH, Skolan för kemi, bioteknologi och hälsa (CBH), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-251735.
Full textAbstract:
Sensory feedback possesses the possibility of adding a new dimension to many applications, including, but not limited to, prosthetics and surgical robots for improved control, virtual reality for incorporation of another sense, and phantom limb pain reduction for amputees. Electrotactile stimulation provides a compact, light-weight, energy efficient, highly responsive, and non-invasive option for sensory feedback; however, it has been found to commonly elicit unnatural or uncomfortable sensations for the user. To address this issue, this thesis was designed to test the impact of the different electrotactile stimulus parameters – current amplitude and polarity, pulse width, frequency, and waveform – on the user’s perceived sensation and afferent neural response. The relationship between sensation and neural response was also analysed. The aim of this thesis was to create guidelines to assist in the design and use of electrotactile stimulation. Neural data and matching psychophysical data from one healthy subject and purely psychophysical data from three others were gathered while applying electrotactile stimulations of different parameter combinations on the dorsal side of the hand or lower arm. Significant (p < 0.05) correlations and differences were found in all three relationships between electrotactile stimulus parameters, primary afferent response, and perceived sensation. Current (specifically negative) or pulse width control in monophasic waveforms were deemed most appropriate in applications that relay information through varying intensity. However, monophasic waveforms produced more discomfort, rendering biphasic waveforms more suitable when mild, local, and more natural sensations are of greater importance. Surprisingly, the data also suggested higher sensitivity to positive currents. While lower values of current amplitude and pulse width increased neural spike count, stimulus frequency could reliably control neural firing at all tested frequencies. Spike counts were moderately to strongly correlated with perceived intensity; however, practically identical neural responses could elicit different sensations. High current pulses at low frequencies induced spikes with the shortest latency – but with greater risk of discomfort. Due to limitations in sample size, generalisability is limited, and this thesis should be considered a pilot study to guide future investigations. The results suggest that recording from single and multiple afferent nerve fibres simultaneously would improve the understanding of the neural population response to electrotactile stimuli. Moreover, the one-to-one neural response to electrotactile stimuli raised the question of whether an electrotactile stimulation based on a natural spike pattern could replicate the original sensation. A future study testing this hypothesis may find a new approach to designing painless electrotactile stimulations for sensory feedback use.Sensorisk återkoppling har möjlighet att drastiskt förbättra många användningsområden, t.ex. genom att bidra till enklare kontroll av proteser och kirurgiska robotar, mer verklighetstrogna VR-spel, och minskade fantomsmärtor hos patienter med amputeringar. Elektrisk hudstimulering erbjuder ett kompakt, lätt, energisnålt, hög-responsivt och icke-invasivt alternativ för sensorisk återkoppling – dock framkallar denna metod ofta onaturliga och obehagliga förnimmelser för användaren. Detta examensarbete bemöter detta problem genom att undersöka effekten av stimuleringsparametrar som strömstyrka, pulsbredd, frekvens och vågform på försökspersonens upplevda förnimmelse samt den afferenta nervresponsen. Även relationen mellan förnimmelse och nervrespons analyserades. Examensarbetets ändamål var att skapa riktlinjer för att förenkla designen och användandet av elektrisk hudstimulering. Nervdata med matchande psykofysiska data samlades från en frisk försöksperson, samt enbart psykofysiska data från tre andra, under olika elektriska hudstimuleringar (med varierande parametervärden) på handens dorsala sida eller på underarmen. Signifikanta (p < 0.05) korrelationer och skillnader fanns i alla tre relationer mellan parametrarna för elektrisk hudstimulering, primärafferent respons och upplevd förnimmelse. Kontroll av ström (i synnerhet negativ) eller pulsbredd i monofasisk vågform visade sig vara mest fördelaktigt i applikationer där information kommuniceras till användaren genom att variera den upplevda intensiteten. Dock skapade denna vågform mer obehag, och bifasiska vågformer bedömdes mer passande då milda, lokala, och mer naturliga förnimmelser är av högre värde. Positiv ström upplevdes, förvånande, starkare än negativ. Vid låga värden på ström och pulsbredd var dessa faktorer viktiga gällande antalet aktionspotentialer (AP), men stimuleringsfrekvensen kunde kontrollera antalet AP vid alla frekvenser. Mängden AP var måttligt till starkt korrelaterad med upplevd intensitet – samtidigt kunde praktiskt taget identiska nervresponser vara kopplade till olika förnimmelser. Lågfrekvent stimulering med hög ström hade kortast latenstid, men högre risk för obehag. P.g.a. lågt antal försökspersoner är generaliserbarheten begränsad och detta examensarbete bör beaktas som en förstudie för att guida framtida forskning. Resultaten från denna studie antyder att en tydligare bild av populationsresponsen skulle kunna skapas genom samtidig läsning av ett flertal enskilda nervfibrer samtidigt. Det faktum att varje stimulering kunde ge upphov till en AP väckte frågan: kan ett stimuleringsmönster baserat på en naturlig nervrespons återskapa den ursprungliga förnimmelsen? En studie som testar denna hypotes har möjligheten att finna ett nytt tillvägagångssätt för att skapa smärtfri elektrisk hudstimulering för sensorisk återkoppling.
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Bunch, Jacinda Lea. "Rapid response systems : evaluation of program context, mechanism, and outcome factors." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1558.
Full textAbstract:
Prevention of in-hospital cardiac arrest (IHCA) is critical to reducing morbidity and mortality as both the rates of return to pre-hospital functional status and overall survival after IHCAs are low. Early identification of patients at risk and prompt clinical intervention are vital patient safety strategies to reduce IHCA. One widespread strategy is the Rapid Response System (RRS), which incorporates early risk identification, expert consultation, and key clinical interventions to bedside nurses caring for patients in clinical deterioration. However, evidence of RRS effectiveness has been equivocal in the patient safety literature.
This study utilized a holistic Realistic Evaluation (RE) framework to identify important clinical environment (context) and system triggers (mechanisms) to refine our understanding of an RRS to improve local patient emoutcomesem and develop a foundation for building the next level of evidence within RE research. The specific aims of the study are to describe a RRS through context, mechanism, and outcome variables; explore differences in RRS outcomes between medical and surgical settings, and identify relationships between RRS context and mechanism variables for patient outcomes.
Study RRS data was collected retrospectively from a 397-bed community hospital in the Midwest; including all adult inpatient RRS events from May 2006 (2 weeks post-RRS implementation) through November 2013. RRS events were analyzed through descriptive, comparative, and proportional odds (ordinal) logistic regression analyses.
The study found the majority of adult inpatient RRS events occurred in medical settings and most were activated by staff nurses. Significant differences were noted between RRS events in medical and surgical settings; including patient status changes in the preceding 12 hours, event trigger patterns, and immediate clinical outcomes. Finally, proportional odds logistic regression revealed significant relationships between context and mechanism factors with changes in the risk of increased clinical severity immediately following at RRS event. RE was utilized to structure a preliminary study to explore the complex variables and relationships surrounding RRSs and patient outcomes. Further exploration of settings, changes in clinical status, staffing and resource access, and the ways nurses use RRSs is necessary to promote the early identification of vulnerable patients and strengthen hospital patient safety strategies.
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Chen, Mitchell. "Computer-assisted volumetric tumour assessment for the evaluation of patient response in malignant pleural mesothelioma." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:44c0aef6-5f1b-4777-91d8-5bc663df2503.
Full textAbstract:
Malignant pleural mesothelioma (MPM) is a form of aggressive tumour that is almost always associated with prior exposure to asbestos. Currently responsible for over 47,000 deaths worldwide each year and rising, it poses a serious threat to global public health. Many clinical studies of MPM, including its diagnosis, prognostic planning, and the evaluation of a treatment, necessitate the accurate quantification of tumours based on medical image scans, primarily computed tomography (CT). Currently, clinical best practice requires application of the MPM-adapted Response Evaluation Criteria in Solid Tumours (MPM-RECIST) scheme, which provides a uni-dimensional measure of the tumour's size. However, the low CT contrast between the tumour and surrounding tissues, the extensive elongated growth pattern characteristic of MPM, and, as a consequence, the pronounced partial volume effect, collectively contribute to the significant intra- and inter-observer variations in MPM-RECIST values seen in clinical practice, which in turn greatly affect clinical judgement and outcome. In this thesis, we present a novel computer-assisted approach to evaluate MPM patient response to treatments, based on the volumetric segmentation of tumours (VTA) on CT. We have developed a 3D segmentation routine based on the Random Walk (RW) segmentation framework by L. Grady, which is notable for its good performance in handling weak tissue boundaries and the ability to segment any arbitrary shapes with appropriately placed initialisation points. Results also show its benefit with regard to computation time, as compared to other candidate methods such as level sets. We have also added a boundary enhancement regulariser to RW, to improve its performance with smooth MPM boundaries. The regulariser is inspired by anisotropic diffusion. To reduce the required level of user supervision, we developed a registration-assisted segmentation option. Finally, we achieved effective and highly manoeuvrable partial volume correction by applying a reverse diffusion-based interpolation. To assess its clinical utility, we applied our method to a set of 48 CT studies from a group of 15 MPM patients and compared the findings to the MPM-RECIST observations made by a clinical specialist. Correlations confirm the utility of our algorithm for assessing MPM treatment response. Furthermore, our 3D algorithm found applications in monitoring the patient quality of life and palliative care planning. For example, segmented aerated lungs demonstrated very good correlation with the VTA-derived patient responses, suggesting their use in assessing the pulmonary function impairment caused by the disease. Likewise, segmented fluids highlight sites of pleural effusion and may potentially assist in intra-pleural fluid drainage planning. Throughout this thesis, to meet the demands of probabilistic analyses of data, we have used the Non-Parametric Windows (NPW) probability density estimator. NPW outperforms the histogram in terms of its smoothness and kernel density estimator in its parameter setting, and preserves signal properties such as the order of occurrence and band-limitedness of the sample, which are important for tissue reconstruction from discrete image data. We have also worked on extending this estimator to analysing vector-valued quantities; which are essential for multi-feature studies involving values such as image colour, texture, heterogeneity and entropy.
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Minucci, Sarah B. "Mathematical Models of the Inflammatory Response in the Lungs." VCU Scholars Compass, 2017. https://scholarscompass.vcu.edu/etd/5191.
Full textAbstract:
Inflammation in the lungs can occur for many reasons, from bacterial infections to stretch by mechanical ventilation. In this work we compare and contrast various mathematical models for lung injuries in the categories of acute infection, latent versus active infection, and particulate inhalation. We focus on systems of ordinary differential equations (ODEs), agent-based models (ABMs), and Boolean networks. Each type of model provides different insight into the immune response to damage in the lungs. This knowledge includes a better understanding of the complex dynamics of immune cells, proteins, and cytokines, recommendations for treatment with antibiotics, and a foundation for more well-informed experiments and clinical trials. In each chapter, we provide an in-depth analysis of one model and summaries of several others. In this way we gain a better understanding of the important aspects of modeling the immune response to lung injury and identify possible points for future research.
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Dieke, Ada. "ADOLESCENT ENGAGEMENT WITHIN COMMUNITY-BASED PUBLIC HEALTH EMERGENCY PREPAREDNESS AND RESPONSE ORGANIZATIONS: AN ASSESSMENT OF THE MEDICAL RESERVE CORPS." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/216973.
Full textAbstract:
Participation in risky behaviors is a common threat to an adolescent's health. Youth engagement (YE), a youth's meaningful and sustained participation in an activity, is a way to help reduce that threat. The Medical Reserve Corps (MRC), a public health emergency preparedness and response organization, has opportunities for engaging youth. However, few adolescents participate in MRC activities, signaling network-wide variations in working with youth. Furthermore, there is a gap in the literature exploring YE in emergency preparedness organizations, including the MRC. The purpose of this dissertation was to better understand youth engagement and development within organizations like these. With the MRC as the example and youth development theories as the lens, YE was examined as well as challenges and benefits of YE, needs, and use of YE strategies within the MRC. An exploratory sequential mixed-methods approach was used to assess YE in the MRC: Phase I- key informant interviews of youth (ages 14-18) and adults in and out of MRC (N=17); and Phase II- a nationwide web-based survey of adult MRC unit leaders (N=215). Qualitative data was analyzed with Microsoft Word and Excel; quantitative data analyzed with Stata 12.0. Results revealed common challenges experienced by MRC units working with youth, including liability concerns. Benefits found include preparation of the youth for future careers and giving youth a focus beyond themselves. A Spearman's correlation found a statistically significant association (r=0.30, N=52, p=0.0288) between the use of the core YE principles and the level of youth participation among the MRC units with youth membership, meaning use of these principles may be helpful in better involving youth. Furthermore, "Building Youth and Adult Capacity" was the top YE principle used among the MRC units that allow youth membership to engage youth. Despite noted challenges, engaging adolescents in the MRC still has many benefits with long-term public health and maternal and child implications for youth in emergency preparedness organizations. These include development of a responsible youth that protects their peers, families, and local communities from public health challenges, positively impacting the community. Recommendations for building student MRC programs across the nation have been provided.
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Saks, Michael Paul. "Professions and the public interest : the response of the medical profession to acupuncture in nineteenth and twentieth century Britain." Thesis, London School of Economics and Political Science (University of London), 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.432495.
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