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1
Ingle, Gordon Thorpe. "Clinical and MRI features of primary progressive multiple sclerosis." Thesis, University College London (University of London), 2006. http://discovery.ucl.ac.uk/1444980/.
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In approximately 10-15% of cases Multiple Sclerosis follows a progressive rather than a relapsing course and this is known as Primary Progressive Multiple Sclerosis (PPMS). In this thesis previous clinical, pathological and Magnetic Resonance Imaging (MRI) studies of PPMS are reviewed and new studies using two cohorts of patients with PPMS are presented. In the first of these studies an existing cohort of patients with PPMS are re-examined at first two, and then five years, clinically and with MRI, to provide the longest period of MRI follow up in the condition to date. Changes in clinical and MRI measures over this time, and their correlation, are described. Over this extended period, some limited correlation can be found between clinical and MRI measures in PPMS. It is also seen that there is great variability in the rate of MRI and clinical progression between individuals with PPMS, although for a given individual progression is relatively constant. The possible implications of this observation for the nature of the underlying disease process are discussed. The second part of this thesis describes the clinical and MRI features of a second cohort of patients with clinically early PPMS, examined within five years of the first onset of symptoms, the first study to examine this stage of the condition. It is seen that much of the MRI variation seen in established PPMS is already present at this time and that the degree of MRI abnormality, even at this early stage, can be substantial. The specific question as to whether a distinct, early, inflammatory phase occurs in the condition (on the model of the more fully studied relapsing MS subtype) is addressed by the use of triple dose Gadolinium in a subgroup of this cohort examined over six months and evidence for the possible existence of such a phase in some patients with PPMS is found.
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Herrmann, Felix J., and Dirk J. Verschuur. "Robust curvelet-domain primary-multiple separation with sparseness constraints." European Association of Geoscientists & Engineers, 2005. http://hdl.handle.net/2429/454.
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A non-linear primary-multiple separation method using curvelets frames is presented. The advantage of this method is that curvelets arguably provide an optimal sparse representation for both primaries and multiples. As such curvelets frames are ideal candidates to separate primaries from multiples given inaccurate predictions for these two data components. The method derives its robustness regarding the presence of noise; errors in the prediction and missing data from the curvelet frame's ability (i) to represent both signal components with a limited number of multi-scale and directional basis functions; (ii) to separate the components on the basis of differences in location, orientation and scales and (iii) to minimize correlations between the coefficients of the two components. A brief sketch of the theory is provided as well as a number of examples on synthetic and real data.
3
Saab, Rayan, Deli Wang, Ozgur Yilmaz, and Felix J. Herrmann. "Curvelet-based primary-multiple separation from a Bayesian perspective." Society of Exploration Geophysicists, 2007. http://hdl.handle.net/2429/562.
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In this abstract, we present a novel primary-multiple separation
scheme which makes use of the sparsity of both primaries and
multiples in a transform domain, such as the curvelet transform,
to provide estimates of each. The proposed algorithm
utilizes seismic data as well as the output of a preliminary step
that provides (possibly) erroneous predictions of the multiples.
The algorithm separates the signal components, i.e., the primaries
and multiples, by solving an optimization problem that
assumes noisy input data and can be derived from a Bayesian
perspective. More precisely, the optimization problem can be
arrived at via an assumption of a weighted Laplacian distribution
for the primary and multiple coefficients in the transform
domain and of white Gaussian noise contaminating both the
seismic data and the preliminary prediction of the multiples,
which both serve as input to the algorithm.
4
Probert, Adam. "The genetic epidemiology of multiple primary breast and ovarian cancer /." Thesis, McGill University, 1999. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=20971.
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Breast and ovarian cancers are among the most common tumours affecting Canadian women. A proportion of these tumours was thought to be due to family history and the breast cancer susceptibility gene and are more likely to occur before the age of 50. It is hypothesized that women who have both primary tumours of the breast and ovary are more likely to have a mutation in this gene. The main objective of this study is to examine the role of family history in those women with breast cancer that subsequently develop ovarian cancer. The role of chemotherapy and radiotherapy in the treatment of breast cancer, as a risk factor for future development of ovarian cancer, was also assessed.<br>This was a case-control study. The cases studied were women with multiple primary breast and ovarian cancers and were identified from the Quebec Tumour Registry and a database at Sunnybrook Hospital in Toronto.
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Probert, Adam. "The genetic epidemiology of multiple primary breast and ovarian cancer." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0024/MQ50860.pdf.
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Soerjomataram, Isabelle. "Multiple primary cancers in patients with breast ans skin cancer." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10779.
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Arun, Tarunya. "A longitudinal study of biomarkers in primary progressive multiple sclerosis." Thesis, University of Leeds, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589407.
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This thesis describes the work performed using conventional (whole and regional brain volume) and non-conventional magnetic resonance imaging (MRI) which measures diffusion tensor imaging, magnetization transfer imaging and magnetic resonance spectroscopy, to arrive at the most sensitive way of detecting neurodegenerative change in patients with primary progressive multiple sclerosis (PPMS). The experiments described aim to identify the most useful surrogate marker or combination of such markers that could be used to power trials of neuroprotective agents in PPMS. First, we compared within-patient variability using the same primary progressive MS cohort and a small number of healthy controls of a number of different MR outcome measures. We outlined efforts made to reduce this measurement related variability. We then demonstrated significant longitudinal change over one year in most MR measures in our PPMS cohort compared to healthy controls. We also compared these values to the measured change over time and the across group standard deviation which are necessary values required to power studies. Next we explored the value of non-conventional MRI metrics at baseline and time to get to a baseline value (disease duration) to predict brain atrophy longitudinally over one year. We demonstrated that baseline corpus callosum volume predicted percentage brain volume change over the 6 subsequent year and this correlation between the two became stronger when the annual baseline loss in corpus callosum volume (CCV) was considered. Finally, we showed that the grey matter volume when incorporated into the power calculation for a longitudinal study was the single measure that reduced the sample size required by the most. The combination of volumetric measures (Thalamic Volume+GM Volume) was the most powerful combination, interestingly more powerful than combinations involving PBVC which is the current gold standard. Sample sizes were halved by combining two measures and reduced even futhur by using three measures in combination compared to using a single MR measure.
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Petgrave, Dannel K., Kayla McCarter, Courtney Lilly, Natasha Gouge, and Jodi Polaha. "Managing Multiple Concerns in Pediatric Primary Care: Impact on Time." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6632.
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Behavioral problems in children are common concerns in pediatric primary care. Time is an important factor for primary care providers (PCP) and it has been shown that pediatricians spend approximately five minutes longer providing care when behavioral concerns are presented, reducing the number of patients for which they can provide care. To date, no research has looked at the relationship between the quantity of behavioral concerns and PCP time demands, which is the aim of the present study. Using a sample of 516 children at a pediatric setting in rural southwest Virginia, data was recoded to classify children in one of two groups: those with behavioral concerns and those without. Using descriptive statistics, it was found that 96 children (18.6%) presented with at least one behavioral concern (with a range of 1 to 6 total behavioral concerns). Children with behavioral concerns were compared to children with medical-only concerns (with a range of 1-7 total medical concerns). When one concern was presented and it was behavioral, it took longer to address than when patients presented with up to four medical-only concerns. Regardless of the total number of concerns presented, PCPs spent 6.57 minutes longer with children presenting with at least one behavioral concern when compared to children in the medical-only group. More specifically, PCPs spent 5.07 additional minutes when one behavioral concern was presented and 9.03 additional minutes when two behavioral concerns were presented. Despite the quantity of behavioral concerns presented and the impact such concerns have on PCP’s time, results show that 100% of concerns raised were addressed at all times by PCPs within this clinic. Although from a consumer’s prospective, this is a desirable approach, such a model is not an especially time or cost efficient way for pediatricians to spend their time. As PCPs continue to address behavioral concerns, it is critical to develop and implement strategies (e.g., prioritizing concerns, identifying less time consuming concerns, scheduling follow up appointments) to address behavioral concerns more efficiently. Furthermore, incorporation of a full time on-site behavioral health provider might be an especially efficient way to maximize patient care while also relieving providers from the additional time burdens associated with the high prevalence of behavioral concerns within pediatric practices.
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Kohli, Jaskaren Singh. "Senescence and immortalisation in melanoma progression and multiple primary melanoma." Thesis, St George's, University of London, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.706529.
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Multiple primary melanoma is defined as the gain of at least one additional independent melanoma and occurs in approximately 5% of melanoma patients. Germline mutations can be identified in genes in these patients, which are known to, or are predicted to result in an extension of melanocyte lifespan e.g. pl6, CDK4, and components of the telomere shelterin cap. We therefore hypothesised that 'normal' melanocytes from pl6 and CDK4 wild-type multiple primary melanoma patients have a statistically longer lifespan compared to those from single primary melanoma patients. Melanocytes from multiple primary melanoma patients did display a significantly extended culture lifespan, independently of donor age. Multiple primary melanoma is therefore commonly associated with a delay in normal melanocyte senescence. There is currently a shortage of diagnostic markers for melanoma and novel ones are needed for more accurate diagnosis and prognosis. TERT (the enzymatic component of telomerase) expression is the commonest route to telomere maintenance, required for melanoma immortality. TERT expression was tested via immunohistochemistry in a series of melanoma precursor and melanoma lesions, to analyse at which point in progression its expression is activated. The protein was found to be localised in either the nucleolus, the nucleoplasm (designated non-nucleolarTERT), or both. Only non-nucleolarTERT expression significantly increased with melanoma progression, suggesting this location is associated with immortality. As senescence likely needs to be bypassed for advanced melanoma development, microarrays were previously carried out comparing growing and senescent wild-type and pl6-null melanocyte lines to evaluate significantly up- or downregulated genes which could be used as future markers. In the present study, potential novel markers were authenticated using PCR and immunoblotting and validated genes were analysed via immunohistochemistry in a series of melanoma precursor and melanoma lesions. ETS1 was tested owing to recent findings that it can bind to and activate the mutant TERT promoter found commonly in melanomas. ETS1 was expressed at all stages from benign nevi onwards, perhaps owing to its link with the MAPK pathway.
10
Abdelhak, Ahmed [Verfasser]. "Primary progressive multiple sclerosis (PPMS) – cerebrospinal fluid (CSF) profile / Ahmed Abdelhak." Ulm : Universität Ulm, 2018. http://d-nb.info/1150780983/34.
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Symeou, Loizos. "Teacher-family communication in Cypriot primary schools : a multiple case study." Thesis, University of Cambridge, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.615918.
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Andersson, Ingo, and Joel Garbers. "Developing Primary Controls for Multiple CE-Machines in a Teleoperation's Environment." Thesis, Mälardalens högskola, Akademin för innovation, design och teknik, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-49372.
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Background: An intermediate step towards fully autonomous construction equipment is “assisted tele-remote operation”. These sorts of operations imply that an operator remotely supports machines that has encountered a situation that autonomous systems onboard the construction machines (CM) cannot solve. Considering teleoperators are not required to continuously monitor the CM in an assisted tele-remote environment, multiple construction machines can be teleoperated simultaneously. For simplification, “assisted tele-remote operation” will now be referred to as “teleoperations”. Volvo Construction Equipment is currently exploring the possibility to teleoperate wheel loaders, articulated haulers, and excavators from a single platform. To do this, primary controls adapted for operating these machines are needed. The primary controls should be designed with the needs of a teleoperator in mind while taking functionality into account, which is needed when CM are both operated conventionally and in tele-remote applications. This procedure will be referred to as relevant primary controls. As the primary controls from three different CM-types are destined to be combined into one platform, the teleoperations platform will be referred to as “3-1 CM teleoperations platform”. The purpose of this thesis project was to propose a relevant solution to primary controls for a 3-1 CM teleoperations platform. To fulfil this purpose, the following two research questions (RQ) where formulated: • RQ1: What are the challenges for teleoperating construction equipment? • RQ2: What defines primary controls in a 3-1 CM teleoperations platform and how can the layout be improved? Method: Using interviews, observations, and literature as qualitative data collection methods, several insights where gained. A scenario for the CM was defined to define the situation in which the quantitative data collection method would be performed. Needs of current CM operators combined with teleoperators have been analysed and listed. Quantitative data has been collected and analysed to design the layout of the primary controls using the objective data as a basis. Result: The research questions were answered with the following results: • RQ1: Insights that resulted in several themes describing how teleoperations can be developed by looking at different challenges it can face. • RQ2: Specifications of the functions included in the new ‘primary controls’ based on CM functions from the company and from teleoperating experiences from several industries. An analysis on how often the functions for the new ‘primary controls’ were used, was carried out. The answers to the research questions were used as a basis to fulfil the purpose of this thesis project by proposing a conceptual solution for primary controls to a teleoperation’s platform for operating multiple CM. Conclusions: It was established that a 3-1 CM teleoperations platform can be developed towards certain CE-machine types. Moreover, additional analysis with experienced operators of each machine type are needed to improve and verify the most optimal layout of the primary controls and platform. Further research is still required to validate the answers to RQ1 and RQ2.
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Knowlton, Anne. "Getting it right a multiple case study of exemplary ARI schools /." Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008d/knowlton.pdf.
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Thesis (Ph. D.)--University of Alabama at Birmingham, 2008.<br>Additional advisors: Nataliya Ivankova, Foster Watkins, Martha Barber, Margaret Rice. Description based on contents viewed May 29, 2008; title from title screen. Includes bibliographical references (p. 224-235).
14
Hackenbroch, Jessica. "CD4⁺ and CD8⁺ naïve T-cell homeostasis in primary progressive multiple sclerosis." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=112629.
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Multiple Sclerosis (MS) is a chronic inflammatory and demyelinating disease of the central nervous system. The etiology of MS is unknown but many researchers believe that it is autoimmune mediated. This study investigated naive CD4+ and naive CD8+ T-cell homeostasis in patients with Primary Progressive Multiple Sclerosis and Relapsing Remitting Multiple Sclerosis. The naive T-cell compartment involves a balance between thymic production of naive T-cells, homeostatic proliferation and the delivery of death and survival signals. Naive T-cell production was quantified by measuring signal joint T-cell receptor excision circles (sj-TRECs); episomal byproducts formed during V(D)J T-cell receptor rearrangement.<br>Homeostatic proliferation was quantified by flow cytometry analysis of % expression of CD31 and Ki-67. CD31 is a marker found on CD4+ recent thymic emigrants (RTE) but not on naive T-cells that have undergone homeostatic proliferation. CD31 can be used as a marker of the proliferation history of naive CD4+ T-cells. Ki-67 is a nuclear and nucleolar antigen found in actively cycling cells. It can be used as a marker of cell proliferation at the moment of isolation. Cell survival was measured by quantifying plasma IL-7 levels and by measuring Bcl-2 expressions. IL-7 plays an important role in maintaining and restoring peripheral naive T-cell homeostasis. It stimulates naive T-cell proliferation and prevents the reduction of Bcl-2, an antiapoptotic protein.<br>In this study, PPMS patients had significantly reduced naive CD4 + T-cell sj-TRECs compared to healthy controls (p = 0.0007) and compared to RRMS patients (p = 0.0010). RRMS patients had fewer sj-TRECs than healthy controls but this difference was not significant (p = 0.4652). Similarly, in PPMS, naive CD4+ T-cells had significantly lower CD31 expression than healthy controls (p = 0.0017) and RRMS patients (p = 0.0032). This finding indicates increased homeostatic proliferation in naive CD4 + T-cells in PPMS, most probably a response to decreased thymic export as marked by the decreased naive CD4+ T-cell sj-TRECs. % CD31 expression in naive CD4+ T-cells did not differ significantly in RRMS compared to healthy controls (p = 0.7455) which is consistent with their naive CD4+ sj-TREC levels.<br>Naive CD8+ T-cell sj-TRECs were significantly reduced in PPMS patients compared to healthy controls (p = 0.0212) but not compared to RRMS patients (p = 0.2379). RRMS patients had fewer naive CD8 + T-cell sj-TRECs compared to healthy controls but this difference was not significant (p = 0.1517). PPMS patients expressed increased Bcl-2 levels in their naive CD8+ T-cells. This finding indicates upregulation of survival signals, most probably a consequence of reduced thymic export of naive CD8+ T-cells.<br>The data from this study indicate that PPMS is different from RRMS in their naive CD4+ T-cell sj-TRECs and naive CD4 + T-cell % CD31 expression but is similar to RRMS in their naive CD8+ T-cell sj-TRECs. This study concludes, therefore, that both PPMS and RRMS patients have altered naive T-cell homeostasis.
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Demosthenous, Eleni. "Algebra-related topics : a multiple case study in Cypriot primary school classrooms." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708602.
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Wang, Deli, Rayan Saab, Ozgur Yilmaz, and Felix J. Herrmann. "Recent results in curvelet-based primary-multiple separation: application to real data." Society of Exploration Geophysicists, 2007. http://hdl.handle.net/2429/565.
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In this abstract, we present a nonlinear curvelet-based sparsitypromoting
formulation for the primary-multiple separation
problem. We show that these coherent signal components can
be separated robustly by explicitly exploting the locality of
curvelets in phase space (space-spatial frequency plane) and
their ability to compress data volumes that contain wavefronts.
This work is an extension of earlier results and the presented
algorithms are shown to be stable under noise and moderately
erroneous multiple predictions.
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Leary, Marie Siobhan. "Magnetic resonance imaging evaluation and therapeutic trials in primary progressive multiple sclerosis." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268723.
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Villablanca, Andrea. "Genetic background of familial primary hyperparathyroidism /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-520-4/.
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Sivri, Hakan. "School Effectiveness: A Qualitative Investigation Of Multiple Cases At Primary Schools In Izmir." Master's thesis, METU, 2011. http://etd.lib.metu.edu.tr/upload/12613461/index.pdf.
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This study aimed to explore the characteristics of successful primary schools in the province of Izmir. In this study, qualitative research technique is employed through the perspective of multiple case studies. It was conducted in 9 distinguishingly effective primary public schools located in various districts of Izmir. The participants of the investigation were school administrators and teachers of the investigated schools.
Reviewing the relevant literature of the field, a model of school effectiveness characteristics (consisting of five factors) was exploited in order for conceptualizing the research. This frame of effectiveness characteristics were identified as achievement &ndash<br>oriented policy, orderly and secure climate, strong educational leadership, maintaining parental support and thorough monitoring of pupil progress.
Throughout the study, multiple case study method was adopted, and semi-structured interview technique was employed as the main data collection instrument. Content analysis technique was utilized to unfurl the data gathered through the interviews. The results of the research revealed that achievement orientation, strong educational leadership, school climate, monitoring students&rsquo<br>progress, parental support, and supportive physical environment are among the identified characteristics for school effectiveness.
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Fitz-Gerald, Leslie. "Naive CD4+ T-cell homeostasis in primary progressive and secondary progressive multiple sclerosis." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=106368.
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The peripheral naive CD4+ T-cell pool is maintained through homeostatic mechanisms, which balance thymic output, cell survival and death, and peripheral T-cell proliferative processes. Naive CD4+ T-cells are divisible into several subsets based on their surface expression of CD31: cells having highest levels of expression of CD31 correspond to recent thymic emigrants (CD4+ RTEs), whereas CD31-negative (CD31neg) naive CD4+ T-cells have lost CD31 expression and are distant in origin from the thymus. We report that SPMS patients have altered naive CD4+ T-cell homeostasis with increased TCR-signalling and loss of CD31 from naive CD4+ T-cells with increasing age. Second, we report increased proliferation of the CD31neg subset of naive CD4+ T-cells in both SPMS and PPMS compared to controls. PPMS patients had an increased frequency of CD31neg naive CD4+ T-cells expressing the Fas receptor CD95. We conclude in PPMS that CD31neg cells have an increased propensity for cell death following proliferation. Self-peptide-MHC induced TCR signalling helps maintain naive CD4+ T-cell survival. TCR signalling with loss of CD31 leads to loss of the immunoregulatory function of CD31 molecules in naive CD4+ T-cells, i.e. would favour the development of autoimmune processes. Furthermore, increased proliferation of CD31neg naive CD4+ T-cells is known to expand auto-reactive T-cells, i.e. may contribute to ongoing autoimmune processes in progressive MS. In conclusion, we report peripheral naive CD4+ T-cell homeostatic alterations in both SPMS and PPMS that have potential implications for ongoing immunopathogenesis of these MS subtypes.<br>La population des cellules-T CD4+ naïves périphériques est maintenue par des mécanismes homéostatiques qui fonctionnent en balancent la sortie du thymus, la survie et la mort des cellules, et la prolifération périphériques des cellules-T. Les cellules-T naive CD4+ se divisent en plusieurs sous-ensembles en fonction de leur expression de CD31 en surface: Les cellules ayant un plus haut niveau d'expression de CD31 correspondent aux émigrants thymiques récents (CD4+ ETRs), alors que les cellules CD31-négatif (CD31neg) ont perdu l'expression de CD31 et sont éloignées de l'origine du thymus. Nous avons constaté que chez les patients atteints de SPPS, l`homéostasie des lymphocytes-T CD4+ naïves est alterée, et se caractérise par une augmentation de la signalisation des récepteurs des cellules-T (RCT) et par la perte de CD31 des cellules-T CD4 + naïves avec l'âge. Deuxièmement, nous avons constaté une augmentation de la prolifération du sous-ensemble CD31neg des cellules-T CD4+ naïves chez les patients atteints de SPPS et SPPP comparé aux controles. Les patients atteints de SPPP avaient une fréquence accrue dede type CD31neg exprimant le récepteur Fas, CD95. Nous concluons que les cellules CD31neg des patients atteints de SPPP ont une propension accrue à la mort cellulaire après leur prolifération. La signalisation des TCR induite par le complexe auto-peptide-CMH-induit signalisation des TCR permet de maintenir la survie des cellules-T CD4+ naives. Le signalisation des TCR avec un perte de CD31 entraîne la perte des fonctions immunorégulatrices des molécules CD31 dans les cellules-T CD4+ naives ; i.e. favorisant le développement de processus auto-immunitaires. En outre, la prolifération des cellules-T CD4 + naïves de type CD31neg est une cause connue de l'augmentation des cellules-T auto-réactives, c'est-à-dire peuvent contribuer à l'établissement de processus auto-immunitaires dans la SP progressive. En conclusion, nous rapportons des modifications homéostatique périphériques des lymphocytes-T CD4 + naïves dans les deux SPPS et PPPS ayant des implications potentielles pour l'immunopathogènes de ces sous-types de SP.
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Quibell, Gina. "Reintegrating pupils with BESD from a PRU to mainstream primary schools : Multiple perspectives." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.506255.
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Li, Zhenying. "Learning opportunities in story-based EFL primary classrooms : an evaluative multiple case study." Thesis, University of Newcastle Upon Tyne, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417540.
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Ntambwe, Lupetu Ives. "Sequential sample size re-estimation in clinical trials with multiple co-primary endpoints." Thesis, University of Warwick, 2014. http://wrap.warwick.ac.uk/66339/.
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In this thesis, we consider interim sample size adjustment in clinical trials with multiple co-primary continuous endpoints. We aim to answer two questions: First, how to adjust a sample size in clinical trial with multiple continuous co-primary endpoints using adaptive and group sequential design. Second, how to construct a test in order to control the family-wise type I error rate and maintain the power, even if the correlation ρ between endpoints is not known. To answer the first question, we conduct K different interim tests, each for one endpoint and each at level α/K (i.e. Bonferroni adjustment). To answer the second question, either we perform a sample size re-estimation in which the results of the interim analysis are used to estimate one or more nuisance parameters, and this information is used to determine the sample size for the rest of the trial or the inverse normal combination test type approach; or we conduct a group sequential test where we monitor the information, and the information is adjusted to allow the correlation ρ to be estimated at each stage or the inverse normal combination test type approach. We show that both methods control the family-wise type I error α and maintain the power and that the group sequential methodology seems to be more powerful, as this depends on the spending function.
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Evanshen, Pamela, and Susan Lewis. "Reading and Writing Workshop in a Multiage Primary Classroom." Digital Commons @ East Tennessee State University, 2003. https://dc.etsu.edu/etsu-works/4466.
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Manthri, Sukesh, Haroon Rehman, Rabia Zafar, and Kanishka Chakraborty. "A Rare Case of Non-Producing Primary Plasma Cell Leukemia." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/89.
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Non-Secretory Multiple Myeloma (NSMM) is characterized by typical morphological and pathological multiple myeloma (MM) characteristics and the absence of an M-protein on immunofixation electrophoresis with estimated prevalence of 3%. Among the NSMM cases there is a subset in which no cytoplasmic Immunoglobulin synthesis is detected, and this entity is called ‘’Non-Producing’’ Multiple Myeloma (NPMM). Plasma cell leukemia (PCL) is an aggressive form of MM characterized by high levels of abnormal plasma cells circulating in the peripheral blood. We present a rare case of non-producing variant of PCL. 75-year-old male was admitted due to anemia and thrombocytopenia. His CBC revealed hemoglobin of 9.0 g/dl and platelets were 9 k/ul. CMP showed creatinine of 1.34 mg/dl, total protein of 6 g/dl, albumin 3.6 g/dl and corrected calcium was normal. LDH was 204 IU/L. Peripheral smear review showed 8% circulating atypical plasmacytoid cells, normochromic normocytic anemia and thrombocytopenia. SPEP showed no monoclonal protein. IgA was normal. IgG, IgM were low 315 mg/dl and 20 mg/dl respectively. Serum beta-2 microglobulin was high (5.5, 1.1 – 2.4 mg/dl). Serum free kappa light chain was low (0.15, 0.33-1.94 mg/dl), lambda light chain and ratio was normal. Skeletal survey showed possible lytic lesions in right femur neck and subtrochanteric left femur. Bone marrow biopsy showed plasma cell myeloma involving 90-95% of bone marrow cellularity. The plasma cells show morphologic heterogeneity with prominent immature, plasmablastic and pleomorphic morphology. Flow cytometry shows a dominant abnormal CD45-dim population with expression of CD38, CD138, CD56 and CD117 (partial). The abnormal cells are negative for cytoplasmic kappa and lambda immunoglobulin light chains and negative for myeloid and lymphoid markers (by flow cytometry and immunohistochemical stains). Complex chromosomal analysis. Plasma cell FISH studies was positive for t(11;14). Based on suggested revised diagnostic criteria for PCL from outcomes of patients at mayo clinic, our patient was diagnosed with plasma cell leukemia. Given aggressive biology of this disease, he was started on VD-PACE chemotherapy. Bone marrow biopsy after cycle 1 chemotherapy showed no morphologic, immunophenotypic or flow cytometric features of a plasma cell neoplasm. Given excellent treatment response and discussion with transplant center subsequent cycle 2 was changed to Velcade, Revlimid and low-dose dexamethasone. He is scheduled for stem cell transplant later this month. Primary plasma cell leukemia (pPCL) is the most aggressive form of the plasma cell dyscrasias. The outcome of pPCL has improved with the introduction of autologous stem cell transplantation and combination approaches with novel agents, including bortezomib and immunomodulatory drugs, such as lenalidomide. This case highlights the challenges in diagnosis of non-producer primary plasma cell leukemia.
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Boyum, Danielle C. "Primary Sources in Social Studies| A Multiple Case Study Examining the Successful Use of Primary Sources in the Secondary History Classroom." Thesis, Piedmont College, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10288372.
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<p> The ultimate goal of teaching history to young people is to create effective, responsible citizens (Fallace, 2009). Despite such ambitious goals, the traditional teacher-centered method of instruction has not proven to have engaged students. As a result, students often rank history as their least-liked subject, particularly at the secondary level. One instructional strategy that may ameliorate this problem is the incorporation of primary sources. Identifying the inhibitors and inducers of primary sources, the researcher in this study explored and described the elements of successful primary source use in the secondary American and world history classrooms of three teacher participants in a qualitative, semester-long case study. Student and teacher perspectives of the impact of primary sources were also considered. In contrast to some of the existing literature, primary sources can be employed successfully and consistently in the secondary history classroom as demonstrated by the three teacher participants in this semester-long study in a large suburban Atlanta, Georgia, school district.</p>
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Morgan, Holly G. "Reading teachers' attitudes toward scripted reading programs a multiple case study /." Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008d/morgan.pdf.
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Thesis (Ph. D.)--University of Alabama at Birmingham, 2008.<br>Additional advisors: Lois M. Christensen, Lynn D. Kirkland, Maryann Manning, Deborah Strevy. Description based on contents viewed May 29, 2008; title from title screen. Includes bibliographical references (p. 86-92).
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Alrawashdeh, Omar. "Pathology of the spinal cord in progressive multiple sclerosis (primary progressive vs secondary progressive)." Thesis, University of Nottingham, 2011. http://eprints.nottingham.ac.uk/28520/.
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Background: Recent studies have shown that the two major forms of multiple sclerosis are different in the degree of demyelination and atrophy, degree of inflammation, and extent of axonal loss. However, the majority of the previous studies that compared primary progressive and secondary progressive multiple sclerosis were carried out at the brain level. Material and methods: Human post-mortem spinal cords were used to compare the two progressive subtypes. In this project, the 5 major pathological changes associated with MS were studied in the spinal cords of primary progressive and secondary progressive multiple sclerosis. These changes include degree of demyelination, atrophy of the tissue, oligodendrocytes pathology, axonal loss, and neuronal pathology. Results: There was significant atrophy in the spinal cords of MS compared to healthy controls, which affects mainly the upper cord levels. There is a greater degree of demyelination and atrophy affecting secondary progressive compared to primary progressive especially in the upper cord levels. Oligodendrocytes numbers are dramatically reduced in the chronic lesions of WM and GM lesions. But there was high numbers of oligodendrocytes in the normally appearing GM of secondary progressive multiple sclerosis. There was greater reduction in axonal density in the secondary progressive sample especially in the normally appearing WM. Neurons were reduced in the demyelinated grey matter regions with no difference between the two disease forms in this respect. Conclusions: SPMS seem to have greater degree of tissue destruction in the form of demyelination, atrophy, and axonal loss in the normally appearing WM. However, SPMS showed greater numbers of oligodendrocytes in the demyelinated areas of the WM and the GM. Although the disability scale in the two examined groups was found to be similar, the tissue damage appeared to be variable.
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Horn, E. M., Cynthia R. Chambers, and Y. Saito. "Techniques for Infants, Toddlers, Preschoolers, and Primary-Aged Children with Severe and Multiple Disabilities." Digital Commons @ East Tennessee State University, 2008. https://www.amzn.com/0205488722.
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This text for early childhood special education pre-service and in-service teachers provides a unique and much needed focus on how to collaborate effectively with the wide variety of professionals who work with young children who have developmental delays.
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Fillon, Gwenaëlle. "Pathologies associated to α-synuclein aggregation in primary culture models of multiple system atrophy". Paris 6, 2006. http://www.theses.fr/2006PA066030.
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Vanhusen, Lauren. "HEALTH CARE STEREOTYPE THREAT AMONG PATIENTS WITH MULTIPLE MARGINALIZED IDENTITIES: A QUALITATIVE STUDY." OpenSIUC, 2018. https://opensiuc.lib.siu.edu/dissertations/1640.
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It is well documented that some populations experience higher rates of certain diseases. While researchers have explored factors contributing to health disparities, attention has turned to the influence of social factors. For instance, stereotype threat has recently been applied to the health care setting in order to explain growing health disparities (e.g., Aronson et al., 2013). Health care stereotype threat (HCST) may arise when patients become aware that a negative health stereotype exists about a group or groups with which they identify, thus negatively impacting their utilization of health care services. Furthermore, patients with multiple marginalized identities have unique experiences of stereotyping and discrimination within the health care system. The purpose of the current study is to address Abdou et al.’s (2016) recommendation that researchers examine health care stereotype threat among individuals with multiple marginalized identities. The present study identified patients with a chronic illness and multiple marginalized identities including: (a) identifying as Black, (b) being considered overweight by medical community, and/or (c) identifying as Lesbian, Gay, Bisexual, and Transgender (LGBT). These identities were chosen based on research indicating that physicians hold implicit bias attitudes towards and stereotypes about these groups (e.g., Blair et al., 2013; Chapman et al., 2001; Sabin et al., 2009). I utilized qualitative research methodology to contextualize patients’ experiences of stereotyping in a health setting. In person, semi-structured interviews were conducted with eight patients. During the interview process, four major categories and 22 sub-level categories emerged. Grounded theory methodology (Corbin & Strauss, 2008) was used to analyze the data. The results of the study revealed a complex relationship between negative experiences with a provider (i.e., dismissive communication and perceived stereotyping) and health care utilization. Patients’ negative experiences with providers made it more difficult for patients to continue engaging in care. Systemic barriers as well as level of coping and social support influenced patients’ perception of stereotyping and discrimination. Level of support from other providers and use of coping skills also determined the extent to which patients continued to utilize available health care in the face of discrimination. Implications for future research and clinical practice are delineated.
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Collett, Tess Janeen. "Informant Discrepancy in Y-OQ Reporting and Inferences Regarding Youth and Primary Caregiver Functioning." BYU ScholarsArchive, 2018. https://scholarsarchive.byu.edu/etd/7005.
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Discrepancy in reporting is a frequent phenomenon in psychotherapy research and its presence indicates added information to take into account when assessing youth functioning (De Los Reyes, 2011; Hawley & Weisz, 2003). There is a need to further understand patterns in youth psychotherapy to protect from risk of treatment failure or deterioration. Our study aimed to explore informant discrepancy and its relation to key therapeutic constructs as well as youth functionality over time within youth outpatient mental health populations who use the Y-OQ and TSM in routine outcome monitoring and as clinical support measures. Using an outpatient mental health sample, regular Y-OQ and TSM data from n=157 youth ages 12-18 and their primary caregivers was assessed. Informant discrepancy was measured using initial total Y-OQ scores from both the youth and primary caregiver. Therapeutic constructs were measured using the TSM domains of primary caregiver distress, therapeutic alliance, and youth motivation. Change in functioning throughout the course of treatment was measured by the primary caregiver and youth Y-OQ total scores at each session. Results indicated that informant discrepancy predicted primary caregiver distress as well as change in youth functioning over time as perceived by the primary caregiver. Consistent with previous research, higher discrepancy between was associated with higher primary caregiver distress and predicted poorer youth functioning throughout the course of treatment. Implications and conclusions are discussed.
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Partovi, Monireh. "An inquiry into pupil voice in five Iranian and two English primary schools : multiple-case study." Thesis, University of Warwick, 2014. http://wrap.warwick.ac.uk/66958/.
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This thesis reflects the voices of 9 to 10 year-old primary school children in Iran and England. The findings were collected from 81 Iranian pupils within five single-sex primary classrooms and 41 English pupils in two primary classrooms. The study is mainly focused on Iranian pupils and their views. However, since all the terms used in this study originated within the Western education system, it was prudent to undertake the study in England too. It aimed to deepen understanding of the concepts as well as to have a better reflection on my findings in Iran. In order to listen to the voices of pupils, two methods of data collection were applied: participant observation and individual semi-structured interviews. As a participant observer, I facilitated six hours of workshops with each classroom adopting the community of enquiry as my pedagogical method. The selected stories of ‘One Thousand and One Nights’ were used as a ‘springboard or trigger’ to facilitate the classroom inquiry. The findings suggest that the stories of ‘One Thousand and One Nights’ may enable children’s voice in four ways. First, stories engaged children in discussion on topical issues that matter to them. Second, they open up space for imaginative journeys and help children to ‘go visiting’ different views of story characters. Third, these stories contain astonishment which may foster children’s imagination. Finally, they nurture moral reasoning by picturing moral dilemmas. The findings also revealed that building of a reciprocal relationship between teacher/pupils and pupils/pupils is required when giving voice. In addition to this, it was recommended to transform a classroom into a shared space where all the children can be seen and heard.
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Sastre, Garriga Jaume. "Brain volume and brain metabolite changes in the first stages of primary progressive multiple sclerosis." Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/290843.
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Antecedents: Hi ha escassa informació disponible sobre l’atròfia cerebral global i de substància gris i blanca (SG i SB) en l'esclerosi múltiple primària progressiva (EMPP) i en la seva relació amb paràmetres clínics i de ressonància magnètica (RM); per altra banda, les anomalies en el teixit cerebral d’aparença normal poden contribuir a la discapacitat. Objectiu: Avaluar els mecanismes subjacents a la progressió de la malaltia en les primeres fases de l'EMPP emprant eines de volumetria cerebral i calculant les concentracions de metabòlits mitjançant la imatge de RM per espectroscòpica de protons (IRME) a l'inici de l'estudi i després d'un any de seguiment, i avaluant la seva relació amb els paràmetres clínics i radiològics convencionals. Mètodes: Quaranta-tres pacients amb EMPP dins dels 5 anys primers anys de malaltia i 45 subjectes sans s’inclogueren a l'inici de l'estudi per a l’anàlisi volumètric; després d'un any 31 pacients tingueren un segon examen de RM volumètrica; per als estudis d’IRME, hi havia 41 pacients amb EMPP i 44 subjectes sans disponibles a l'inici de l'estudi i després d'un any es disposava de 21 parells d’estudis (basal – 12 mesos) de pacients amb vòxels de SG cortical i 24 parells d’estudis de pacients amb vòxels de substància blanca d’aparença normal (SBAN) utilitzables. Per als estudis d'atròfia, es va adquirir una seqüència 3D inversion-prepared fast spoiled gradient recall (3DFSPGR); les dades d’IRME es varen adquirir d’un volum situat immediatament superior al sostre dels ventricles laterals emprant una seqüencia point resolved spectroscopy (PRESS). Els anàlisis volumètrics es van realitzar emprant els programes SPM99 (Statistical Parametric Mapping 99) i SIENA (Structural Imaging Evaluation, using Normalization, of Atrophy). Les imatges cerebrals varen ser segmentades en SB, SG, i líquid cefaloraquidi, calculant-se els valors de les fraccions de parènquima cerebral total (FPC), SB (FSB), i SG (FSG). Utilitzant SIENA es va obtenir el percentatge de canvi de volum cerebral (PBVC). Les concentracions de colina (Cho), fosfocreatina (Cr), myo-inositol (Ins), N-acetil-aspartat total (tNAA), i glutamat-glutamina (Glx) es van estimar a través del programari Linear Combination Model (LCModel). Es varen determinar els volums de lesió en seqüències ponderades en T2 i en T1 que realçaven amb gadolini. Es varen obtenir les puntuacions en les escales Expanded Disability Status Scale (EDSS) i Multiple Sclerosis Functional Composite (MSFC) per a cada pacient. Les anàlisis estadístiques es varen realitzar utilitzant les proves apropiades en cada moment per tal d’investigar l'associació entre els paràmetres volumètrics i metabòlics i els corresponents a les valoracions clíniques i de RM convencional, i per avaluar el canvi en aquests paràmetres després d'un any. Resultats i conclusions: S’ha observat pèrdua de volum cerebral global, que afecta tant la FSG com la FSB, als pacients amb EMPP a l'inici de la malaltia per damunt el que s’observa en una mostra de controls sans. Tant la FSG com la FSB s’associen als paràmetres clínico-radiològics convencionals. S’observen disminucions significatives en FPC i FSG al cap de l’any, però no en FSB. Els canvis en FSB es poden predir per la quantitat d'inflamació visible per RM a l'inici de l'estudi, mentre que els canvis en FSG no es poden predir per cap paràmetre. A la SG cortical, les concentracions de tNAA i Glx són més baixes en pacients que en controls. A la SBAN, el tNAA s'ha trobat reduït (encara que en menor mesura) i l’Ins elevat en pacients en comparació amb controls. A la SG cortical el tNAA i a la SBAN l’INS s'han trobat associats amb els paràmetres clínics i radiològics. No s'han detectat canvis significatius de concentració de cap dels metabòlits a cap teixit al cap d’un any.<br>Background: There is little information available on global and on grey and white matter (GM and WM) atrophy in primary progressive multiple sclerosis (PPMS) and on their relationship with clinical and with other magnetic resonance imaging (MRI) measures; on the other hand abnormalities in normal-appearing brain tissues may contribute to disability in PPMS, where fewer lesions are seen on conventional imaging.
Aim: To evaluate the mechanisms underlying disease progression in the early phase of PPMS, focusing on axonal loss as assessed by volumetric MRI measures of WM and GM, and by measuring metabolite concentrations in normal-appearing white matter (NAWM) and cortical GM using proton magnetic resonance spectroscopic imaging (MRSI) at baseline and after one year of follow-up and to assess their relationship with clinical outcomes.
Methods: Forty-three patients with PPMS within 5 years of symptom onset and 45 control subjects were included at baseline for the volumetric study; after one year 31 patients returned for a second volumetric MRI examination; for the MRSI examinations 41 patients with PPMS and 44 control subjects were available at baseline (final availability of usable voxels vary according to tissue and group) and 21 pairs of patients yielded usable cortical GM voxels and 24 patients yielded usable NAWM voxels after one year. For atrophy studies, a 3D inversion-prepared fast spoiled gradient recall (3DFSPGR) sequence was acquired; for spectroscopy studies, MRSI data were acquired from a volume located superior to the roof of the lateral ventricles using a point resolved spectroscopy (PRESS) localization sequence. Volumetric analyses were performed at baseline and follow-up using SPM99 (Statistical Parametric Mapping 99) and SIENA (Structural Imaging Evaluation, using Normalization, of Atrophy) software; brain scans were segmented into WM, GM, and cerebrospinal fluid, and brain parenchymal (BPF), WM (WMF), and GM fractions (GMF) normalized against total intracranial volumes were estimated. Using SIENA the percentage brain volume change (PBVC) over one year was obtained. Concentrations of choline-containing compounds (Cho), phosphocreatine (Cr), myo-inositol (Ins), total N-acetyl-aspartate (tNAA), and glutamate-glutamine (Glx) were estimated using proton MRSI using the Linear Combination Model (LCModel) software. T2-weighted and T1-weighted gadolinium-enhancing lesion volumes were also determined. Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) scores were recorded in all patients. Statistical analyses were performed using appropriate tests to investigate the association between volumetric and metabolic parameters with those obtained from clinical and conventional MRI assessments, and to evaluate change in these parameters after one year.
Results & conclusions: Brain atrophy, affecting both GMF and WMF, has been found to be present early in the course of PPMS exceeding what is observed in a sample of healthy controls after adjusting for significant variables. Both GMF and WMF are related to clinical and MRI lesion-related parameters. Significant decreases in BPF and GMF can be observed after one year, but cannot be detected in the WMF. WMF changes can be predicted by the amount of MRI-visible inflammation at baseline, whereas GMF changes cannot be predicted by any clinical or MRI parameter investigated. In cortical GM, concentrations of tNAA and Glx have been found to be lower in patients as compared to control subjects. In NAWM, tNAA has also been found to be reduced (although to a lower extent) and Ins to be increased in patients as compared to control subjects. In cortical GM tNAA and, in NAWM, Ins levels have been found to correlate with clinical parameters. No changes have been detected in either cortical GM or NAWM for any of the metabolite concentrations after one year of follow-up.
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Khaleeli, Z. "Understanding progression in primary progressive multiple sclerosis : a longitudinal clinical and magnetic resonance imaging study." Thesis, University College London (University of London), 2010. http://discovery.ucl.ac.uk/19213/.
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The work in this thesis applies magnetization transfer imaging (MTI) and conventional MRI measures (brain volume, T2 lesion load and enhancing lesions) to investigate the mechanisms underlying progression in primary progressive multiple sclerosis (PPMS), and identifies MR markers to predict and monitor progression. First, we demonstrated that MTI was sensitive to change in the normal appearing brain tissues over one year, and that clinical progression over this period was predicted by baseline normal appearing white matter (NAWM) MT ratio (MTR). However, our second study showed that over three years, grey matter MTR became a better predictor of progression than any other MRI measure. Grey matter MTR and T2 lesion load changes reflected concurrent progression during this study. To localize the baseline grey matter injury more precisely, we developed a voxelbased technique to identify areas of grey matter MTR reduction and volume loss in patients compared with controls. The regions of grey matter MTR reduction identified correlated with clinical function in anatomically related systems. Finally, because our studies showed that lesion load influenced progression, we used contrast enhanced T1-weighted imaging to examine active focal inflammation. We found that while lesion activity declined over five years, levels of activity at the start of the study could influence mobility five years later. The work presented in this thesis suggests that grey matter damage has a predilection for certain brain regions and is an important determinant of progression in early PPMS. In the white matter, changes in lesion volume and activity continue to influence progression, but NAWM injury may have a declining role. MTR is a sensitive and responsive tool for predicting, monitoring, and localizing clinically relevant brain injury in early PPMS.
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Ringsmose, Charlotte, and Pamela Evanshen. "A Comparative Narrative of the Danish "Folkskole" and a Primary Multiage School in America." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/4472.
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Temiz, Nida. "Implications Of Multiple Intelligences Theory On 1st Graders'." Master's thesis, METU, 2004. http://etd.lib.metu.edu.tr/upload/12605295/index.pdf.
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The purpose of the study was to explore in what ways the principles of Multiple Intelligences Theory (MIT) are implemented on the 1st graders&rsquo<br>Literacy Education (LE), to find out the effects of the implementation on 1st graders&rsquo<br>tendency towards the course and their teachers<br>on the 1st grade teachers&rsquo<br>tendency towards their students<br>on the 1st graders&rsquo<br>literacy achievement<br>on improvements of the 1st graders&rsquo<br>multiple intelligences.
The qualitative data were gathered through interviews, observations, checklist form, students&rsquo<br>drawings and writings about the LE, students&rsquo<br>portfolios, photographs, written document and Teele Inventory for Multiple Intelligences. Descriptive and content analysis were done.
The study was conducted during the 2003-2004 academic year. Based on purposeful sampling methods, the participants of the study was comprised of one 1st grade classroom with 26 students, five 1st grade teachers from BaSkent University College AySe Abla Schools and four 1st grade teachers from Gazi University Foundation Private Primary School.
The results of the data analysis indicated that the teachers&rsquo<br>main focus was on preparing learning activities while planning the LE lesson based on the principles of MIT. They had difficulty in preparing and implementing the learning activities for naturalistic intelligence. However, they prepared and implemented learning activities for linguistic, interpersonal, bodily-kinesthetic, visual-spatial intelligences easily. Also, the students willingly participated in the learning activities that were based on bodily-kinesthetic, visual-spatial, musical-rhythmic, interpersonal intelligences<br>that were based on their most dominant intelligences and that activated more than one intelligence. Also, when the students who faced difficulty throughout the LE were helped by using the way based on the students&rsquo<br>dominant intelligences, they overcame the difficulties. Besides, most of the teachers knew various assessment methods based on the principles of MIT, but they rarely used them. Moreover, the teachers&rsquo<br>views about the differences and similarities between the LE based on MIT and that based on traditional methods were different from each other. The effects of the implementation on the 1st graders&rsquo<br>tendency towards the course, their teachers<br>on the 1st grade teachers&rsquo<br>tendency towards their students<br>on the 1st graders&rsquo<br>LE achievement were positive. Also, some variations were observed in terms of the students&rsquo<br>multiple intelligences throughout the LE.
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Stover, Mary Anne. "Second grade life science curriculum design using Howard Gardner's theory of multiple intelligences." CSUSB ScholarWorks, 2003. https://scholarworks.lib.csusb.edu/etd-project/2401.
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The purpose of this project is to bring the subject of life sciences to second grade students through a diverse curriculum design. The theory of multiple intelligence and the principles of brain-based learning areused to incorporate elements that will reach each student on an individual basis.
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Greig, Gail. "The role and importance of context in collective learning : multiple case studies in Scottish primary care." Thesis, St Andrews, 2008. http://hdl.handle.net/10023/500.
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Liu, Yi. "Testing for Efficacy for Primary and Secondary Endpoints by Partitioning Decision Paths." The Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1259598621.
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McDonnell, Gavin Vincent. "Multiple sclerosis in Northern Ireland : epidemiological, immunological and genetic aspects and study of primary progressive disease." Thesis, Queen's University Belfast, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263325.
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Dudeck, Barbara Jean. "Development of a life science curriculum for kindergarten and first grade reflecting the theories of multiple intelligence and brain-based learning." CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/1897.
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Fillon, Gwenaelle. "Establishment of Primary Culture Models of Multiple System Atrophy Based on Expression of a-Synuclein in Oligodendrocytes." Diss., lmu, 2005. http://nbn-resolving.de/urn:nbn:de:bvb:19-129297.
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Ekiz, Durmus. "Exploring primary school teachers' preactive teaching and practical theories of teaching science : multiple case studies from Turkey." Thesis, University of Nottingham, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.366474.
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Raghavan, Kesav. "Progression Rates and Sample Size Estimates for Primary Progressive Multiple Sclerosis Based on the CLIMB Study Population." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295863.
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Background: The clinical trial design for primary progressive multiple sclerosis (PPMS) requires understanding of disability progression in modern patient cohorts.
Objective: To characterize demographic and clinical characteristics of the CLIMB study
(Boston, MA) PPMS patient cohort and assess rate of disability progression.
Methods: We studied PPMS (n = 73) and relapsing-onset MS (ROMS) patients (n =1541) enrolled in CLIMB, a longitudinal study of MS patients at the Brigham and Women’s Hospital (Boston, MA). Disability progression for each group was compared using interval-censored survival analysis and time to six-month sustained progression.
Results: The PP group had 1.09:1 male:female ratio compared to 1:2.89 for the RO group and greater mean age of onset (PP: 44.4+/-9.6; RO: 32.7+/-9.9; p<0.0001). Motor symptoms at onset and first symptoms localized to spinal cord were each strongly associated with PPMS (p<0.001). Median time from onset to EDSS 6.0 was faster in PPMS (p<0.001). PPMS patients progressed faster to EDSS 3 (p<0.001) and from EDSS 3 to 6 (p<0.001). Median time to sustained progression in the PP group was 4.85
years (95% CI 2.83-8.35), significantly faster than the RO group (p<0.001).
Conclusions: Our modern PPMS cohort is demographically similar to previously studied cohorts. PPMS is associated with faster disability accrual than ROMS. Current real-world observations of time to sustained progression will inform design of new
clinical trials for PPMS.
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Chang, Elizabeth H. "Implementation of the physician-pharmacist collaborative model in primary care clinics." Diss., University of Iowa, 2013. https://ir.uiowa.edu/etd/2190.
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In the modern society, chronic diseases have become the leading causes of death. With early recognition and proper management, however, many of the complications from chronic diseases could be prevented or delayed. Taking such a proactive approach in managing a population often requires the use of team-based approaches and delegation of certain clinical and nonclinical tasks to nonphysician team members. This three-study dissertation used a combination of methods to explore contextual factors that influence primary care teamwork and physician-pharmacist collaboration. The first study quantitatively examined baseline barriers and facilitators of physician-pharmacist collaboration in clinics participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) Trial. Pharmacist expertise and clinic staff support were found to be the most important facilitators for physicians, while insurance reimbursement and task design factors were important for pharmacists. The second study characterized clinic personnel experience participating in the CAPTION trial and explored determinants of disease state control. Higher proportions of indigent and minority populations and higher baseline pharmacy structure scores were found to be associated with lower blood pressure control. The third study qualitatively examined organizational influences on primary care team effectiveness and the roles of pharmacists in a separate sample of primary care clinics. A lack of organizational rewards for teamwork in primary care was identified and pharmacists were integrated into clinic workflow in various degrees. These findings will be informative for practice managers and health care professionals seeking to redesign their practice to meet increasing needs of patients with chronic diseases.
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Vierimaa, O. (Outi). "Multiple Endocrine Neoplasia Type 1 (MEN1) and Pituitary Adenoma Predisposition (PAP) in Northern Finland." Doctoral thesis, University of Oulu, 2008. http://urn.fi/urn:isbn:9789514288227.
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Abstract
Multiple endocrine neoplasia type 1 (MEN1) is an inherited syndrome characterized by parathyroid, gastroenteropancreatic and pituitary neuroendocrine tumours. In Northern Finland, two founder mutations of the MEN1 gene (1466del12, 1657insC) accounting for the majority of the MEN1 cases, have common ancestors born in the 18th and 19th centuries, respectively. Three small clusters of familial pituitary adenoma have also been detected, two of which could be linked by genealogy to a common ancestral couple born in the 18th century.
Clinical evaluation of 82 MEN1 mutation carriers showed that age was a risk factor for most of the MEN1-related manifestations. In the whole group, nonfunctional pancreatic tumour (NFPT) was more common in the frameshift/nonsense mutation carriers (odds ratio 3.26; 95% confidence interval 1.27–8.33, P = 0.014), whereas gastrinoma was more common in the in-frame/missense mutation carriers (OR 6.77, CI 1.31–35.0, P = 0.022). In the founder mutation carriers, the 1657insC mutation predicted the risk for NFPT (OR 3.56, CI 1.29–9.83, P = 0.015), while the 1466del12 mutation was associated with the risk for gastrinoma (OR 15.1, CI 1.73–131.9, P = 0.014).
The mean ages at death of the 32 obligatory MEN1 founder mutation carriers born between 1728 and 1929 were compared to those of the 29 spouses and sex-matched life expectancy estimates derived from Finnish national statistics. The ages at death of the mutation carrier males (61.1 ± 12.0 years) and females (67.2 ± 10.7 years) did not differ from the control groups.
PAP (pituitary adenoma predisposition) locus was mapped in the chromosome region 11q12–11q13 by whole-genome single-nucleotide polymorphism genotyping. Combining the linkage and the gene expression array data, AIP (aryl hydrocarbon receptor interacting protein) was chosen for sequencing. The nonsense mutation Q14X was identified in the affected (acromegaly, gigantism, prolactinoma) family members and in four other patients. Loss of heterozygosity was detected in pituitary adenomas of AIP mutation carriers.
Mutation analysis of MEN1, HRPT2 (hyperparathyroidism 2), CASR (calcium-sensing receptor), CDKN1B (cyclin-dependent kinase inhibitor 1B) and AIP genes was performed in primary hyperparathyroidism patients with features of inherited predisposition. One out of 29 patients was found to have the 1466del12 mutation, while no mutations were detected in other genes.
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Maharaj, Lenushka. "Use of in vitro primary culture models to investigate the activity of standard and novel therapies in haematological malignancies." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8532.
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Despite improved treatments for Non-Hodgkin’s Lymphoma (NHL) and Multiple Myeloma (MM), most patients eventually relapse and these diseases remain largely incurable. This has precipitated recent research into more clinically relevant in vitro models to enable development of more effective therapies. We have validated and standardised two in vitro primary culture models using tumour samples derived from patients with NHL, Chronic Lymphocytic Leukaemia (CLL) and MM. Several novel findings have been demonstrated. In vitro sensitivity of primary NHL cells cocultured in a CD40L model predicted clinical response to bortezomib in patients receiving the drug in a phase II trial. In vitro sensitivity correlated with CD40 expression, identifying a potential surrogate biomarker for response to bortezomib. The novel HDAC inhibitor, UCL67022 was 10-fold more potent than vorinostat in NHL and produced synergy when combined with bortezomib. UCL67022 maintained its potency in primary MM samples grown in an HS-5 stromal model. It modulated cytokine secretion resulting in downregulation of cytokine-induced signalling pathways (JAK/STAT3). A novel Hsp90 inhibitor, KW-2478 maintained activity in the HS-5 model and enhanced the activity of bortezomib and melphalan. Hsp70 was identified as a potential surrogate biomarker to monitor the combinatorial effect in future clinical trials. A highly synergistic and schedule-dependent cytotoxic effect occurred when primary MM cells were pre-treated with melphalan followed by bortezomib, with important implications for future clinical trial design. IL-6, IL-8 and VEGF levels correlated with resistance to bortezomib and melphalan and were associated with activation of JAK/STAT, MAPK and PI3K/Akt signalling pathways. Antibody neutralization of IL-6, IL-8 and VEGF resulted in restoration of drug sensitivity. We have therefore demonstrated the ability of primary culture models to predict response to chemotherapy, to identify therapeutically beneficial novel agents and to enable study of tumour microenvironmental interactions responsible for drug resistance in patients with haematological malignancies.
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Beanblossom, Kathryn M. "EXPLORING THE EXPERIENCES AND PERCEPTIONS OF PERSONS DIAGNOSED WITH EARLY ONSET DEMENTIA AND THEIR PRIMARY CAREGIVERS." Miami University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=miami1366835742.
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Akkus, Cikla Oylum. "The Effects Of Multiple Representations-based Instruction On Seventh Grade Students'." Phd thesis, METU, 2004. http://etd.lib.metu.edu.tr/upload/12605615/index.pdf.
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The purpose of this study was to investigate the effects of multiple representations-based instruction on seventh grade students&<br>#8217<br>algebra performance, attitudes toward mathematics, and representation preference compared to the conventional teaching. Moreover, it was aimed to find out how students use multiple representations in algebraic situations and the reasons of preferring certain modes of representations.
The study was conducted in four seventh grade classes from two public schools in Ankara in the 2003-2004 academic year, lasting eight weeks.
For assessing algebra performance, three instruments called algebra achievement test, translations among representations skill test, and Chelsea diagnostic algebra test were used. To assess students&<br>#8217<br>attitudes towards mathematics, mathematics attitude scale, to determine students&<br>#8217<br>representation preferences before and after the treatment representation preference inventory were administered. Furthermore, as qualitative data, interview task protocol was prepared and interviews were carried out with the students from experimental and control classes.
The quantitative analyses were conducted by using multivariate covariance analyses. The results revealed that multiple representations-based instruction had a significant effect on students&<br>#8217<br>algebra performance compared to the conventional teaching. There was no significant difference between the experimental and control groups in terms of their attitudes towards mathematics. The chi square analyses revealed that treatment made a significant contribution to the students&<br>#8217<br>representation preferences.
The results of the interviews indicated that the experimental group students used variety of representations for algebra problems and were capable of using the most appropriate one for the given algebra problems.